Health Knowledge, Attitudes, and Practices among Street Children in LMICs

Background: Worldwide, it is estimated that there are up to 150 million street children. Street children are an understudied, vulnerable population. While many studies have characterized street children’s physical health, few have addressed the circumstances and barriers to their utilization of health services.

Methods: A systematic literature review was conducted to understand the barriers and facilitators that street children face when accessing healthcare in low and middle income countries. Six databases were used to search for peer review literature and one database and Google Search engine were used to find grey literature (theses, dissertations, reports, etc.). There were no exclusions based on study design. Studies were eligible for inclusion if the study population included street children, the study location was a low and middle income country defined by the World Bank, AND whose subject pertained to healthcare.

In addition, a cross-sectional study was conducted between May 2015 and August 2015 with the goal of understanding knowledge, attitudes, and health seeking practices of street children residing in Battambang, Cambodia. Time location and purposive sampling were used to recruit community (control) and street children. Both boys and girls between the ages of 10 and 18 were recruited. Data was collected through a verbally administered survey. The knowledge, attitudes and health seeking practices of community and street children were compared to determine potential differences in healthcare utilization.

Results: Of the 2933 abstracts screened for inclusion in the systematic literature review, eleven articles met all the inclusion criteria and were found to be relevant. Cost and perceived stigma appeared to be the largest barriers street children faced when attempting to seek care. Street children preferred to receive care from a hospital. However, negative experiences and mistreatment by health providers deterred children from going there. Instead, street children would often self treat and/or purchase medicine from a pharmacy or drug vendor. Family and peer support were found to be important for facilitating treatment.

The survey found similar results to the systematic review. Forty one community and thirty four street children were included in the analysis. Both community and street children reported the hospital as their top choice for care. When asked if someone went with them to seek care, both community and street children reported that family members, usually mothers, accompanied them. Community and street children both reported perceived stigma. All children had good knowledge of preventative care.

Conclusions: While most current services lack the proper accommodations for street children, there is a great potential to adapt them to better address street children’s needs. Street children need health services that are sensitive to their situation. Subsidies in health service costs or provision of credit may be ways to reduce constraints street children face when deciding to seek healthcare. Health worker education and interventions to reduce stigma are needed to create a positive environment in which street children are admitted and treated for health concerns.

On gathering in Art therapy: a way to understand and build the discipline with the other

In the present article I try to share some reflections on a case study of an attachment disorder child I worked with for two years through art therapy in a day hospital. Those reflections let me go deeply in some specific elements concerning the discipline which let us delimit its theoretical and methodological possible scope. In this way, from the specific of the case study on propose to reflect on those elements that conform a methodology related to the art therapist way of doing, in order to concrete and evaluate other possible interventions to develop in similar cases and contexts.

The puppet as a tool for working in Art Therapy

This article aims to investigate the possibilities of building puppets in art therapy workshop, for this it realizes a tour of the primitive use of the puppet as a magical twin and potential towards the study of authors who have used the puppets as a therapeutic tool from the first half of the twentieth century. It’s raised an own theoretical organization, which includes the consideration of the significance of the body in the construction and management of the puppet and the puppet transitional perspective, halfway of external reality and psychic reality as an object that makes fantasy and reality arises built.

Formal Aspects in SDH for Children in Spanish Television: A Descriptive Study

The comprehension of a subtitle goes far beyond the understanding of the meaning of the words it comprises. Formal aspects of subtitles for the d/Deaf and the hard-of-hearing (SDH) can be crucial in the cognitive effort necessary to process the subtitle within its audiovisual context (Perego 2008). The present article studies common practices of formal aspects in SDH for children, focusing on three parameters: layout and positioning of the subtitle; orthotypographic conventions; and resources for the identification of characters in the three TV channels dedicated exclusively to the youngest audiences in Spain. The present piece of research was carried out by analysing and evaluating these three parameters in comparison with the current UNE Standard 153010 (AENOR 2012) and with previous theoretical studies in the field.

Invisible Victims: Recorded Crime and Children in the UK

While violence against children is a common occurrence only a minority of incidents come to the attention of the authorities. Low reporting rates notwithstanding, official data such as child protection referrals and recorded crime statistics provide valuable information on the numbers of children experiencing harm which come to the attention of professionals in any given year. In the UK, there has been a strong tendency to focus on child protection statistics while children as victims of crime remain largely invisible in annual crime reports and associated compendia. This is despite the implementation of a raft of policies aimed at improving the system response to victims and witnesses of crime across the UK. This paper demonstrates the utility of a more detailed analysis of crime statistics in providing information on the patterns of crime against children and examining case outcomes. Based on data made available by the Police Service for Northern Ireland, it highlights how violent crime differentially impacts on older children and how detection rates vary depending on case characteristics. It makes an argument for developing recorded crime practice to make child victims of crime more visible and to facilitate assessment of the effectiveness of current initiatives and policy developments. Copyright © 2013 John Wiley & Sons, Ltd.

