i “Children on the streets of Ibadan, Nigeria: experiences, family dynamics and health status” Abimbola Margaret Obimakinde Wits Student ID: 2305575 MBBS; Bachelor of Medicine, Bachelor of Surgery; MSc (Child & Adolescent Mental Health); FWACP ({Fellow West Africa College of Physician}-Family Medicine) mabimbola@cartafrica.org A thesis submitted to the Department of Family Medicine and Primary Care School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa in fulfilment of the requirement for the degree of Doctor of Philosophy (15TH December 2023) Supervised by Associate Professor Shabir Moosa MBChB, MFamMed, MBA, PhD Department of Family Medicine and Primary Care School of Clinical Medicine, Faculty of Health Sciences. University of Witwatersrand Current Academic Program Doctoral Program (PhD) in Family Medicine School of Clinical Medicine Faculty of Health Sciences University of Witwatersrand, South Africa mailto:mabimbola@cartafrica.org ii Candidate’s declaration I, Abimbola Margaret Obimakinde declare that i. This intellectual content of the thesis is the product of my work including literature review, proposal development and research design, data collection, data analysis and manuscript preparation. My supervisor contributed to the content of this thesis and supported me throughout the process. ii. All sources in this thesis are accurately referenced. iii. This thesis has not previously, in its entirety or part, been submitted to any other University for any degree or examination in the interest of any academic qualification. iv. This thesis is being submitted for the degree of Doctor of Philosophy in the Department of Family Medicine in the Faculty of Health Sciences at the University of Witwatersrand, Johannesburg. v. This dissertation has been submitted with the permission of the supervisor. Signature Date 15th December 2023 Dr Abimbola Margaret Obimakinde iii Statement by the supervisor I, Moosa Shabir As the candidate’s supervisor agrees to the submission of this thesis ________________ 15th December 2023 Supervisor’s Signature Date iv Dedication I dedicate this to my husband Obitade and my sons Toluwanimi and Oluwatamilore for their encouragement and understanding during the years of my Ph.D. journey and activities. I also dedicate this to every vulnerable child who strives and struggles to succeed against all odds. v Acknowledgement I acknowledge the blessings of God almighty, the amazing grace of our Lord Jesus Christ and the fellowship of the Holy Spirit in this instance and always. I acknowledge and appreciate the Consortium for Advance Research Training in Africa (CARTA) for its immeasurable and continuing support that contributed to this PhD's seamless pursuit. I appreciate the leadership of the African Population and Health Research Center (APHRC) and CARTA including Prof Sharon Fonn, Marta Vicente-Crespo, Rita Karoki, Janet Moora and the focal CARTA persons in the University of Witwatersrand and CARTA focal persons in the University of Ibadan including Professor Akinyinka Omigbodun and Dr Funke Fayehun. I am grateful to everyone for their tirelessness and positive response to all my requests through the years of my PhD, till date. I appreciate my supervisor Prof Moosa Shabir for his time, patience, tutoring, supervision and nudging me to be the best version of my academic self. I am thankful for Prof Moosa’s dedication to the smooth progress of my PhD, despite his very busy schedule and leadership roles in many spheres in South Africa, and WONCA. I appreciate being able to tap from my supervisor’s wealth of knowledge and the opportunity to understudy his tenacity in pursuit of improving and ingraining the speciality of Family Medicine in Africa and beyond. Despite our scanty prior interaction before the PhD commencement, I am grateful for his acceptance to be my supervisor. I plan to pay this act of kindness forward. I am grateful to the Faculty members in the Department of Family Medicine at the Faculty of Health Science, University of Witwatersrand including Prof Robert Cooke, Prof Olufemi Omole, Prof Sandra Benn, Dr Joel Francis, Anne Muronga, Pumla Sodo, and others, for been responsive at all the times to my request and providing the needed guidance and assistance. vi Gratitude to my family, particularly my mum Mojisola Matilda, my sister Titilola Stella, my brother Abayomi Emmanuel, and my husband Obitade for taking up my role as a mother and supporting me whenever I needed to embark on the numerous travels throughout my PhD. I am grateful for having my family as a good support system. I acknowledge and appreciate my sons for being understanding of my unavailability, particularly on some important milestones in their lives during my PhD journey. I appreciate all my senior and contemporary CARTA fellows and graduates who had supported and guided me, including fellows at the University of Ibadan, Nigeria; University of Ife, Nigeria; Moi University in Kenya; University of Malawi; University of Rwanda; University of Uganda and Gothenburg University, Sweden. I must say a big “thank you” to my Heads of departments and colleagues in both the Department of Community Medicine, College of Medicine University of Ibadan, Nigeria and the Department of Family Medicine, University College Hospital, Ibadan, Nigeria. I do not take their support and encouragement for granted. I also acknowledge the officials of the College of Medicine, University of Ibadan, Nigeria for supporting me throughout the years of my Ph.D. vii Abstract Background This research explored the phenomenon of children-on-the-streets of Ibadan, Nigeria. These children are found on the streets without any adult supervision. They constitute the majority of street children but are linked to their families and therefore they come from and return home daily. The Bronfenbrenner ecological system theory on children’s development and interactions within contextual ecosystems, underpinned this study. This research aimed to understand the phenomenon of children on the streets of Ibadan, specifically their family dynamics, lived experiences, health, and needs. Method This was mixed-method research, although largely a qualitative approach was employed to obtain the narratives of children on the streets and significant adults in the children’s exosystem. All ethical principles were observed in the conduct of the studies. In-depth interviews, street photographs, field notes and observation were employed during the data collection, between June 2021 to September 2021. Fifty-three (53) participants including street shop owners, children on the street, Oyo State’s child welfare officers and parental figures were selected from a street in each of Ibadan's five urban Local Government Areas (LGAs). These LGAs include the Ido, Northwest (NW), Southwest (SW), North(N) and Northeast (NE). Relevant quantitative data was collected from the children only. The sampling of participants was initially purposive and subsequently by snowball technique. Framework analysis supported with Atlas Ti version 22, was conducted and the data was triangulated, for a robust understanding of the lived experiences, health, family dynamics and needs of children on the streets of Ibadan. Principal component analysis and frequencies were conducted with SPSS version 21 for the descriptive quantitative data obtained from the 21 recruited children, solely for thick description. The quantitative data included the Household Hunger Scale (HHS), Wealth Index (WI), and Body Mass Index (BMI). viii Results The participants comprised, 12 child welfare officers, 10 street shop-owners, 10 parental figures and 21 children on the street. The children were average 15.8 years old and had spent at least 4 years on the streets. The children had structurally defective families including broken large-sized families (18 of the 21 children were from families with > 4 children) with attendant poor socioeconomic resources and poor filial interpersonal relationships. More than half of the children were from families with poor WI scores. The lived experiences of children on the street included beneficial experiences related to the monetary gains on the streets with overwhelming challenging experiences. The challenging experiences included financial crisis, school failure, initiation into prostitution and street gangs, induction into substance use, harassment on the street, risk of kidnapping and ritual killing. The physical health problems of the children on the streets included poor nutrition, poor toilet habits, allergies, infectious diseases, and physical minor and major injuries (40% of them had evident facial or limb scars) sustained on the streets. Half of the children had a BMI in the “underweight” range and a third had HHS scores which indicated moderate household hunger. The mental health problems included sexual, verbal and substance abuse, although psychological strength was found in a few children on the street, more than half of the children responded “yes” to feelings of sadness or hopelessness. The children on the streets of Ibadan had many unmet needs due to governmental shortcomings including failure of the Oyo State’s education systems, inadequate vocational training programs for uneducable children, lax State child welfare laws, difficult rehabilitation of children on the street and poor policies on family size. There were bits of interventions which catered to children on the streets including parental poverty alleviation schemes and community-based child welfare alert programmes. Discussion The family dynamics driving child streetism for family-connected children in Ibadan are devaluation of family life, parental irresponsibility, and poor filial relationship, underscored by large family size, economic constraints and socio-cultural decadence. The family setting is that of broken homes with many children from a monogamous union or blended families with poor financial and social resources. The mothers were either in a monogamous unwedded union with “absent” fathers cohabiting with another woman. There was an economic-oriented filial ix relationship with the parentification of the children. The lived experiences of children on the street included beneficial experiences centred around monetary gains, overshadowed by challenging experiences. Monetary gains were meagre and predominantly through the hawking of edible produce. The challenging experiences included the loss or theft of money made on the streets by these children, school failure, initiation into prostitution and street gangs, induction into substance use, street harassment, risk of kidnapping and ritual killing. The physical health problems included poor carbohydrate-based diet with consequent undernutrition, open defecation with attendant health risks, predisposition to allergies, acquisition of infections including STIs, minor physical injuries and a few deaths from Road Traffic Accidents (RTAs). Sexual, verbal and substance abuse were common mental health problems, although few children acquired mental resilience. The governmental shortcoming which feds the epidemic of children on the street included the failure of the Oyo State’s education systems, inadequate vocational training programs for uneducable children, lax State child welfare laws, difficult rehabilitation of children on the street and poor policies on family size. The parental poverty alleviation scheme was one of the state’s government interventions, however, jurisdictional failure overshadows the efforts against child streetism in Ibadan. Conclusion The continuing influx of children on the streets of Ibadan is due to the peculiar family dynamics and the prevailing governmental jurisdictional failure. The presence of children on the street is fraught with a lot of difficult lived experiences and health problems. An appreciation of these factors, and synchronized targeted multi-level interventions within the ecosystems can positively influence measures to combat the epidemic of children on the streets of Ibadan, Oyo state, South- west Nigeria. Keywords: streetism, lived, phenomenology, needs, hawk, relationship, welfare, rights x Publications and presentations from the thesis Publications 1. Obimakinde, A. M., & Shabir, M. (March, 2023). Recount and Account of Lived Experience of Children on the Street: A Phenomenology Approach. International Journal of Qualitative Research, 2(3), 183-194. https://doi.org/10.47540/ijqr.v2i3.756 2. Obimakinde, A., & Shabir, M. (May, 2023). Physical, mental and healthcare issues of children on the street of Ibadan, Nigeria. African Journal of Primary Health Care & Family Medicine, 15(1), 10 pages. doi: https://doi.org/10.4102/phcfm.v15i1.3819 3. Obimakinde, A., & Shabir, M. (2023). The Family Dynamics of Children on the Streets of Ibadan, Southwest Nigeria. South African Family Physician Journal: Submitted May 19th,2023 and accepted for publication on 12th August 2023. (in press for release early January 2024). S Afr Fam Pract. 