Beneath the itch: a qualitative exploration of burden of scabies among urban street connected children in Ethiopia

Scabies, a neglected and stigmatizing skin disease, has complex effects on marginalized communities with limited access to healthcare. In Ethiopia, existing studies suggest that street connected children are particularly vulnerable to scabies and often hold misconceptions about its transmission and effects. However, there is a significant gap in evidence regarding the psychological, social, and economic consequences of scabies in this population. This qualitative study- guided by the biopsychosocial framework, investigates the psychosocial and economic impacts of scabies on street connected children in selected Ethiopian cities. We collected qualitative data from purposively selected children of the street who have been living in Addis Ababa, Hawassa, and Adama cities between May and March, 2024. Data collection methods included focus group discussions, individual in-depth interviews, and key informant interviews. To facilitate expression of self and social stigma associated with scabies, we employed participatory techniques such as drawing exercises. Audio recordings were transcribed and collaboratively coded by the research team, followed by thematic analysis of transcripts and field notes. Scabies infestation was found to have layered physical, psychological, and economic repercussions, exacerbated by the lack of accessible healthcare services. Street connected children reported experiencing both self-stigma and external stigma from peers and the broader community. Psychosocial impacts included exclusion from social activities, self-isolation, and feelings of loneliness and depression. Participants described how scabies eroded their ability to earn a living, noting that the time lost to illness combined with the burden of out-of-pocket medical expenses created overwhelming financial strain. In conclusion, the physical, psychosocial and economic impacts of scabies among street-connected children in Ethiopia is emblematic of broader structural inequities. Addressing scabies effectively requires a holistic approach that combines medical treatment with psychosocial support, economic inclusion, and policy-level recognition of street connected children’s health rights.