Experiência de gravidez e aborto em crianças, adolescentes e jovens em situação de rua / Pregnancy and abortion experience among children, adolescents and youths living on the streets

Resumo O objetivo deste estudo é identificar a prevalência de experiência de gravidez e aborto e os fatores associados em crianças, adolescentes e jovens em situação de rua, das cidades de Porto Alegre e Rio Grande, RS, Brasil. Neste estudo transversal, como método de amostragem, foi utilizado o Respondent-Driven Sampling (RDS), inovador em pesquisas com populações de difícil acesso. Foram entrevistados 307 indivíduos, com idade entre 10 e 21 anos. Na análise multivariada foi utilizada regressão de Poisson, com ajuste robusto da variância. A maioria dos participantes foi do sexo masculino, sem vínculos com escola e com a família. Quase metade estava há cinco anos ou mais na rua, permanecendo mais de 15 horas diárias nela. A prevalência de experiência de gravidez foi de 29,3%, estando independentemente associada com ser do sexo feminino, ter mais de 10 parceiros sexuais no último ano, ter parceiro sexual fixo no último ano e ter mais idade. A prevalência de experiência de aborto foi de 10,4%, estando associado com não morar com a família, ter duas ou mais gravidezes e ter menos idade. A alta prevalência de experiência de gravidez e aborto aponta para a necessidade de melhores políticas de saúde sexual e reprodutiva específicas para esta população.

Abstract The aim of this study is to identify the prevalence of pregnancy and abortion experience, along with associated factors among street children, adolescents and youths in Porto Alegre and Rio Grande, RS, Brazil. The sampling method in this cross-sectional study was Respondent-Driven Sampling (RDS), innovative in research about hidden populations. Interviews were conducted with 307 subjects, aged 10 to 21 years. In multivariate analysis, Poisson regression with a robust error variance was used. Most of this sample were males, with no contact with school and family. Almost half of the participants had been on the street for five years or more, spending more than 15 hours per day on the streets. The prevalence of pregnancy experience was 29.3%, independently associated with being a girl, having 10 sexual partners or more in the last year, having a fixed sexual partner in the last year, and being older. The prevalence of abortion experience was 10.4%, independently associated with not living with the family, having more than two pregnancies, and being younger. The high prevalence of pregnancy and abortion experience highlights the need for the development of better sexual and reproductive health policies focused on this population.

Drug use among street children and adolescents: what helps? / Uso de drogas entre crianças e adolescentes em situação de rua: o que ajuda?

The aim of this study was to investigate factors associated to frequent and heavy drug use among street children and adolescents aged 10 to 18 years. A sample of 2,807 street children and adolescents from the 27 Brazilian state capital cities was analyzed. A World Health Organization questionnaire for non-students was adapted for use in Brazil. Data analysis was performed using logistic regression and decision tree models. Factors inversely associated with frequent and heavy drug use were: being age nine to 11 years (OR = 0.1); school attendance (OR = 0.3); daily time (one to five hours) spent on the streets (OR = 0.3 and 0.4); not sleeping on the streets (OR = 0.4); being on the streets for less than one year (OR = 0.4); maintenance of some family bonds (OR = 0.5); presence on the streets of a family member (OR = 0.6); not suffering domestic violence (OR = 0.6); being female (OR = 0.8). All of these variables were significant at the p < 0.05 level. The findings suggest that being younger, having family bonds and engagement in school are important protective factors that affect drug use among this population and should be considered in the formulation of public policies.

O objetivo do estudo foi verificar fatores associados ao uso frequente e pesado de drogas entre adolescentes em situação de rua no Brasil. Estudo transversal com amostra representativa nacional de 2.807 crianças e adolescentes (10-18 anos). Foi usado um questionário da Organização Mundial da Saúde adaptado para o Brasil e análise dos dados, modelo de regressão logística. Fatores inversamente associados ao uso frequente e pesado de drogas: faixa etária entre 9-11 anos (OR = 0,1); frequentar escola (OR = 0,3); permanecer entre 1 e 5 horas na rua (OR = 0,3 e 0,4); não dormir na rua (OR = 0,4); estar na rua há menos de um ano (OR = 0,4); manter algum vínculo familiar (OR = 0,5); permanecer na rua com algum membro da família (OR = 0,6); não ter sofrido violência doméstica (OR = 0,6); gênero feminino (OR = 0,8). Todas essas variáveis apresentaram p < 0,05. Os achados sugerem que ser mais jovem, ficar menos tempo na rua e manter vínculos com escola e família são importantes fatores de proteção para essa população quanto ao uso frequente e pesado de drogas. Esses são fatores importantes na formulação de políticas públicas para essa população.

