In the heart of Ethiopia’s bustling urban centers, a silent yet pervasive health crisis unfolds among one of society’s most vulnerable groups—street children. A groundbreaking qualitative study recently published in the International Journal for Equity in Health brings to light the nuanced perceptions, vulnerabilities, and distinctive resilience mechanisms these children embody in the face of scabies infestations. This skin condition, often dismissed as a mere nuisance in more affluent contexts, manifests with devastating consequences within marginalized street communities, where access to adequate healthcare, hygiene, and living conditions is alarmingly scarce.
Scabies, caused by the microscopic mite Sarcoptes scabiei, is an intensely contagious skin disease marked by relentless itching and rash. While globally recognized and studied, the interplay of socio-economic status, living environment, and cultural attitudes profoundly shapes the disease’s prevalence and the community’s response. The Ethiopian street children’s landscape offers a unique epidemiological and sociological tableau, where vulnerable youth navigate complex survival challenges amid harsh climatic conditions, stigma, and limited institutional support. This study meticulously explores these children’s lived experiences, revealing a tapestry of suffering interwoven with resilience.
The investigation unfolds through detailed interviews and participant observation, employing an anthropological lens to understand how street children perceive vulnerability to scabies. Their reflections extend beyond mere symptoms, spotlighting how chronic infestations affect daily routines, social interactions, and psychological well-being. For these children, scabies is not isolated from their broader struggles—it’s emblematic of systemic marginalization, neglect, and the bodily manifestation of social invisibility. The study underscores this by portraying how scabies deepens existing social fractures, fueling stigma and exclusion even within street children’s own peer groups.
Importantly, the research avoids reductionist approaches, emphasizing that vulnerability is not simply a consequence of poverty or homelessness. Instead, it is shaped by intersecting factors including gender, age, access to communal resources, and informal social networks. For instance, younger children without guardians appear disproportionately affected, experiencing greater difficulty in managing hygiene and accessing medical care. Meanwhile, some older youths demonstrate surprisingly robust adaptive capacities, organizing makeshift cleansing routines, sharing medicinal remedies, and advocating for each other’s health.
Resilience emerges as a central theme, offering a counter-narrative to the predominant discourse of victimhood. Despite harsh conditions, the participants articulate strategies that sustain their physical and emotional survival. These include innovative sourcing of soap and treatment, utilizing natural remedies informed by local ethnobotanical knowledge, and cultivating social bonds that insulate against complete isolation. The study poignantly details how these children exercise agency, challenging the notion that they are merely passive recipients of misfortune. Instead, they actively negotiate their circumstances with ingenuity and courage.
From a technical standpoint, the study employs rigorous qualitative methodology, combining thematic analysis with grounded theory principles to generate rich, context-sensitive insights. Fieldwork was conducted over several months across multiple Ethiopian cities, ensuring data triangulation and saturation. Ethical considerations were paramount, given the participants’ vulnerability. Researchers adopted trauma-informed interviewing techniques, fostering trust and ensuring confidentiality. This methodological rigor lends significant credibility to the findings, enabling them to inform both public health interventions and social policy with precision.
The epidemiological dimension of the study highlights how scabies transmission among street children is exacerbated by environmental factors such as overcrowding, lack of clean water, and inadequate shelter. These conditions create fertile grounds for mite proliferation and impede effective treatment cycles. Furthermore, the study elucidates how interruptions in treatment due to transient lifestyles or logistical barriers contribute to persistent outbreaks. Conventional health systems often fail to adapt to these realities, resulting in gap-filled service provision. The study calls for tailored public health frameworks that integrate mobile clinics, community health workers, and culturally sensitive education campaigns.
From a broader health equity perspective, this research voices a stark indictment of global neglect toward marginalized youth populations. It delineates how health disparities rooted in socio-political determinants converge with biological vulnerabilities to produce disproportionate scabies burden. The entrenched stigma exacerbates children’s marginalization, restricting their access to schooling, employment, and social inclusion. By chronicling these dynamics, the study amplifies the imperative to embed equity-focused strategies in disease control. Such strategies must transcend biomedical solutions, incorporating psychosocial support and structural reforms.
