Asking, giving, receiving:friendship as survival strategy among Accra's street children

This article considers friendship among street children in Accra. Drawing upon the findings of a three-year qualitative research project, the article argues that friendship is a neglected element of research yet cooperation, mutuality and exchange between friends are essential to street children's survival. Living within the extremities of the urban informal sector, the article considers the existence of a strong ethos of 'help' between friends and how street children go about the (re) creation of friendship around those aspects of their lives essential for their daily survival. © The Author(s) 2010.

Researching with, not on:using photography in researching street children in Accra, Ghana

What is discussed in this chapter is work-in-progress, an opportunity for reflection upon elements of an on-going research project examining the lives of street children in Accra, Ghana. Street children have received much research in recent years but our project is, we believe, distinctive in two respects. The first of these is that access to reliable data on the growing presence of children on the streets of African cities is often problematic. Available research is often diffuse and hard to access, it is more often than not driven by the short-term requirements of specific programmes and interventions and as a consequence can be lacking in depth, rigour and innovation. Without the means to provide a sufficiently self-conscious and critical engagement with accepted understandings of the lives of street children, consideration of the experience of street children in Africa continues to rely heavily on the more capacious and better disseminated research from the Americas (e.g., Mickelson, 2000). At the very least, Africa's specific experience of large population displacements, diversity of family forms, rapid urbanisation, vigorous structural adjustment and internal conflict raise important questions about the appropriateness of such ready generalisations. Judith Ennew (2003, p. 4) is clear that caution is needed in an uncritical endorsement of the “globalisation of the street child based on Latin American work”. She is equally mindful, however, that as far as Africa is concerned the absence of reliable evidence continues to hinder debate.

Agency as vulnerability:accounting for children's movement to the streets of Accra

This paper considers the agency of children moving to the streets of Accra, Ghana's capital city. A much used but largely unexamined concept, agency is nevertheless commonly deployed in childhood studies as a means to stress the capacity of children to choose to do things. In the literature on street and working children, and a cognate area of study concerned with children's independent migration, this has involved accounts of children's agency made meaningful by reference to theories of rational choice or to the normative force of childhood. It is our argument that both approaches leave unanswered important questions and to counter these omissions we draw upon the arguments of social realists and, in particular, the stress they place on vulnerability as the basis for human agency. We develop this argument further by reference to our research with street children. By drawing upon the children's accounts of leaving their households and heading for Accra's streets, it is our contention that these children do frame their departures as matters of individual choice and self-determination, and that in doing so they speak of a considerable capacity for action. Nevertheless, a deeper reading of their testimonies also points to the children's understandings of their own vulnerability. By examining what we see as their inability to be dependent upon family and kin, we stress the importance of the children's perceptions of their vulnerability, frailty and need as the basis for a fuller understanding of their agency in leaving their households. © 2013 The Author. The Sociological Review © 2013 The Editorial Board of The Sociological Review.

Engaging with a world outside of ourselves:vistas of flatness, children's work and the urban informal economy

This paper considers the work and labour of children living on the streets of Accra, Ghana. It does so in two distinctive ways. First, it considers how the children's photographs of a day or two in their working lives, and the dialogues that go on in, through and around them, may contribute to the making of strong sociological arguments about children's work. In so doing, this paper elaborates the connections between visual sociology and realist traditions of photography, and argues that photographs can contribute distinctive and novel sources of insight into working children's lives and a powerful, humanising media of dissemination. Second, these arguments are then deployed to examine street children's experiences of work. Conceptualised in terms of its 'flatness', the paper explores the informal means of regulation through which the children are locked into types of working that prove difficult to escape. © Sociological Research Online, 1996-2012.

Exploring business models to provide a foundation for enhanced eye care services in high street optometric practice

High street optometric practices are for-profit businesses. They mostly provide sight testing and eye examination services and sell optical products, such as spectacles and contact lenses. The sight testing services are often sold at a vastly reduced price and profits are generated primarily through high margin spectacle sales, in a loss leading strategy. Published literature highlights weaknesses in this strategy as it forms a barrier to widening the scope of services provided within optometric practices. This includes specialist non-refraction based services, such as shared care. In addition this business strategy discourages investment in advanced diagnostic equipment and higher professional qualifications. The aim of this thesis was to develop a greater understanding of the traditional loss-leading strategy. The thesis also aimed to assess the plausibility of alternative business models to support the development of specialist non-refraction services within high street optometric practice. This research was based on a single independent optometric practice that specialises in advanced retinal imaging and offers a broad range of shared care services. Specialist non-refraction based services were found to be poor generators of spectacle sales likely due to patient needs and presenting concerns. Alternative business strategies to support these services included charging more realistic professional fees via cost-based pricing and monthly payment plans. These strategies enabled specialist services to be more self-sustainable with less reliance on cross-subsidy from spectacle sales. Furthermore, improving operational efficiency can increase stand-alone profits for specialist services.Practice managers may be reluctant to increase professional fees due to market pressures and confidence. However, this thesis found that patients were accepting of increased professional fees. Practice managers can implement alternative business models to enhance eye care provision in high street optometric practices. These alternative business models also improve revenues and profits generated via clinical services and improve patient loyalty.

