Magazine 2014
International Peer-Reviewed Journal
RESEARCH HORIZONS, VOL. 4 JULY 2014
FOOD & NUTRITION
GROWTH STATUS OF STREET CHILDREN -
BENEFICIARIES OF FEEDING PROGRAMME IN MUMBAI
Unnati Shah
Perpetua Machado
ABSTRACT
Growing urbanization, migration from rural areas, disintegration of traditional family and community
structure have ushered in changes in socioeconomic scenario which have given rise to new vulnerable
group of children in cities residing on streets called ‘street children’. The street children phenomenon is
an increasing problem in most cosmopolitan cities of the developing countries. The government and
NGOs have initiated various food programs for street children. It is therefore important to know their
growth status. The present study was undertaken to assay growth status of street children using
anthropometric measurements like height, weight and BMI. Second objective of the study was to ascertain
the adequacy of the meals provided to street children at these institutes. Study design was exploratory
and descriptive. Three hundred and fourteen street children (aged 9 to 18 years) including beneficiaries
of school feeding programme (184- Type I), NGO feeding programme (68- type II) and shelter feeding
programme (62 -type III ) were selected using purposive sampling from three institutes in Mumbai. Data
on the number of consumed meals provided by institutes, meal composition, height, weight and BMI for
age was recorded. Data was analyzed using SPSS (16). Measures of centre and measures of variability
were computed. One sample t test was used for analysis as an advanced statistical procedure. The
results indicated that the street children benefitted from the free food services available at the institutes.
All children were given same proportion of food however all basic five food groups were not included in
any of the meals. The anthropometric indicators for mean height, weight and BMI for age were below
th
9
5 centile. Five percent of boys and 8 % of girls were stunted, 7 % of boys and 9% of girls were under
weight, 6 % boys and girls were thin for their age. Approximately one third of subjects suffered from mild
under nutrition with regards to height, weight and BMI for age despite of consuming meals and being a
beneficiary of food programme. One sample t test indicated significant differences with regards to
height, weight and BMI for age when compared with reference standards for both genders(P < 0.01).
Currently no dieticians are attached with these institutes hence there is an utmost need for dietician in
these institutes, so that quality food is provided in terms of nutrition and thereby improve the growth
status of street children.
Keywords : ꢂ Beneficiaries ꢂ Dietician l Food programme ꢂ Growth status l Street children
Introduction
Children are an asset for any society. It is the responsibility of the society to nurture them through
various phases of their development, to enable them to make meaningful contribution. Yet there are
millions of children throughout the world who live on street, an unfriendly environment.
During the recent years cities have undergone rapid changes that have transformed the urban
environment as well as lives of millions of people who live in this setting. Growing urbanization, migration
from rural areas, disintegration of traditional family and community structure have ushered in changes
in socioeconomic scenario which have given rise to new vulnerable group of children in metropolitan
cities residing on streets called ‘street children’. The street children phenomenon was first noticed in
Kenya in 1969, Ayaya and Esamai (2001).
The rapid population growth could be associated with an increase in number of children living alone
on urban streets or spending most of their days on the streets inquest of survival. Other factors that
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RESEARCH HORIZONS, VOL. 4 JULY 2014
contribute to street children phenomenon include poverty, unplanned pregnancies, parent’s death,
HIV / AIDS and drug abuse especially alcohol, Ayaya and Esamai (2001).
In India while no accurate and authentic estimate of their number is available it is safe to assume that
their number is substantial and is ever increasing. Highest numbers of street children are found in
Maharashtra, D’lima and Gosalia (1992). As per UNICEF the exact number of street children is impossible
to quantify but it is likely that the number are increasing. In practice, every city in the world has some
street children, including the biggest and the richest cities of the industralised world (UNICEF, 2014).
An estimated by Tata institute of social science and voluntary organization Aid India total of 37,059
children were found to be living on the streets of Mumbai
The definition of street children varies although much research distinguishes two groups: Home based
children who usually return home at night, Street based children who remain on street and have no
family support. These include orphans, runaways and refugees.