2024;66(1), a5774. https://doi.org/10.4102/safp.v66i1.5774 4. Obimakinde, A., & Shabir, M. (2023). Children on the streets of Ibadan Nigeria: neglect of children’s rights submitted July 1st 2023 to International Journal of Children’s Rights. Presentation 1. Obimakinde, A., & Shabir, M. The physical, mental, and healthcare issues of children on the street of Ibadan, Southwest Nigeria: a qualitative approach. Oral presentation submitted for CARTA-Witwatersrand SPH conference 2023, School of Public Health Auditorium, University of the Witwatersrand, Johannesburg, South Africa. Sept 14-15. 2023. https://doi.org/10.47540/ijqr.v2i3.756 https://doi.org/10.4102/phcfm.v15i1.3819 https://doi.org/10.4102/safp.v66i1.5774 xi Ethical Clearance certificates xii Ethical Clearance certificates xiii Copyright Notice The copyright of this thesis vests in the University of the Witwatersrand, Johannesburg, South Africa, by the University’s Intellectual Property Policy. No portion of the text may be reproduced, stored in a retrieval system or transmitted in any form or by any means, including analogue or digital media, without prior written permission from the University. Extracts of or quotations from the thesis may, however, be made in terms of Section 12 or 12 of the South African Copyright Act No. 98 of 1978 (as amended) for non-commercial or educational purposes. Full acknowledgements must be made to the author and the University. An electronic version of this thesis is available on the library web page (www.wit.ac.za/library) under ‘Research Resources’. For permission requests, please contact the University Legal Office or the University Research Office (www.wits.ac.za). If you wish to contact Abimbola email mabimbola@cartafrica.org or +2348028406568 mailto:mabimbola@cartafrica.org xiv Table of Contents Title page…………………………………………………………………………………………i Candidate’s Declaration………………………………………………………………………… ii Statement by the supervisor……………………………………………………………………. iii Dedication……………………………………………………………………………………… iv Acknowledgement…………………………………………………………………………… v-vi Abstract………………………………………………………………………………………vii-ix Publications and presentations from the thesis…………………………………………………..x Ethical clearance certificates………………………………………………………………...xi-xii Copyright notice………………………………………………………………………………. xiii Table of content……………………………………………………………………………xiv-xvi List of figures…………………………………………………………………………………xvii List of tables………………………………………………………………………………... xviii Abbreviations ………………………………………………………………………………xix-xx CHAPTER ONE: BACKGROUND AND INTRODUCTION TO THE STUDY .........................2 1.1 Background ............................................................................................................................2 1.2 Conceptual framework ...........................................................................................................3 1.3 Experiences of children-on-the street.....................................................................................5 1.4 Family dynamics of children-on-the street ............................................................................7 1.5 Health status of children-on-the street .................................................................................10 1.6 Problem statement................................................................................................................12 1.7 Justification ..........................................................................................................................13 1.8 Objectives of the Study ........................................................................................................14 CHAPTER TWO: METHODS......................................................................................................16 2.1 Study design .........................................................................................................................16 2.2 Study sites ............................................................................................................................17 2.3 Study 1: In-depth interviews with child welfare officers.....................................................18 2.4 Study 2: In-depth interviews of street shop owners .............................................................21 2.5 Study 3: In-depth Interview of children-on-the-street .........................................................23 2.6 Study 4: In-depth interviews of pairs of a child on the street and a parental figure ............26 2.7 Sampling matrix for the research participants (studies 1,2,3&4).........................................28 2.8 Data Management ................................................................................................................29 2.9 Ethical considerations ..........................................................................................................31 2.10 Source of research funding.................................................................................................34 xv CHAPTER 3: PRELIMINARY RESULTS ..................................................................................36 3.1 Introduction ..........................................................................................................................36 3.2 Description of participants selected for the four studies......................................................36 3.3 Results of quantitative data on Family of children on the street (part of study 3 and study 4) ....................................................................................................................................................37 CHAPTER FOUR .........................................................................................................................42 RECOUNT AND ACCOUNT OF LIVED EXPERIENCE OF CHILDREN ON THE STREET: A PHENOMENOLOGY APPROACH.........................................................................................42 Abimbola Margaret Obimakinde1, Moosa Shabir2. Recount and Account of Lived Experience of Children on the Street: A Phenomenology Approach. International Journal of Qualitative Research, 2 (3), 183-194. DOI: 10.47540/IJQR. v2i3.756 (Published March 2023) ................42 4.1 Introduction ..........................................................................................................................43 4.2 Abstract ................................................................................................................................43 CHAPTER FIVE ...........................................................................................................................44 PHYSICAL, MENTAL AND HEALTHCARE ISSUES OF CHILDREN ON THE STREET OF IBADAN, NIGERIA .....................................................................................................................44 Obimakinde AM, Shabir M. Physical, mental and healthcare issues of children on the street of Ibadan, Nigeria. Afr J Prm Health Care Fam Med. 2023;15(1), a3819. https://doi.org/10.4102/ phcfm. v15i1.3819(Published May 2023)..................................................................................44 5.1 Introduction ....................................................................................................................................45 5.2 Abstract ...........................................................................................................................................45 CHAPTER SIX: THE FAMILY DYNAMICS OF CHILDREN ON THE STREETS OF IBADAN, SOUTHWEST NIGERIA ............................................................................................48 6.1 Introduction ..........................................................................................................................48 6.2 Abstract ................................................................................................................................48 6.3 Introduction ..........................................................................................................................49 6.4 Methods................................................................................................................................53 6.5 Results ..................................................................................................................................55 6.6 Discussions...........................................................................................................................66 6.7 Recommendation..................................................................................................................75 6.8 Conflict of Interest ...............................................................................................................75 6.9 Authors’ Contributions.........................................................................................................75 6.10 Data Availability ................................................................................................................76 xvi 6.11 Funding Information ..........................................................................................................76 CHAPTER SEVEN: CHILDREN ON THE STREETS OF IBADAN NIGERIA: NEGLECT OF CHILDREN’S RIGHTS ................................................................................................................78 7.1 Introduction ..........................................................................................................................78 7.2 Abstracts...............................................................................................................................78 7.3 Introduction ..........................................................................................................................79 7.4 Methods................................................................................................................................81 7.5 Results ..................................................................................................................................83 