Literature review

The medicinal utility of a medicine is contingent upon its legal status and may vary [20]. The act of using a pharmaceutical substance to treat an ailment, mitigating the risk of a sickness, or enhancing overall well-being is sometimes referred to as “drug use.” However, when a substance is consumed for purposes unrelated to medical treatment, in quantities, potencies, frequencies, or methods that result in impairment of an individual’s physical or mental capabilities, it is classified as ‘substance abuse’ [20]. Various types of medicines and other legally available solvents have the potential to be subjected to misuse, including those that are prescribed for medical purposes.

Despite receiving much low attention [17], especially among the marginalized groups [21], [22, 23] substance use problems are on the rise not only in the US [24] but globally [25–29] as well as in many low-developed countries[23, 30] it is not all the members of the marginalized groups that develop substance abuse [31]. Drugs and medicine use can be induced by cultural, religious, and traditional medicinal use as in home remedies and economic pressures where the vulnerable and underprivileged service such drugs to cope with energy demands in their jobs [32] and to evade harsh realities of life [17, 33, 34]. Some kids live on the street because of homelessness, [35] have been overtaken by drug abuse. Lack of basic needs and parental guidance [35] in Nigeria, family financial pressures in Pakistan [36] social exclusion in Asians [37], social isolation in Delhi [38], short-term psychosocial and physiological gratification [39] peer influence in Gambia [40] catalyze drug and substance abuse among street kids.

Depression is a common challenge among the youths in Malawi, leading to adverse coping strategies [4, 13], with tobacco, alcohol, and marijuana being typical, among others [1, 3]. In alternative geographical locations such as India, the substances most frequently subject to misuse include alcohol, marijuana, heroin, bhang, hashish, different types of cough syrups, sedative pills, brown sugar, cocaine, tobacco [20], glue in Pakistan [36], and various solvents and inhalants in Bangladesh [39].

Street kids sometimes suffer rape [41], kidnapping, violence among themselves and from the community, police arrests, exploitation from the community, robbery, low immunity [41], and various other forms of abuse [36]. Despite adequate awareness about street life and associated dangers, the kids continue living this dangerous life because there are no viable options [36] live in cliques or gangs within which members protect each other against external forces and also take care of each other in many cases [36], and share the resources such as the drugs and substances.

However, the Malawian scenario has focussed much on the wrong things the kids do, neglecting what they also go through, thereby endangering their lives more. Locally, studies indicate a link between drug use and sexual risk behaviors among youths in Malawi [1, 3, 4]. The presence of ecological variables facilitated the engagement in hazardous behaviors through resource availability [3], the presence of supporting norms endorsed the view that drug use increased one’s capabilities [3], cultural endorsements [4], the absence of inhibitory factors, community-level poverty [4], interpersonal pressures, early initiation of drug use, and school dropout [4]. Other factors inducing drug abuse include accessibility to the resources [1]. Contrary to the professional teacher’s moral responsibility of supporting and enhancing retention [42] teachers’ sour relationships with learners induce school dropout [43–45], which is correlated with substance abuse [46, 47].

Individuals suffering from drug and substance abuse frequently have a range of accompanying health complications [4], including ailments such as pulmonary or cardiovascular disorders, cerebrovascular incidents, neoplastic growths, and psychiatric disorders [18], with detrimental consequences of prolonged substance abuse on the overall physiological well-being of the individual [18, 29]. Dealing with street kids through policing and strict law enforcement proved unpleasant in a study by Ribeiro [48].

Theoretical framework

Various researchers have studied substance and drug abuse using different theoretical models [49], the Social Stress Model [22], and ecological models [4]. In contrast, others have narrowed down to a particular aspect of a model, such as Competence [50]. The theories are either biological (genetic or metabolic), psychological (inadequacy personality, self-derogation perspective, problem behavior proneness), sociological (routine activities, anomie, subcultural, social control, self-control, social disorganization, social learning, conflict theory) [49, 51, 52].