Street children are found to be deprived both socially and physically in most of the studies. The most
common diseases among Street children examined were malnutrition, especially between the ages of
1
2 and 13, dental caries, skin problems, urinary problems, bone fracturestrauma and certain infection
like upper respiratory tract infection, skin diseasesand malariaare found to be more common in children
who are street based than in home based children (Ayaya and Esamai (2001); Nzimakwe and Brookes
(
1994); Solomon et.al. (2002); Thomas et.al (1998)).
Studies of homeless populations in developed countries have consistently revealed inadequate dietary
intake. A situational analysis of street children in Pakistan reported stunted and wasting in 32% of
population, Shahab et.al (2004). A significant difference in nutritional status was observed in street
children and school children, street children were more nutritionally vulnerable as compared to school
children, Ayuku et.al (2004). The ways these children acquire food have also shown some association
with nutrition vulnerability, Tarasku et.al (2004).
Social service agencies, health centers and voluntary organizations have responded by initiating various
environmental programs for public particularly homeless street children to obtain food, shelter and
primary health care. It is therefore important to know growth status of street children who are
beneficiaries of feeding programme.
The present study was undertaken to assay growth status of street children using anthropometric
measurements like height, weight and BMI. Another objective of the study was to ascertain the adequacy
of the meals with regards to energy and proteins provided to street children at these institutes.
Methodology
The study was conducted in Mumbai. Study population included street children who are beneficiaries
of feeding programmes. Study design was exploratory and descriptive. Ethical approval for research
on human subjects was obtained from Nirmala Niketan College of Home Science - Institutional Ethics
Committee (NNCHIEC) affiliated to the University of Mumbai.
Sampling Technique - Purposive sampling technique was used, Three Organizations (State board
school, NGO and Shelter house) in Mumbai, known to have close experience with street children were
approached. These organizations offered various services like imparting education, providing shelter
and food to number of underprivileged children like street children living with their family on streets,
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orphans, run away kids, children of sex workers and children in extreme difficulty under the physically
suffering single parent.
Protocol of the study was explained and approved by the heads of the above mentioned three
organisations. Informed written consent was obtained from all three heads of the three institutions.
Informed oral consent was obtained from participants of the study
Inclusion Criteria
1
2
3
4
5
.
.
.
.
.
Children residing on street / slum / in shelters
Street children affiliated with institutes
Between the age group of 9 to 18 years
Willing to participate voluntarily
Consuming at least one institute meal
Data Collection and Analysis
The following anthropometric measurements were taken during the study. Height in (cms), Weight in
2
(
Kgs) and using this data Body Mass Index (BMI – kg / m ) was calculated. These measurements were
compared with Indian reference standards (ICMR 2010 standards) using advanced statistical measure
one sample t test) with the help of SPSS software version 16.
(
As per the second objective to ascertain the adequacy of the meals provided to street children at these
public institutes following data was obtained:
1
2
3
4
5
.
.
.
.
.
Number of meals provided each day to street children
Weekly menu was studied
Personnel involved in meal planning
Food groups incorporated in the meals
Quantity of food provided in each meal - The serving size was determined by using live models of
different sizes and thickness for chapatti, standardized cups and standardized spoons.
Energy and proteins provided in each meal - Closely approximated raw equivalents of cooked
foods were then employed to calculate nutrients. Raw equivalent amounts used for making common
recipes were used to calculate energy and proteins of the recipes. Calculations were done using
6
.
‘
Nutritive Value of Indian Foods’ published by ICMR (Gopalan et al, 2004).
Results and Discussion
A total of 314 street children were assessed, ranging in age from 9 to 18 years, including beneficiaries
of school feeding programme (184 - consuming one institute meal), NGO feeding programme (68-
consuming 2 institute meals) and shelter feeding programme (62 – consuming 4 institute meals).
Mean age of children was 12 ± 2 years. Among 314 street children, 108 (35%) were girls and 206
(
65%) boys respectively.
Anthropometrical measures of participants
The average height of participants, standard deviation, Z score and significant difference from reference
2
standards for Height in cms, Weight in Kgs and Body Mass Index kg / m for boys (Table No 1) and
girls (Table No 2) are discussed below.