7.6 Discussions...........................................................................................................................94 7.7 Conclusions and Recommendation ....................................................................................102 CHAPTER EIGHT; INTRODUCTION, SUMMARY OF THE ARTICLES, DISCUSSION, REFLECTIONS, LIMITATIONS, STRENGTHS, CONTRIBUTION TO KNOWLEDGE, IMPLICATIONS, CONCLUSIONS ...........................................................................................104 8.1. Introduction .......................................................................................................................104 8.2 Summary of published articles and submitted manuscripts from this study......................105 8.3 Discussions.........................................................................................................................108 8.4 Reflections on the study protocol.......................................................................................117 8.5 Limitations of the study .............................................................................................................119 8.6 Strengths of the study.........................................................................................................120 8.7 Contribution to knowledge.................................................................................................122 8.8 Implication .........................................................................................................................123 8.9. Recommendation...............................................................................................................125 8.10 Conclusions ......................................................................................................................127 REFERENCES ............................................................................................................................129 APPENDICES .............................................................................................................................138 APPENDIX A (STUDY 1):IN-DEPTH INTERVIEW OF CHILD WELFARE-OFFICERS 138 APPENDIX B: (STUDY 2):IN-DEPTH INTERVIEW OF STREET SHOP OWNERS........144 APPENDIX C. STUDY 3:IN-DEPTH INTREVIEW OF CHILDREN-ON-STREET...........151 APPENDIX D. (STUDY 4): PAIRED IN-DEPTH INTERVIEW (child-parental figure) .....161 APPENDIX E: PUBLISHED ARTICLES..............................................................................167 xvii List of Figures Fig 1: Bronfenbrenner ecological model of the child on the street 5 Fig 2.1. The map of Ibadan LGAs within Oyo State, Southwest Nigeria 17 Fig 2.2 The street selected in each of the Ibadan urban LGA 18 Fig 3. The health indices of children on the street of Ibadan 41 xviii List of Tables Table 2.1 Sample matrix for all recruited participants (studies 1,2, 3 &4) ...................................19 Table 3.1 Participants recruited 1 ..................................................................................................23 Table 3.2 Family profiles of the children .....................................................................................26 Table 3.3 Socioeconomic characteristics of the children on the street..........................................27 Table 3.4 Household Hunger Scale and Body Mass Index of children on the street ....................28 Table 6.1 Characteristics of Participants ......................................................................................26 Table 6.2 Themes and Subthemes ................................................................................................26 xix Abbreviations used in this study Abbreviation Meaning APGAR Adaptability, Partnership, Growth, Affection, and Resolve APHRC African Population and Health Research Center ATLAS Archiv fur Technik, Lebenswelt und Alltagssprache (Archive for Technology, Lifeworld and Everyday Language) BMI Body mass index CARTA Consortium for Advanced Research Training in Africa COVID-19 COronaVIrus Disease of 2019 CRC Convention on the Rights of the Child CRA Child Rights Act CYPA Children and Young Persons Act DelPHE Development Partnerships in Higher Education DfID Department for International Development DHS Demographic and Health Survey F Female FCO Family Court of Oyo state FCT Federal Capital Territory FMOH Federal Ministry of Health FMWA&SD Federal Ministry of Women’s Affairs and Social Development GEEP Government Employment and Entrepreneur Program GOPD General Outpatient Department HHS Household Hunger Scale HIV Human Immunodeficiency Virus IDIs In-depth interviews IMF International Monetary Fund IRB Institutional Review Board JAMB Joint Admissions Matriculation Board Kg Kilogram LGAs Local Government Areas LMICs Low- and Middle-Income Countries M Male m meters MWA&SI Ministry of Women’s Affairs and Social Inclusion MWP Mature Woman Projects N North NATIP National Agency for the Prohibition of Traffic in Persons and other related matters NE Northeast NGO Non-Governmental Organizations NHR Nigeria-Bar Human Rights NHRC National Human Rights Comission NURTW National Union of Road Transport Workers NW Northwest PC Paired Child xx PCA Principal Component Analysis PhD Doctor of Philosophy PP Paired Parent PRB Population Reference Bureau PTA Parent Teachers’ Association RRT Rapid Response Team RTI Road traffic injuries SIDA Swedish International Development Cooperation Agency SCREEM Social, Cultural, Religious or spiritual, Economic, Educational, Medical SDGs Sustainable Development Goals SO Shop Owner *SO Shop Owner, previously a child on the street SOCU State Operating Coordinating Unit SPSS Statistical Package for Social Sciences SSNP Social Safety Net Program STIs Sexually Transmitted Infections SW Southwest UBE Universal Basic Education UCH University College Hospital UI University of Ibadan UK United Kingdom UN United Nations UNICEF United Nations Children’s Fund UPE Universal Primary Education USD United States Dollars VWA Volunteer Work Africa WAEC West Africa Examination Council WI Wealth Index WO Welfare Officer WOFFE Women Fund for Economic Empowerment yrs. years 1 CHAPTER ONE BACKGROUND AND INTRODUCTION TO THE STUDY 2 CHAPTER ONE: BACKGROUND AND INTRODUCTION TO THE STUDY 1.1 Background Street children were first described as a public health burden in Ethiopia in 1887 and they remain as such despite several interventions. (Arthur, 2012) “Child-streetism”, describes the presence of children below the age of 18 years who for various reasons are seen on the street without any adult supervision.(Arthur, 2012; Boakye-Boaten, 2006; Ennew, 2003; Owusuaa, 2010; UNICEF, 2001) This phenomenon is growing fast globally.(Parveen, 2014; Sorre & Oino, 2013; Tefera, 2015; Zarezadeh, 2013) The United Nations Children’s Fund (UNICEF) views street children as children in difficult circumstances without the necessary attention in health research.(Ennew, 2003; UNICEF, 2001, 2006) Currently, there is an epidemic of child streetism in low-and middle-income countries (LMICs), with an estimate of over 15 million street children in Nigeria.(Adewale & Afolabi, 2013; Chamwi, 2010; S. Cumber et al., 2017; Inciardi & Surratt, 1998; Sorre & Oino, 2013) There are four categories of street children: children of the streets with severed families link, children-from-street-families, children-who-absconded-from- institutional care and children-on-the street, which is the dominant category.(Alem & Laha, 2016; S. N. Cumber & Tsoka-Gwegweni, 2015; Mounir et al., 2007) Children-on-the street are distinctly different, as they earn a livelihood during the day but return home to their families at night.(Asanbayev et al., 2016; Parveen, 2014; Sorre & Oino, 2013; Tefera, 2015; Zarezadeh, 2013) They constitute 80-90% of street children in urban regions of LMICs, where they contribute to the public health burden.(Alem & Laha, 2016; S. N. Cumber & Tsoka-Gwegweni, 2015; Mounir et al., 2007) It is alarming that the highest proportion of street children are those who have links to their families. This suggests the failure of the family systems and a lack of in-depth understanding of the experiences and health of these children. (S. 3 N. Cumber & Tsoka-Gwegweni, 2015; Dybicz, 2005; Hills et al., 2016) Yet, most literature examines the other categories of street children. A 2015 Nigerian report revealed that children on the street significantly contribute to child labour in parts of Nigeria, but acknowledged a strong lack of understanding of the phenomenon. (FMOH, 2015; UN-CRC, 2008; UNICEF Nigeria-Bar Human Rights Committee, 2013) Ibadan, the third most populous metropolis in Nigeria has an active population of children on the streets because several interventions targeted against children on the streets have failed, perhaps because of poorly understood and unmet needs of these children. (S. N. Cumber & Tsoka-Gwegweni, 2015; Dybicz, 2005; Faloore & Asamu, 2010; FMOH, 2015; Hills et al., 2016; Olaleye & Oladeji, 2011; UN-CRC, 2008; UNICEF Nigeria-Bar Human Rights Committee, 2013) This study titled “Children on the streets of Ibadan, Nigeria: experiences, family dynamics and health status” re-addressed the phenomenon of child streetism for family-connected children in Ibadan, South-West Nigeria. Ibadan is a prototype Nigerian city flanked by rural suburbs. Ibadan has sociodemographic similarities to major cities in Nigeria burdened with rising numbers of children on the streets despite purported interventions against child streetism in the country. This research explored the family dynamics, experiences and health status of children on the streets of Ibadan to fill in research gaps regarding the pervasive phenomenon of child streetism. The result of this research provided an insight into the phenomena of children on the streets in Nigeria. 1.2 Conceptual framework The Bronfenbrenner ecological model and the structural analysis of factors that act as “push” and “pull” in the family systems are theoretical frameworks for this study.(Bengtsson, 2011; Dennis & Martin.Peter, 2005; Kaime-Atterhog, 2012; Loknath, 2014; Mhizha et al., 2016; Moura, 2002; 4 Thornberg & Delby, 2019) Bronfenbrenner addresses the microsystem, mesosystem, exosystem macrosystem and the chronosystem of the developing child. The microsystem is the family, where the structural analysis of factors that acts as “push” and “pull” is elucidated. (Dennis & Martin.Peter, 2005; Kaime-Atterhog, 2012; Loknath, 2014; Mhizha et al., 2016; Thornberg & Delby, 2019) The filial(parent-child) relation comprising adaptability, role performance, decision-making, cohesion, and communication, is important and when distorted, underscores the family dynamics of a child on the street. (Bengtsson, 2011; Dennis & Martin.Peter, 2005; Kaime-Atterhog, 2012; Loknath, 2014; Mhizha et al., 2016; Moura, 2002; Thornberg & Delby, 2019) The “push” factors encompass the family characteristics and socioeconomic experiences, while the “pull” includes the perceived benefit of street life and experiences. (Dennis & Martin.Peter, 2005; Kaime-Atterhog, 2012; Loknath, 2014; Thornberg & Delby, 2019) The street constitutes an atypical microsystem and an unhealthy ecological crossing for a child. (Bengtsson, 2011; Mhizha et al., 2016; Moura, 2002) The dysfunctional family and street microsystem cumulate into a low-quality mesosystem which becomes a risk to the normal development of the child on the street.