The theoretical framework guiding this study draws from phenomenology and symbolic interactionism. Within this context, phenomenology informs the qualitative inquiry by exploring participants’ subjective experiences and consciousness related to substance abuse. It focuses on understanding how street kids perceive and make sense of their world, shedding light on their lived realities concerning substance use.

In tandem, symbolic interactionism enriches the framework by spotlighting the significance of interactions, meanings, and symbols in shaping individuals’ behaviors and identities within their social contexts. This theoretical perspective underscores the importance of examining how street kids interpret and assign meaning to substance use within the framework of their social interactions and environments.

By integrating phenomenology and symbolic interactionism, this research framework aims to delve deeply into the subjective experiences and social dynamics surrounding substance abuse among street kids in Malawi, recognizing the interplay between personal experiences, interpretations, and social interactions within their lived environment.

Design

This study was conducted in Malawi, a developing country [53] east of Zambia, south of Tanzania, and west of Mozambique [54, 55]. This study employs a qualitative research design centered around in-depth semi-structured interviews as the primary data collection method. The research design emphasizes a qualitative exploration, focusing on the richness and depth of narratives obtained through these interviews. By engaging street kids in Malawi through this method, the aim is to unearth nuanced perspectives, lived experiences, and personal insights related to substance abuse within their community. The qualitative nature of this design allows for a profound exploration of subjective experiences and contextual influences shaping substance abuse among street kids.

Aligned with an interpretivist research philosophy, the study recognizes and embraces the subjectivity inherent in individuals’ experiences and perceptions regarding substance abuse. The interpretivist philosophy underpins the belief that reality is socially constructed, emphasizing the importance of understanding the unique interpretations and meanings attributed by street kids to their experiences with substance abuse. This philosophy advocates for a qualitative approach that prioritizes exploring the complexities and intricacies of lived experiences, in line with the nature of in-depth semi-structured interviews.

Instrument validity and reliability

The questionnaire designed for this study (S1 Appendix) underwent a rigorous content validation process, pilot testing, and subsequent analysis to ensure its effectiveness and reliability in capturing the intended information. Content validation constituted the initial phase of questionnaire refinement. A panel of subject matter experts, comprising individuals with substantial experience in the field pertinent to the study’s focus, meticulously scrutinized the questionnaire’s items. Their primary objective was to assess whether the questions comprehensively covered the targeted constructs and aligned with the study’s objectives. Through thorough discussions and evaluations, adjustments were made to refine the questionnaire, ensuring its relevance and accuracy in measuring the intended parameters.

A pilot test was conducted following content validation to gauge the questionnaire’s applicability and comprehensibility. A subset of the intended participant pool was administered the questionnaire, and their responses were assessed for clarity, coherence, and any ambiguities in the questions. Feedback from the pilot test participants facilitated the identification of potential issues, enabling necessary modifications to enhance the questionnaire’s readability and relevance.

Upon completion of data collection using the refined questionnaire, a meticulous analysis was undertaken to verify its reliability and efficacy.

A reliability test was conducted to assess the internal consistency and reliability of the interview guide, using Cronbach’s alpha coefficient, a commonly employed measure of internal consistency. The questionnaire items were analyzed for their correlation with each other to evaluate the overall reliability of the instrument. The Cronbach’s alpha coefficient for the interview guide was 0.78, indicating moderate internal consistency among the items. This coefficient suggests that the questionnaire items, when combined, demonstrate a satisfactory level of reliability in measuring the constructs related to societal, economic, and environmental dynamics, personal experiences, social interactions, interventions, and additional insights into substance abuse among street children in Malawi.

Additionally, the obtained responses were meticulously scrutinized to determine the questionnaire’s ability to capture the intended constructs accurately. The questionnaire’s validity and effectiveness in measuring the targeted parameters were affirmed through comprehensive analysis, ensuring its suitability for the study’s objectives.

This sequential process of content validation, pilot testing, and subsequent analysis fortified the questionnaire’s robustness and credibility, establishing its reliability in eliciting pertinent information aligned with the study’s focus.

Data collection

Data collection commenced on July 12, 2023 and ended on October 13, 2023 and three sampling techniques were used: Convenient, purposive, and targeted snowball sampling.

