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'Department of Health Science, College of Health and Human Performance, Brigham Young
University, Provo, Utah;2 TURN International, Provo, Utah, United States of America
Abstract: Purpose: To describe health problems and social, environmental, and health behavior
characteristics among street children in Manila, Philippines. Methods: A cross-sectional survey and
clinical tests that included chest radiographs blood, urine, and stool samples were completed with 179
street children, ages 8-17 years, served by Childhope-Asia Philippines. Results: The most frequently
occurring health problem was coughing, followed by fever, dyspnea, diarrhea, and then blood in the
stools. Males compared with females were more likely to be kicked, punched, or slapped by an adult.
Among males, 65% are current smokers and 52% have consumed alcohol. Among females, 37% are
current smokers and 67% have consumed alcohol. The percentage of children with low hemoglobin
was 91% for males and 16% for females. The percentage of children with low hematocrit was 69%
for males and 22% for females. Of all children tested, 7.9% had hepatitis B, 12.3% had pneumonia,
and 25.5% had ascariasis. Conclusions: Filipino street children have a high level of infectious disease,
with females experiencing higher levels of coughing, dyspnea, and fever whereas males had higher
levels of diarrhea. Males are more likely to be physically abused and to smoke tobacco whereas
females are more likely to drink alcohol. Both males and females experienced depression and anxiety
and many children were sexually active. Diseases common among the population are pneumonia,
anemia, hepatitis Β and ascariasis, primarily due to their lack of adequate nutrition, close living
proximity, and unsanitary living conditions.
Correspondence: Ray Μ Merrill, Department of Health Science, Brigham Young University, Provo, Utah
84602 United States. Tel: 801-422-9788 (work); Fax: 801-422-0273 (fax); E-mail: Ray_Merrill@byu.edu
Submitted: February 06, 2008. Revised: June 01, 2008. Accepted: June 08, 2008.
Table 2. Hematology, hepatitis, and blood chemistry according to gender among street
children in Manila
Males Females
Mean Standard Deviation Mean Standard Deviation t Ρ value
Hematology
Hemoglobin 135.8 10.7 131.5 8.3 0.0028
Hematocrit 0.40 0.03 0.38 0.02 0.0005
Hepatitis
HBsAg 0.51 0.61 0.50 0.60 0.8585
Anti HAV Igm 0.31 0.04 0.31 0.04 0.6604
Blood Chemistry
Total protein 7.0 0.4 7.1 0.5 0.2243
Albumin 4.1 0.4 4.1 0.4 0.3909
Globulin 3.0 0.3 2.9 0.4 0.8478
Albumin/Globulin ratio 1.4 0.3 1.4 0.2 0.5287
Nutrients Mean SD
How many days over the last seven days did you drink or eat each of the following?
Plain water 6.2 1.8
Fruit juice 2.7 2.7
Other beverage 4.4 2.6
Any foods made with grains 6.0 1.9
Pumpkin, squash, carrots or potatoes 2.2 2.3
Other food made from roots or tubers 2.3 2.4
Green leafy vegetables 3.0 2.6
Mango, papaya 3.6 2.6
Other fruits or vegetables 3.1 2.5
Meat, poultry, fish, shellfish, or eggs 4.1 2.5
Any food made from legumes (beans) 2.4 2.3
Table 4. Risk of situations and behaviors according to current smoking status (yes vs. no)
among street children in Manila
females (Ρ < .0001). None had low total behavior characteristics of street children in
protein, 7% had low albumin, 4% had low Manila. Although a small percentage of
globulin, and 58% had low albumin/globu- children experienced malaria or convul-
lin ratio. No significant difference was found sions, episodes of coughing, fever, and
in the percentage of children having low dyspnea were common problems, more so
albumin, globulin, or albumin/globulin ratio. in females than males. This finding can be
Nutritional intake for the street children explained by male Filipino street children
is presented in table 3. The range for each of being exposed to the street environment at
these items was from 0 to 7. No significant an earlier age and for a longer duration.
difference was found by gender for any of Female children in Filipino culture are
the nutritional variables. Hence, means are more protected and encouraged to remain
reported for each type of drink or food for around the home, limiting their exposure to
males and females combined. Approximately diseases and risky health behaviors common
32% never ate pumpkin, squash, carrots, or among street children (9). A possible expla-
potatoes. On the other hand, 80% drank water nation for the high prevalence in respiratory
daily and 75% ate foods containing grain daily. problems is inhalant abuse. Toluene is an
The relative risks for smokers vs non- industrial solvent that is commonly inhaled
smokers of experiencing selected situations by Filipino street children and has been
and behaviors are presented in Table 4. proven to cause dyspnea and coughing (18).
