Begging on the streets of Addis Ababa: an impact of musculoskeletal disability

Background: This was a 2-year interventional prospective study aimed at determining the frequency and pattern of musculoskeletal disability among beggars of the streets of Addis Ababa. It was part of a continuous multidisciplinary study that was trying to assess causes of street begging and looked for ways to stop it or at least bring it to 'tolerable' proportions. This part of the study mainly focused on treatable/correctable musculoskeletal disabilities leading to begging on streets in the city. It also assessed the degree, duration and reasons for street begging and determined whether correcting treatable musculoskeletal disabilities stopped beggars from begging or not. The study setting was in Addis Ababa city, in collaboration with C.A.R.D.O.S. Ethiopia. Methods: This was an interventional prospective follow-up study on beggars of the streets of Addis Ababa who claimed musculoskeletal disability as their main cause for begging. A location in a sub city was selected for a reason of hosting the largest number of beggars. In collaboration with the local administrator a clinic was opened amidst the busy street and volunteer street beggars with musculoskeletal disability were recruited for the study. Surgical procedures were performed in 61 'patients' and were followed for two years, from April 2007-April 2009. Some beggars refused a clearly beneficial surgery Results: Our survey revealed there are 1,237 street beggars including the outskirts of 'Entoto' mountain. Nearly two-third of the street beggars were males and age ranged from a week to 90. Of the 204 beggars with musculoskeletal disability, 118 were evaluated to clearly benefit from a successful surgical procedure. The commonest diagnosis was leprosy with its complications recorded in 47 of the 204, followed by bone and joint infections, 13.2 %( 27/204) and complex, unclear congenital anomalies ranked third. Neglected dislocations, mal-united of non-united fractures were observed in twenty (9.8%) of the street beggars. Iatrogenic cause was discovered as a cause of disability in six beggars. Sixty one beggars were operated. The ages for operated cases ranged from 12 to 78 years. The duration of begging in beggars selected for surgery was from 4.5 to 56 years. Corrective amputation, Bone grafting and Sequestrectomy were the commonest procedures in respected order. One patient died due to concomitant cardiac illness. From the whole group 68 patients went back to begging while from the operated group only a single patient recently was found begging in one of the streets in Addis. Conclusion: Musculoskeletal disability may lead to begging. Well-funded, multi-sectoral long-term campaign on begging will possibly reduce it to a 'tolerable' level