Convenience sampling was employed to access street kids in easily reachable areas such as bustling markets, transportation hubs, and areas known for high street kid activity in Lilongwe, Zomba, and Blantyre. This approach aimed to engage with readily available participants who were likely to have experienced or observed the phenomenon [56–58] of substance abuse within their street communities. Researchers identified critical locations frequented by street kids based on local outreach programs and reports from social workers. Upon locating these areas, researchers approached street kids, explained the study’s purpose, and invited their participation.

A challenge was the potential bias in the sample due to accessibility issues. To mitigate this, efforts were made to diversify sampling locations and times, ensuring broader representation. The second challenge was that, initially, there was an apparent distrust among street kids. To mitigate this, rapport-building exercises were conducted to foster trust and comfort, involving interactions without immediately delving into the study.

Purposive sampling targeted street kids who had direct experiences or close exposure to substance abuse within their communities [59]. This approach aimed to capture nuanced and detailed insights from individuals familiar with the issue. With purposive sampling, social workers and community leaders familiar with street kids were consulted to identify individuals who could provide valuable insights. Participants with varying street life experiences and lengths were approached for interviews through referrals and recommendations.

However, data collectors experienced challenges related to limitations in sample size due to the specific criteria for participant selection. To address this, extensive networking and collaboration with local NGOs and community leaders were undertaken to widen the pool of potential participants. Besides, some initially identified participants were reluctant to engage due to apprehension or fear. To mitigate this, a gradual approach was adopted, emphasizing confidentiality and the non-judgmental nature of the study.

Due to its for its convenience and flexibility, especially useful in recruiting participants from hard-to-reach populations [60], snowball sampling was instrumental in reaching more isolated or less visible street kids who might not frequent typical gathering spots. It sought to leverage networks within the street community for referrals to individuals with diverse experiences. Seeds were established through convenient and purposive samples who were asked if they knew individuals not readily accessible in mainstream areas. These seeds were encouraged to refer peers or acquaintances who might have valuable insights [60] into substance abuse among street kids. Still more, the challenge was the limited number of referrals obtained. To address this, efforts were made to deepen relationships with initial contacts and foster a sense of trust to encourage more referrals. Besides, verifying information about the referred individuals’ experiences posed a challenge due to the nature of referrals. To mitigate this, triangulation of data from multiple sources and cross-referencing information with other participants’ narratives were employed to enhance reliability.

Moreover, continual adjustments and flexibility were exercised to accommodate the dynamic and transient nature of the street kid population in these regions. For referrals from the welfare personnel, getting adult consent from the people looking after them was easy.

Data processing

Ethical standards

We obtained ethical approval from a Research Ethics Committee with approval number Ref No: MZUNIREC/DOR/22/55. We highly regarded ethical considerations in this study since it involved minor participants, especially those staying away from their parents or guardians. Informed consent procedures were followed, ensuring the minors and their guardians were informed about the study’s purpose, procedures, risks, and benefits in age-appropriate language.

Assent: The minor’s agreement to participate, was obtained if they could understand the study, while parental or guardian consent was sought. Guardianship for the participants fell into three categories: Some kids stayed with their parents on the streets. In that case, such parents consented to the study. Others were under the care of non-governmental organizations, while the rest were free rangers who either told us how to find their parents in the villages, or could not trace them.

We ensured strict confidentiality measures to protect the identity and privacy of the minor participants. Personal information was kept confidential and shared only among authorized personnel involved in the study. Emphasis was placed on respecting minors’ autonomy to participate or withdraw from the study without coercion or pressure. Measures were taken to ensure that participation was voluntary and that juveniles were not unduly influenced or compelled to participate in the research. Some minors were staying away from their parents or guardians, so extra sensitivity was exercised to ensure their safety, well-being, and emotional comfort during interviews or interactions.

