Child labor is prevalent worldwide [
Young workers run a higher risk of work injuries arising from lack of experience, limited awareness of existing or potential risks, or immaturity [
Although there is enough research evidencing socioeconomic disparities as a risk factor for unintentional injuries among adolescents (i.e., pedestrian, recreational) [
A household survey conducted by the Palestinian Center Bureau of Statistics in 2000 estimated the number of children within the 10–17 age group at 605,409. The percentage of documented employed children was 5.5% (
Currently, it is estimated that about 40,000 children under 18 are engaged in some form of labor activity in Palestine [
Little information exists on injury and factors associated with injury among Palestinian working schoolchildren. The lack of national data regarding working schoolchildren aged 12–18 years prompted this study to document the prevalence and nature of work related injuries among children as well as to identify sociodemographic factors that predict these injuries.
The selected sample was stratified according to region (West Bank and Gaza Strip), school types (government, private, and UNRWA), and grades (6th, 8th, 10th, and 12th) and it excluded school-aged children who did not attend school. Assuming an average class size of 35 students, the aim was to recruit 4000 students at each grade level, from both regions, to produce a sample size of around 16000 students. A two-stage cluster sampling technique was used with the school as the primary sampling unit. In the first stage, 405 schools were selected randomly with probability proportional to their size (size defined as number of classes in the school). The list of the schools and number of classes in each school, for the academic year 2005/2006, was obtained from the Ministry of Education. All of the randomly selected schools (
The questionnaire was developed using the WHO international HBSC questionnaire (2001-2002) including all mandatory HBSC questions [
In addition to the major variables addressed in the survey (demographics, general health, well-being, family and peer relationships, school environment, lifestyle, exposure to political violence, and mental health) [
Selected schools were informed about the survey by sending a letter to the school principle. All school principals agreed to participate. In each school, the student advisor distributed the questionnaires in the classroom and was instructed to respond to the students’ enquiries about the procedure. School children completed the questionnaires independently during one school period, lasting 45 minutes. The survey was conducted through self-completed questionnaires and data were collected anonymously in the West Bank and Gaza Strip by Al-Quds Nutrition and Health Research Institute (ANAHRI) in Al-Quds University between April and May of 2006. The 2006 Palestinian HBSC survey was approved by Al Quds University Ethical Committee and the Research Ethics Board of the Palestinian Ministry of Education.
Data analysis was performed using the SPSS statistical package version 20 (SPSS Inc., Chicago, IL, USA). Chi-square test was used to compare differences in work status, type of work, and related injuries among adolescents by several sociodemographic characteristics. Univariate and multivariate logistic regression models were used to assess the association between work injury and work intensity, work shift, type of work, and sociodemographic characteristics. Crude and adjusted odds ratios (OR) with 95% confidence intervals (CI) were derived. A significance level of
The average age of the schoolchildren was 15.1 years; 28.4% of them were in grade 6, 26.6% in grade 8, 24.0% in grade 10, and 20.9% were in grade 12. More than half of the working children resided in the West Bank (55.4%) while the rest resided in Gaza Strip (44.6%). A high percentage of parents whose children were employed had low educational levels (70.9% of the fathers and 64.4% of the mothers). Of all respondents, 73.8% (
Approximately half of the children (52.8%) reported working ≥3 hours/day while 47.2% were employed for <3 hours/day. High work intensity was significantly higher among boys than girls (57.4% versus 41.7% resp.;
Sociodemographic characteristics of adolescents according to work status and related injuries in the Palestinian HBSC-2006 study.
