AMERICAN JOURNAL OF HUMAN BIOLOGY 19:51–60 (2007)

Original Research Article

Growth and Health Status of Street Children

in Dhaka, Bangladesh
LAWRENCE P. GREKSA,1* NAGANUMA RIE,2 A.B.M. RAFIQUL ISLAM,3 UCHIDA MAKI,4
2
AND KINUKO OMORI
1
Department of Anthropology, Case Western Reserve University, Cleveland, Ohio 44120
2
Division of Health Science, Graduate School of Medical Science, Kanazawa University,
Ishikawa, 920-0942 Japan
3
Department of Human Ecology, School of International Health, Graduate School
of Medicine, University of Tokyo, Tokyo, 119-0033 Japan
4
Ichikawa Prefectual Nursing University, Ishikawa, 920-0942 Japan

ABSTRACT The purpose of this study was to assess the effect of street life on the growth
and health status of poor children who live and work full-time on the streets of Dhaka, Bangla-
desh (street children), independent of the effects of poverty. This was accomplished by compar-
ing 142 street children with 150 poor children who live and work on the streets of Dhaka but
who return to their families at night (slum children). Children between 7–14 years old were
recruited at locales where street and slum children are typically found. Weight and upper arm
circumference did not differ significantly between street and slum children (P > 0.05), but
energy reserves, as assessed by skinfolds, were significantly larger in street than in slum chil-
dren (P < 0.05). There was no wasting in either street or slum children. Although the majority
of children in both groups were stunted and underweight, there were no significant differences
between groups (P > 0.05). The prevalence of disease symptoms tended to be slightly higher in
street children than in slum children, but few of the differences were statistically significant
(P < 0.05). These data do not support the contention that street children are a particularly
high-risk group. The greater-than-expected growth and health status of street children, com-
pared to other poor children, may be due to biologically fitter children being more likely to per-
manently move to the streets and/or to remain on the streets once the move has been made. Am.
J. Hum. Biol. 19:51–60, 2007. ' 2006 Wiley-Liss, Inc.

Due to the sensitivity of the growth process i.e., children who live with their families but
to the effects of a wide variety of stressors, spend most of their day on the streets. It has
indices of various aspects of growth and deve- become increasingly clear that these catego-
lopment are frequently used to assess not only ries are much more flexible and heterogeneous
the well-being of children, but of the society to than originally envisaged, with children fre-
which they belong (Bogin, 1988; Eveleth and quently moving from one category to the other,
Tanner, 1990). As so aptly described by the for example. The theoretical and methodologi-
oft-quoted chapter title of Tanner (1986), chil- cal limitations of these categories were thor-
dren provide ‘‘a mirror of the condition of soci- oughly discussed by Panter-Brick (2002), and
ety.’’ Logically, children who are living on the thus need not be repeated here. Even with
streets without the social, economic, and emo- their limitations, these categories can be use-
tional support of their families and commun- ful for research purposes, especially if the
ities should be at particularly high risk, par-
ticularly if such children are viewed as devi-
ant, victimized, and marginalized segments of
society, as they often have been (Aptekar, Kinuko Omori is deceased.
1994; Lalor, 1999; Panter-Brick, 2001). *Correspondence to: Lawrence P. Greksa, Department of
Anthropology, Case Western Reserve University, 236
Much of the research on children living on Mather Memorial, Cleveland, OH 44106.
the streets has categorized children as either E-mail: lpg2@case.edu
‘‘children of the streets,’’ i.e., children who live Received 5 April 2006; Revision received 17 July 2006;
Accepted 19 July 2006
and work on the streets largely independent Published online in Wiley InterScience (www.interscience.
of their families, or ‘‘children on the streets,’’ wiley.com). DOI 10.1002/ajhb.20573

V
C 2006 Wiley-Liss, Inc.
52 L.P. GREKSA ET AL.