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Table No 1: Anthropometric characteristics of boys and comparison with standards
Age
HEIGHT FOR AGE
WEIGHT FOR AGE
Std. Mean
BMI FOR AGE
Std. Mean
Mea ± Std. Mean
Sig
Mea
±
Sig
Mea
±
Sig
Deviation
Z
(t va lue)
Deviation
Z
(t value)
Deviation
Z
(t value)
score
-0.03
score
-0.49
score
-0.60
9
132.1
6.85
133.08
6.43
138.82
7.77
0.27
(-1.15)
26.35
± 4.81
0. 30
(-1.08)
14.97
± 1.27
0.22
(-1.29)
±
10
11
12
13
14
15
16
17
18
-0.70
-0.65
-0.30
-0.92
-1.05
-0.66
-0.22
-0.68
-1.23
0.00
(-6.54)*
26.61
± 4.82
-1.00
-0.90
-0.65
-0.84
-1.02
-0.91
-0.48
-0.85
-0.89
0.00
(-5.26)*
14.92
± 1.65
-0.85
-0.77
-0.66
-0.58
-0.71
-0.80
-0.44
-0.64
-0.38
0.00
(-
±
2.86)*
0.00
(-5.70)*
30.49
± 6.65
0.00
(-4.01)*
15.71
± 2.57
0.09
(-1.68)*
±
146.82
7.99
147.77
9.45
151.78
7.65
159.25
6.39
166.2
0.00
(-3.11)*
35.93
± 8.67
0. 17
(-1.38)
16.53
± 2.90
0.89
(-0.13)
±
0.00
(-4.9 7) *
37.32
± 5.20
0.00
(-5.85)*
17.28
± 3.72
0.67
(-0.42)
±
0.00
(-6.2 2) *
39.71
± 6.83
0.00
(-5.13)*
17.14
± 2.02
0.06
(-2.00)
±
0.00
(-3.8 1) *
43.90
± 6.05
0.00
(-4.34)*
17.26
± 1.85
0.03
(-2.49)*
±
0.54
(-0.66)
52.20
± 8.04
0. 59
(-0.58)
18.79
± 1.64
0.61
(-0.55)
±
7.08
165.83
0.18
(-1.55)
51.01
± 5.27
0. 05
(-2.54)
18.57
± 1.85
0.23
(-1.35)
±
6.55
164.67
2.08
0.03
(-5.5 1) *
53.7
± 1.47
0.03
(-5.50)*
19.81
± 0.98
0.89
(-0.14)
±
Significant difference *
As reported above mean height, weight and BMI of boys for all ages were below or equal to the 95
th
centile values and few ages were significantly below the ICMR reference standards as highlighted above.
Table No 2: Anthropometric characteristics of girls and comparison with standards
Significant difference *
th
As per the above table mean height, weight and BMI of girls for all ages were below or equal to the 95
centile values and few ages were significantly below the ICMR reference standards as highlighted
th
above. Only 18 boys and 10 girls of children assessed met the reference ICMR standards (95 centile
value and above) of height, weight and BMI for age.
The following graphs (Figure No 1 and 2) describes the degree of under nutrition and over nutrition as
per Z score calculation from reference standards published by Khadilkar for Indians.
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RESEARCH HORIZONS, VOL. 4 JULY 2014
Figure No 1: Nutritional status of boys
Fifty six percent of boys and 58% of girls met the standard height for age reference, 54% of boys and
7% of girls met the weight for age reference standards and 63% of boys and 68% of girls met the
5
standard reference for BMI respectively. Out of the remaining children only 13% of boys and 9% of girls
were over nourished, rest all were under nourished.
Figure No 2: Nutritional status of girls
Adequacy of the meals provided to street children
All three institutes were following a weekly cyclic menu. School feeding programme included one
afternoon meal (lunch) on daily basis, NGO feeding programme included two meals (one midmorning
snack and lunch), shelter house feeding programme included four meals (breakfast, lunch, evening
snack and dinner). The school meal was provided for five days, NGO provided for six days and the
shelter offered for all seven days. Daily average menu, per serving quantity of food and energy and
proteins provided per day by the three institutes is shown in table 3.
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RESEARCH HORIZONS, VOL. 4 JULY 2014
Table No 3: Average daily meal composition of institutes.