Smokers were significantly more likely to Diarrhea was also a common problem,
be kicked, punched, or slapped by an adult which can be attributed to approximately
or peer; less likely to shower or bathe three 75% of the street children surveyed being
or more times per week, less likely to eat routinely exposed to contaminated water.
dinner on a daily basis, more likely to be Other possible -causes of diarrhea among
sexually active; and more likely to have the street children surveyed include con-
consumed alcohol. After adjusting for age taminated food or child-to-child trans-
and gender, smokers weighed significantly mission (19). In 2006, the Philippines
less (31.4 vs 34.5 kg; Ρ = .0072), had lower National Epidemiology Center at the
BMI (15.2 vs 16.3; P = .0111) and lower Philippines Department of Health docu-
respiration in one minute (23.9 vs 25.7; mented diarrhea as the second leading cause
Ρ = .0609). No evidence that smokers drank of morbidity among all ages (20).
or ate less than nonsmokers was found. Physical abuse has been positively
Of 178 children tested for hepatitis B, linked to increased depression, hopeless-
14 (7.9%) tested positive. Of 179 children ness, and proneness to suicide (21). Abuse
tested for pneumonia, 22 (12.3%) tested in the form of being kicked, punched, or
positive. Of 102 children were tested for slapped by an adult or a peer was a
ascariasis, 26 (25.5 %) tested positive. No common occurrence among street children
significant difference was found between in this study. The frequent occurrence of
gender or smoking in correlation with hepa- such events was much higher for males than
titis B, pneumonia, or ascaris parasitic females. The high level of physical abuse
infection prevalence. by an adult or peer may help explain why
above 20% of the children felt anxious or
DISCUSSION depressed on a daily basis. Physical abuse
This study describes health problems in is also positively associated with risky
relation to social, environmental, and health health behaviors such as smoking (22), as
confirmed by the current study. Physical carrying out daily tasks (25). Ascariasis can
abuse, which increases the risk of smoking, also be attributed to the close proximity of
may also increase the risk of other harmful street children, coupled with unsanitary
behaviors associated with smoking. environmental conditions (25). These findings
Prostitution is a common practice among closely compare with results from a study
Filipino street children (8,11). Street children showing increased parasitic infections among
are both coerced into prostitution and institutionalized Filipino street children (3).
practice prostitution voluntarily to earn a Study limitations include participant
living (13). Of children who were sexually selection and sample collection from parti-
active, 36% of males and 38% of females cipants. Randomized surveying of street
had received money for sex. Street life children is difficult because of their
makes prostitution especially appealing transient lifestyle. Yet, we believe the street
because of limited employment opportunities children considered in this study are fairly
(13, 23). Prostitution exposes children to both representative of street children in general
communicable diseases and psychological in Manila. Specifically, seven different
trauma, making them especially susceptible locations were randomly selected from the
to ill health. Of children who were sexually different areas serviced by social workers of
active, 61% were aware that abstaining Childhope-Asia Philippines (CHAP). All
from sexual relations could prevent AIDS. children under the supervision of CHAP
Males experienced significantly lower within the chosen areas were included in
hemoglobin and hematocrit levels than the study. The participants were not dis-
females, relative to their gender, with many couraged from participating based on illness
being anemic. Anemia identified among or being under the influence of drugs.
street children in other studies has primarily Children were also encouraged to partici-
been attributed to malnutrition (24). The pate by our offering them free meals and
higher percentage of anemia among males snacks. Many of the street children were
relative to females is inconsistent with the unable to produce a stool sample for testing
finding that nutritional intake was similar because of their malnourished state. One
between the two groups. Further research is child refused to have blood taken and one
needed to determine the cause of the child refused to have a chest radiograph.
disparity in low hematocrit and hemoglobin
between genders. ACKNOWLEDGMENTS
Filipino street children routinely gravi- Supported by the Mary Lou Fulton Chair
tate together in tight social groups called for Health and Human Performance, Brigham
'Barkada'. This close living situation helps Young University.
explain the high prevalence of contagious
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