Child labour in Addis Ketema, Ethiopia : a study in mental health

Background: Child labour is a very common global problem. There are an estimated over 250 million in the world, and about 7.5 million child labourers in Ethiopia. Most of the studies available to date focus on the social, political, and economical issues, but very little on mental health or psychosocial problems of child labourers. There is no study describing the epidemiology of psychiatric disorders among this group of children. Aims: 1. to assess the level of awareness and attitude of an urban community on child labour. 2. to describe the patterns of child labour and the experiences of child labourers in the informal sector with emphasis to child domestic labour. 3. to determine the risk factors contributing to child abuse and psychiatric disorders in child labourers. Method: An initial qualitative survey, using key informants in a Rapid Assessment Procedure, was conducted in a central urban area of Addis Ababa, to determine the knowledge, attitude, and intervention priorities of the people on child labour. A cross-sectional quantitative study informed by this initial survey was conducted in a sampled population of 5-15 year old child labourers and non-economically active controls. Information about possible risk factors, socio-demography and child abuse were gathered using a questionnaire different from that used for mental health assessment. An Amharic translation of the Diagnostic Interview for Children and Adolescents (DICA) was used to collect data for symptoms of mental disorders and diagnosis was made according to the American Psychiatric Association (APA) Diagnostic and Statistical Manual, 3rd edition (DSM-III-R) criteria. Data analysis was done using Statistical Package for Social Sciences (SPSS) software. Results: Domestic labour, working in the streets, and in private enterprises were the three main types of child labour identified. These types of child labour were identified by 82% (n=158) key informants, who thought child labour was a social problem, mainly resulting from poverty, and associated with abuse. In the quantitative study (5-15 year old sample) 528 child labourers and 472 non-labourers were included in the study. Of the child labourers, 34% were engaged in domestic labour, 57% working in the streets, and 9% in private enterprises. Over half of the child labourers worked for more than 9 hours daily. The prevalence of child abuse was 43.9% and 17.2% among child labourers and controls, respectively (OR=3.7, 95% CI: 2.74, 5.09; p<0.001). Emotional abuse was the commonly encountered abuse compared to other types (OR=3.06, 95% CI: 2.23-4.20; p< 0.001). Child domestics and street labourers were the most vulnerable group. The prevalence of any DSM-III-R psychiatric disorder was 20.1% and 12.5% among child labourers and controls, respectively and the difference was statistically significant (OR=1.89, 95% CI: 1.34-2.67, p<0.01). Controlling for all socio-demographic factors, child labour status was the only significant factor in determining DSM-III-R diagnosis. Discussion: In a comparable group of child labourers and controls, child labourers were found to be a high-risk group for different types of abuse and psychiatric disorders. Although parental unemployment and low maternal education were associated with child labour, the only factor that was associated with psychiatric morbidity was being a child labourer. It seems that poverty is not the only reason for child labour; hence its mere alleviation alone is unlikely to dramatically improve the risk for child labour and mental health of the children. There are many motivating reasons to be a child labourer, and likewise various positive and negative maintaining factors. Therefore, not all child labourers are prepared to stop their paid job altogether in order to become a full time student. Recommendation: Education of all children and parents is a keystone to prevent child labour and the associated consequences. In enforcing legislations on child labour, the government, non-governmental organisation (NGO), and the public should view child labour as a menace in children’s development, with risk of psychiatric disorders. Policy design should accommodate the interests of children. It is recommended to do a cohort and a larger size study, in order to further examine the association of various risk factors, and psychiatric disorders in a comparative and similar vulnerable group of children