Sociodemographic characteristics | Work shift | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Low intensity (<3 h/d) |
High intensity ( |
During school hours | Before school hours | After school hours | On the weekend | End of school semester/academic year | Work related injuries | |||||||||
% |
|
% |
|
% |
|
% |
|
% |
|
% |
|
% |
|
% |
| |
Gender | ||||||||||||||||
Boys |
|
1439 |
|
1941 |
|
514 |
|
420 |
|
823 |
|
658 |
|
654 |
|
2760 |
Girls |
|
807 |
|
578 |
|
240 |
|
185 |
|
262 |
|
303 |
|
165 |
|
1011 |
Grade | ||||||||||||||||
6th grade |
|
650 |
|
702 |
|
274 |
|
186 |
|
330 |
|
241 |
|
155 |
|
1117 |
8th grade |
|
609 |
|
661 |
|
207 |
|
185 |
|
247 |
|
274 |
|
204 |
|
976 |
10th grade |
|
510 |
|
635 |
|
121 |
|
119 |
|
294 |
|
240 |
|
247 |
|
874 |
12th grade |
|
477 |
|
521 |
|
152 |
|
115 |
|
214 |
|
206 |
|
213 |
|
804 |
School ownership | ||||||||||||||||
Gov. |
|
1843 |
|
2019 |
|
607 |
|
507 |
|
890 |
|
756 |
|
661 |
|
3071 |
UNRWA |
|
279 |
|
325 |
|
108 |
|
77 |
|
153 |
|
123 |
|
80 |
|
497 |
Private |
|
124 |
|
175 |
|
39 |
|
21 |
|
42 |
|
82 |
|
78 |
|
203 |
Region | ||||||||||||||||
West Bank |
|
1295 |
|
1345 |
|
399 |
|
289 |
|
590 |
|
536 |
|
509 |
|
2036 |
Gaza Strip |
|
951 |
|
1174 |
|
355 |
|
316 |
|
495 |
|
425 |
|
310 |
|
1735 |
FAS | ||||||||||||||||
FAS 1 (low) |
|
1421 |
|
1417 |
|
465 |
|
369 |
|
653 |
|
562 |
|
478 |
|
2243 |
FAS 2 (moderate) |
|
482 |
|
639 |
|
163 |
|
150 |
|
265 |
|
227 |
|
199 |
|
904 |
FAS 3 (high) |
|
208 |
|
315 |
|
68 |
|
45 |
|
114 |
|
124 |
|
113 |
|
411 |
Father’s education | ||||||||||||||||
Low education |
|
1594 |
|
1784 |
|
553 |
|
410 |
|
785 |
|
691 |
|
581 |
|
2686 |
High education |
|
522 |
|
626 |
|
165 |
|
153 |
|
261 |
|
236 |
|
196 |
|
918 |
Mother’s education | ||||||||||||||||
Low education |
|
1457 |
|
1614 |
|
522 |
|
410 |
|
690 |
|
597 |
|
509 |
|
2429 |
High education |
|
689 |
|
819 |
|
201 |
|
169 |
|
367 |
|
329 |
|
282 |
|
1214 |
Table
Sociodemographic characteristics of adolescents according to type of work in the Palestinian HBSC-2006 study.
Type of work | Gender | Grade | School ownership | Region | FAS | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Boys | Girls | 6 G | 8 G | 10 G | 12 G | Gov. | UNRWA | Private | West |
Gaza Strip | FAS 1 (low) | FAS 2 (moderate) | FAS 3 (high) | |
Agricultural production | ||||||||||||||
% |
|
14.2 |
|
17.8 | 19.9 |
|
|
15.7 | 19.8 |
|
18.3 | 18.1 | 21.2 |
|
|
966 | 317 | 365 | 307 | 321 | 290 | 1076 | 129 | 78 | 781 | 502 | 714 | 317 | 163 |
Retail trade | ||||||||||||||
% | 46.0 |
|
49.3 | 52.7 |
|
50.1 | 51.3 |
|
47.3 | 48.9 |
|
|
49.1 | 47.9 |
|
1948 | 1377 | 857 | 908 | 868 | 69.2 | 2691 | 448 | 186 | 1818 | 1507 | 2120 | 732 | 336 |
Street traders | ||||||||||||||
% |
|
5.7 | 7.1 |
|
5.0 | 5.7 | 6.8 |
|
5.6 | 6.7 | 6.9 | 6.4 |
|
6.4 |
|
307 | 128 | 123 | 153 | 81 | 78 | 354 | 59 | 22 | 247 | 188 | 254 | 102 | 45 |
Tool maintenance work | ||||||||||||||
% |
|
2.0 |
|
3.3 | 2.9 | 3.8 | 3.5 |
|
|
3.4 |
|
3.0 |
|
3.3 |
|
182 | 45 | 72 | 56 | 47 | 52 | 181 | 31 | 15 | 127 | 100 | 119 | 69 | 23 |
Cleaners | ||||||||||||||
% |
|
2.9 |
|
3.2 | 2.2 | 2.2 | 2.9 |
|
3.3 | 2.9 |
|
2.7 |
|
2.7 |
|
138 | 66 | 84 | 55 | 35 | 30 | 150 | 41 | 13 | 106 | 98 | 107 | 59 | 19 |
Movement of goods | ||||||||||||||
% |
|
1.2 | 2.9 | 2.4 |
|
2.4 | 2.8 | 2.7 |
|
2.7 |
|
2.8 |
|
2.7 |
|
158 | 27 | 51 | 41 | 60 | 33 | 146 | 22 | 17 | 102 | 83 | 111 | 50 | 19 |
Building construction/maintenance | ||||||||||||||
% |
|
1.0 | 2.1 | 2.0 |
|
3.0 | 2.4 | 2.3 |
|
|
1.9 | 2.3 | 2.7 |
|
|
145 | 22 | 36 | 35 | 54 | 42 | 128 | 19 | 20 | 116 | 51 | 91 | 41 | 25 |
