Disease Perceptions, Risks, and Responses: Using the Health Belief Model to Understand Street Children and Youths Health-Seeking Behaviour in Cameroon

Disease Perceptions, Risks, and Responses: Using the Health Belief Model to Understand Street Children and Youths Health-Seeking Behaviour in Cameroon | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Disease Perceptions, Risks, and Responses: Using the Health Belief Model to Understand Street Children and Youths Health-Seeking Behaviour in Cameroon Valerie Makoge, Jean-Patrick Molu, Derick Ntale, Dongang Nana Rodrigue Roman, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7474433/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Improving access to quality healthcare for underserved and resource-limited populations (like street children and youths- SCaYs) remains a critical development challenge. In Cameroon, street children represent a vulnerable and marginalized population, facing numerous health risks exacerbated by poverty, precarious living conditions, and social exclusion. Despite growing recognition of their health challenges, these SCaYs remain underrepresented in health service planning and interventions. This study applies the Health Belief Model (HBM) to explore disease perceptions, risk factors, and health-seeking behaviours among SCaYs in Yaoundé, Cameroon. Methods A mixed-methods study was carried out with 147 male SCaYs. Data was collected using a pretested semi-structured questionnaire, in-depth interviews and focus group discussions to determine perceived diseases, health behaviours, barriers and facilitators to healthcare access. Participants were also screened for malaria, helminths, HIV and Hepatitis B. Quantitative data were analysed using Microsoft Excel and IBM SPSS Statistics, version 24. A cross-sectional analysis was conducted to explore factors associated with hospital health-seeking behaviour among respondents. Descriptive statistics were used to summarize sociodemographic characteristics, street-living conditions, risk behaviors, and laboratory test results. Univariate logistic regression models were then applied to assess the individual association of each variable with hospital attendance. Odds ratios (OR), 95% confidence intervals (CI), and p-values were reported. Results The majority of participants (96%) were Cameroonian, aged primarily between 10–25 years. Poverty-driven unstable informal employment and open-air living conditions heightened their exposure to health risks. Malaria (54.7%), stomach aches (53.3%), and skin infections (40.9%) were the most commonly perceived illnesses. Despite 98% reporting illness in the prior three months, only 5.9% sought formal healthcare due to substantial financial constraints and stigma. Self-medication via street vendors was the predominant coping strategy (86.1%), driven by affordability and accessibility. Participants demonstrated awareness of susceptibility and severity of some illnesses (HBM constructs), but perceived barriers and social stigma limited healthcare engagement. Conclusion The study highlights a complex interaction of individual perceptions and systemic barriers influencing SCaYs health-seeking behaviours in Cameroon. Interventions should prioritize reducing financial obstacles, addressing stigma within health facilities, and improving living conditions to enable accessible, respectful, and effective healthcare for this marginalized group. The Health Belief Model provides a useful framework for understanding and addressing these multifactorial challenges. Street children and youths Health-seeking Behaviour Health Belief Model street children Cameroon Malaria Figures Figure 1 Background Improving access to quality healthcare for underserved and resource-limited populations remains a critical development challenge ( 1 , 2 ). Poverty not only increases the incidence of disease but also restricts the capacity of individuals and communities to respond to health threats effectively ( 3 ). Among the vulnerable and underserved groups globally are street children and youths, whose numbers are estimated to be in the tens of millions ( 4 ). In Cameroon, this demographic represents a significant yet marginalised population within urban settings. Cities such as Yaoundé, Bamenda, Bafoussam, and Douala are home to large numbers of street children and youths ( 5 ). Street children and youths are typically those for whom the streets have become more of a home than their family environments. The United Nations Educational Fund categorises this population into three groups: children on the street, of the street, and those at risk of becoming street children. Those on the street may live with their families at night but work or spend most of their time on the streets during the day ( 6 ). In contrast, children of the street have left home due to a combination of factors, such as family poverty, domestic dysfunction, abuse, parental death, and a lack of educational opportunities. Regardless of classification, these children and youths are exposed daily to significant risks, including physical harm, abuse, exploitation, and a lack of adult supervision ( 3 ). Despite the growing visibility of this issue, street children and youths are frequently excluded from national planning, healthcare service provision, and resource allocation ( 7 ). They are often stigmatised and stereotyped as delinquents, criminals, or public nuisances—perceptions that further entrench their marginalisation ( 8 ). Nevertheless, the presence of street children and youths continues to grow in Cameroon’s urban centres, where many live partially or entirely disconnected from familial support systems. In their daily struggle for survival, they often engage in informal and sometimes hazardous economic activities, from begging to forms of labour that jeopardise their health and safety ( 5 ). The health challenges faced by street children and youths (SCaY) in Cameroon are numerous and closely tied to their precarious living conditions. Studies report high susceptibility to communicable and non-communicable diseases, including malaria, gastrointestinal illnesses, injuries, dermatological conditions, and respiratory complaints such as chest pain ( 7 , 9 ). These health problems are further exacerbated by environmental exposure, inadequate nutrition, limited access to clean water, and the absence of shelter. Understanding the health-seeking behaviour of SCaY is essential