Morbilidad atendida y conductas de riesgo de la niñez y adolescencia en situación de calle de Medellín, 2008 / Morbidity and risk behavior regarding street-children in Medellin, Colombia, 2008

Objetivos Describir características, morbilidad atendida y conductas de riesgo para la salud de la niñez y adolescencia en situación de calle de Medellín. Metodología Estudio observacional descriptivo y retrospectivo. Se revisaron historias clínicas de niños, niñas y adolescentes que recibieron atención médica en cinco instituciones de protección entre enero y diciembre del 2008. El análisis incluyo análisis uni y bivariado con las variables de interés. La edad fue agrupada en: niños y niñas (0-12 años) y adolescentes (13-17 años). Resultados Se incluyeron 483 historias clínicas. El 73,1 por ciento de los registros del sexo masculino, 73,1 por ciento adolescentes y 44,7 por ciento residían en la calle. Los principales diagnósticos fueron: Ciertas enfermedades infecciosas y parasitarias (18,3 por ciento), factores que influyen con el estado de salud y contacto con servicios de salud (13,7 por ciento), enfermedades del sistema respiratorio (11,8 por ciento). El 81,0 por ciento consumían sustancias sicoactivas, la más consumida fue la marihuana (80,0 por ciento). El 84,0 por ciento reporta actividad sexual. Conclusión La morbilidad atendida, su actividad sexual y consumo de sicoactivos evidencian una alta vulnerabilidad en salud en este grupo poblacional. Esto exige a instancias de planificación y dirección de políticas públicas en salud la garantía de su derecho constitucional a la salud a través de la ejecución de programas de promoción de la salud y la salud sexual y reproductiva y de estrategias para la prevención de enfermedades y del consumo de sicoactivos.

Objectives Describing the characteristics, morbidity and risk behaviour of street children from Medellin. Methodology This was a descriptive, retrospective study. The medical charts of children aged less than 17 who sought medical attention in five protection institutions in Medellin during 2008 were reviewed. The analysis included descriptive statistics and bivariate analysis. Age was categorised into two groups: boys/girls (0- 12 years) and adolescents (13-17 years). Results The following characteristicswere found after reviewing 483 medical charts: being male (73.1 percent), adolescent (73.1 percent) and living in the streets (44.7 percent). The most common diagnoses were for infectious and parasite illnesses (21.8 percent), factors that affected health status and contact with health services (13.7 percent), respiratory diseases (11.8 percent). A total of 81.0 percent of all children were engaged in psychoactive substance abuse,smoking marijuana being the most common (80.0 percent);84.0 percent reported engaging in sexual activity. Conclusion Infectious diseases, sexual activity and usingpsychoactive substances placed this population in a high vulnerability category. This situation demands that local health-policy makers guarantee thispopulation's constitutional right to health, through health-promotion programmes and sexual and reproductive health strategies to prevent disease and psychoactive substance abuse.

Recreational use of benzydamine as a hallucinogen among street youth in Brazil / Uso recreacional de benzidamina como alucinógeno entre adolescentes em situação de rua no Brasil

OBJECTIVE: To describe the recreational use of benzydamine, an anti-inflammatory drug, among street youth in Brazil. METHOD: Design: a descriptive, cross sectional survey. Setting: 93 welfare services for the street youth in 27 Brazilian capitals. Participants: 2807 street youth, 10 to 18 years old. Main outcome measures: demographic characteristics, drug use pattern (lifetime use, use in the past 30 days, frequency, and characteristics of use in the past month) and effects of benzydamine through the use of a questionnaire. RESULTS: 78 reported lifetime recreational benzydamine use (67 cases identified only in three capitals). Among the 30 respondents reporting drug use in the last month (the month preceding the survey), 66.7 percent (n = 20) used the drug on 4 or more days (in the month preceding the survey). The most frequently (50 percent) pleasure effects reported were hallucination and nonspecific sensory changes described as "trips". Unwanted effects were reported by 75 percent of respondents, they were especially nausea and vomiting (21.4 percent). In the majority of the cases, drug was obtained from drugstores without a medical prescription. CONCLUSION: This study identifies the recreational use of benzydamine among street youth, mainly in the Northeast of Brazil, and also indicates the need for special controls on the dispensation of this substance.