Workshops like carpenting, mechanics, aluminum | ||||||||||||||
% |
|
0.7 | 1.0 |
|
1.5 |
|
1.5 | 1.2 |
|
|
1.1 | 1.4 |
|
|
|
84 | 16 | 17 | 32 | 25 | 26 | 77 | 10 | 13 | 70 | 30 | 55 | 25 | 12 |
House work | ||||||||||||||
% | 6.9 |
|
7.8 | 7.8 | 7.7 |
|
|
7.8 | 7.4 |
|
6.7 |
|
6.5 | 7.7 |
|
290 | 242 | 135 | 135 | 125 | 137 | 439 | 64 | 29 | 347 | 185 | 367 | 97 | 54 |
Table
Type of work according to type of injury in the Palestinian HBSC-2006 study.
Type of work | Type of injury | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Back pain | Muscle pain | Injuries, deep scratches, or wounds | Bone fractures | Eye injuries | Exposure to poisonous or burn-causing materials | Other, specify | ||||||||
|
% |
|
% |
|
% |
|
% |
|
% |
|
% |
|
% | |
Agricultural production | 423 |
|
178 | 13.9 | 137 | 10.7 | 92 | 7.2 | 66 | 5.1 | 30 | 2.3 | 117 | 9.1 |
Retail trade | 814 | 24.5 | 398 | 12.0 | 317 | 9.5 | 213 | 6.4 | 141 | 4.2 | 69 | 2.1 | 472 | 14.2 |
Street traders | 72 | 17.7 | 49 | 11.3 | 35 | 8.0 | 21 | 4.8 | 22 | 5.1 | 5 | 1.1 | 66 | 15.2 |
Tool maintenance work | 45 | 19.8 | 30 | 13.2 | 47 |
|
29 | 12.8 | 21 | 9.3 | 6 | 2.6 | 13 | 5.7 |
Cleaners | 43 | 21.1 | 28 | 13.7 | 27 | 13.2 | 33 |
|
27 |
|
8 | 3.9 | 19 | 9.3 |
Movement of goods | 47 | 25.4 | 33 | 17.8 | 25 | 13.5 | 18 | 9.7 | 14 | 7.6 | 7 | 3.8 | 20 | 10.8 |
Building construction/maintenance | 42 | 25.1 | 33 |
|
14 | 8.4 | 15 | 9.0 | 10 | 6.0 | 4 | 2.4 | 20 | 12.0 |
Workshops like carpenting, mechanics, aluminum | 19 | 19.0 | 15 | 15.0 | 20 | 20.0 | 10 | 10.0 | 8 | 8.0 | 5 |
|
7 | 7.0 |
House work | 158 | 29.7 | 59 | 11.1 | 34 | 6.4 | 29 | 5.5 | 11 | 2.1 | 10 | 1.9 | 97 |
|
Table
Crude and adjusted
Crude OR | 95% CI | Adjusted OR | 95% CI | |
---|---|---|---|---|
Work intensity | ||||
h/d | 1 | 1 | ||
|
|
1.53–1.95 |
|
1.11–1.54 |
Work shift | ||||
End of school semester/academic year | 1 | 1 | ||
During school hours |
|
1.93–3.18 |
|
1.80–3.12 |
Before school hours |
|
1.77–3.09 |
|
1.63–3.01 |
After school hours |
|
1.43–2.16 |
|
1.30–1.94 |
On the weekend |
|
1.25–1.85 |
|
1.31–1.90 |
Type of work | ||||
Agricultural production | 1 | 1 | ||
Retail trade |
|
1.37–1.89 |
|
1.35–1.92 |
Street traders |
|
1.98–3.21 |
|
1.96–3.34 |
Tool maintenance work | 0.82 | 0.56–1.20 | 0.77 | 0.49–1.19 |
Cleaners |
|
0.27–0.73 |
|
0.28–0.83 |
Movement of goods |
|
0.34–0.89 | 0.69 | 0.42–1.12 |
Building construction/maintenance | 0.91 | 0.59–1.39 | 1.01 | 0.64–1.59 |
Workshops like carpenting, mechanics, aluminum | 0.83 | 0.47–1.44 |
|
0.53–1.71 |
House work |
|
1.15–1.86 |
|
1.07–1.80 |
Gender | ||||
Girls | 1 |
|
||
Boys |
|
1.66–2.10 |
|
1.32–1.84 |
Grade | ||||
6th grade | 1 |
|
||
8th grade |
|
0.55–0.76 |
|
0.41–0.65 |
10th grade |
|
0.53–0.73 |
|
0.38–0.60 |
12th grade |
|
0.66–0.94 |
|
0.46–0.74 |
FAS | ||||
FAS 1 (low) | 1 |
|
||
FAS 2 (moderate) |
|
0.79–0.93 | 0.93 | 0.85–1.02 |
FAS 3 (high) |
|
0.75–0.95 | 0.94 | 0.82–1.06 |
Region | ||||
West Bank | 1 |
|
||
Gaza Strip |
|
1.08–1.37 | 1.15 | 0.99–1.35 |
Father’s education | ||||
Low education | 1 |
|
||
High Education | 0.97 | 0.89–1.06 | 1.02 | 0.92–1.12 |
Mother’s education | ||||
Low education | 1 |
|
||
High education | 0.98 | 0.82–1.18 | 0.95 | 0.80–1.10 |
CI: confidence intervals; OR: odds ratio; FAS: family affluent scale.
