Understanding vulnerability to scabies among street children in Ethiopia through health literacy, stigma and health seeking behavior

Scabies is a common public health problem among street children in low- and middle-income countries. Previous studies have attributed vulnerability to their living conditions—overcrowded sleeping arrangements, sharing of clothes, and lack of access to health services. Using data from a baseline survey, this study aims to identify how personal attributes intersect with structural factors to expose street children to the risks and consequences of scabies infestation. We conducted a mixed methods study, collecting quantitative data from 130 children, and interviewing 20 of these children to obtain information on perspectives and lived experiences. Using a Statical Package for Social Science (SPSS) software version 26, quantitative data analyses were conducted through descriptive (frequencies, percentages, and charts) and inferential statistical (X 2 , One Way Anova, binary and multivariate logistic regressions) techniques. We used a thematic analysis approach to interpret the qualitative data. Respondents had moderate knowledge about scabies with significant variations on the basis of sex (AOR = 9.5, 95% CI: 1.84–49.27, p = 0.007), educational status (AOR = 5.33, 95% CI: 1.16–24.52, p = 0.031), and experience of infestation (AOR = 0.26, 95% CI: 0.07–1.00, p = 0.049), indicating that scabies-related knowledge is associated with sex, level of education, and history of scabies infestation. Misperceptions in relation to causes, prevention, and treatment were very common. This coupled with poor health seeking behavior, highly prevalent stigma, and limited access to health services increased vulnerability to scabies infestation. The findings underscore the pathways through which layered personal and structural circumstances intersect to enhance street children’s vulnerability to scabies, implying relevance to global initiatives such as sustainable development goal 3 (good health and wellbeing) and 10 (reduced inequalities). We suggest integrated and context-specific public health interventions targeting improvement of living conditions, health literacy and health seeking behavior to mitigate skin-to-skin contact, the transmission of scabies, reduce stigma, and promote mutual support initiatives.