OBJETIVO: Descrever o uso recreacional de benzidamina, um medicamento antiinflamatório, entre adolescentes em situação de rua no Brasil. MÉTODO: Desenho: descritivo, transversal. Local: 93 instituições assistenciais para crianças e adolescentes em situação de rua nas 27 capitais do Brasil. Participantes: 2.807 crianças e adolescentes em situação de rua, com idade entre 10 e 18 anos. Principais medidas de interesse: características demográficas, padrão de uso (uso na vida, uso nos últimos 30 dias, frequência e características de uso no mês anterior à pesquisa) e efeitos da benzidamina usando um questionário. RESULTADOS: 78 relataram uso recreacional na vida de benzidamina (67 casos identificados somente em três capitais). Entre os 30 entrevistados que relataram uso recente da substância (no mês que precedia a investigação), 66,7 por cento (n = 20) tomaram o medicamento em quatro dias ou mais no mês. Os efeitos desejados mais frequentemente reportados foram alucinações e alterações sensoriais inespecíficas como "viagem" (50 por cento). Efeitos indesejados foram citados por 75 por cento dos entrevistados, principalmente náuseas e vômitos (21,4 por cento). Na maioria dos casos, o medicamento foi obtido de drogarias sem apresentação de prescrição médica. CONCLUSÃO: Os resultados observados neste estudo identificam o uso recreacional de benzidamina entre crianças e adolescentes em situação de rua, especialmente no Nordeste do Brasil, e indicam a necessidade de controle especial sobre a dispensação desta substância.

Maltrato y abuso sexual como causas de abandono del hogar en niños y adolescentes de la calle: primer premio póster: LIV Congreso Nacional de Pediatría 2008 / Physical and sexual abuse as a cause of home abandonment: first prize poster: LIV Congreso Nacional of Pediatria 2008

Evaluar el maltrato y abuso sexual como causa de abandono del hogar en niños, niñas y adolescentes de la calle en Maracaibo. Investigación prospectiva y descriptiva, realizada desde enero de 2000 hasta enero de 2001, integrada por 68 casos de ambos sexos, seleccionados al azar. El grupo etario estuvo comprendido entre 5 y 17 años, predominando los adolescentes de 11 a 13 años (43,8%). La causa de abandono del hogar fue el maltrato físico en 39,71%; el 20,51% fue agredido sexualmente. Los 9 años fue la edad más vulnerable (5,88%), la región anatómica más utilizada por el agresor fue la anal (85,71%). Los agresores fueron amigos de las víctimas en 64,29%. 53,84% iniciaron relaciones sexuales entre 8 y 11 años. El inicio del consumo de drogas fue a los 9 años en 46,15%; y el alcohol la más usada. (46,15%). El 20% intentó suicidarse, todos ellos eran de sexo masculino. El 61,76% procedieron de hogares con padres casados. El 100% de las muestras para HIV y VDRL resultaron negativas. Sólo 20 casos (29,41%) entre 5 y 10 años, (18 varones y 2 hembras) aceptaron ser trasladados a Casa Mía, institución para reeducar a niños, niñas y adolescentes de la calle. El maltrato infantil fue la causa más importante de abandono del hogar en este grupo, no así el abuso sexual. Las condiciones de vida que llevan, los ponen en situación de alto riesgo en el aspecto biológico y psico-emocional. Se requiere la participación de toda la población para lograr la implementación y cumplimiento de políticas eficaces para la prevención de este problema.

