"It totally depends on the goodwill of the health professional": health seeking behavior and access to health services among street children infested with scabies in Ethiopia.

backgroundScabies is a neglected stigmatizing skin disease which is common in resource-limited tropical areas. Due to their living conditions, street children are highly vulnerable to scabies infestation. Efforts to prevent and control scabies rely heavily on access to health services, hygienic conditions, and other aspects of health-seeking behavior of a population. The purpose of this research was to identify the health-seeking behavior of street children and the state of interventions to respond to their health service needs in selected areas of Ethiopia.

methodsThe study employed an ethnographic design with multiple methods, datasets, and investigators. Data collection methods were: in-depth interviews, key informant interviews, non-participant observations, and FGDs with a drawing exercise in which children were given the opportunity to actively participate. We collected rich qualitative data from street children, parents, government officials, health professionals, and leaders of NGOs working on street children selected through purposive sampling techniques. In addition to taking field notes, audio records were transcribed, translated, and collaboratively coded to identify themes and sub-themes.

resultsScabies was a common health problem in all the study sites. The street children lacked awareness about the causes, treatments, and consequences of scabies, shaping their response to their perceived risk and experience of scabies infestation. Low perceived severity of scabies, lack of access to sanitary amenities, the nature of interaction with health professionals, inaccessibility of public health services and lack of money to pay for healthcare contributed to poor primary and secondary health-seeking behavior. Variations in experience of engaging in preventive activities and treatment seeking behavior existed between street children of different sociodemographic characteristics, and regional differences in interventions were identified.

conclusionsWith the absence of adequate targeted interventions and policy frameworks, responding to the healthcare and other needs of street children infested with scabies remains a highly neglected issue. Identifying street children's access to healthcare services and the intricacies of policy environments driving morbidity from scabies, this study indicated the important steps that should be taken toward addressing inequity related to a neglected tropical disease.