term ‘‘children of the streets’’ is used to SUBJECTS AND METHODS

describe the extreme of this category, or those
children who are reasonably permanent resi- A convenience sample of children was re-
dents of the street with limited or no contact cruited in Dhaka, Bangladesh, in 2001 with
with their families. the assistance of Bangladeshi public health
Most of the research on children living on workers. Children were recruited and studied
the streets has focused on their social and psy- at locales (parks, railway stations, or airport)
chological development, and has concluded identified as where both street and slum chil-
that life on the streets has a negative impact dren tended to congregate to work, look for
on the social and psychological development of work, or socialize with friends. Children were
children (e.g., de la Barra, 1998; le Roux, approached individually and, after the project
1996; Silva, 1996; Wright, 1990; Wright et al., was explained, asked if they would like to par-
1993). Some studies, however, concluded that ticipate. Children were recruited only by the
moving to the streets may in fact be an adapt- research staff; study children were not asked
ive response for at least some children, and to recruit other children. Given the age and
that these children may be much more psycho- educational level of the subjects, each child
logically healthy and resilient than originally orally consented. Subjects received 20 Taka,
assumed (Aptekar, 1994; Felsman, 1984; Veale or about $0.35 US, to reimburse them for the
et al., 2000). interruption in their work time ($1 US ¼ 58
Relatively little is known about the impact of Taka in 2001). The protocol was approved by
street life on biological, as opposed to psychologi- the Ethics Committee of Kanazawa University
cal, well-being. Generally, studies concluded that and by the Institutional Review Board of Case
children of the street are either no less biologi- Western Reserve University.
cally fit (Dobrowolska and Panter-Brick, 1998; No data are available on the prevalence or
Scanlon et al., 1998) or are actually somewhat demographic composition of street children in
fitter (Gross et al., 1996; Panter-Brick et al., Dhaka. Samples could thus not be designed to
1996; Wright et al., 1973) than other poor chil- reflect the age and sex structure of street and
dren. One possible explanation for the finding slum children in Dhaka. Instead, the sam-
that children living on the streets may not be as pling strategy was designed to facilitate statis-
vulnerable as originally assumed is that psycho- tical comparisons by sampling approximately
logically and biologically fitter children may be equal numbers of street and slum children of
more likely to make the decision to move to the both sexes. In addition, an attempt was made
streets, and/or once the move to the streets has to focus on street children with little or no con-
been made, may be more likely to remain there tact with their families, or the extreme in the
(Aptekar, 1994; Panter-Brick, 2002; Solomons continuum of street children.
and Gross, 1995; Veale et al., 2000). The final sample consisted of 296 children
The purpose of the present study is to add to between ages 7–14 years. Of these, 150 (75 boys,
the literature on the impact of street life on bio- 75 girls) were slum children, or children who
logical well-being by evaluating the impact of were living with their families in one of the
street life on the growth and health status of Dhaka slums, but who spent their days working
children of the street residing in Dhaka, Ban- on the streets of Dhaka. Another 142 children
gladesh, as well as describing the social and (74 boys, 68 girls) were street children, or chil-
economic characteristics of these children. As dren who both lived and worked on the streets
noted by Panter-Brick et al. (1996), both chil- of Dhaka. Most of the parents of both groups of
dren of the street and children on the streets children lived in Dhaka slums, but a few were
tend to come from poor families, so that deter- living in rural areas near Dhaka.
mining the effects of street life, independent of Most of the children were not sufficiently lit-
the effects of poverty, requires utilizing ap- erate to complete a survey designed to elicit ba-
propriate controls. This was accomplished in sic demographic, social, and economic data on
the present study by comparing the physical themselves and their families. This survey was
growth and health of children of the streets therefore collected verbally by Bangladeshi
with little or no contact with their families with research personnel. Anthropometric measure-
fairly comparable children living in the slums ments were made by one researcher according
of Dhaka with their families but working on to standard protocols (Weiner and Lourie,
the streets during the day. For simplicity, these 1981), and included height, weight, upper arm
two groups will be referred to as ‘‘street chil- circumference, and triceps and subscapular
dren’’ and ‘‘slum children,’’ respectively. skinfolds. All measurements were made with

American Journal of Human Biology DOI 10.1002/ajhb

 GROWTH AND HEALTH STATUS OF DHAKA CHILDREN 53

portable equipment (stadiometer, portable scale, between street and slum girls (w ¼ 0.3, P >
2