According to the authors’ knowledge, this is the first national survey to document the labor experiences of Palestinian schoolchildren. More specifically, 73.8% of the students reported being engaged in labor during the past 12 months. Moreover, among Palestinian schoolchildren workers, 47.1% reported working less than three hours daily (less than 15 hours weekly if extrapolated over five work days) and 52.8% more than three hours daily (more than 15 hours weekly extrapolated over a typical work week). Data for 6th, 8th, 10th, and 12th grade Palestinian workers indicate similar patterns. In comparison with data from the National Longitudinal Study of Adolescent Health (Add Health) in 1996 which indicated that less than 8% of 10th graders, 20% of 11th graders, and 46% of 12th graders worked more than 19 hours per week during the school year [
The high prevalence observed among Palestinian working children may be due to the high overall unemployment rate observed in the West Bank (44%) and in the Gaza strip (72%) populations which are below the poverty line [
This study found that out of those who reported working, 79.1% (boys 81.7% versus girls 73.0%) suffered from occupational injuries. This prevalence of injuries was higher when compared with Lithuanian school adolescents (59% among boys and 40% among girls) [
Our findings from this study indicate that youth employed more than three hours daily (high intensity workers) were approximately 1.3 times more likely to experience an occupational injury than students working fewer than three hours a day. Several studies have revealed that extensive employment during the school year may have deleterious consequences on young workers [
We found that most of the schoolchildren work was of an informal nature in the retail trades, agriculture, and clerical/cleaning positions. By comparison, in the U.S. slightly more than half of 15- to 17-year-olds are employed in the retail sector (restaurants, grocery stores). Another one-quarter of them work in the service industry while slightly more than one-fifth work in agriculture, manufacturing construction, and other trades [
In a study of working children in Nigeria, almost half reported street trading while one-quarter worked in retail and another one-quarter in farming [
The present study indicates that Palestinian schoolchildren are more frequently injured while working in retail trades, such as grocery stores, food establishments, street vending (around one half of all injuries), and agriculture (about one-fifth of the total injuries), and in service positions, such as house cleaning and clerical work (11.4%). In the U.S., also, retail trades produce about half of all injuries to working youth followed by service jobs (one-fifth of the total injuries), agriculture, and manufacturing (11%) [
Greater numbers of Palestinian boys reported working compared to girls and with more hours daily. These results are not surprising and are supported by the findings of several nationally representative studies conducted in the U.S.; across the board, these investigations note differences in the prevalence and intensity of work by gender [
Among Indian child laborers, girls began working one-two years before boys. By the age of 15, however, more boys than girls were working and about one-quarter of the boys in this Indian study worked for more than 10 hours daily [
Boys appear to be more likely to sustain an injury at work than girls. This study found that Palestinian boys were 1.6 times more likely to be injured than girls. Numerous other investigations of youth work also find an injury rate for boys that is about twice that of girls [
The present study indicated that younger children (6th graders) were more likely to experience a work injury than older ones (8th, 10th, and 12th graders). Although the U.S. national studies and those at the state level showed similar patterns of injury by age, older US children sustained more injuries (85% of all nonfatal work related injuries occur in 16- and 17-year-olds) than younger children[
