CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

This chapter explains what other researchers had in relation to psychological well-being of

street children in urban areas. Information gathered here was mainly from textbook, journals,

magazines, newspapers plus internet. Street children is a common problem and has been

occurring throughout the world for a long time since even before written history. Developed

countries have managed to protect, however it is not fully controlled.

201 Causes of Increasing Population of Street Children

This section presents an overview of street children by reporting on the prevalence of the

possible causes of the increasing street children population. It is also essential to note that in

describing children that live on the street, various words such as homeless youth and street

youth.

The reasons why children are drawn to reside within the domains of the streets is complex and

multifaceted Veeran (2004) likes possible causes of street children to socio-economic and

political structures that prevails worldwide. Previous research suggests that the reason or

possible causes for children to reside on the streets include but not limited to; low purchasing

power, overcrowding. abuse. neglect, and family disintegration (Consortium of Children

2014). Poverty as a social factor in Uganda cannot be viewed in isolation when

comprehending the causes of street children in the country (Kok at al 2010). Bamaby, Penny

and Erickson (2010) affirm that being homeless increase the risk of being in conflict with the

law, using substance and engaging in illegal activities.

whether it could be due to poor housing and infrastructure a combination of multiple factors.

Health, social and economic factors have been repoffed to be possible causes for street

children population in Uganda.

The history of Uganda characterized by great inequalities and fragmented legislation and

policy on the protection, nurture and development of children, especially those on the streets.

Factors such as fragile support, parental poor health and child neglect have reported as

common causes for the increase in the number of street children (Olley, 2006). Gender is

another factor that has been reported to play a role in the cause of homeless youths (Olufemi,

2000). When examining the causes that contribute to the phenomenon of street children.

consideration regarding the analysis of the childhood adversity, urban poverty, and social

segregation should be taken into account (Panter Brick, 2004). Regardless of the reasons why

children reside on the streets, a large proportion of street children find themselves without

family support (UNICEF, 2004). Available literature to date on street children continue to

focus on the drivers of street populace, rather than the impact of living on the street children's

general well-being. Little is known about the extent of the psychological impact of

homelessness of children living on the street.

2.2 Potential effects of street children

Behavioral problems reviewed include hyperactivity, conduct and emotional problems.

comorbidity of psychiatric disorders and suicidal behaviors among street children.

Hyperactivity conduct and poor problems. Street children's behavioral patterns often show
signs of mental health problems. These problems may also influence their psychological well-

being. According to

Schmutte and Ryff (1997) the definition of psychological well-being encompass a range of

attributes such as desirable psychological state and mental functioning that can be influenced

by predisposing factors when examining behavioral problems among homeless youths,

Bamaby et al. (2010) reported that street youth experience feelings of loneliness,

homelessness, fear, shame, doubt, despair, trauma and stress.

Mental health of street children, street children are vulnerable and known to experience

general and mental health problems. This section discusses the mental health of street children

with particular focus on their behavioral problems and substance use behaviors.

Co-morbidity of psychiatric disorders, homeless youths or children are category of groups at

high risk for psychiatric disorders such as depression (Whitbeck, Hayt and Bao, 2000).

Common mental health disorders diagnosed in street children include depression, anxiety, bi-

polar and schizophrenia (Bamaby et al 2010). A study by Taib and Ahmad (2014) reported

high prevalence rate of co-morbid psychiatric conclitions among street children. The same

authors revealed that over a half of participants in their study had co-morbid conditions such

as depression and anxiety (Taib and Ahmad 2014). Findings from a study by Whitbeck et al

(2000) on psychiatric disorder alnong street children fund that about a fourth of participants

had elevated scores on the depression scales. A positive correlation between the experience of

violence and aggression and its reciprocal illipact on adolescent depression was reported

(Lartzman and swisher, 2005). In a psychological study on psychiatric disorders among

homeless youths with over 57 percent of participants who were be street youth met criteria for
anxiety disorders, in particularly linked to post traumatic street disorder (PTSD). Similarly,

the researcher in the same study found that over 29 percent had childhood suicide attempts

and suicide ideation among street children are been reported to be prevalent. Yoder, Whit

beck and Hoyt (2008) suggest a view of suicidality as psychological progression that begins

with thoughts of death and continues to suicidal ideation then move to suicidal attempts,

which may have led to completed suicide. This view was also earlier supported by Desai, Liu-

Mares, Dausey and Rosenheck (2003) who viewed suicidality on a continuum that begins

from suicidal thoughts, attempts and completed suicide. Conclusion drawn by Desai et al.