tape, and skinfold caliper). 0.05), or between boys and girls within the
Height-for-age, weight-for-height, and weight- sample of slum children (w2 ¼ 1.3, P > 0.05).
for-age z-scores were calculated based on NCHS/ However, street boys were significantly older
CDC reference curves (Jordan, 1986). The than street girls (w2 ¼ 5.4, P < 0.05).
growth of many of the children was suffi-
ciently stunted that they had heights below Street children. Street children reported that
the minimum required to calculate weight-for- they began living on the streets at a median
height z-scores. A strategy proposed by Cole age of 8 years (range, 0–13 years), and had
(1993), and used successfully by Panter-Brick lived on the streets for a median of 3 years
et al. (1996) in a study of Nepali street chil- (range, 0–10) at the time they were inter-
dren, was used to estimate weight-for-height viewed. Only 16% of street children reported
z-scores for the Dhaka children. Children with that they had any contact with their families,
z-scores of less than
2.00 for height-for-age, and only 5% reported seeing their families
weight-for-height, and weight-for-age were clas- with any frequency (at least once a week).
sified as stunted, wasted, and underweight, re- Considering only those few children who still
spectively (Waterlow et al., 1977; WHO Working had some contact with their families, 27%
Group, 1986). reported that they occasionally gave some
Health status was determined by a registered money to their families.
nurse, based on a physical examination of each Street children were generally satisfied with
child. In particular, it was determined if a child their move to the streets, with 60% stating
exhibited symptoms of diarrhea, respiratory that they preferred living on the streets to liv-
infection, scabies, ringworm, dermatitis, chronic ing at home, with 71% indicating that they
otitis media, conjunctivitis, parasites, burns, or would make the same decision again. Perhaps
cuts. Physical evidence for Bacillus Calmette- surprisingly, 59% reported that their parents
Guerin (BCG) and measles vaccinations was also were also happy with their decision to move to
recorded. A 24-hr activity recall was used to the streets. Street children slept in a variety
assess time spent working. All statistical analy- of locations, with the most popular being train
ses were performed with SPSS for Windows, and boat stations (46%).
version 11.0. Street children were asked several open-ended
questions about their move to the street. Mul-
RESULTS tiple responses were possible. Only responses
with a frequency of greater than 10% are
Demographic and social characteristics
reported. By far, the most frequent explana-
of slum and street children
tion the children gave for why they moved to
The age and sex distributions of samples the street was not really a reason; 66% empha-
are given in Table 1. There were no signifi- sized that the decision to move to the streets
cant differences in the proportion of boys and was their own decision. In addition, 35% indi-
girls between the samples of street and slum cated that they moved to the streets due to a
children (w2 ¼ 0.1, P > 0.05). Median age was change in the composition of their family (death
11.5 years in street boys, 10.0 years in street of a parent, remarriage, or desertion), 30% stated
girls, 11.0 years in slum boys, and 10.0 years they were abused or oppressed in their home,
in slum girls. The age range was 7–14 years in and 29% made the move for economic reasons
each of these subsamples. A median test indi- (insufficient family resources, desire to earn
cated no significant differences in age between money). There were no significant differences
street and slum boys (w2 ¼ 2.4, P > 0.05), between boys and girls in any of these meas-
ures (w2 ¼ 0.2–0.7). When asked what they
TABLE 1. Age and sex distribution of samples
hoped to gain by moving to the street, three
children indicated that they had no hope, but
Slum children Street children the remainder provided essentially economic
reasons (e.g., to earn money, for a better life, to
Age (years) Boys Girls Boys Girls
be self-reliant, to survive).
7–8 7 14 6 12 The children gave two primary reasons for
9–10 30 30 23 25 what they thought would be the hardest part of
11–12 25 21 27 17 living on the street before they left their homes.
13–14 13 10 18 14
Total 75 75 74 68
Forty-one percent felt that finding shelter, food,
and work would be hard, while 39% had no

American Journal of Human Biology DOI 10.1002/ajhb

54 L.P. GREKSA ET AL.

TABLE 2. Selected characteristics of slum and street children

Slum Street

N % N % w2

a. Both birth parents in household 99 6.0 44 31.0 35.8*

Only one birth parent 42 28.0 80 56.3 24.1*
At least one step-parent 11 7.3 37 26.1 18.6*
b. Sibs on street? 32 21.5 37 26.1 0.8
c. Father employed 109 73.6 81 59.6 6.4*
Mother employed 89 59.7 58 42.3 8.6*
d. Are you happy? 119 79.9 99 70.7 3.3
Ever need to steal food? 18 12.1 29 20.7 4.0*
Ever feel threatened? 58 38.7 49 35.3 0.4
Place to go when feel threatened? 81 54.4 44 32.8 13.3*

*P < 0.05.