Type of work, however, does not appear to explain this discrepancy as about half of all workers in this study, regardless of grade or age, worked in retail, the category of work least likely to result in a work injury. Another fifth of all workers, again regardless of grade/age, were employed in agriculture, a type of work that frequently produces injuries in workers of any age. We may only theorize that their lack of experience, premature cognitive and developmental systems, undeveloped judgment, more immature psychosocial and emotional development, and the pressure of balancing the demands of school and work could play a role in the incidence of work related injury in these younger youth [
Among Palestinian adolescents, common reported injuries were strains and sprains (about one-half of all injuries), cuts/bruises/lacerations and fractures, which make up about one-fifth of all injuries, and eye injuries and poisoning, which comprise small percentages of the total injury amount. Similar patterns are seen among U.S. youth where the most common nonfatal injuries in order of decreasing prevalence are lacerations (about one-third of all injuries), contusions or abrasions (almost one-fifth of the total injuries), sprains and strains (slightly less than one-fifth), and burns and fractures (slightly less than one-fifth) [
Several cautions should be noted in interpreting study results: (1) data represent workers attending school during April-May, 2006, and do not include the large numbers of Palestinian children who are not enrolled in school; (2) results from this study are based on self-reported data and thus are subjected to accuracy of recall; (3) cutoff points for daily work hours were arbitrarily set and limited to the categories used in this analysis (<3 hours/day; >3 hours/day).
This is the first national study in Palestine to examine the prevalence and characteristics of work related injuries among schoolchildren. Our results both replicate and contradict the findings of other studies on the same topic among very different young populations. In view of our findings and those of other studies, we believe that parents, policymakers, and professionals involved with schoolchildren should carefully monitor the work circumstances of this exceedingly vulnerable population. Increased efforts are needed to reduce labor injuries. Since children need to work to supplement their family income, they must be trained and monitored with special emphasis on the youngest as they are the most vulnerable. Working schoolchildren, parents, employers, medical providers, and school personnel should be targeted for education, training, and counseling about health and safety hazards and safeguards as well as workplace rights and responsibilities for working schoolchildren. More qualitative research is needed for in-depth understanding of the main reasons behind the high percentage of adolescents’ labor in order to find out the appropriate interventions to reduce work related injuries.
The authors declare that there is no conflict of interests regarding the publication of this paper.
This survey was supported by grants from USAID MERC program, Grant no. TA-MOU-00-M20-051. The study was conducted by the Al-Quds Nutrition and Health Research Institute (ANAHRI) at Al-Quds University. The authors thank the Palestinian Ministry of Education for their assistance in the data collection procedure as well as the Greek Scholarship Foundation (IKY) for its financial support during writing the paper.