Global Social Welfare

, Volume 3, Issue 2, pp 119–124 | Cite as

A Forgotten Population: Estimating the Number of Children Outside of Households in Cambodia

  • Beth L. Rubenstein
  • Lindsay Stark


Two national household surveys, the Demographic and Health Surveys and the Multiple Indicator Cluster Surveys, drive assessment of the Millennium Development Goals, Poverty Reduction Strategies, and other major international platforms in most low- and middle-income countries. However, little attention has been given to the fact that household surveys are limited to people living in households, therefore excluding some of the world’s most vulnerable populations and including the homeless, people living in institutions, and migrant laborers. The situation of children living outside of households is particularly precarious because many of these children are also outside of families or in families that cannot adequately care for them. Deprivation and stress related to these early life experiences can negatively affect health and productivity across the life course. This manuscript reviews the issues facing children outside of households and argues for the importance of gathering robust data about this population to formulate responsive policies and services, mobilize resources, and foster accountability. Cambodia is highlighted to illustrate the recent work that the government has undertaken to quantify two key subgroups of children outside of households: children living in residential care institutions and homeless children living on the street or in other public places. The methods, ethical considerations, and implications of Cambodia’s enumeration are discussed.


Estimation Street children Residential care institutions Children outside of households Cambodia 



The authors thank Dr. Richard Rinehart, Global Alliance for Children, for his guidance and support as well as his helpful comments on an earlier version of this manuscript. The authors also acknowledge the financial support of the US Agency for International Development and John Snow International. Statements made in this paper are the views of the authors alone and do not constitute the policy of the above-listed funding bodies.