‘Poor prison flowers’: convict mothers and their children in Ireland, 1853-1900

Pregnant women and mothers were among the thousands of individuals who were sentenced to at least three years’ penal servitude and admitted to the nineteenth-century Irish female convict prison. While some babies were born behind bars, others were permitted to accompany their convicted mothers into the prison after the penal practice of transportation had ceased. Other dependent children were separated from their convicted mothers for years, cared for by family members or friends, or accommodated in Ireland’s growing web of institutions. Using individual case studies, this article focuses on convict mothers and their young offspring. It draws attention to the increasing restrictions on the admission of infants that were imposed as the nineteenth century progressed, the problems that children of various ages in the penal system seemed to pose for officials, and the difficulties faced by incarcerated mothers who wished to maintain communication with their offspring. This article argues that while there were benefits to parenting within the confines of the prison, sentences of penal servitude had a significant impact on the lives of dependent offspring by dislocating families, separating siblings, or initiating institutional or other care that broke familial bonds permanently. In so doing, the article reveals attitudes towards motherhood as well as female criminality and institutionalization generally during this period and sheds light on an aspect of convict life unique to the women’s prison.

Comparing long-term placements for young children in care: Does type of placement really matter?

This paper presents findings from the third phase of a longitudinal study, entitled Care Pathways and Outcomes, which has been tracking the placements and measuring outcomes for a population of children (n = 374) who were under the age of five and in care in Northern Ireland on the 31st March 2000. It explores how a sub-sample of these children at age nine to 14 years old were getting on in the placements provided for them, in comparative terms across five placement types: adoption; foster care; kinship foster care (with relatives); on Residence Order; and living with birth parents. This specifically focused on the development of attachment and self-concept from the perspective of the children, and behavioural and emotional function, and parenting stress, from the perspective of parents and carers. Findings showed no significant placement effect from the perspective of children, and a statistically weak, but descriptively compelling, effect from the perspective of parents. The findings challenge the notion of adoption as the gold standard in long-term placements, specifically from the perspective of children in terms of their parent/carer attachments and self-concept, and highlight what appears to be the central importance of placement longevity for delivering positive longer-term outcomes for these children, irrespective of placement type.

Respiratory virus-associated severe acute respiratory illness (SARI) and viral clustering in Malawian children in a setting with a high prevalence of HIV, malaria and malnutrition

BACKGROUND:  We used four years of paediatric severe acute respiratory illness (SARI) sentinel surveillance in Blantyre, Malawi to identify factors associated with clinical severity and co-viral clustering.

METHODS:  From January 2011 to December 2014, 2363 children aged 3 months to 14 years presenting to hospital with SARI were enrolled. Nasopharyngeal aspirates were tested for influenza and other respiratory viruses. We assessed risk factors for clinical severity and conducted clustering analysis to identify viral clusters in children with co-viral detection.

RESULTS:  Hospital-attended influenza-positive SARI incidence was 2.0 cases per 10,000 children annually; it was highest children aged under 1 year (6.3 cases per 10,000), and HIV-infected children aged 5 to 9 years (6.0 cases per 10,000). 605 (26.8%) SARI cases had warning signs, which were positively associated with HIV infection (adjusted risk ratio [aRR]: 2.4, 95% CI: 1.4, 3.9), RSV infection (aRR: 1.9, 95% CI: 1.3, 3.0) and rainy season (aRR: 2.4, 95% CI: 1.6, 3.8). We identified six co-viral clusters; one cluster was associated with SARI with warning signs.

CONCLUSIONS:  Influenza vaccination may benefit young children and HIV infected children in this setting. Viral clustering may be associated with SARI severity; its assessment should be included in routine SARI surveillance.