The study adhered to legal requirements and institutional guidelines regarding research involving minors, ensuring compliance with ethical standards and regulations. Collaboration with local NGOs, community leaders, and relevant authorities helped navigate the ethical complexities of involving children living away from their parents. It ensured that their interests and well-being were prioritized. For all the participants whose parents were also living on the streets, it was much easier to get consent to interview their kids, just like those kids under the custody of an organization. However, such parents usually demanded some money before we could interview their kids. This was understandable since the parents were also very destitute on the streets. On the contrary, some street kids stay far away from their homes or parents. For those kids who could help us find their original homes or schools attended before they lived on the streets, we traced their parents either directly or through their previous schools for consent. Due to the complexity of tracing their villages, the District Commissioners helped trace the traditional leaders who led us to the parents/guardians’ homes. The kids whose guardians were minors or whose parents or guardians could not be traced were not interviewed.

Data analysis

The qualitative data collected from in-depth, semi-structured interviews with street children in Malawi underwent a meticulous thematic analysis to extract and elucidate thematic patterns within their sociocultural context. This analytical journey commenced with a deep immersion into the raw textual data from interview transcriptions. Researchers extensively engaged in repeated readings and familiarization exercises, cultivating a profound understanding of the narratives that conveyed the substance abuse experiences articulated by street children.

The subsequent step involved systematically segmenting data into meaningful units through initial coding. These units encapsulated substantive elements related to substance abuse experiences, perceptions, and socio-contextual nuances expressed by the street children. Through a rigorous thematic coding process, data segments were grouped, categorized, and organized into preliminary themes. Iterative refinement and revision were vital, ensuring comprehensive coverage of diverse substance abuse narratives capturing the essence of experiences, interpretations, and socio-contextual influences.

Themes underwent critical review, refinement, and precise definition to ensure coherence, relevance, and distinctiveness. Careful scrutiny of thematic content against the original data substantiated interpretations and ensured alignment with the substance abuse experiences conveyed by the street children. Subsequently, a hierarchical coding structure was formulated, organizing the refined themes into a coherent framework. This structured representation illustrated interrelationships and subordination among themes, establishing a comprehensive and systematic architecture for interpreting substance abuse narratives.

Each refined theme underwent comprehensive elaboration, including detailed descriptions and direct data exemplifications. This process contextualized and substantiated thematic content, firmly anchoring interpretations within the substance abuse experiences narrated by the street children. The finalization and integration of themes resulted in a cohesive narrative that reflected the rich tapestry of substance abuse experiences among street children in Malawi. This thematic map encapsulated diverse dimensions, nuances, and salient aspects of substance abuse narratives.

Table 1 is an overview of the demographic characteristics of this qualitative study’s participants. It provides a detailed portrayal of the diverse socio-demographic attributes, offering a nuanced understanding of the contextual backdrop against which substance abuse experiences among street children were explored.

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Table 1. An overview of the demographic characteristics of the participants.

https://doi.org/10.1371/journal.pone.0304353.t001

The demographic descriptions encompass various sociocultural, economic, and contextual facets, including age, educational background, and length of street residency, as pertinent socio-economic indicators. These descriptors serve as foundational elements in contextualizing the narratives and experiences shared by the participants, shedding light on the intersectionality of their backgrounds and the dynamics influencing substance abuse within their lived environments.

The table outlines the profiles of fifteen street children engaged in substance abuse in Lilongwe, Zomba, and Blantyre. The participants’ ages range from 10 to 16 years old. Education levels vary from never attending school to reaching grade 6. The initiation into drug use varied, with influences such as peer pressure, fitting in, protection, comfort, and parental influence.

Commonly used substances include marijuana, glue, alcohol, bostic, paraffin, and paint. The duration of street residence varies, with some born into street life. Participants were often involved in crimes like stealing, fighting, robbery, and, in some cases, more severe offenses like rape.

Reasons for being on the street varied, including parental issues like shouting or blaming, rejection from social groups, feeling born into street life, seeking emotional security, and needing companionship or belonging. These street children had diverse backgrounds but shared a commonality in experiencing neglect, abuse, or emotional distress, leading them to seek solace in substance abuse and street life.

This comprehensive demographic overview enriches the study’s contextual understanding and lays the groundwork for comprehending the diverse perspectives and experiences elucidated through qualitative inquiry. By delineating the socio-demographic characteristics of the participants, this table contributes to a more holistic comprehension of substance abuse experiences among street children in Malawi within the broader sociocultural framework.