(Bengtsson, 2011; Mhizha et al., 2016; Moura, 2002) The exosystem includes the social support systems, parent’s workplace, mass media and local government policies or norms that indirectly affect the child’s development. (Bengtsson, 2011; Mhizha et al., 2016; Moura, 2002).This macrosystem include the culture, formal and informal social structures, national regulations, policies and laws, societal and ideological forces which affect the child’s development indirectly and impact on the other direct ecosystems. (Bengtsson, 2011; Mhizha et al., 2016; Moura, 2002) The chronosystem encompasses major life transitions(e.g. death/divorce of a parent) and environmental encounters(economic/political calamities) during childhood that can shape the child’s behaviour and subsequent life choices. (Bengtsson, 2011; Mhizha et al., 5 2016; Moura, 2002) A child on the street most likely will encounter more negatives than positives within the dysfunctional family and the streets. All these direct and indirect factors within the ecosystem are interconnected complexities that can negatively impact the child on the street. The characteristics and unmet needs of children on the streets are embedded in the “push” and pull” factors within the family dynamics, which influences their experiences and affects their health status. Hence, we adopted a holistic and multilevel approach to the exploration of the family dynamics, experiences and health of children on the street sourcing information from the children on the streets (current and past), parental figures, street shop-owners and Oyo state’s child welfare officers. Fig 1: Bronfenbrenner ecological model of the child on the street The Bronfenbrenner ecological model of the child-on-the-street Chronosystem 1.3 Experiences of children-on-the street Lived experiences of street children entail the nature of their daily activities, in terms of their use of time and what they endure to survive on the street.(Faloore & Asamu, 2010; Mickelson, 2000; Myburgh et al., 2015; O’Haire, 2011) Their experiences stem from “work” and social activities on the street.(Faloore & Asamu, 2010; Mickelson, 2000; Myburgh et al., 2015; O’Haire, 2011) They experience exploitation, insecurity and may have feelings of hopelessness. (S. Cumber et Street - experience Family - dynamics Health- status Macrosystem Exosystem 6 al., 2017; S. N. Cumber et al., 2017; S. N. Cumber & Tsoka-Gwegweni, 2015; S. N. Cumber & Tsoka-gwegweni, 2017; Molahlehi, 2014; NHR Commission Nigeria, n.d.; UNICEF, 2001; Wargan & Dershem, 2009a) This is partly because of the underlying unfavourable family dynamics and lack of hope that society will come to their aid. (Mickelson, 2000; Myburgh et al., 2015; O’Haire, 2011) These experiences are documented for children of the street, who are deprived of family contact and support, with gaps in the literature regarding the experiences of the children on the street. (Mickelson, 2000; Myburgh et al., 2015; O’Haire, 2011) For instance, only 2 of 108 papers in a systematic review of publications on street children from 35 LMICs, speak to children on the streets being less likely to encounter some of these experiences.(Kerfoot et al., 2007; Merril et al., 2010; Woan et al., 2013) These two studies are ambiguous and neither evaluated their experiences relative to the family sociodemography or dynamics. (Kerfoot et al., 2007; Merril et al., 2010) Hence, there is a need to explore the dimensions of the experiences of children on the street. Street children engage in begging, hawking, and being hired help to people on the street, with these financial activities forming a major part of their experiences. (Mickelson, 2000; O’Haire, 2011) A meta-analysis of 31 outdated (1993 to 2000) papers from Africa, Asia, and Latin America with a total sample of 68014 street children, found that the majority were male children on the street in Africa with a significant variation for all livelihood strategies. (Alem & Laha, 2016) Money made by children on the street remains a major pull factor, with street girls having a higher tendency to sexual exploitation. (S. Cumber et al., 2017; Mickelson, 2000; Myburgh et al., 2015; O’Haire, 2011; Stephen et al., 2013) The meta-analysis captured three Nigerian papers and listed daily labour as the most common financial activity, followed by street vending and begging.(Alem & Laha, 2016; Ekpiken-ekanem & Ayuk, 2014; Ikechebelu et al., 2008; Owoaje 7 et al., 2011) Two of the Nigerian studies were old and not explicit about children-on-street while one study only focused on sexual abuse and exploitation amongst the females. Street children lack adequate nutrition and are exposed to unhygienic conditions, like poorly packaged food with no access to clean drinking water and toilet facility. (S. Cumber et al., 2017; Myburgh et al., 2015; Stephen et al., 2013) Their feeding depends largely on their earnings or they go hungry and desperate to do anything for food. (S. Cumber et al., 2017; Myburgh et al., 2015; Stephen et al., 2013) Children-on-the street may go home intermittently to use the toilet facilities, drink water or eat and may not experience desperation, but these are speculations with no evidence. Fifteen of the meta-analysis of 108 articles from LMICs, found contradictions between the nutritional status of children-on-the street and children-of-the-street. (Woan et al., 2013) Likewise, other studies lacked data on the peculiarities of children on the street regarding their feeding, drinking or toilet habits. (S. Cumber et al., 2017; Myburgh et al., 2015; Stephen et al., 2013; Woan et al., 2013) What are the experiences of children on the street in Ibadan metropolis, Nigeria? Plausibly the underlying family dynamics of children on the street expose them to these experiences. 1.4 Family dynamics of children-on-the street Globally, street children are viewed as a by-product of socio-economically challenged families in urban slums of LMICs, characterized by overpopulation and inadequate social security. (Alem & Laha, 2016; Kerfoot et al., 2007; Merril et al., 2010) Besides poverty, a variety of other unhealthy structural and functional family problems underscore child-streetism. (Abubakar- Abdullateef et al., 2017; Azuka & Patrick, 2019; Ekpiken-ekanem & Ayuk, 2014; Faloore & Asamu, 2010; Inyang & Ralph, 2015; McAlpine et al., 2010; Olaleye & Oladeji, 2011; Tefera, 2015; Ugwuadu, 2017) Particularly for children-of-the street, being orphaned, child abuse, poor 8 parent-child interaction, and family dysfunction can push children to the streets.(Abubakar- Abdullateef et al., 2017; Azuka & Patrick, 2019; Ekpiken-ekanem & Ayuk, 2014; Faloore & Asamu, 2010; Inyang & Ralph, 2015; Olaleye & Oladeji, 2011; Tefera, 2015; Ugwuadu, 2017) Streetism, for children on the street, maybe a survival strategy for a well-functioning family, however, there are gaps in the literature, which this thesis hopes to fill. Studies have reported that children of the street are sent out of their homes to provide financial sustenance for themselves.(Hills et al., 2016; Mounir et al., 2007; Netshiombo, 2015; Tefera, 2015; Wargan & Dershem, 2009b, 2009a) A Brazilian study conducted about two decades ago on poorly categorized children on the street reported that they are from disintegrated female-headed families, living in slums, with a high level of illiteracy and poverty.(Abdelgalil et al., 2004) A meta-analysis of the literature on street children reported that a major push factor in Africa is coercion by family members due to socioeconomic challenges, family dysfunction and the inability to provide educational support. (Alem & Laha, 2016) Similar conclusions were drawn from West African studies, which addressed the family dynamics of the minority categories of street children.(Abubakar-Abdullateef et al., 2017; Adewale & Afolabi, 2013; Faloore & Asamu, 2010; Ugwuadu, 2017) There is a paucity of literature on family dynamics of children on the street in Nigeria while extensive research has been conducted mostly on children of the street, especially the Almajiris in Northern Nigeria.(Adewale & Afolabi, 2013; Ekpiken-ekanem & Ayuk, 2014; Faloore & Asamu, 2010; FMOH, 2015; Olaleye & Oladeji, 2011; Ugwuadu, 2017) A 2008 United Nations(UN) report of the Convention on the Rights of the Child Committee (CRC) in Nigeria, recognized the gap in knowledge regarding the prevalent children-on-the-street in southern states. (UN-CRC, 2008) Likewise, the 2013 Nigeria Child Rights Act manual, recognized a poor 9 understanding of the phenomenon of children-on-the-street, in the southern states, and proposed that this category of street children cannot be arrested for wandering. (UNICEF Nigeria-Bar Human Rights Committee, 2013) This is because, under section 26(1) of the Children and Young Persons Act (CYPA), any local authority in Nigeria may arrest a child if they have reasonable grounds that the child is wandering and has no home. (UNICEF Nigeria-Bar Human Rights Committee, 2013) Children-on-the street are not culpable because of the clause, thereafter the CRC recommended that research should generate baseline data on various issues affecting the rights of the children on the street, after which laws can be amended. (UN-CRC, 2008; UNICEF Nigeria-Bar Human Rights Committee, 2013) Recently a dissertation in 2017, investigated the push factors for children-of-the-street, in Iwo- road, a popular street in one of the urban local government areas (LGAs) of Ibadan, Nigeria. (Ugwuadu, 2017) This was a qualitative study and involved only male children-of-the street, three traders and two social workers. (Ugwuadu, 2017) Sample size, participants and study-site selection bias were obvious limitations of this study even though the author acknowledged children on the street as a majority group in Ibadan. (Ugwuadu, 2017) Escape from an abusive home environment, was a major push factor for streetism in that study, with bear mention of other domains of family dynamics. (Ugwuadu, 2017) The family-APGAR, a validated family function tool, which assesses Adaptability, Partnership, Growth, Affection, and Resolve (Eseigbe et al., 2014; Ogundokun et al., 2016) was incorporated as an interview prompt in this thesis. The family-APGAR will assist to decipher the poorly understood family dynamics of children on the street of the Ibadan metropolis. The hazards from the street and family ecology cumulatively engender health challenges for children on the street. 10 1.5 Health status of children-on-the street The health problems observed in street children can be attributed to their family dynamics and adverse street experiences. Health problems of street children include malnutrition-related poor growth, skin infections and poor dentition.(Abubakar-Abdullateef et al., 2017; Asante et al., 2015; S. N. Cumber & Tsoka-Gwegweni, 2015; Mounir et al., 2007; Savarkar, 2018) They readily sustain unintentional physical injuries due to the roughness of street life. (Marcal, 2017) They lack access to health care when ill and can suffer maltreatment, sexual abuse or exploitation with subsequent sexually transmitted infections(STI) and HIV risk.