To evaluate maltreatment and sexual abuse as causes of home abandonment in children, and adolescents of the streetin Maracaibo. 68 chidren of both genders were selected at random and studied in a prospective and descriptive investigation, performed from January 2000 to January 2001. Ages were between 5 and 17 years, predominating the adolescents between 11 and 13 years (43.8%). The cause of home abandonment was physical maltreatment (39.71%). 20.51% was sexually abused, although this was not stated as the cause for home abandonment. The age of 9 years was the most vulnerable for sexual abuse (5.88%). The anal region was the anatomic region mostly abused (85.71%). The aggressors were friends of the victims in a high percentage of cases (64.29%). Children began sexual activity between 8 and 11 years of age (53.84%). The age at which children began drug abuse was between 9 and 11 years (46.15%) with alcohol(46.15%) as the most frequently used. 20% tried to commit suicide and all were boys. 61.76% came from homes with married parents. All children were negative for HIV and VDRL tests. Only 20 cases (29.41%) between 5 and 10 years, (18 boys and 2 girls) accepted to be transferred to Casa Mia, which is an Institution for the re-education of children and adolescents of the street. Child abuse was the most important cause of home abandonment in this group, although sexual maltreatment was not. Life conditions to which these children are exposed, place them in situation of high risk in the biological and psyco-emotional aspects. The participation of the entire population is needed to obtain the implementation and fulfillment of effective policies for the prevention of this problem.

Life on streets.

OBJECTIVE: Millions of children leave home in hope of finding a more tolerable life. The study tries to find out the kind of life they lead once out on the streets. METHODS: Cross-sectional study of all street boys admitted to a Child Observation Home in New Delhi during specified 6 months. Questions regarding various aspects of survival on streets were asked. RESULTS: Majority are forced to work in informal sector for survival with earnings well below the minimum wages. To escape from the exploitation and hardships, many begin abusing substances. The street experience leads to hopelessness for the future and suicidal tendencies. CONCLUSION: After circumstances at home force these kids to escape, they are caught up in yet another world of exploitation, hunger, violence and abuse.

Runaway youths and correlating factors, study in Thailand.

OBJECTIVE: To study differences between runaways and non-runaways in a mental health clinic and to study differences between runaways in a mental health clinic and legal / shelter system. MATERIAL AND METHOD: Psychiatric records of runaways and non-runaways from Vajira Hospital were collected from June 1994 to October 2003. 21 cases in each group were studied in various factors. 21 runaway cases who were in child and adolescent shelters were interviewed by the researchers. RESULTS: Neglect, sexual abuse, rejection, poverty and truancy were more common in the runaway group. The runaway group had more conduct disorder and substance abuse. Physical abuse, authoritarian and being in custody were more common in runaways in shelters. CONCLUSION: Various factors correlate with running away. These factors lie beneath long before runaway has taken place and understanding and managing them help in preventing and prompt treatment.

Sexual abuse of street children brought to an observation home.

This study was conducted to assess the magnitude and pattern of sexual abuse among male inmates of an observation home in Delhi. A total of 189 boys aged 6 to 18 years were assessed for sexual abuse using Finkelhors scale and Child Maltreatment History Self-Report followed by clinical examination using American Medical Associations guidelines. Majority of boys were runaways and 38.1 percent had suffered sexual abuse. On clinical examination, 61.1 percent showed physical signs and 40.2 percent showed behavioral signs of sexual abuse. Forcible sex was reported by 44.4 percent of victims and 25 percent had signs suggestive of sexually transmitted diseases. Strangers were the most common perpetrators of sexual abuse.

Mental health status of runaway adolescents.

There are 47.22 million homeless and runaway adolescents roaming on the streets of our country (Voluntary Health Association of India - VHAI) of which one lakh are in Delhi.1 Very little is known about them, their needs or their experiences. OBJECTIVE: (1). To assess the psychological problems amongst the runaway adolescent boys. (2). To determine possible risk factors. METHODS: This study was cross-sectional in design and done at a child observation home for boys in Delhi. All runaway boys aged 10 to 16 years of age were included in the study. The study was conducted from 15th June to 15th July 2001. A comprehensive schedule consisting of five parts, viz identification data, hopelessness scale for children by Kazdin, Beck depression inventory, Psychological survey questionnaire and RUTTER-B2 scale were used to assess various mental health problems. RESULTS: 20.7% of children were found to have high hopelessness and 8% of children had depression. 2% of children revealed that they had attempted suicide at any point of time in life. Among children with high hopelessness, 3.2% had ever attempted suicide. 8.3% of the depressed children gave history of suicidal attempts. 38% of children gave history of physical abuse, 14.6% of sexual abuse and a large number reported substance abuse. 69.33% were found to have behavioral problems (i.e. scored above the recommended cut off score of 9). 81% of children had antisocial behavior, 7.8% were neurotic and 10.5% remained undifferentiated. CONCLUSION: Runaway adolescents suffer from a wide array of mental health problems and there is a need for a broad based psychosocial intervention programme.