Phenomenological lens

Through their narratives, a profound sense of detachment and yearning for connections echoes persistently. Expressions like “Using drugs makes us feel better, even if it’s just for a while” delineate their pursuit of fleeting solace amidst their profound desolation. The name “Jamaica” likely holds symbolic significance for these street kids. Jamaica is often associated with reggae music, Rastafarian culture, and a relaxed, carefree atmosphere. By naming their area after Jamaica, these kids might be creating a symbolic link to a place or culture known for its laid-back attitude and perhaps the association with marijuana.

Furthermore, their use of glue or Bostic might reflect a deeper socio-economic context, signifying a coping mechanism or an escape from difficult circumstances, possibly stemming from poverty, neglect, or other challenging life situations.

Symbolic interactionist lens

Peer influence and the societal normalization of drug use, encapsulated in statements such as “Some older kids here said it would help forget the hunger and the cold, so I tried it,” underscore the symbolic significance attached to drug use as a coping mechanism within their social spheres. This nomenclature, “Jamaica,” holds symbolic significance within the street children’s social interactions and shared meanings beyond its literal geographical reference. Symbolic interactionism, as a theoretical framework, emphasizes the role of symbols, language, and shared meanings in shaping human behavior and social interactions.

It could symbolize a perceived connection or similarity to a place associated with marijuana or substance culture. This symbolic renaming reflects how these children construct and share meanings within their social circles. This renaming could also serve as a form of coded language within their group, establishing a collective identity, besides reflecting the aspirational or escapist aspects of their substance use, and mirroring some cultural references often associated with the Caribbean nation of Jamaica.

Thematic analysis

The narratives portray various origins of early drug exposure, ranging from parental influence (using substances to sedate infants or alleviate hunger) to environmental factors (community survival via substance abuse) and abandonment, such as children born to sex workers and left homeless.

Conclusion

In culmination, this study embarked on a painstaking qualitative exploration, delving into the multifaceted realm of substance abuse experiences among street children in Malawi. Through in-depth, semi-structured interviews, a comprehensive understanding of the intricate sociocultural, economic, and environmental dimensions influencing substance abuse within this marginalized cohort was meticulously unraveled.

The narrative analysis illuminated a diverse tapestry of substance abuse narratives intricately interwoven with the lived experiences, perceptions, and interpretations of street children. Themes encapsulated the nuanced interplay between personal encounters, socio-environmental dynamics, and the broader fabric of societal influences, providing a comprehensive mosaic of substance abuse realities.

The thematic analysis culminated in a coherent framework that unveiled the complexities of substance abuse experiences and illuminated pathways for tailored interventions and support mechanisms. These findings hold profound implications for policy formulation and targeted interventions, advocating for context-specific strategies distinct from broader demographic approaches.

Moreover, the study’s significance resonates beyond academic spheres, serving as a clarion call to address the plight of marginalized street children grappling with substance abuse issues. By amplifying their voices and experiences, this study advocates for inclusive interventions and support mechanisms tailored to their specific needs, fostering a more holistic approach to addressing substance abuse within this overlooked demographic.

In essence, this qualitative inquiry stands as a testament to the imperative of understanding substance abuse through the lens of the lived experiences of street children. The insights gleaned not only contribute to scholarly discourse but also advocate for tangible societal change, emphasizing the urgency for compassionate and contextually sensitive interventions to ameliorate the plight of street children confronting substance abuse in Malawi.

A localized follow-up investigation could pivot towards the assessment and implementation of bespoke intervention initiatives explicitly tailored for this demographic, concentrating on evaluating the efficacy and application of community-driven intervention strategies designed to mitigate substance abuse issues among street children. Augmenting quantitative assessments with qualitative inquiries, this research would navigate the nuanced landscape of participants’ experiences, eliciting firsthand perspectives to elucidate the elements contributing to the success or limitations of these interventions, thus offering a robust blueprint for tailored intervention strategies to address substance abuse among street children in Malawi.