(2003) suggested that homeless persons with a mental illness are at a greater risk for suicidal

behaviors than the general populace. Studies conducted in United States of America (USA)

and Canada on suicide among street children reported that self-esteem played a key protective

role in predicting feelings of hopelessness and helplessness amongst street children (Kidd and

Shabar,

2008),

A study in Sudan reported factors such as adverse street life conditions, family disintegration,

economic factors and abuse to have impacted the psychological functioning of street children

(Ali, 2011).

Substance use among street children, has been widely documented to be highly prevalent the

who (2014, pg 1) defines substance abuse as "persistent or sporadic drug abuse inconsistent

with or unrelated to acceptable medical practice" street children, especially adolescents, are

populations that are at risk groups for using and abusing substances (Merscham, Van Leewen,

and McGuire, 2008). A strong correlation between the use of substance and mental health

issues among street children was found to be prevalent (Krupiwnicki, 2012). The use of
substance in developed and developing countries. The use of illicit drugs is relatively high

among the youth population in Uganda. In a study by childhood enhancement through training

and action about 500 of street children were addicted to more than one type of substance.

Furthermore, homeless youth were at a great risk for substance use ancl poly substance

(Bousman et al, 2015). Dhawan 2009 found the onset of substance use among street children

to occur from an early age. A study by Bamaby et al,

(2010) found the onset of substance use among street children to be from the age of 12 years.

due to the difficult and unstable environment of street children, they are more vulnerable to

the use of substance (UN, 2014).

Factors linked to the onset of substance use include availability and access of substance, the

nature of the drug use, background, social networks and individual motivation (Bamaby et al

2010).

Violence and violent behaviors, street children are risk of exposure to violence, engagement in

violent behaviors on the streets or being the victims of violence. Violence according to the

WI-IO (2017) involves intended force or power directed at an individual, group or community

which can result in physical injuries, death or psychological injury.

In this study, violence includes all forms and exposure within the street with street children

may endure. In a report by (WHO, 2006) the types of drugs and substance used by street

children are associated with the nature of violence they encounter. Homeless youth, prior to

homeless, are reported to experience high rate of trauma and abuse (Huemeret all, 2016).

Street youths, who previously had concurrent mental health and substance use problems, were

more likely to experience abuse and be victimized (Kirst et al, 201 1). the risk of victimization
correlates with mental health problems in street children within a history of trauma were

likely to present with suicidal ideation (Merscham et al, 2008).

Sexual health risk behaviors among street children, life within the domains of the streets

sometimes exposes street children to high level of health risks due to the adverse

environments that they are embedded in. the most vulnerable group exposed to varied forms

of exploitation includes the abuse of street children (Raja, Bano and Ahmed cited 2005) which

impact their health. Risks that confront street children include abuse, sexual risk behaviors

with increased susceptibility to sexually transmitted diseases, mental and general health

problems (Celik, 2009, UNESCO 2016).

Street children move in groups that are sexually active with over two-thirds of them being

sexually active as reported in a study conducted in Canada (Marshall, Kerr, Shoveller and

Patterson, 2009). There is a noteworthy correlation between high-risk sexual behaviors and

the form of abuse that homeless youths are exposed to (Ferguson, 2009). There are higher

rates of physical and sexual; violence among street children than the general populace

(Bamaby et al, 2010). When examining sexual risk behaviors among street children, sexual

abuse was found to be prevalent among street children with over 68 percent reported

experiencing sexual abuse and about 39 percent reported victimizing other street pears.

Ferguson 2009, found that experience for homeless youths. Risky sexual behaviors are on the

increase among street children and this vulnerability may result in sexual health illness and

diseases (WHO, 2017). In western Kenya, the majority of children and youth begin to engage

in sexual activities with a lack knowledge of the consequences of their behaviors (Kayembe et

al, 2008). In a report by WHO (2013), the age of sexual debut was correlated by high-risk
behaviors which included multiple sexual partners and little condom use negotiation. Within

Central region, district of Kampala, the use of substances, petty theft and risky sexual

behaviors are highly prevalent (Old Stadium Street Children, 2017). In a study conducted in

Kampala district it was found that gender plays an influential role in the onset of sexual debut

among street children (Manzini, 2001). Young females were found to be a risk for engaging in

risky sexual behaviors in exchange for food, clothing or shelter (Manzini, 2001).

Survival sex, the sexual behaviors street youths adopt as a way of life within the realm of the

streets place them at high-risk for STDs including HIV infection (Maestro et al, 2014: Tyler

Whit beck, Chen and Johnson, 2007). Some of the behavior street youths engage in may

include survival sex and the exchange of sex for substance use (Van Leeuwen et al, 2004;

Maestro et al, 2012, Nada and Suliman, 2010). Survival sex is sometimes a consequence of

trauma and being homeless, which is also associated with health risks problem (the national

child traumatic street network, 2017). Within the sub-Sahara region, studies have examined

sexual behaviors among homeless youths. In Zimbabwe a positive correlation between risky

sexual behaviors and the use of substance among street children (WHO, 2014). The way of

life of street children make them vulnerable to injuries and substances use that might include

sexual and reprocluctive health (UN, 2014).