  1. Alderson, P. (2007). Competent children? Minors’ consent to health care treatment and research. Social Science & Medicine, 65(11), 2272–2283.CrossRefGoogle Scholar
  2. Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., et al. (2006). The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience, 256(3), 174–186.CrossRefGoogle Scholar
  3. Arora, S., Shah, D., Chaturvedi, S., & Gupta, P. (2015). Defining and measuring vulnerability in young people. Indian Journal of Community Medicine, 40(3), 193–197.CrossRefGoogle Scholar
  4. Bick, J., Zhu, T., Stamoulis, C., Fox, N. A., Zeanah, C., & Nelson, C. A. (2015). Effect of early institutionalization and foster care on long-term white matter development: a randomized clinical trial. JAMA pediatrics.Google Scholar
  5. Carr-Hill, R. (2013). Missing millions and measuring development progress. World Development, 46, 30–44.CrossRefGoogle Scholar
  6. Chan, M. (2013). Linking child survival and child development for health, equity, and sustainable development. The Lancet, 381(9877), 1514–1515.CrossRefGoogle Scholar
  7. Clay, R., CdeBaca, L., De Cock, K. M., Goosby, E., Guttmacher, A., Jacobs, S., et al. (2012). A call for coordinated and evidence-based action to protect children outside of family care. Lancet, 379(9811), e6–e8. doi: 10.1016/s0140-6736(11)61821-7.CrossRefGoogle Scholar
  8. Engle, P. L., Black, M. M., Behrman, J. R., Cabral de Mello, M., Gertler, P. J., Kapiriri, L., et al. (2007). Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world. The Lancet, 369(9557), 229–242.CrossRefGoogle Scholar
  9. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al. (1998). The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine, 14(4), 245–258.CrossRefGoogle Scholar
  10. Gertler, P., Heckman, J., Pinto, R., Zanolini, A., Vermeersch, C., Walker, S., et al. (2014). Labor market returns to an early childhood stimulation intervention in Jamaica. Science, 344(6187), 998–1001.CrossRefGoogle Scholar
  11. Gurgel, R., Da Fonseca, J., Neyra-Castaneda, D., Gill, G., & Cuevas, L. (2004). Capture-recapture to estimate the number of street children in a city in Brazil. Archives of Disease in Childhood, 89(3), 222–224.CrossRefGoogle Scholar
  12. Hatloy, A., & Huser, A. (2005). Identification of Street Children: Characteristics of Street Children in Bamako and Accra. FAFO: Research Program on Trafficking and Child Labour. Retrieved 10 Feb., 2015, from
  13. Irwin, L. G., Siddiqi, A., & Hertzman, C. (2007). Early child development: a powerful equalizer. Final report to the WHO Commission on Social Determinants of Health. Geneva.Google Scholar
  14. Lum, K., Price, M. E., & Banks, D. (2013). Applications of multiple systems estimation in human rights research. The American Statistician, 67(4), 191–200. doi: 10.1080/00031305.2013. 821093.CrossRefGoogle Scholar
  15. Masten, A. S., Herbers, J. E., Desjardins, C. D., Cutuli, J., McCormick, C. M., Sapienza, J. K., et al. (2012). Executive function skills and school success in young children experiencing homelessness. Educational Researcher, 41(9), 375–384.CrossRefGoogle Scholar
  16. Ministry of Women’s Affairs, UNICEF Cambodia, & US Centers for Disease Control and Prevention. (2014). Findings from Cambodia’s Violence Against Children Survey 2013. Retrieved May 31, 2015, from
  17. Nelson, C. A., Zeanah, C. H., Fox, N. A., Marshall, P. J., Smyke, A. T., & Guthrie, D. (2007). Cognitive recovery in socially deprived young children: the Bucharest Early Intervention Project. Science, 318(5858), 1937–1940.CrossRefGoogle Scholar
  18. Petersen, A. C., & Leffert, N. (1995). Developmental issues influencing guidelines for adolescent health research: a review. Journal of Adolescent Health, 17(5), 298–305.CrossRefGoogle Scholar
  19. Red Cross, & Red Crescent. (2011). The sphere handbook: humanitarian charter and minimum standards in humanitarian response. Third edition. Retrieved November 20, 2015, from
  20. Retrak (2015). Making the invisible visible: an enumeration of children on the streets in Malawi. Retrieved November 20, 2015, from
  21. Ritterbusch, A. (2012). Bridging guidelines and practice: toward a grounded care ethics in youth participatory action research. The Professional Geographer, 64(1), 16–24.CrossRefGoogle Scholar
  22. Smyke, A. T., Zeanah Jr., C. H., Fox, N. A., & Nelson III, C. A. (2009). A new model of foster care for young children: the Bucharest Early Intervention Project. Child and Adolescent Psychiatric Clinics of North America, 18(3), 721–734.CrossRefGoogle Scholar
  23. Stark, L., Rubenstein, B. L., Muldoon, K., & Roberts, L. (2014). Guidelines for implementing a national strategy to determine the magnitude and distribution of children outside of family care. Retrieved Nov. 20, 2014, from
  24. Stephen, C. (1996). Capture-recapture methods in epidemiological studies. Infection Control and Hospital Epidemiology, 17(4), 262–266.CrossRefGoogle Scholar
  25. Street Kids International (2013). Annual Report 2012–2013: Street Kids International. Retrieved May 31, 2015, from
  26. US Department of State and USAID (2012). United States Government Action Plan on Children in Adversity. A framework for international assistance: 2012–2017. Washington, DC.Google Scholar
  27. USAID (2015). Family Care First Initiative. Retrieved May 31, 2015, from
  28. van Ijzendoorn, M. H., Bakermans-Kranenburg, M. J., & Juffer, F. (2007). Plasticity of growth in height, weight, and head circumference: meta-analytic evidence of massive catch-up after international adoption. Journal of Developmental and Behavioral Pediatrics, 28(4), 334–343.CrossRefGoogle Scholar
  29. van Ijzendoorn, M. H., Luijk, M. P., & Juffer, F. (2008). IQ of children growing up in children’s homes: a meta-analysis on IQ delays in orphanages. Merrill-Palmer Quarterly, 54(3), 341–366.CrossRefGoogle Scholar
  30. Vanderwert, R. E., Marshall, P. J., Nelson, C. A., Zeanah, C. H., & Fox, N. A. (2010). Timing of intervention affects brain electrical activity in children exposed to severe psychosocial neglect. PloS One, 5(7), e11415.CrossRefGoogle Scholar
  31. World Health Organization (2008). Steps in applying probability proportional to size (PPS) and calculating basic probability weights.> Retrieved Nov. 20, 2014, from

Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  1. 1.Program on Forced Migration and Health, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  2. 2.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA

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