idea what difficulties they would face. When 21% of street children reported involvement in
asked what they actually found to be hardest school activities (homework, school attendance)
about living on the street, 30% stated that on the previous day in their activity recall
there were no problems, 22% felt that coping (w2 ¼ 5.1, P < 0.05), which is still larger than
with the physical environment (sun, rain) was might be expected in working children. On the
hard, 20% thought the hardest part was find- other hand, only 12% of slum children and 6%
ing shelter, food, and work, and 17% felt the of street children reported spending at least
hardest aspect of street life was being abused 240 min in schooling the previous day, a differ-
and mistreated by other street children, adults ence which approaches significance (w2 ¼ 2.8,
in general, and the police. None of these P < 0.10). Whichever of these estimates is most
responses differed significantly between boys accurate, few of these children have obtained
and girls (w2 ¼ 0.0–1.3, P > 0.05). much education. Of the 64 slum children and
65 street children who reported a current grade,
Slum vs. street children. There were signifi- only 42% of slum children and 22% of street
cant differences between slum and street chil- children reported that they had completed at
dren in the composition of their households least 2 years of schooling, a difference which is
(Table 2a). In particular, slum children were significant (w2 ¼ 6.3, P < 0.05).
twice as likely as street children to come from a When asked what they hoped to be when
home with two birth parents, while about twice they are adults, 26% of slum children and 23%
as many street children as slum children came of street children identified skilled or profes-
from a household with only one birth parent sional occupations (e.g., doctors, lawyers, tech-
(P < 0.05). Also, street children were about 3.5 nicians, teachers). The remainder identified
times more likely to come from a house with at more feasible future occupations (e.g., manual
least one step-parent (P < 0.05). There were laborer, rickshaw puller, factory worker, vender,
only minor and, according to the median test, housewife, maid).
insignificant differences between samples in The majority of both slum and street chil-
family size or parity of subjects (P > 0.05). In dren reported that they were happy with their
particular, slum children had a median of 4 lives (Table 2d), with no significant differences
sibs, and street children had a median of 3 sibs between groups (P > 0.05). However, signifi-
(w2 ¼ 0.3, P > 0.05), while the median parity of cantly more street than slum children reported
subjects in both groups was 2. There were no that they sometimes needed to steal food
significant differences between groups on whether (Table 2d, P < 0.05). Between 35–40% of chil-
or not they reported having a sib on the street dren in both groups reported that they some-
(Table 2b, P > 0.05). times felt threatened on the streets, with no sig-
The children gave contradictory answers to nificant differences between groups (Table 2d,
questions about their current educational sta- P > 0.05). However, significantly more slum
tus. Almost half (45%) of both the slum and than street children reported that they felt they
street children reported that they were cur- had a safe place to go when they felt threat-
rently attending school, which is of course ened (Table 2d, P < 0.05).
inconsistent with their working regularly on The parents of slum children were signifi-
the streets. Only 32% of slum children and cantly more likely to be employed than were

American Journal of Human Biology DOI 10.1002/ajhb

 GROWTH AND HEALTH STATUS OF DHAKA CHILDREN 55
TABLE 3. Work activities of slum and street children

Boys Girls

Slum Street Slum Street

N % N % w 2
N % N % w2

Waste collection 20 27.4 22 29.7 1.0 13 17.3 26 28.8 7.9**

Vending 38 52.1 8 10.8 29.1*** 47 62.7 25 36.8 9.6**
Begging 1 1.4 3 4.1 0.2 6 8.0 10 14.7 1.6
Porter 1 1.4 29 39.2 30.1*** 0 0.0 1 1.5 0.0
Other 13 17.8 12 16.2 0.2 9 12.0 6 8.8 1.0