IVIultiple sexual partners, there is a link between survival sex among street children and

health riskthis include sexual multiple partners and inconsistent condom use. In a study on

sexual behaviors among street children, about 54 percent reported having sexual multiple

partners for survival reasons (Nada and Suliman, 2010). The conditions in which street

children reside correlate within a high prevalence of sexual multiple partners (Marshall, Kerr,
Shoveller and Patterson, 2009). Some of the predictors of sexual multiple partners among

street children are associated with living conditions and the use of substance (Solorio et al,

2008; UN, 2014).

Non-condom use, although studies in Uganda have examined sexual risk behaviors among

street children. studies date from early 2000s. Not much is available and known on the current

sexual behaviors of this category of youths in Uganda. In a study on condom use among

homeless youths (Nada and Suliman, 2010) found that 52 percent of the participants reported

never using condoms. Non-condom use amongst street children is association with the use of

substance (tucker et al, 2012). In a report by the UN (2014) street children that use substances

were more likely to engage in risky sexual behaviors, which may involve the non-use of

condoms.

2.3 Strategies for reducing street children.

several organizations working with the issue. As a social worker described; a rewarding party

of social work is the realization that there is awareness of the issue now as well as the

politicians are engaged in the phenomenon of the street children.

Street children are an issue on the agenda or the political levels. One social worker described

that; "there are many organizations who work with street children but there often not

specialized nongovernment organization that mainly focus on crime prevention. The

NGO/NPOs work with social development, churches and there are organizations specialized

in street children and organizations specialized in family problems.

preventively with different schools where the children are struggling by measuring what the

need is, it makes it easier to work from where the children are, emotionally and physical.

Another interview discloses that the organizations can exhort the children to not use drugs, to

explain the invortance of good relationships and to prevent criminal activities.

The possibility of making a difference, according to the social workers with the children. the

Inost meaningful part in their work is the possibility of making a difference in the street

children's lives; it is not always a difference as in changing everything for better in tie, it's

about the ability to have an impact the process of the system and on the political level. Some

of the interviews mentioned that all humans need love and respect. Every child in the world

has a need of love, attention and care in order to change behavior. street children have a

tendency to respond negatively to generosity and action of love due to the lack of love in their

earlier experience.

Genders method does not look the same for boys and girls. Firstly, the boys are usually easier

to find on the street and are more openly selling items or begging for money. The children

always need to come up with things to entertain people in order to get money. There are

specific actions on how to reach out to the girls, there is. a first need to make contact with the

leaders (often males) of the group. We do not see female street children, most are boys. We

often see female's prostitutes. They could be 14 years old or younger. Street children as we

know it are not really females. In the cities there are more boys, but there most boys in charge

of the decisions.

Family-based work. it was brought to our attention that street children usually have done

everything that could have done at home in order to save themselves without any success and
this leads to feelings of not being loved. It is a child that takes charge of their own lifeand

when they decide to leave their families, there is usually nothing that can make them return

home. Sometimes, when you see what they been through at home.

Government have implemented programs to deal with street children, the general solution

involves placing the children into orphanages juvenile homes, or correctional institutions.

Efforts will be macle by various government has tried to implement programs to put these

children in state-run homes, but efforts have largely failed, and street children have become a

victim group of social cleaning by the national policy, because they assumed to be drug users

and criminal.

In Uganda, the primary response to homelessness is the supported accommodation assistance

program.

Public approaches to street children, there are four categories as follow;

i) The correctional model is primarily used by governments and the police. They view

children as a public nuisance and risk to the security of the general public. The objective of

this model would be to protect the public and help keep the kids away from the life of crime

are the juvenile justice system.

ii) The rehabilitative model is supported by churches and NGOs. The view of this model is

that street children are damaged and in need of help. The objective of this model is to

rehabilitate children into mainstream society. The method used to keep children from going

back to the streets are education, drug detoxification programs and providing children with

safe family-like environment.

The strategy views street children as oppressed individuals in need of support from their

communities. The objective of the outreach education and training to support children.

iv) The preventive approach is supported by NGOs, the coalition of street children, and

lobbying governments. They view street children's poor circumstances from negative social

and economic forces. In order to help street children, this approach focuses on the problems

that cause children to leave their homes for the street.

2.4 Conclusion

This chapter provided an overview about the phenomenon of street children that included the

definition, prevalence and causes of this phenomenon. The study will be comprehensively

review literature on the mental health and sexual health risk behaviors among street children.

In addition, research finding on these issues were discussed.