(Abubakar- Abdullateef et al., 2017; Asante et al., 2015; S. N. Cumber & Tsoka-Gwegweni, 2015; Mounir et al., 2007; Savarkar, 2018) A meta-analysis of African literature published between 1990 to 2015 from 16 countries revealed the above morbidities are prevalent among street children. (S. N. Cumber & Tsoka-Gwegweni, 2015) However, this review recognized the fact that most of the studies were outdated and centred on children of the street. The meta-analysis recommended a detailed review of the health profile of different categories of street children in different regions of Africa. (S. N. Cumber & Tsoka-Gwegweni, 2015) Another meta-analysis of quantitative research published between 1995 and 2011 representing 35 countries, found a higher prevalence of malnutrition, poor growth, infection, injury, conduct problems and substance use among children of the street but specifics for children on the street were blurry. (Woan et al., 2013) Children of the street are easily susceptible to the aforementioned morbidities due to a lack of family support and poor shelter. (S. N. Cumber & Tsoka-Gwegweni, 2015; Woan et al., 2013) Contrarily children on the street with substantively different family and street dynamics may have different health outcomes, but this has been underexplored. Most studies in the meta- analysis merely compared the health of the generality of street children to that of school children. 11 (Woan et al., 2013) Only one multinational study in the meta-analysis reported a high prevalence of physical injuries among street children with no delineation for the children on the street.(Pinzon-Rondon et al., 2009; Woan et al., 2013) Four of the reviewed articles gave contradictory evidence on the nutritional and growth status of street children. A Kenyan study suggested that children on the street with family ties have better growth outcomes and recommended in-depth research in this area.(Ayaya & Esamai, 2001; Woan et al., 2013) The Kenyan study also found skin infections were the commonest morbidity in children of the street while dental problems were more in children on the streets Another four studies in the review reported a higher prevalence of sexual activity, STI and HIV among children of the street except for one of the four studies, which found comparable syphilis prevalence rates in children-on-the- street. (Jorge A. Pinto, Andrea J. Ruff, Jose V. Paiva, Carlos M. Antunes, Irene K. Adams, Neal A. Halsey, 1994; Woan et al., 2013) Health outcomes frequently assessed in street children are growth status (using body mass index), sexual and dental health.(Ayaya & Esamai, 2001; Woan et al., 2013) A study examined the social network, livelihood and health-seeking behaviour of children of the street in three busy transit motor parks in Ibadan in 2008. (Faloore & Asamu, 2010) Although the authors acknowledged that 90% of the street children were children-on-the-street, they focused on children-of-the-street. (Faloore & Asamu, 2010) The study acknowledged their sampling strategy as a limitation and suggested further studies involve shop owners who are part of the social network of street children. (Faloore & Asamu, 2010) This thesis plans to fill the gaps in the aforementioned study by involving shop owners and utilizing a proportional sampling of children on the street in all five urban LGAs of Ibadan. Street children have been described as invisible and excluded from research that has to do with population vital statistics, health indices and 12 healthcare plans.(Abubakar-Abdullateef et al., 2017; Asante et al., 2015; Bassuk et al., 2015; S. N. Cumber & Tsoka-Gwegweni, 2015; Mounir et al., 2007; Savarkar, 2018; UNICEF, 2006) The research gap on the health status of children on the street serves as a compelling example of the global disparity in child health, which negates Sustainable Development Goals (SDGs) concerning children’s rights. (Woan et al., 2013) The 2015 report on “Children Left Behind in Nigeria”, and similar reports recommended targeted research to ameliorate the disparity. (FMOH, 2015; UN-CRC, 2008; UNICEF Nigeria-Bar Human Rights Committee, 2013) What are the specific family characteristics, experiences and health of children-on-the street in Ibadan, South-West Nigeria and what are the associations between these? 1.6 Problem statement The growing number of children on the streets in Ibadan Nigeria is concerning, particularly in the purview of a variety of published research and targeted interventions over the years. Although the literature on street children are numerous, information on the children on the street is lagging. The lack of explicit data on the phenomenon particularly the contextual family dynamics, experiences, needs and health underscores the epidemic of child streetism for family- connected street children cities of LMICs like Ibadan, Nigeria. Existing literature are not precise and most do not utilize a holistic approach to the evaluation of the phenomenon of children on the street in Nigeria. Poor understanding of the phenomenon may be the reason for the failed interventions targeted at eradicating the acknowledged continuing presence of children on the streets of a metropolis like Ibadan, in Nigeria. The ‘epidemic’ of children on the streets in Nigeria is a public health concern and conflicts with the SDGs concerning children’s rights, welfare and health. 13 1.7 Justification Studies on street children capture mostly the children of the street with paucity regarding children on the streets, who are the major category. The fewer studies on children on the street in Nigeria are outdated, porous, usually unidirectional and quantitative without multidimensional exploration of the complexities that surround this major category of street children. These studies some of which are cited in the background to this thesis extrapolated data regarding children on the street as a sub-set of street children. Importantly review of literature revealed that most of the studies that acknowledged the uniqueness of children on the street among were old, centred on children of the street and recommended further focused research of children on the street. This research focused on the major category of street children using in-depth description and exploration of their situations considering the complexities of interconnected factors that can be drivers for child streetism for a family-connected child. Therefore, using a mixed-method approach, we adopted and applied the Bronfenbrenner ecological model to the multidimensional exploration of the family dynamics, experiences and health of children on the streets of Ibadan. This afforded us the opportunity of multiple reliable sources of rich information from the children and significant adults in their ecosystem. We triangulated this multidimensional information and obtained an appreciation of an updated situation of children on the streets of Ibadan. The result of this research has expectedly bridged literature gaps and can guide meaningful interventions against child streetism in Ibadan, Nigeria, considering we explored the unmet needs vis a vis the existing interventions in context of the family, experiences and health of children on the street. 14 1.8 Objectives of the Study 1.8.1 Aim of the study This study explored the lived experiences, health, and family dynamics including specific family characteristics and needs of children on the streets in Ibadan, Nigeria. 1.8.2 Specific objectives of the study 1. To explore the lived experiences of children on the streets of Ibadan, Nigeria 2. To explore the family dynamics of children-on-the-streets of Ibadan, Nigeria 3. To explore the health of children on the streets of Ibadan, Nigeria 4. To describe the existing intervention and needs of children on the street of Ibadan, Nigeria 15 CHAPTER TWO METHODS 16 CHAPTER TWO: METHODS This research utilized a mixed-method approach but largely qualitative, with four study designs. A descriptive phenomenological qualitative approach was utilized for the four study designs and relevant descriptive quantitative data was obtained in two of the four study designs. 2.1 Study design The research utilized four qualitative studies, of which two of the studies had quantitative measures included for descriptive purposes. The studies included: 1) In-depth interviews with the Oyo States child welfare officers. 2) In-depth interviews with street shop owners. 3) In-depth interviews with children on the street. 4) Paired In-depth interviews with a child on the street and a parental figure. Descriptive quantitative data was obtained from the children who participated in the stand-alone in-depth interviews (study 3) and the children who participated in the paired in-depth interviews (study 4). The research team consisted of the researcher who is a trained Family Physician (the lead research), two research assistants who are graduates with Masters in Public Health and a trained psychologist with a PhD in psychology, who has at least 10yrs working experience with the Department of Family Medicine at the University College of Hospital Ibadan. The research team had 3-days of training, discussions and briefing on the study protocol and procedure before the commencement of data collection. All team members had been involved in research, ethics training and certification. The lead researcher is a CARTA PhD fellow who had been trained on research methods inclusive of qualitative research design and data management. The training was part of the PhD series of program organized by CARTA during the 2nd Joint Advance Skills 17 (JAS 2) at the School of public health in the University of Witswaterands, during the thesis proposal writing stage. 2.2 Study sites The study sites were five streets with a known active population of street children in Ibadan, Oyo State, Nigeria. Oyo State, the largest state in South-West Nigeria, has 33 local government areas (LGAs), with six rural and five urban LGAs situated within Ibadan, the state capital. Street children are found in the urban LGAs of Ibadan where they could benefit from the working class. Therefore, five streets were purposely selected at one street from each of the five urban LGAs in Ibadan, namely Ido, Northwest (NW), North (N), Northeast (NE) and Southwest (SW) LGAs. Fig 2.1. The Map of Ibadan LGAs within Oyo State, Southwest Nigeria The Ibadan urban LGAs are surrounded by the rural LGAs including the Akinyele, Lagelu, Egbeda, Ona-Ara and Oluyole LGAs, as shown in Fig 2(Adeola Fashae et al., 2020) above. 18 Fig 2.2 The street selected in each LGAs 2.3 Study 1: In-depth interviews with child welfare officers This study utilized in-depth interviews with child welfare officers. 2.3.1 Population: These were Oyo-state-appointed child-welfare officers designated to each of the five urban LGAs of Ibadan. 2.3.2 Sampling Strategy: Child welfare officers working in the five urban LGAs (Ido, NW, N, NE and SW) were purposively selected at two officers per LGA. All, the LGAs’ child welfare offices in Ibadan report to the central directorate for child welfare services in the Oyo State secretariat. Therefore, an additional two child welfare officers were selected from the Oyo State secretariat in Ibadan. The Oyo State secretariat is located in Ibadan North(N) LGA, wherein the Oyo State’s Ministry of women affairs and social inclusion is located and within this Ministry the Department of child welfare services for Oyo State. The Oyo State’s Ministry of women affairs and social inclusion is linked to the Federal Ministry of women affairs and social inclusion in the Federal Capital Territory (FCT) in Abuja, where all matters of child welfare Ido LGA •Street name : Apata North LGA •Street name : Iwo-road North West LGA •Street name: Dugbe North East LGA •Street name: Oje South West LGA • Street name: Orita- Challenge 19 services are coordinated in Nigeria. The study protocol and ethical approvals were submitted to the office of the director for child welfare services at the Oyo state secretariat for notification and approval was obtained before the study commenced. The director for child welfare services in Oyo state represent a lower level policy advocate for child welfare service in the country. A total of 12 (selected at 2 per each of the 5 LGAs and 2 from the Oyo state secretariat) child welfare officers were selected by purposive and snowball sampling techniques, until saturation was reached. 