**P < 0.01.

***P < 0.001.

the parents of street children (Table 2c, P < 0.05). Street boys (w2 ¼ 6.2, P < 0.05) and
0.05). The parents of both groups had a wide street girls (w2 ¼ 12.4, P < 0.001) both
variety of jobs, but some differences were sig- reported working significantly longer during
nificant between groups. In particular, fathers the previous day than slum children. Never-
of slum children were significantly more likely theless, the longer working day of street chil-
to have a construction job (19% vs. 5%, w2 ¼ dren did not result in greater reported
6.8, P < 0.01), while fathers of street children incomes. Slum children reported a median
were significantly more likely to be involved daily income of 175 Taka (range, 14–490 Taka;
in agriculture (26% vs. 6%, w2 ¼ 14.6, P < boys, 175 Taka; range, 35–490 Taka; girls, 145
0.001). Mothers of slum children were signifi- Taka; range, 14–420 Taka), while street chil-
cantly more likely to work in a garment fac- dren reported a median income of 150 Taka
tory (19% vs. 13%; w2 ¼ 4.0, P < 0.05) and to (range, 15–2,000) the previous day (boys, 200
be a housewife (19% vs. 9%; w2 ¼ 4.0, P < Taka; range, 15–2,000; girls, 140 Taka; range,
0.05), while mothers of street children were 20–700 Taka). There were no significant dif-
significantly more likely than mothers of slum ferences in reported income either between
children to earn money through the recycling boys and girls within each group (w2 ¼ 1.2–
of waste (4% vs. 18%; w2 ¼ 9.0, P < 0.05). 3.7) or between slum and street children
within each sex (w2 ¼ 0.0–1.0, P > 0.05).
Work
Anthropometry and nutritional status
There were significant differences between
boys and girls within each group in the types Height, weight, upper arm circumference,
of work they reported performing (Table 3). and the sum of triceps and subscapular skin-
Comparisons between slum and street chil- folds in slum and street children are describ-
dren were therefore calculated separately for ed by sex and age in Table 4, and anthropo-
boys and girls. Generally, slum boys and girls metric indices of nutritional status are given
were more likely than street children to work in Table 5. The results of two-way analyses of
as vendors, primarily of food (P < 0.05). Street covariance of these measures by group and
boys were more likely than slum boys to work sex while controlling for age are provided in
as porters, while street girls were more likely Table 6. There were no significant group or sex
than slum girls to collect waste (primarily pa- effects for weight or upper arm circumference
per and polyethylene) for recycling (P < 0.05). (P < 0.05). The sum of triceps and subscapular
Slum children reported working a median of skinfolds was the only measure with a signifi-
420 min during the previous day (range, 0– cant group effect, with street children having
840 min; boys, 480 min; range, 0–840; girls, larger fat deposits than slum children (P <
420 min; range, 120–840 min), while street 0.05). Finally, both height and sum of skinfolds
children reported working a median of 480 exhibited significant sex effects, with boys tend-
min (range, 0–960 min; boys, 540 min; range, ing to be taller and leaner than girls (P < 0.05).
0–960 min; girls, 480 min; range, 0–780 min). There were no significant group differences
Median tests indicated that the reported in anthropometric indices of nutritional sta-
working day for boys was significantly longer tus, but boys were significantly less stunted
than for girls in slum children (w2 ¼ 6.8, P < than girls (Table 6, P < 0.05). There was no
0.05), but not in street children (w2 ¼ 3.2, P > wasting in either slum or street children. The

American Journal of Human Biology DOI 10.1002/ajhb

56 L.P. GREKSA ET AL.

TABLE 4. Anthropometry of slum and street children, by sex and age

Upper arm Sum of

circumference skinfolds
Age (years) Height (cm) Weight (kg) (cm) (mm)
Age
(years) N X SD X SD X SD X SD X SD

A. Slum boys
7–8 7 7.9 0.4 120.4 4.3 20.3 2.9 15.7 0.8 8.7 1.3
9–10 30 9.7 0.5 125.8 5.3 23.2 2.8 17.2 1.1 10.1 2.4
11–12 25 11.6 0.5 135.3 6.2 27.7 3.9 17.8 1.4 9.7 2.4
13–14 13 13.4 0.5 143.1 7.7 33.7 5.1 20.5 1.7 10.0 2.1
B. Slum girls
7–8 14 7.8 0.4 116.6 5.6 19.9 3.4 15.9 1.3 11.3 2.3
9–10 30 9.6 0.5 124.3 8.3 22.6 3.4 16.7 1.4 10.6 2.2
11–12 21 11.5 0.5 133.2 7.0 28.4 4.4 18.5 1.7 12.3 3.0
13–14 10 13.4 0.5 140.5 4.9 32.7 2.9 19.2 1.0 12.9 2.8
C. Street boys
7–8 6 7.8 0.4 119.1 8.1 19.8 3.8 15.5 0.9 10.0 1.5
9–10 23 9.8 0.4 129.8 5.7 26.1 2.8 18.0 1.3 11.2 2.4
11–12 27 11.7 0.5 136.0 6.7 28.1 4.4 18.3 1.6 10.3 1.8
13–14 18 13.3 0.5 141.8 7.8 31.6 4.4 19.5 1.5 11.0 2.9
D. Street girls
7–8 12 7.6 0.5 112.6 7.7 18.5 3.4 16.1 1.1 11.3 1.7
9–10 25 9.6 0.5 127.2 6.6 24.4 4.0 17.0 1.4 11.3 2.1
11–12 17 11.4 0.5 133.9 6.9 28.1 3.9 18.0 1.1 11.8 2.0
13–14 14 13.1 0.4 142.1 8.1 33.8 5.5 19.9 1.8 16.0 5.1