Child labour in Addis Ketema, Ethiopia : a study in mental health

Background: Child labour is a very common global problem. There are an estimated over 250 million in the world, and about 7.5 million child labourers in Ethiopia. Most of the studies available to date focus on the social, political, and economical issues, but very little on mental health or psychosocial problems of child labourers. There is no study describing the epidemiology of psychiatric disorders among this group of children. Aims: 1. to assess the level of awareness and attitude of an urban community on child labour. 2. to describe the patterns of child labour and the experiences of child labourers in the informal sector with emphasis to child domestic labour. 3. to determine the risk factors contributing to child abuse and psychiatric disorders in child labourers. Method: An initial qualitative survey, using key informants in a Rapid Assessment Procedure, was conducted in a central urban area of Addis Ababa, to determine the knowledge, attitude, and intervention priorities of the people on child labour. A cross-sectional quantitative study informed by this initial survey was conducted in a sampled population of 5-15 year old child labourers and non-economically active controls. Information about possible risk factors, socio-demography and child abuse were gathered using a questionnaire different from that used for mental health assessment. An Amharic translation of the Diagnostic Interview for Children and Adolescents (DICA) was used to collect data for symptoms of mental disorders and diagnosis was made according to the American Psychiatric Association (APA) Diagnostic and Statistical Manual, 3rd edition (DSM-III-R) criteria. Data analysis was done using Statistical Package for Social Sciences (SPSS) software. Results: Domestic labour, working in the streets, and in private enterprises were the three main types of child labour identified. These types of child labour were identified by 82% (n=158) key informants, who thought child labour was a social problem, mainly resulting from poverty, and associated with abuse. In the quantitative study (5-15 year old sample) 528 child labourers and 472 non-labourers were included in the study. Of the child labourers, 34% were engaged in domestic labour, 57% working in the streets, and 9% in private enterprises. Over half of the child labourers worked for more than 9 hours daily. The prevalence of child abuse was 43.9% and 17.2% among child labourers and controls, respectively (OR=3.7, 95% CI: 2.74, 5.09; p<0.001). Emotional abuse was the commonly encountered abuse compared to other types (OR=3.06, 95% CI: 2.23-4.20; p< 0.001). Child domestics and street labourers were the most vulnerable group. The prevalence of any DSM-III-R psychiatric disorder was 20.1% and 12.5% among child labourers and controls, respectively and the difference was statistically significant (OR=1.89, 95% CI: 1.34-2.67, p<0.01). Controlling for all socio-demographic factors, child labour status was the only significant factor in determining DSM-III-R diagnosis. Discussion: In a comparable group of child labourers and controls, child labourers were found to be a high-risk group for different types of abuse and psychiatric disorders. Although parental unemployment and low maternal education were associated with child labour, the only factor that was associated with psychiatric morbidity was being a child labourer. It seems that poverty is not the only reason for child labour; hence its mere alleviation alone is unlikely to dramatically improve the risk for child labour and mental health of the children. There are many motivating reasons to be a child labourer, and likewise various positive and negative maintaining factors. Therefore, not all child labourers are prepared to stop their paid job altogether in order to become a full time student. Recommendation: Education of all children and parents is a keystone to prevent child labour and the associated consequences. In enforcing legislations on child labour, the government, non-governmental organisation (NGO), and the public should view child labour as a menace in children’s development, with risk of psychiatric disorders. Policy design should accommodate the interests of children. It is recommended to do a cohort and a larger size study, in order to further examine the association of various risk factors, and psychiatric disorders in a comparative and similar vulnerable group of children

Introducing evidence based public health practice through a journal club for public health officers in Somaliland

Evidence based public health is one of the basic training tools of public health students and young officers in decision making. The training tools for early career specialists and trainees in public health is journal clubs (JC). It keeps the knowledge of professionals up to date and assist them in receiving information to design, plan, implement health care services, policies and strategies. The intention of the JC team was to raise awareness of methods for public health literature search, appraising it and applying this knowledge in their daily practices. A senior public health practitioner in Somaliland (the corresponding author) invited medical students and residents to have JCs as a part of their training. They did not accept the offer so the organizer invited practicing junior public health professionals instead. The JC team members were a general practitioner and 3 public health workers from Ministry of Health, public hospital physician, public health school and field public health officer. A weekly or twice weekly journal club took place to train them in critical appraisal. This continued for 15 months in a hybrid mentorship for the health care professionals. The team mentor selected a paper for discussion. Mentees choose a study design appraisal tool from the Critical Appraisal Skills Program (CASP) that matched the study to present. In the process of appraisal, a team member led the discussion using the checklist. The mentees presented their critical appraisal either orally or via a presentation. The checklist and paper were compared for assessing the study design and structure of the paper of the week. This approach of empowering junior public health officers in Somalia is a way forward for encouraging the professionals to use evidence based practice in their daily practices. This will improve their selection of research tools and translating the scientific work into their practice and services