2.3.3 Criteria for participant selection 2.3.3.1 Inclusion criteria for participant selection 1. Oyo States’ child welfare officers with a minimum of six months’ work experience in each urban LGAs and the Oyo State secretariat directorate of child welfare services (to guarantee the officers’ familiarity with the locality of interest) 2.3.3.2 Exclusion criteria for participant selection 1. Non-consenting Oyo States’ child welfare officers 2.3.4 Data collection from child welfare officers The data collection via in-depth interviews took place between June 2022 and September 2022 across all urban LGAs in Ibadan. The interviews were conducted in LGAs’ child welfare offices and at the state central directorate secretariat office, based on availability and at the convenience of the consenting child welfare officers. Research assistants assisted with the recruitment and the interviews were conducted only by the researcher once and during the day, in English language. The translated interview guides in the local languages (Yoruba) were available for reference or clarity during the interview. In-depth interviews were conducted using an interview guide (APPENDIX_A) to explore the child 20 welfare officers’ work experiences, knowledge, and perception of the family dynamics, lived experiences, health and needs of children on the streets of Ibadan. The researcher developed the interview guide using validated a questionnaire (family APGAR) as a prompt during the interview. The family APGAR questionnaire was utilized as an interview prompt to explore the interpersonal relationship between parental figures and the child on the street. The interview guide had questions which also probed the family structure and resources of children on the street. The prompt questions used to explore the lived experiences, health and needs of children on the street were guided by validated evidence from literature and existing literature gaps. The same interview guide was adapted and used for the four categories of participants in this research (i.e. Studies 1,2,3, and 4). The interviews were audio-recorded and field notes were used to record activities of interest during the interview. The child welfare officers shared their knowledge and perception of the lived experiences, family dynamics, health, needs and existing interventions for children-on-the streets of Ibadan. The director of the child welfare services in each of the urban LGAs suggested the street known with an active population of street children to the research team. The child welfare directors in each LGAs were informed of the date, time and location of the research activity on the select street. This official notification enabled the research team to promptly report incidence that required the intervention of a child welfare officer. But the child welfare officers were not present during any of the interactions with the children on the street or with the parental figure to avoid the feeling of being coerced. They were also not present at the interviews with street shop owners. 21 2.4 Study 2: In-depth interviews of street shop owners This method utilized in-depth interviews of street shops or business owners. 2.4.1 Population These were consenting street-shop or street-business owners within the five urban LGAs (Ido, NW, N, NE and SW). They were purposively selected at two street shops or business owners per each urban LGA in Ibadan. The choice of street in each LGA was guided by the information on a known active population of children on the street provided by the office of the director of child welfare services in each LGAs. 2.4.2. Sampling Strategy Two street-shop or street-business owners were selected by purposive and snowball sampling techniques from each of the five LGAs (Ido, NW, N, NE and SW). A total of 10 street shops or business owners were selected, until saturation was reached. 2.4.3 Criteria for participant selections 2.4.3.1 Inclusion criteria for participant selection 1. Adults (above 18 years of age), both male and female 2. Street-shop or street-business owners at major road intersections close to public market- places (they readily unconsciously can observe the activities of children on the street due to their location) 3. Operates a shop/business from dusk to dawn for a minimum of six months on the select street. (they are knowledgeable about the activities and movement of the children throughout the day) 22 4. Being a past children-on-the-street was a desirable but not compulsory selection criterion (which was a criterion met by 5 out of 10 selected street-shop owners) 2.4.3.2 Exclusion criteria for participant selection 1. Previously belonged to other categories of street children (i.e. children of the street, children from street families and children who absconded from institutional care) 2.4.4 Data Collection The data collection via in-depth interviews took place between June 2022 and September 2022 across all urban LGAs in Ibadan. Interviews were audio-recorded using an interview guide (APPENDIX_B) and field notes were used to record activities during the interview. The interview guide is the same one used for study 1 but tailored for questioning street shop owners or street small-business owners. These interviews also constituted formative data, as these participants assisted in the identification of current children on the streets. These participants also facilitated contact with the parental figures to obtain parental permission for the children’s recruitment for sole interviews and recruitment for paired child-parent interviews. Research assistants recruited the participants and the researcher conducted the interview once and during the day, in the translated local language (Yoruba), using the English version of interview guides when needed. During interaction with street shops or street-business owners, observation of the activities of the children on the street was recorded in the research memo. Photographs of the street within the consented shop-owners' vicinity were taken after the interview. Only area photographs of the streets were taken after photograph consent was obtained from the shop owners and images of children on the street were avoided and blurred. The photographs taken were street scenes relevant to study objectives and the photos are for data enhancement as photo- elicitation (Glaw et al., 2017) to give robust insight into the everyday life of children-on-the 23 street. This study 2 explored the lived experiences, family dynamics, health issues perceived and expected needs of children on the street from adult street-shop or street-business owners’ knowledge and perspectives. The recruited street-shop/small business owners who were past children on the street shared their history of lived experiences, family dynamics, health issues perceived and expected needs and expressed their concerns about the current children on the street. 2.5 Study 3: In-depth Interview of children-on-the-street This mixed-method utilized a combination of an in-depth interview and a short-abridged questionnaire to obtain relevant descriptive information from each select child-on-the-street. A short-abridged questionnaire was administered before an in-depth interview with each child. The quantitative questionnaire was strictly for the thick description (Korstjens & Moser, 2018) of the children-on-the streets, from the 5 urban local government areas of Ibadan. 2.5.1 Population These were assenting children-on-the-street selected from a street per each of the urban five LGAs of Ibadan. 2.5.2. Sampling Strategy Children on the street were initially purposively selected with the assistance of street-shop or street-business owners and subsequently by snowball technique. A minimum of two children on the street were selected on each street in each of the five LGAs, with a total of 11 children the on street selected, until saturation was reached. The purposive sampling was applicable because this was largely a qualitative study and the quantitative measures was complementary for thick description of the children on the street. Children are found on the streets of Ibadan year-round without seasonal variation and the recruitment fitted conveniently into the research timeline. 24 2.5.3 Criteria for participants selection 2.5.3.1 Inclusion criteria for selection 1. A child-on-the-street whose parent/guardian had consented to the child’s participation in the study 2. A child-on-the-street, aged 13yrs -17yrs 11months. (the mid to late teenagers are expectedly more neurocognitively developed and could participate and respond appropriately to questions) 3. A child on the street who returns home daily to his/her family at night to sleep. 2.5.3.2 Exclusion criteria for selection 1. A child on the street mentally or physically ill or impaired (The parental figures of the two ill/impaired boys encountered during the research were sought after and their healthcare was initiated and facilitated by the researcher. A referral was made to the Paediatric outpatient clinics of University College Hospital for a boy with physical limitation of one upper limb. The other child with mild depressive symptoms was evaluated by the researcher, referred to the Child and Adolescent Psychiatric Clinic of the University College Hospital, Ibadan and followed up by the researcher. 2.5.4. Data Collection The data collection took place between June 2022 and September 2022 across all urban LGAs in Ibadan. Permission was sought from the children on the streets to approach the parental figure for consent. Thereafter, parental consent was obtained for all recruited children after which the child’s assent was obtained. The time and venue of the data collection was based on parental preference, child’s assent and convenience but the parental figures were not present during data 25 collection from each child. For this mixed-method, a short-abridged questionnaire was administered to each child before the in-depth interview. The interviewer-administered questionnaires (APPENDIX_C_SECTION_A) is a compilation of short abridged questionnaires validated for street children in West Africa.(Korstjens & Moser, 2018; McAlpine et al., 2010; UNICEF, 2001; Wargan & Dershem, 2009a) This questionnaire was used for the thick description(Korstjens & Moser, 2018) of the children-on-the-streets for urban health geography(Ennew, 2003) of the child streetism phenomenon in Ibadan. This questionnaire included the 3-item Household Hunger Scale (HHS) (APPENDIX_C_HHS), the 11-item Demographic and Health Survey(DHS)-Wealth Index(WI) questionnaire (APPENDIX_C_DHS_WI), questions on street activities, school, HIV, sexual activity, and some measures of physical health. (Córdova, 2009; Deitchler et al., 2010, 2011; Rutstein & Johnson, 2004; UNICEF, 2001; Wargan & Dershem, 2009a; Wiesmann et al., 2009) The DHS-WI questionnaire assessed the household’s ownership of selected assets (e.g. television) as a measure of socioeconomic status. The DHS-WI separates households into five wealth quintiles namely; Lowest, Second, Middle, Fourth, and the Highest. The lowest quintile corresponds to the poorest and the highest quintile corresponds to the wealthiest.