The Diet of Preschool Children in the Mediterranean Countries of the European Union: A Systematic Review

This systematic review discusses data on the dietary intake of preschool children living in the Mediterranean countries of the European Union, including the comparison with a Mediterranean-like diet and the association with nutritional status. Specifically, data from the multinational European Identification and Prevention on Dietary and life style induced health effects in children and infants (IDEFICS) study and national studies, such as the Estudo do Padrão Alimentar e de Crescimento Infantil (EPACI) study and Geração XXI cohort in Portugal, ALimentando la SAlud del MAñana (ALSALMA) study in Spain, Étude des Déterminants pré-et postnatals précoces du développement et de la santé de l'ENfant (EDEN) cohort in France, Nutrintake 636 study in Italy, and Growth, Exercise and Nutrition Epidemiological Study in preSchoolers (GENESIS) cohort in Greece, were analyzed. In the majority of countries, young children consumed fruit and vegetables quite frequently, but also consumed sugared beverages and snacks. High energy and high protein intakes mainly from dairy products were found in the majority of countries. The majority of children also consumed excessive sodium intake. Early high prevalence of overweight and obesity was found, and both early consumption of energy-dense foods and overweight seemed to track across toddler and preschool ages. Most children living in the analyzed countries showed low adherence to a Mediterranean-like diet, which in turn was associated with being overweight/obese. Unhealthier diets were associated with lower maternal educational level and parental unemployment. Programs promoting adherence of young children to the traditional Mediterranean diet should be part of a multi-intervention strategy for the prevention and treatment of pediatric overweight and obesity.

Dietary exposure assessments for children in Europe (the EXPOCHI project): rationale, methods and design

[EN]The number of dietary exposure assessment studies focussing on children is very limited. Children are however a vulnerable group due to their higher food consumption level per kg body weight. Therefore, the EXPOCHI project aims [1] to create a relational network of individual food consumption databases in children, covering different geographical areas within Europe, and [2] to use these data to assess the usual intake of lead, chromium, selenium and food colours.

Brief Psychotherapy with Children in a Specialist School: An Exploration of the Underlying Issues for Children and Mainstream Schools

This thesis explores brief psychotherapy with children on placement at a specialist school setting, as part of an on-site, child psychotherapy outreach provision. The study sought to explore two research questions concerning the themes that could emerge in brief work with children and how these themes could be discussed in relation to the understanding formed by their mainstream school teachers. A qualitative research design was used to investigate these questions. The methods used to collect data were case studies, concerning the brief psychotherapy with 4 boys, aged 7 years, and and semi-structured interviews were conducted with the teachers. Thematic analysis was used to explore the data. The themes that were derived from the analysis were described in detail. The research found that brief work has considerable benefit for children and mainstream schools. Through the brief work intervention, the children all made significant progress in all areas of their lives a school. Contributions that the research makes to related fields, the implications that it has for policy and practice and recommendations for future research were all discussed.

Return to Hanging Rock: Lost Children in a Gothic Landscape

Using the philosophical position of phenomenology this article examines the ways in which ideas of wildness combine with Australian Gothic tropes such as the white colonial lost child and the bush as a haunted locale to compose key features of an Australian Ecogothic. Joan Lindsay’s enigmatic novel Picnic at Hanging Rock (1967) has prompted scholars such as Lesley Kathryn Hawkes to describe how in Australian literature for both adults and children ‘the environment is far more than a setting or backdrop against which the plot takes place’ (Hawkes, 2011,67). On St Valentine’s Day in 1900 three young Australian girls and their teacher disappear from a school picnic at the ancient site of Mount Macedon in Victoria. The analysis, which focuses on Lindsay’s posthumously published chapter eighteen (1987) examines how elements of the material, sensing world combine with the mythological or sacred to connect the human protagonists with the gothic landscape they inhabit. The resulting intersubjectivity problematizes colonial ideology and unsettles notions of national identity. Using the philosophical position of phenomenology this article examines the ways in which ideas of wildness combine with Australian Gothic tropes such as the white colonial lost child and the bush as a haunted locale to compose key features of an Australian Ecogothic. Joan Lindsay’s enigmatic novel Picnic at Hanging Rock (1967) has prompted scholars such as Lesley Kathryn Hawkes to describe how in Australian literature for both adults and children ‘the environment is far more than a setting or backdrop against which the plot takes place’ (Hawkes, 2011,67). On St Valentine’s Day in 1900 three young Australian girls and their teacher disappear from a school picnic at the ancient site of Mount Macedon in Victoria. The analysis, which focuses on Lindsay’s posthumously published chapter eighteen (1987) examines how elements of the material, sensing world combine with the mythological or sacred to connect the human protagonists with the gothic landscape they inhabit. The resulting intersubjectivity problematizes colonial ideology and unsettles notions of national identity.