TITLE: Health Status of Children living in Orphanages

of Peshawar, Pakistan.

INTRODUCTION:

Children are the most vulnerable to the adverse effects of crisis and conflicts
that happen around the world. Child population makes up 2.2 billion of 7 billion
world populations. And 143 to 210 million of child population are orphaned.
There are an estimated 8 to 10 million infants and children living in orphanages
around the world. The regions where most orphans reside are Asia, Africa Latin
America and the Middle East. (1,2). The practice of placing deprived children in
orphanages has long been prevailing in socio-economically poor Asian
countries. (3)
According to UNICEF report, Pakistan is home to some 4.2 million
orphaned children. The current adoption process in Pakistan discourages the
taking in of orphans, who are left to mercy of the State or the private charities. (4)
UNICEF study by Deininger et al (2003) reports that orphans are more likely to
be underdeveloped in their growth and less likely to be enrolled in school than
children living with both parents. Poor nutrition and incomplete access to health
services put orphans at increased risk of starvation, illness and death. (5)
Children in orphanages suffer from malnutrition and infectious diseases and
malnutrition leads to immune-compromised state resulting in recurrent and
increasingly rigorous infections, which further compromise nutritional intake
and ultimately may threaten the child’s survival. (6,7)
According to studies conducted in other developing countries, malnutrition,
physical or mental abuse, food insecurity as well as lack of parental care and
protection are predominantly common scenarios among the children living in
orphanages. (8,9) As there hasn't been any research done before on health status of
children in orphanages of Pakistan, so we felt the need to conduct this study,
“Health status of children living in orphanages of Peshawar, Pakistan.”. Its aim
is to determine the health profile of children sheltered in orphanages of
Peshawar and highlight the pros and cons associated with it.
OBJECTIVES:
1. To assess the nutritional status of children living in orphanages by
anthropometry.
2. To clinically assess their general physical health status.
3. To assess their visual acuity.
4. To assess their oral and dental hygiene.

METHODOLOGY:
A cross-sectional descriptive study was conducted at 3 of the orphanages of
Peshawar. Study was conducted from 19th Nov’ 18 to 31st Jan’ 19 and a sample
size of 300 was calculated of children from age 5 to 15 years old through
EpiInfo 7, but it was reduced to 266 after fieldwork up and data cleaning. The
orphanages were chosen through Non-probability purposive convenience based
sampling and our participants were selected through Randomized sampling.
Ethical approval was taken from Institutional Review Committee. An informed
written consent was taken to collect data was from the heads of respective
orphanages and informed assent was taken from the participants. Data was
collected using modified WHO healthcare proforma. Through this proforma we
assessed the BMI by taking weight using bathroom scale in KG and height
using measuring tape in meters. Visual acuity was assessed through Snellen’s
chart and Pinhole test was performed. Signs of pallor and jaundice, general and
dental hygiene, ear and skin conditions, and vaccination marks were checked.
Data was entered and analysed using SPSS ver.19.

ETHICAL CONSIDERATION:
1. Approval from ERC was taken.
2. Letter of facilitation was submitted to the orphanage administrators.
3. Informed written consent was taken from the administrators. The verbal
assent was taken from the participants.
4. The participants of the study were children who were respected and their
privacy was kept.
5. Any child that needed referral was referred to a hospital and arrangements
were made for those in need of supplements and spectacles.
RESULTS:
Of the total 266 participants we assessed, 58.6% fall under the malnutrition
classification of BMI by WHO, of which 57.1% were in the category of
underweight and 1.5% fell under the overweight category. 30.5% participants
showed signs of anaemia/pallor and only 0.4% had jaundice. 21.4% participants
had decreased Visual acuity, of which 17.3 % had refractive errors. 28.6% had
excessive ear wax and 11.3% had history of ear discharge. 23.4% had different
skin conditions. 37.6% had dental gross deposits, 3.1% had bad breath, 7.1%
suffered from bleeding gums and 29.3% from dental carries. Lastly, 54.5%
participants did not show vaccination mark.

Table:1
BMI Calcification
Total Partcipants Underweight Normal Overweight
266 57.1% 41.4% 1.5%

Table: 2
Visual Acuity
Total Participants Normal Decreased Pinhole sign Positive
266 78.6% 21.4% 17.3%

Table: 3
Signs of Pallor and Jaundice
Total Participants Negative Signs Signs of Pallor Signs of Jaundice
266 60.1% 30.5% 0.4%

Table: 4
Ears Conditions
Total Participants Excessive Earwax Ear Discharge
266 28.6% 11.3%
Table: 5
Skin Conditions
Total Scabies Boils and Itches Rashes
Participants Furuncles
266

Table: 6
Dental Hygiene
Total Gross Bad breath Bleeding Carries
Participants Deposits Gums
266 37.6% 3.1% 7.1% 29.3%

Table: 7
Vaccination Mark
Total Participants Mark Present Mark Absent
266 45.5% 54.5%

DISCUSSION:

CONCLUSION:
Majority of the children residing in orphanages were malnourished and suffer
from different disorders related to eyes, skin and teeth. The orphanages should
attend to health care needs of their children. Also majority are non-vaccinated at
birth which put them at greater risk of attaining diseases, for which the
orphanages should have them vaccinated.
REFERENCES:
1. The Washington Post. Orphanages are no place for children.
<https://www.washingtonpost.com/opinions/orphanages-are-no-place-for-
children/2013/08/09/6d502fb0-fadd-11e2-a369-d1954abcb7e3_story.html?
utm_term=.961b0aa487c5> (2013, Aug 9)

2. Kavak H. Z., Report on world orphans, IHH Humanitarian and Social

Researches Center, 2014.

3. Mashkoor AL & Ganesan P (2016). Health and nutritional status of orphan

children’s living in orphanages with special reference to the distric of Anantnag
of Jammu and Kashmir. Inter J Indian Psychol 3(2): 163-169.

4. The Nation. Pakistan's Orphans. <https://nation.com.pk/22-May-

2016/pakistan-s-orphans> (2016, May 22)

5. Deininger et al. (2003) "AIDS-Induced Orphanhood as a Systemic Shock:

Magnitude, Impact, and Program Interventions in Africa", World Development,
31(7), p1201-1220

6. Duggal S, Chugh TD, Duggal AK. 2012. HIV and malnutrition: effects on
immune system. Clin Dev Immunol 2012:784740. doi:10.1155/2012/784740.

7. Flank D, Klass P, Earls F and Eisenberg L. Infants and young children in

orphanages. One view from Pediatrics and child psychiatry.1996,97(4),569-578.

8. Madumita Banik PC, Mondol R, Rahman MA & Khan MAM (2017).

Assessment of nutritional status of a government girls orphanage in Tangail
District of Bangladesh.SMU Medical Journal 4 (1):79-87

9. Vaida N. Nutritional Status Of Children Living In Orphanages In District

Budgam, J&K. Int J Humanities & Social Science Invention. 2013;2(2):36–41.