TABLE 5. Anthropometric indices of nutritional status in slum and street children, by sex and age

Height-for-age Weight-for-height Weight-for-age

z-score z-score z-score

Age (years) N X SD X SD X SD

A. Slum boys
7–8 7
1.10 0.64
0.16 0.11
1.53 0.85
9–10 30
1.70 0.83
0.08 0.10
1.62 0.67
11–12 25
1.64 0.79
0.11 0.11
1.67 0.60
13–14 13
1.89 0.94
0.09 0.14
1.78 0.72
B. Slum girls
7–8 14
1.45 0.80
0.05 0.14
1.32 0.88
9–10 30
1.71 1.13
0.10 0.15
1.65 0.66
11–12 21
2.16 0.87
0.10 0.18
1.62 0.58
13–14 10
2.68 0.86
0.27 0.21
1.93 0.42
C. Street boys
7–8 6
1.33 1.25
0.16 0.14
1.73 1.14
9–10 23
1.09 1.00
0.05 0.15
1.02 0.73
11–12 27
1.64 0.76
0.11 0.10
1.67 0.59
13–14 18
2.01 0.85
0.12 0.13
2.03 0.55
D. Street girls
7–8 12
1.97 1.24
0.04 0.22
1.67 0.83
9–10 25
1.33 0.87
0.10 0.16
1.35 0.80
11–12 17
1.98 1.07
0.15 0.28
1.62 0.60
13–14 14
2.33 1.23
0.17 0.26
1.67 0.71

majority of children in both groups were each group are included in Table 8. Also in-
stunted and underweight, but there were no cluded in Table 8 are the results of a logistic
significant differences between groups (Table 7, regression of morbidity variables by group (0
P < 0.05). ¼ slum children; 1 ¼ street children) and sex
(0 ¼ male; 1 ¼ female), while controlling for
Morbidity age. The prevalence of disease symptoms
tended to be slightly higher in street children
The frequency of selected disease symp- than in slum children, but few differences
toms and vaccination acceptance rates within were statistically significant. Street children

American Journal of Human Biology DOI 10.1002/ajhb

 GROWTH AND HEALTH STATUS OF DHAKA CHILDREN 57
TABLE 6. Results of analyses of covariance of anthropometry and anthropometric indices of nutritional
status by group (slum vs. street) and sex while controlling for age

Slum children Street children

Boys Girls Boys Girls Group F Sex F Group by sex F

Anthropometry
Height (cm) 130.9 129.3 131.8 130.4 1.9 4.1* 0.9
Weight (kg) 26.0 26.0 26.5 26.8 1.9 0.1 0.8
Upper arm circumference (cm) 17.7 17.7 17.9 17.9 1.4 0.2 1.0
Sum of skinfolds (mm) 9.8 11.6 10.5 12.5 6.9* 37.5* 0.9
Anthropometric indices of nutritional status
Height-for-age z-score
1.64
1.98
1.46
1.85 1.9 10.2** 0.0
Weight-for-height z-score
0.10
0.12
0.09
0.12 0.1 2.3 0.0
Weight-for-age z-score
1.65 1.65
1.52
1.56 1.7 0.0 0.1

*P < 0.05.
**P < 0.01.

TABLE 7. Frequency of stunted, wasted, and underweight slum and street children

Slum children Street children

N % N % w2

Stunted 92 61.3 96 67.6 1.3

Wasted 0 0.0 0 0.0 0.0
Underweight 109 72.7 102 71.8 0.0

TABLE 8. Results of logistic regression of sex and group (slum vs. street) on disease
symptoms and vaccination status, after controlling for age

Slum children Street children

Odds ratios
Boys Girls Boys Girls (age-adjusted)

N % N % N % N % Sex Group

Diarrhea 8 10.7 5 6.7 20 27.0 12 17.6 1.679 0.329*

Respiratory infection 17 22.7 29 38.7 24 32.9 22 32.4 0.689 0.907
Scabies 27 36.0 41 54.7 38 51.4 38 55.9 0.655 0.690
Ringworms 3 4.0 3 4.0 6 8.1 5 7.4 1.154 0.482
Burn scars 2 2.7 1 1.4 3 4.1 2 3.0 2.437 0.494
Dermatitis 2 2.7 6 8.1 5 6.9 3 4.7 0.648 0.949
Chronic otitis media 16 21.3 12 16.0 19 26.0 10 14.7 1.731 0.886
Conjunctivitis 5 6.7 11 14.7 12 16.4 7 10.3 0.767 0.820
Parasites 63 84.0 65 86.7 68 93.2 65 95.6 0.792 0.338*
Accidental cuts 14 18.7 2 2.7 18 24.3 7 10.3 4.710* 0.522
Vaccinations
BCG 38 50.7 38 50.7 41 56.2 43 63.2 0.924 0.674
Measles 11 25.0 12 24.0 2 7.4 1 5.6 1.277 4.654*