(Rutstein & Johnson, 2004) The 3-item HHS was used as a measure of food security in the family, each of the 3 items was scored as; 1=Never 2=Rarely 3= Sometimes 4=Often. (Deitchler et al., 2010, 2011) The higher the HHS score the worse the food insecurity in the family or household. (Deitchler et al., 2010, 2011) Upon completion of the short questionnaire, an in-depth interview was conducted and audio- recorded using an interview guide (APPENDIX_C_SECTION_B). Research assistants recruited the children and interviews were conducted by only the researcher, once and during the day, in the local language (Yoruba), using translated interview guides. Although a few of the children 26 understood English as expected and based on their level of education. Observation of the activities of children on the street was recorded in the research memo. The interview with each assenting child on the street was conducted only in the presence of the researcher and child, in the child’s parent/guardian’s shop or home. Subsequently, after the interview, a brief physical examination of the exposed scalp, skin, anterior teeth and measurement of weight and height was conducted at the parent/guardian home or shop. This study explored the lived experience, family dynamics, health, and expected needs of children on the street. 2.6 Study 4: In-depth interviews of pairs of a child on the street and a parental figure 2.6.1. Population These were pairs of assenting children-on-the-street and consenting parental figures, selected from a street per each of the five urban LGAs of Ibadan. 2.6.2 Sampling Strategy The children were recruited purposively and by snowball technique after parental consent was obtained as explained in study 3. Only children who agreed to a paired parent-child interview were selected for this while those that declined linked interview were recruited for the stand- alone interview. The children that declined linked interview felt the parental figure wouldn’t appreciate being interviewed and might feel scrutinized. Permission for a linked interview was sought from each recruited child who agreed for the paired parental interview. Thereafter a parental figure for each recruited child on the street was approached for an in-depth interview. The selection of a child-parental figure pair was from the five urban LGAs (Ido, NW, N, NE and SW). Two (2) pairs of child-parental figures were selected from a street in each of the five LGAs, with total a of 10 pairs selected for the paired in-depth interviews. 27 2.6.2.1 Inclusion criteria for selection for the Paired In-Depth-Interview (IDI): 1. A child-on-the-street whose parent/guardian has consented to the child’s participation in the study 2. A child-on-the-street who is aged 13yrs -17yrs 11months 3. A child-on-the-street who returns home daily to his/her family at night to sleep. 4. A parent to the select child-on-the-street who resides or works close to the street. 2.6.2.2 Exclusion criteria for selection for Paired-In-Depth-Interview (IDI): 1. A child-on-the-street that was mentally or physically ill or impaired (None of such children was encountered during the recruitment for the paired interview) 2. A parental figure whose recruited child declined the paired interview despite obtaining parental consent for the child’s participation 3. A child whose parental figure declined a paired interview despite obtaining parental consent for the child’s participation. 2.6.3. Data Collection Data was collected from each selected assenting child on the street as explained for Study 3. Thereafter the parental figure of the interviewed child on the street was sought after by the research team. The parent’s consent for an interview was obtained and a separate in-depth interview was conducted and audio-recorded using the interview guide (APPENDIX_D). Interviews were conducted by the researcher at the parental figure’s convenience, once and during the day, in the local language (Yoruba), using translated interview guides. Identified conflictual parent-child issue found in one pair was attended to briefly by the research team psychologist on the field and the pair was referred to the researcher’s place of work, at the 28 University College Hospital (UCH) for follow-up. The follow-up entailed individual and conjoint therapy by the clinical psychologist in the Department of Family Medicine. This study explored the lived experience, family dynamics, health, perceived and expected needs of children on the street from parent-child pairs. 2.7 Sampling matrix for the research participants (studies 1,2,3&4) This is a summary of how the different categories of participants for the four studies were selected from each of the five urban LGAs in Ibadan. Table 2.1 Sample matrix for all recruited participants(studies1,2,3&4) Study Category of participants Characteristics Selected in each of the 5 LGAs Total participants in each category 1 Welfare officer Oyo State-appointed child welfare officer working in each LGA and the central directorate in Ibadan. 2 per LGA & 2 from the Oyo State Secretariat 12 2 Street shop owner Street shop or business owner on select street Being a past child on the street was an optional desirable criterion 2 10 3 Child on the street Aged 13yrs -17yrs 11months 2 11 4 Parent-child pair One parental figure and a child on the street aged 13yrs - 17yrs 11months 2 pairs 10 pairs Total recruited for the research 53 29 2.8 Data Management 2.8.1 Reflexivity and trustworthiness The researcher observed reflexivity by introspecting to ensure that prior life and work experiences, assumption and beliefs did not conflict nor interfere with objectivity during data collection and interpretation. The PhD supervisor also made conscious effort to remind the researcher of reflexivity during data interpretation. Although the researcher conducted all interviews because of confidentiality and sensitive family issues discussed, trustworthiness was maintained by ensuring two independent transcription of all audio-recording. Likewise, there was painstaking framework analysis (Srivastava & Thomson, 2009) of transcribed data with triangulation (Korstjens & Moser, 2018) of data conducted by the both researcher and PhD supervisor. 2.8.2 Qualitative Data Management (Studies 1,2, 3 and 4) Framework analysis was conducted on the qualitative data set from the four studies. Framework analysis allowed for a systematic and succinct interpretation of qualitative data through five levels of data processing namely; familiarization, identifying a thematic framework, indexing, charting and mapping.(Srivastava & Thomson, 2009) The framework analysis matrix facilitated the identification of the thematic area of interest which was matched to the research objectives. The ATLAS-Ti Version 22 software supported the framework analysis with the generation of codes and quotes specific to the emerged thematic areas. The qualitative data from all studies were triangulated (Korstjens & Moser, 2018) for the framework analysis, which was guided by the research objectives. The field notes, research memorandums and photographs were used to support the framework analysis. Themes and subthemes were used for the results layout. There was the generation of codes and assignments 30 of statements of quotes specific to the subthemes under each theme. A problematization (Alvesson & Jorgen, 2011) approach was considered for data analysis. This allowed for new observation especially as it pertains to the study location and era while acknowledging the current theoretical views about children-on-the street, with the plan to gap-spot and gap-fill literature on children-on-street.(Alvesson & Jorgen, 2011) The results of the framework analysis are displayed within the four (4) articles that emerged from this research, presented in chapters 4,5,6 and 7. 2.8.3 Quantitative Data Management (descriptive data collected from the children part of studies 3 and 4) Quantitative data were collected from all children on the street recruited for this research. A total of twenty-one (21) children participated in this research including eleven (11) children on the street and ten (10) children from the paired parent-child interviews. The collected quantitative data was analysed with SPSS version 23. The quantitative data collected from each of the twenty-one (21) children on the street who participated in this research is strictly for the purpose of thick description of the selected children. The variables of family size (measured by the number of children in the family), the daily amount of monetary street earnings, socioeconomic status (DHS-WI), household food security (HHS), weight (in Kilogram-kg), height (in meters-m) and BMI (kg/m2) were numerically presented or analyzed. The physical health concerns regarding feelings, skin lesions, anterior dentition, halitosis, and awareness of HIV and STI were assessed as (“yes” or “no”/ “present” or “absent”) and tallied. None of the recruited children had a “yes” response to ever participating in sexual activity. Questions on parents’ statuses, street activities and reasons for being on the street were collated and presented for each selected child on the street. 31 The statistical analysis for the quantitative data included 1. Principal Component Analysis (PCA) of the 11-items of the DHS-Wealth Index questionnaire for socioeconomic status classification of the family of each selected child on the street. The PCA result for the families of the 21 children on the street was in the range of 1st to 3rd Wealth Index quintile The DHS-WI interpretation (Córdova, 2009) for the 1st – 5th quintiles: 1st = Poorest family; 2nd =Poorer family; 3rd =Poor/Average family; 4th = Wealthy; 5th= Wealthier 2. Recoding and sum analysis of the 3 items Household Hunger Scale (HHS). The HHS assessed for the household food security for the family of each selected child on the street. The scores for the 21 children ranged from 0-3 with the following interpretation(Deitchler et al., 2011): 0-1 = No or little household hunger; 2-3=Moderate Household hunger > 3=Severe household hunger. The descriptive data for the 21 recruited children on the street were displayed in tables using numbers and text and bar chart was used to depict the frequency of assessed health conditions (see chapter 3). 