No dieticians were associated with these three institutes nor involved in menu planning. These menus
were planned and approved by the heads of the institutes. All children were given same proportion of
food. All basic five food groups were not included in any of the meals. Studies reported in Tarasku’s
paper linked nutritional vulnerability to poor quality and insufficient quantities of food provided to this
target group in Toronto. Tarasku et.al (2005).
Conclusion
Five percent of boys and 8 % of girls were stunted, 7 % of boys and 9% of girls were under weight, 6 %
boys and girls were thin for their age. Approximately one third of subjects suffered from mild under
nutrition with regards to height, weight and BMI for age despite of consuming meals and being a
beneficiary of food programme. Both quality and quantity of food was insufficient. The reason could be
dependency on charitable donations and lack of resource person to plan nutritious meal in the available
resources. Findings of this study suggest efforts should be directed by the administration of institutes
dealing with street children to enroll students who are pursuing masters in nutrition as nutrition counselors
in summer holidays for one month. Infrastructure is already available in these institutes, with the help of
nutrition counselors a weekly institute menu can be planned and tested for a month and can be continued
for a year. The nutritional vulnerability of street children in this study highlights the need of considering
a nutrition expert as a core team member in finalizing the menu provided to the beneficiaries of feeding
programmes. The study will help to understand the Nutritional status of street children in Mumbai
which would further help in making policies by the concerned authorities for the benefit of these children.
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RESEARCH HORIZONS, VOL. 4 JULY 2014
Acknowledgements
I would like to thank my guide Dr. Perpetua. Machado for her constant guidance and invaluable support.
I would like to express my deep senses of appreciation towards the institute members for their co-
operation and support during the course of the study. I would thank my parents and family members
for their constant motivation, blessings and standing beside me as pillars of support through the entire
duration of the study.
References
Ayaya S and Esamai F, ‘Health Problems of Street Children in Eldoret, Kenya’, East African Medical
Journal, 78; (12.), (2001) 624-629.
Ayuku D, Ettyang E and Odero W, ‘Psycho-Social and Nutritionl Status of Street Children In
Comparison To School Children: A Case of Eldoret Town’, African Journal of Food Agriculture
Nutrition and Development, 4; (1.), (2004) 1-8.
D’lima, H and Gosalia R, ‘Street Children of Bombay: A Situational Analysis. National Labour Institute’,
India (1992).
Gopalan, C; Rama, B; Balasbramanian, C; Rao, B; Deosthale, Y and Pant, K (2004). Nutritive Value
of Indian Foods. Published by National Institute of Nutrition.
Khadilkar, V; Khadilkar, A; Cole, T and Sayyed, M (2009). Cross sectional Growth Curves for Height,
Weight and BMI for affluent Indian children, 2007.
Nzimakwe D and Brookes H, ‘An Investigation to Determine the Health Status of Institutionalised
Street Children in a place of safety in Durban’, Curationis, 17; (1.), (1994) 27-31.
Shahab S, Hiroshi U and Aime D, ‘Street Children in Pakistan: A Situational Analysis of Social
Conditions and Nutritional Status’, Social Science and Medicine, 59; (8.), (2004) 1707-1717.
Solomon S, Tesfaye K and Lopiso E, ‘Health Problems of Street Children and Women in Awassa,
Southern Ethiopia’, Ethiop.J.Health Dev, 16; (2.), (2002) 129-137.
Tarasku V, Naomi D and Jinguang L, ‘Homeless Youth in Toronto are nutritionally Vulnerable’, The
Journal Of Nutrition, 135; (2005) 1926-1933.
Thomas J, Andrew T, Margaret A and Francesca S, ‘Street Children in Latin America’, British Medical
Journal, 316; (7144.), (1998) 1596-1600.
UNICEF data retrieved from www.unicef.org.
Rajadhyaksha, M Making Street Children Matter, A Census Study In Mumbai City, TISS And Action
rd
Aid India (2013). Retrieved from www.timesofindia.com, posted on 3 December 2013.
Ms. Unnati Shah : Visiting Faculty & Ph.D. Scholar, Nirmala Niketan College of Home Science, Mumbai
Dr. Perpetua Machado : Principal, Nirmla Niketan College of Home Science, Mumbai.
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