Uma tipologia de crianças e adolescentes em situaçäo de rua baseada na análise de aglomerados (Cluster Analysis) / A typology of street children based on Cluster Analysis

Crianças e adolescentes em situaçäo de rua vêm sendo estudados de forma sistemática desde a década de 1970. Os primeiros estudos procuraram quantificar esta populaçäo, e posteriormente, para melhor conhecê-los, surgiram tipologias baseadas em um critério, como tempo de permanência na rua, ou dois, tempo mais vínculo familiar. Com a finalidade de oferecer um procedimento de classificaçäo, e uma tipologia, este estudo aplicou a análise de aglomerados Cluster Analysis a dois grupos. O primeiro composto de praticamente todas as crianças e os adolescentes em situaçäo de rua no centro de uma cidade do interior do Estado de Säo Paulo, totalizando 67 pessoas, e o segundo uma amostra de 31 crianças e adolescentes, de dois bairros da mesma cidade, participantes de grupos de rua. Para o primeiro grupo foram selecionados 12 critérios e para o segundo, 7, que resultaram, para ambos grupos, em 3 aglomerados distintos. Foram também comparados estes resultados com censo de crianças de rua realizado há 4 anos. Resultados mostraram que este tipo de análise é útil na classificaçäo destas crianças, que por sua vez poderá subsidiar melhor planejamento e açöes de políticas públicas para o setor

Sociodemographic characteristics of street children in Alexandria

The sociodemographic characteristics of street children in the Egyptian city of Alexandria were studied. A cross-sectional descriptive study was designed. Difficulties in random sampling of street children meant that a non-random purposive sampling strategy was used. The final sample consisted of 100 street children [all boys] who were interviewed and medically examined. The study confirmed the findings of other studies that street children come from problematic family backgrounds. They are disproportionately victims of family breakdown, sexual and physical abuse. They suffer from increased health problems, malnutrition and lack of educational opportunities. Recommendations are made for programmes to address the challenging needs of street children in Alexandria

Street children--a preliminary study.

OBJECTIVE: To study the background, life styles, health and prevalence of abuse of street children in Colombo. STUDY SAMPLE: 50 street children receiving temporary day care or night shelter from community service centres were serially recruited. DESIGN: A retrospective descriptive survey. Demographic, experiential and clinical data were collected by an interviewer, based on a semistructured questionnaire, followed by physical examination and laboratory investigation. RESULTS: The children were aged between 4 and 17 years. (Mean 10.5 years.) 64% were males and 18% belonged to ethnic minorities. The majority (84%) had family ties. Family disintegration was mentioned as the cause for life on the streets by 36%. Child labour was reported in 38%. 16% admitted to being sexually abused. 20% were tobacco smokers. Respiratory and skin infections, and injuries incurred in road traffic accidents were the main causes of morbidity. CONCLUSION: Street children in Colombo are an abused and exploited group. Road traffic accidents, and physical and sexual abuse are the main hazards of the street they are exposed to.

Adolescentes de la calle y prostitucion

Se realizaron encuestas y toma de testimonios en entrevistas personales a 40 niñas de la calle en la ciudad de La Paz en horas de la noche y en lugares frecuentados por ellas, con el objetivo de canocer sus caracteristicas de vida. La mayoria tenia entre 15 a 20 años de edad 80 por ciento ; y entre 10 a 14, 20 por ciento . Largo tiempo de permanencia en la calle entre 2 a 4 años 43 por ciento mas de 4 años 27 por ciento (algunas de estas hasta 9 años); 6 meses a un año, 15 por ciento y una semana a 5 meses 15 por ciento , debido a violencia familiar y pobreza. El nivel eductaivo era bajo. La sexualidad fue iniciada por violacion intrafamiliar y callejera. Consumian alcohol y drogas casi el 100 por ciento . Tenian muy naja autoestima e intentaron suicidarse varias de ellas. La mayoria 95 por ciento tuvieron enfermedades de transmision sexual (ETS). Procedian de familias numerosas, desintegradas, de bajo nivel socioeconomico y padres consumidores de alcohol. La encuesta demostro que se dedicaban a la prostitucion impulsadas por la necesidad de alimentarse, por cama y ropa, es decir como una estrategia de sobrevivencia y no como un estilo de vida libremente elegido.