*P < 0.05.

were about 3 times more likely than slum DISCUSSION

children to have diarrhea or show evidence of
parasites, and about 1/5 as likely to have The present study found only minor differ-
received a measles vaccination (P < 0.05). ences in growth and health status between
There were generally minor differences be- street and slum children residing in Dhaka,
tween boys and girls, with only one signifi- Bangladesh. Before discussing these results in
cant difference. In particular, boys were al- greater detail, several potential limitations to
most 5 times more likely than girls to have the study need to be considered. First, given
an accidental cut (P < 0.05). the absence of accurate census data, it is not

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58 L.P. GREKSA ET AL.

possible to determine how representative our 2000). Beyond this explanation, the specific
sample is of all street children in Dhaka, reasons given by the children fell into three
which limits the generalizability of our re- primary categories: inadequate family resour-
sults. On the other hand, the fact that the re- ces, change in composition of the family, and
sults of this study were generally similar to feeling they were abused or neglected. Similar
those of other studies provides some indirect reasons for moving to the streets were
support for their validity. It should be noted reported in other studies (Aderinto, 2000;
that whether the sample of street children is Aptekar, 1994; Gross et al., 1996; Karrar
representative of all street children is a differ- et al., 1993; Lalor, 1999; Mathur, 1993; Rizzini
ent question than whether street children are and Lusk, 1995; Rosa Aneci et al., 1992; Scan-
representative of all poor children, which will lon et al., 1998; Veale et al., 2000; Wright
be addressed shortly. Second, there is consid- et al., 1993). It is likely that some of these
erable heterogeneity in the group labeled as responses are different expressions of the same
‘‘street children’’ (Panter-Brick, 2002). This underlying cause. For example, if the death of
problem was minimized in the present study a parent led to economic hardship, some chil-
by focusing on confirmed street children who dren gave death as the reason for their leav-
have little or no contact with their families. ing, while others reported that it was due to
Third, the research design utilized in any economic hardships. The importance of eco-
study of street children must control for the nomic factors is supported by the fact that
overall negative effects of poverty on growth when they were asked what they hoped to
and health (Panter-Brick, 2002). The ideal gain by moving to the streets, almost all of
research design would be one in which every- the street children provided responses which
thing was similar between samples except for suggested that economic motivations (earn-
whether or not the children returned to a fam- ing money, a better life, to be self-reliant, sur-
ily at night. The two samples in the present vival) were critical. The poorer economic status
study were similar with respect to family size, of their families is also consistent with this
parity, and whether or not a sib had already interpretation. The exceptions were those chil-
moved to the streets. However, there were dren who reported abuse as their primary rea-
some significant social and economic differen- son for moving to the streets.
ces between samples, which could have influ- Street children generally did not have a
enced the indices of growth and health status clear idea of what street life entailed before
reported here. In particular, slum children were they moved to the streets. Nearly 40% stated
about twice as likely as street children to come that they had no idea, and another 40% sim-
from an intact home with two parents, and ply stated the obvious, that they felt it would
the parents of slum children were more likely be difficult to find work, food, and shelter.
to be employed and to have better-paying jobs. After moving to the streets, about 1/3 stated
Similar differences were found in previous that there were no problems with life on the
studies, where they were often cited as rea- streets. This is consistent with the majority of
sons why street children become street chil- the street children indicating that they were
dren (Aptekar, 1994; Campos et al., 1994; Kar- satisfied with their move to the streets, that
rar et al., 1993; Rizzini and Lusk, 1995; Scan- they would do it again, and that living on the
lon et al., 1998; Veale et al., 2000). Thus, such streets was better than living at home. Lalor
differences may be inevitable, in which case (1999), on the other hand, found that the
the research design used in the present study majority of her sample of street children were
probably comes as close to the ideal research unhappy with their move to the streets. How-
design as is possible. More importantly, the ever, about 20% of street children (compared
superior socioeconomic status and familial en- to 12% of slum children) reported that they
vironment of slum children should operate to sometimes needed to steal food to eat, and
enhance their growth and health status rela- about 35–40% of all children reported feeling
tive to street children (Bogin, 1988), making threatened at times, which is consistent with
the results of this study conservative. the findings of others (Felsman, 1981; Karrar
The street children provided a variety of et al., 1993; Lalor, 1999; Lusk et al., 1989;
reasons to explain their move to the streets. Rizzini and Lusk, 1995). Similar to the chil-
The fact that about 2/3 of the children simply dren studied by Campos et al. (1994), however,
stated that it was their own decision is not the street children in the present study were
surprising in a group which, to survive, must less likely than slum children to feel they had
be self-reliant (Aptekar, 1994; Veale et al., a safe refuge when they felt threatened. Thus,