Community-Based Study of the Association of High Myopia in Children with Ocular and Systemic Disease

Purpose. High myopia in childhood is associated with important ocular and systemic conditions. However in the UK, high myopia in early childhood is not specifically identified in current ophthalmology, optometry, or orthoptic protocols for screening, referral, or investigation. An ongoing study in the West Midlands, UK, is investigating high myopia presenting to community health care clinics with the aim of compiling guidelines for assessment and subsequent referral. Methods. Children with high myopia were identified from community optometric and orthoptic sources and invited for an ophthalmology and optometry examination to ascertain possible ocular or systemic disease. Results. High myopia with no associated ocular or systemic condition was present in 15 (56%) of the children. In seven children (25%), associated ocular problems were found including unrecognized retinal dystrophies and amblyopia. Systemic disorders associated with high myopia were found in five children (19%) and included Sticklers syndrome, Weill-Marchesani syndrome, and homocystinuria. In one child, the diagnosis made before this study was found to be incorrect, and in another child, the results were inconclusive. In two cases, the diagnosis of a systemic condition in the child led to the identification of the disease in at least one relative. Conclusions. There is a high prevalence of ocular and systemic abnormality in young children seen in the community. Optometric and ophthalmologic assessment of children less than 10 years with myopia ≥5 D is likely to identify significant ocular or systemic disease, a proportion of which will respond to medical intervention. Detection and prompt referral of these cases by community health care services may be expected to prolong vision and possibly life expectancy.

The aquisition of language skill by children

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Unofficial truths and everyday insights:understanding voice in visual research with the children of accra's urban poor

This article draws upon the use of photography to research the lives of children living in Accra, Ghana. Its aim is to consider method in visual research, and to reflect upon those modes of explanation and understanding that any consideration of method must require. It suggests a role for photography as a 'vector', as something capable of connecting our knowledge and understanding of the everyday with the everyday experiences and reality of others. Drawing upon the photographs and spoken testimonies of children who live and work on the street, and of children who live in a large informal settlement, the article advances an intimate connection between photography and knowledge of the everyday reality of children's lives, most evident in the capacity of children's photographs to surprise and highlight the fallibility of our understandings. © 2010 International Visual Sociology Association.

The perceptual basis of the understanding of some spatial adjectives in primary school children

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The promotion of children's health and wellbeing:the contributions of England's charity sector

Background. Sports and arts based services for children have positive impacts on their mental and physical health. The charity sector provides such services, often set up in response to local communities expressing a need. The present study maps resilience promoting services provided by children's charities in England. Specifically, the prominence of sports and arts activities, and types of mental health provisions including telephone help-lines, are investigated. Findings. The study was a cross-sectional web-based survey of chief executives, senior mangers, directors and chairs of charities providing services for children under the age of 16. The aims, objectives and activities of participating children's charities and those providing mental health services were described overall. In total 167 chief executives, senior managers, directors and chairs of charities in England agreed to complete the survey. From our sample of charities, arts activities were the most frequently provided services (58/167, 35%), followed by counselling (55/167, 33%) and sports activities (36/167, 22%). Only 13% (22/167) of charities expected their work to contribute to the health legacy of the 2012 London Olympics. Telephone help lines were provided by 16% of the charities that promote mental health. Conclusions. Counselling and arts activities were relatively common. Sports activities were limited despite the evidence base that sport and physical activity are effective interventions for well-being and health gain. Few of the charities we surveyed expected a health legacy from the 2012 London Olympics. © 2010 Bhui et al; licensee BioMed Central Ltd.

Medication review of children on long term medications:a review of the literature

INTRODUCTION: Children on long term medication may be under the care of more than one medical team including the patients GP. Children on chronic medication should be supported and their medications reviewed, especially in cases of polypharmacy. Medicines Use Reviews (MURs) were introduced into the pharmacy contract in 2005. The service was designed for community pharmacists to review patients on long term medication. The service specified that MURs were done on patients who can give consent and cannot be conducted with a parent or carer. Hence the service may be inaccessible to paediatric patients. This review aims to find studies that identify medication review services in primary care that cater for children on long term medication. METHODS: A literature search was conducted on 6th June 2015 using the keywords, ("Medication" or "review" or "Medication Review" or "Medicines use review" or "Medication use review" or "New Medicine Service") AND ("community pharmacy" OR "community pharmacist" OR "primary care" OR "General practice" OR "GP" OR "community paediatrician" OR "community pediatrician" OR "community nurse"). Bibliographic databases used were AMED, British Nursing Index, CINAHL, EMBASE, HMIC, MEDLINE, PsycINFO and Health Business Elite. Inclusion criteria were: paediatric specific medication review in primary care, for example by either a GP, community paediatrician, community nurse or community pharmacist. Exclusion criteria were studies of medication review in adults/unclear patient age and secondary care medication reviews. RESULTS: From the 417 articles, 6 relevant articles were found after abstract and full text review. 235 articles were excluded after title and abstract review (11 did not have full text in English); 96 were adult or non-age specified medication review/MUR/New Medicine Service studies; 63 referred to observational, evaluative studies of interventions in adults; 6 were non-paediatric specific systematic reviews and 17 were protocols, commentaries, news, and letters.The 6 relevant articles consisted of 1 literature review (published 2004), 3 research articles and 1 published protocol. The literature review[1] recommended that children's long term medication should be reviewed. The published protocol stated that the NMS minimum age for inclusion in the trial was for children aged over 13 years of age. The four studies were related to psychiatrists reviewing paediatric mental health patients in the USA, a pharmacist using Drug Related Problem to review patients in GP practices in Australia, a UK study based on an information prescription concept by providing children dispensed medications in community pharmacy with signposting them to health information and one GP practice based study observing pharmaceutical care issues in children and adults. CONCLUSION: The results show that there are currently no known studies on medication use reviews specific to children, whereas in adults, published evaluations are available. The terms of the MUR policy restrict children's access to the service and so more studies are necessary to determine whether children could benefit from such access.