2.9 Ethical considerations The Nigerian (secs 50 & 204 of CRA, 2003) and South African (sec 42(8)(c),Act 38 of 2008) Children's Act, favours vulnerable groups like street children,(Abdulraheem-mustapha, 2016; NHRC, 2003; Richter et al., 2007; Songca, 2019) as such all child-right laws were observed in the conduct of the research. All stipulated ethical principles of autonomy, disclosure, competence, understanding, assent, voluntariness, beneficence, non-maleficence and justice,(Richter et al., 2007; Songca, 2019) were observed in this research. The research information documents, consent, permission and assent forms were structured to capture all the above elements of ethical principles 32 (see Appendix A-D). Ethical approval was sought and obtained from two ethics committees - Institutional Review Board (IRB) in both Nigeria and South Africa, detailed below: 1. University of Ibadan-Oyo State Ministry of Health (Health Management Board) Medical Ethical Review Board (Local IRB) number AD/13/479/4118A, dated 7th April 2021 2. University of Witwatersrand Human Research Ethics Committee (Medical) number- M210424, dated 23rd June 2021. Permissions were obtained from the Oyo State’s urban local government councils offices in all five urban LGAs of Ibadan and from the Oyo State’s child welfare department in the Ministry of Women Affairs and social inclusion at the State secretariat in Ibadan, Oyo state, Nigeria. Universal precaution against COVID-19 was ensured for the research team and all participants. The research information letter(document) was written in simple language for ease of understanding for all participants. English is the official language in Nigeria, understood and spoken by most people, while Yoruba is the predominant local language in Ibadan, South-West Nigeria. Therefore, the research information letters, consent/assent forms, questionnaire and interview guides were translated into the local language (Yoruba) and available for participants with local language preferences. Written consent was required from all adult participants and written assent from each of the selected children on the street. Consent was taken from the participants for interviews, audio recordings and street photographs as applicable. The research group comprised of the author, two research assistants, and a clinical psychologist. Anonymity was ensured during data collection by not requesting for names of participants. The research team ensured confidentiality, by use of only identifiers including serial numbers and location tags for easy reference, particularly for follow- up of children on the street who have identifiable family and health problems or needs. 33 The risks & benefits of the research were clearly explained to all participants to ensure that they are fully aware of the scope of the study. They were made to understand that there are no real risks involved in participating in the study nor would there be any consequences if they choose not to participate in the study. The immediate benefit from this study was the gifting of a hygiene kit consisting of a face mask, hand sanitisers, antiseptic soap, face towel, water bottle, toothbrush and toothpaste for each of the recruited children on the street Additionally, a little financial support was provided for two mothers to initiate healthcare for the two identified physically ill and mentally challenged children on the street. This was because the mothers had consented to the healthcare plan. These two children were not too ill to participate in the research, one was with chronic upper limb congenital shoulder movement limitation while the other had previously undiagnosed mild depressive symptoms. The child with mild depressive symptoms was attended to on-site by the researcher and the accompanying research team psychologist and followed up at the University College Hospital Ibadan, with psychotherapy until full recovery. There was a management protocol for psychological distress on-site, which include stopping the interview, talk therapy between the researcher and participant and appropriate psychotherapy by the psychologist. This was instituted for a mother who was distressed (teary and aggrieved) by the martial separation which underscored her son’s presence on the street. The interview was discontinued to allow her to vent and continued after the mother was relieved of psychological distress after the talk therapy. The researcher followed up with the mother and initiated the available family social and emotional support (in the form of her paternal aunt who resides in the same family home) for her. The mother claimed that she is coping well on a follow-up visit by the lead researcher (a family physician) and the research team psychologist. The psychologic distress protocol was in place prior to the commencement of the field work as detailed in the research 34 proposal and aforementioned. The follow-up psychotherapy (motivational interview) received by this distressed participant was at the expert discretion of the team psychologist after a joint agreed case assessment by the lead researcher and the psychologist. All participants were made to realize that there is hope for long-term benefits such as ameliorations of the challenges of children on the street of Ibadan through actions of relevant stakeholders who would be made aware of the result of this study via publications. Participants were made to understand that there would be no financial incentives provided for participating in the study, except for free referral and initiation of healthcare at the Family Medicine Clinic of the UCH, Ibadan, Nigeria for the few concerned. Risks to the research team such as physical exhaustion was mitigated by scheduling data collection exercise for shorter periods and during favourable weather conditions. As such all the principles of beneficence, justice & non-maleficence were observed by the research team and for the participants. All participants were informed of their autonomy and the right to withdraw from the study at any point in time without any consequences. 2.10 Source of research funding This research was fully sponsored by the Consortium for Advanced Research Training in Africa (CARTA) with a provision of $10,000 available for funding the research. CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Wellcome Trust (UK) (Grant No: 087547/Z/08/Z), the Department for International Development (DfID) under the Development Partnerships in Higher Education (DelPHE), the Carnegie Corporation of New York (Grant No: B 8606), the Ford Foundation (Grant No: 1100-0399), Google.Org (Grant No: 191994), SIDA (Grant No: 54100029) and MacArthur Foundation (Grant No: 10-95915-000-INP). 35 CHAPTER THREE PRELIMINARY RESULTS 36 CHAPTER 3: PRELIMINARY RESULTS 3.1 Introduction This chapter detailed the preliminary results including the general description of participants involved in the four qualitative studies (1,2,3, &4) and the result of analysis of the quantitative data obtained from the children on the street (part of studies 3 &4). 3.2 Description of participants selected for the four studies The table below shows the ages and gender of all fifty-three (53) participants selected for the four studies in each of the 5 urban LGAs. The table also shows the extra two child welfare officers selected from the Oyo state Secretariat central child welfare department. Table 3.1 Participants recruited for four studies (studies 1,2,3, & 4) The keys to Table 3.1 1. yrs.-years 2. WO-Welfare Officer. 3. SO-street Shop/business Owner; *SO-street Shop/business Owner who was previously a child on the street 4. C-Child 5. PP-Paired Parent; PC-Paired Child Study sites Study 1 Study 2 Study 3 Study 4 Child Welfare Officer Age (yrs.) Gender Street Shop Owner Age (yrs.) Gender Child Age (yrs.) Gender Paired Parent Age Gender Paired Child Age Gender WO1 43 Female SO1 56 Female C1 17 Male PP1 42 Mother PC1 16 MaleIDO WO2 52 Female *SO2 35 Male C2 14 Male PP2 40 Father PC2 15 Male WO3 41 Female *SO3 35 Female C3 17+ Female PP3 35 Mother PC3 13 MaleSW WO4 55 Female *SO4 40 Female C4 17 Female PP4 30 Mother PC4 17 Male WO5 46 Female SO5 32 Female C5 15 Male PP5 30 Mother PC5 17+ MaleN WO6 54 Female SO6 30 Male C6 14 Female PP6 52 Mother PC6 16 Male WO7 41 Female *SO7 41 Female C7 15 Male PP7 42 Mother PC7 17 MaleNE WO8 43 Male SO8 28 Male C8 17 Female PP8 38 Mother PC8 15 Male WO9 56 Female SO9 45 Female C9 17+ Male PP9 40 Mother PC9 17+ Male WO10 52 Male *SO10 34 Male C10 17 Male PP10 60 Grandmother PC10 13 Male NW C11 17 Male WO11 37 FemaleState Office WO12 51 Male Total 12 10 11 10 10 37 3.3 Results of quantitative data on Family of children on the street (part of study 3 and study 4) There was no specific objective regarding the quantitative aspect of this research. The quantitative data obtained from the selected children on the streets were complementary data; describing the family composition and socioeconomic aspect of family dynamics, street engagement aspect of lived experiences (activities and time spent on the streets, schooling data) and basic health measures complementing the qualitative health data. This complementary quantitative data aids the appreciation of the urban geography of the phenomenon of children on the streets of Ibadan, Nigeria. The relevance of the quantitative data is expatiated in this thesis reflection in Chapter 8. Table 3.2 below shows the details on family size, parents’ status and the primary custodian of each of the children on the streets of Ibadan that participated in this research. The table shows that 18 of the 21 children are from relatively large size family (with a number of 4 or more children in the family) and some with unwedded cohabiting parents with a history of previous failed “marital” unions. 38 Table 3.2 Family Profile of children on the streets (part of study 3 and study 4) LGA I.D Age (yrs.) Gende r Parent’s marital status Status of parent Child resides with Number of children in the family 1 C1 17 M Polygamous Both alive Both parents Mother-2; Father-4 1 full-sibling 2 half-siblings 2 C2 14 M Monogamous Both alive Both parents 3 3 PC 1 16 M Monogamous Both alive Both parents 4 4 IDO PC2 15 M Monogamous Both alive Both parents 5 5 C3 17+ F Monogamous Both alive Both parents 6 6 C4 16 F Monogamous Both alive Both parents 5 7 PC3 13 M Separated Polygamous Both alive Mother Mother-4; Father;6 3 full siblings 2 half-siblings 8 SW PC4 17 M Widowed Monogamous Mother alive Mother 4 9 C5 15 M Monogamous Both alive Both parents 10 10 C6 14 F Widower remarried Father alive Paternal Uncle 4 11 PC5 17+ M Cohabiting/Unwedde d Both alive Both parents 3 12 N PC6 16 M Separated Polygamous Mum had 2 husbands Both alive Mother Mother-5; Father-5 2-full-sibling 7-Half-sibling 13 C7 15 M Monogamous Both alive Both parents 6 14 C8 17 F Widowed/Polygamous Cohabiting Mother alive Mum & stepdad Mother;4 Father:3 2 full and 1 half- sibling 15 PC 7 17 M Separated Mum had 2 husbands Both alive Mum & step- siblings Father-6; Mother-4 1 full and 5 half- siblings 16 NE PC8 15 M Monogamous Both alive Both parents 6 17 C9 17+ M Monogamous Both alive Both parents 4 18 C10 17 M Monogamous Both alive Both parents 5 19 C11 17 M Monogamous Both alive Both parents 3 20 PC9 17+ M Unwedded/Widowed Polygamous Mother alive Mother Father:7; Mother:2 1 full and 5-half siblings 21 NW PC 10 14 M Unwedded/Widowed Mother alive Maternal Grandma 4 39 Table 3.3 shows the socioeconomic classification, reasons for child streetism, years the child had been in the street and approximate daily earnings in United State Dollars (USD-$). Table 3.3 Socioeconomic Characteristics of children on the streets (part of study 3 and study 4) LGA I.D Age (yrs.) Gender Family’s Wealth Index (WI) Reason for being on the street Years on the street Street Daily Earnings (dollars) @ 1$=410 Naira 1 C1 17 M 2 Need money for school 6 7 2 C2 14 M 1 Hawking Mother’s goods 3 12 3 PC 1 16 M 2 Hawking Mother’s goods 3 11 4 IDO PC2 15 M 3 Hawking Dad’s goods 2 27 5 C3 17+ F 1 My family lack money 10 9 6 C4 16 F 3 Hawking Mother’s goods 10 2 7 PC3 13 M 3 Hawking Mother’s goods 0.5 2 8 SW PC4 17 M 1 Assisting mother to make money 3 2 9 C5 15 M 3 Family lack money 6 3 10 C6 14 F 2 Hustling for money for paternal uncle’s wife 3 6 11 PC5 17+ M 2 Hawking Mother’s goods 4 8 12 N PC6 16 M 2 Hawking Mother’s goods 6 7 13 C7 15 M 2 Assisting mother to make money 2 12 14 C8 17 F 3 Assisting mother to make money 7 2 15 PC 7 17 M 1 Need to earn money to eat what I prefer at home 4 1 16 NE PC8 15 M 1 Lack of no money to feed at home 3 1 17 C9 17+ M 3 Needs money for final secondary school exams 1 9 18 C10 17 M 3 Family lack money 1 .5 9 19 C11 17 M 3 Need money for final secondary school exam