American Journal of Human Biology DOI 10.1002/ajhb

 GROWTH AND HEALTH STATUS OF DHAKA CHILDREN 59

although difficult and dangerous at times, Panter-Brick, 1998; Scanlon et al., 1998) or, as
street life was still viewed as preferable to life in the present study, somewhat less nutritional
at home for most of these children. It is thus stress in street children than in slum children
not surprising that the break with their fami- (Gross et al., 1996; Panter-Brick et al., 1996;
lies was complete for most children, with few Wright et al., 1973). The one exception is Ayaya
maintaining contact with their families, and and Esamai (2001), who found more stunting
even fewer reporting that they provided any in street than in slum children.
money to their family, which differs from the There were also few differences in morbidity
findings of others (Aptekar, 1989; Baker et al., patterns between street and slum children in
1997; Felsman, 1981; Lusk et al., 1989; Wright the present study. Street children were signifi-
et al., 1993). cantly more likely to have symptoms of diar-
Slum and street children tended to perform rhea and parasites, and significantly less likely
different kinds of work. The majority of slum to have a measles vaccination, but there were
children worked as vendors, while street chil- few differences otherwise between groups (Ta-
dren tended to have more diverse occupations ble 8). Once again, these results are similar to
with less predictable incomes, primarily waste those from other studies, with most research-
collection and portering for boys, and waste ers finding similar or only somewhat higher
collection and vending for girls. Similar occu- levels of morbidity in street than in slum chil-
pations were reported by others (Aderinto, dren (Ayaya and Esamai, 2001; Panter-Brick
2000; Campos et al., 1994; Connoly, 1990; et al., 1996, 2001; Scanlon et al., 1998).
Lusk, 1992; Mathur, 1993; Panter-Brick et al., In conclusion, although street children are
1996; Wright et al., 1993). The greater irregu- often assumed to be a particularly high-risk
larity and probably lower pay of the work of group (Panter-Brick, 2002), the relatively few
street children may explain why they needed studies which assessed the growth and health
to work longer hours than slum children in status of street children generally concluded
order to make the same amount of money. that they are at no greater risk, or even some-
Given that street children tended to come what lower risk, than other poor children.
from families with only one parent, that their What is the explanation for this paradoxical
parents tended to have lower-paying jobs, and finding? A reasonable explanation is simply
that they themselves had jobs which were that street children, or at least those street
more episodic, one might expect street chil- children captured in cross-sectional studies,
dren to exhibit poorer growth and nutritional are not representative of all poor children.
status than slum children. However, this was Perhaps biologically fitter children are more
not the case. There were very few differences likely to make the decision to move to the
in growth between slum and street children, streets and/or, once they move to the streets,
and the differences which do exist tend to be they are more likely to remain on the streets
in favor of street children, who tended to be (Panter-Brick, 2002; Solomons and Gross,
slightly taller and heavier, and had larger 1995), particularly if they also have a psycho-
upper arm circumferences than slum children logical profile of self-reliance (Aptekar, 1994;
(Table 6). Perhaps most pertinent, street chil- Veale et al., 2000). Also, children who are not
dren had significantly greater energy reserves, coping well with the difficulties of life on the
as assessed by the sum of triceps and subscap- streets might be less willing to interact with
ular skinfolds (Table 6). As would be expected strangers, and thus less likely to participate
in any sample of poor children from a develop- in research studies. Thus, as argued by Pan-
ing country (Keller, 1988), there is a high level ter-Brick et al. (1996), the available evidence
of stunting in both slum and street children. suggests that life on the streets may be a
However, there were no significant differences rational choice for some poor children.
in stunting between street and slum children
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