In terms of treatment, the study critically assesses existing pharmacological and non-pharmacological interventions for scabies within these communities. Medical treatments, such as permethrin cream and oral ivermectin, are often inconsistently administered due to scarcity and adherence challenges. The children’s accounts reveal frequent reliance on traditional herbal remedies, whose efficacy varies but reflects deep-seated cultural knowledge. Integrating these remedies with formal healthcare, through participatory approaches, could enhance treatment adherence and cultural acceptability. The study advocates for collaborative health models that valorize indigenous practices alongside biomedical protocols.
Crucially, the study’s findings have immediate implications for international health agencies and local governments. Addressing scabies among street children demands coordinated action across sectors including health, education, housing, and social services. Policies must prioritize resource allocation for prevention, early detection, and sustained treatment. Collaboration with NGOs and community-based organizations is vital to reach these hard-to-access populations. The study envisions innovative interventions like mobile health units equipped with dermatological expertise and culturally attuned health educators, fostering trust and engagement.
Moreover, the mental health ramifications of scabies infestations cannot be overstated. Chronic itching and visible lesions often lead to psychological distress, including anxiety and social withdrawal, further compounding vulnerability. The study documents distressing narratives of children internalizing stigma, which impede their capacity to seek care or form supportive social networks. Integrative health models combining dermatological treatment with psychosocial counseling are essential to holistically address these interlinked issues. Mental health support, rarely prioritized in marginalized settings, emerges here as a critical pillar of resilience-building.
The study also surfaces gendered dimensions of vulnerability and resilience. Female street children report unique challenges including heightened exposure to sexual exploitation and caregiving burdens, which influence their capacity to manage scabies and related health concerns. Male children face different but equally formidable pressures, such as involvement in informal economies with erratic schedules that disrupt treatment routines. Recognizing these nuanced experiences is key to designing gender-sensitive interventions that respect diverse needs and enhance overall effectiveness.
From a scientific communication perspective, the study sets a benchmark in participatory research with marginalized communities. The research team’s transparent engagement, feedback loops with participants, and inclusion in dissemination activities reflect ethical best practices. This co-creation of knowledge not only enriches data validity but empowers street children as partners in advancing their own health outcomes. Such models could be replicated across other neglected tropical disease research domains, contributing to a paradigm shift toward inclusive and equitable science.
Looking beyond Ethiopia, the insights gained hold relevance for global urban health challenges. Many low- and middle-income countries harbor significant populations of street-connected children facing similar health risks. The nuanced perspectives on vulnerability and resilience can inform cross-contextual adaptations of health programs. Additionally, the research highlights the need for integrated urban policies that address social determinants of health holistically, rather than siloed disease-centric approaches that fail to break cycles of marginalization and poor health.
Another compelling facet revealed is how technological innovations could augment future interventions. Mobile applications, remote monitoring tools, and teledermatology, adapted for low-resource settings, might offer scalable solutions for early identification and management of scabies outbreaks. Coupling technology with community health worker training can amplify reach and empower local stakeholders. While resource constraints are formidable, strategic investments could catalyze transformative progress for street children’s health and beyond.
The narrative woven by this research transcends the clinical domain, illuminating essential human stories of adversity and hope. Street children in Ethiopia do not simply suffer passively under the weight of scabies and social neglect; rather, they embody resilience forged in survival’s crucible. Recognizing and amplifying their voices, and aligning health systems responsively, offers a profound ethical imperative and practical pathway to foster healing and equity. This study thus stands as a clarion call to the scientific, humanitarian, and policy communities alike, urging mobilization against structural inequities manifest in neglected diseases.
In sum, this pioneering qualitative inquiry into street children’s perceptions and experiences of scabies charts critical terrain at the intersection of epidemiology, social justice, and public health innovation. It challenges entrenched paradigms that underappreciate the agency and complexity of marginalized youth, proposing integrated, culturally nuanced, and equity-driven strategies for combating a pervasive but preventable health burden. The implications resonate far beyond Ethiopia, inspiring a reimagined framework for addressing neglected diseases in urban informal settlements worldwide.
Subject of Research: Vulnerabilities and resilience to scabies among street children in Ethiopia
Article Title: Exploring perceptions on vulnerabilities and resilience to scabies among street children: a qualitative study in Ethiopia
Article References:
Ayode, D., Zewude, B., Davey, G. et al. Exploring perceptions on vulnerabilities and resilience to scabies among street children: a qualitative study in Ethiopia. Int J Equity Health 24, 162 (2025). https://doi.org/10.1186/s12939-025-02529-9
Image Credits: AI Generated