for designing effective health interventions and service delivery models. Their patterns of healthcare —shaped by factors such as poverty, stigma, mobility, distrust of formal institutions, and reliance on informal networks—can significantly influence health outcomes. Without insight into how and why they choose to seek or avoid care, public health responses risk being misaligned with their needs and realities. This study aimed to investigate the health-seeking behaviour of street children and youths (SCaY) in urban Cameroon through the lens of the Health Belief Model ( 10 ). Specifically, it sought to understand how perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy shaped individuals’ (ScaY’s) decisions to access or avoid formal healthcare services within the context of their marginalisation and precarious living conditions. This understanding is essential for informing the development of responsive, context-appropriate health interventions. Materials and Methods Study settings This study took place in Yaoundé, the capital of Cameroon, and home to approximately 2.8 million people. Positioned on a plateau covered with hills and forests, Yaoundé lies between the Nyong and Sanaga rivers in the south-central part of the country. Participants were recruited across the six health districts of Yaoundé, namely, Mvan, Mokolo, Efoulan, Bastos, Gare Voyageur, Columbia, and Poste-Centrale. Participants were eligible if they were identified by the Ministry of Social Affairs as street children and youths. This study was carried out in partnership with the Cameroon Ministry of Social Affairs (MINAS), specifically through its Regional Delegation of Social Affairs (RDSA) in Yaoundé. Access to street children was facilitated by the RDSA in collaboration with the Yaoundé Listening and Transit Center (CETY). CETY is a public institution that facilitates the reinsertion of street children and youths in Yaoundé. RDSA and CETY liaised the research team and another association called OCALUCOPER ( Organisation Camerounaise de Lutte Contre le Phénomène des Enfants de la Rue) . The role of OCALUCOPER is to eliminate the phenomenon of street children. It is founded and run by former street children. Study Design The design of this study was cross-sectional and mixed-method in nature. A pretested semi-structured questionnaire and an interview guide were used to obtain information. It was part of a larger project focusing on a broader investigation of street children and youth health challenges, health profiles, infectious disease prevalence and ways in which they navigated these challenges. This study was carried out between March and July 2022 and sought to understand the health-seeking behaviour of street children and youths in the face of (perceived) diseases in their environment. Participant recruitment and study procedure Preliminary meetings prior to the study were held at the RDSA presided over by the Delegate of Social Affairs. In attendance was her team, the Director of CETY and his team, the president of OCALUCOPER accompanied by some members and the research team. These meetings were geared at planning outreach sessions to the street to inform the SCaY about the study and invite them to participate. Participation was strictly voluntary, assent and consent were required before participation, and potential participants were informed that they could discontinue participation at any time with no repercussions. Street children and youths who agreed to participate were provided with transportation means to reach CETY. The members of OCALUCOPER, who are in direct contact with this population, facilitated this process. They hired cars and buses to pick the children from the street to CETY and back. CETY is an institution with which the street children are familiar, as it is a place they visit to be listened to and participate in other activities. Health-seeking behaviour Questionnaire This questionnaire was administered to SCaYs by the research team with the assistance of social workers who are part of the CETY team at the CETY premises. The HSB questionnaire was developed on the basis of a thorough review of previously published studies on the HSB of people in low-resource settings ( 7 ), ( 3 ), the components of the health belief model, prior discussions with the RDSA, Director of CETY and subsequent outreach activities to the different areas where street children are found. The questionnaire had four parts and sought to identify perceived health challenges and response/coping strategies. The questionnaires were administered verbally since most of the SCaYs could not read or write. The first part of the HSB questionnaire included background or entry questions to ascertain the demographic characteristics of the respondents. Part 2 included questions related to the perceived common diseases in the SCaY environment (disease severity, susceptibility, cues to action), perceived reasons for the presence of diseases, disease history, response to diseases and facilitators and barriers to healthcare services. Part 3, sought to reveal the risk behaviours of street children and posed questions on their knowledge and use of narcotic drugs, psychoactive substances and other problematic behaviour tendencies among SCaYs. The last part of the questionnaire included questions related to getting off the street and the ambitions and dreams of street children. Laboratory Tests The street children were screened for malaria, helminth infection, HIV, Hepatitis B and anaemia. The findings related to these tests are published elsewhere. Qualitative Study: Interview Guide In-depth, semi-structured interviews were conducted with street children and youths (SCaYs) using a systematically developed interview guide. This method was chosen to capture detailed, context-rich accounts while providing flexibility to explore emerging topics. The guide covered participants’ lived experiences, trajectories into street life, and strategies for coping with diverse challenges. For this paper, our analysis focuses specifically on health-related challenges reported by SCaY and the strategies they employ to address them. The interview guide used for this study is attached as a supplementary file. Theoretical framework: The health belief model was used to obtain valuable insights into decision-making processes regarding health among street children and youths. In the case of SCaY in Cameroon, the model helped to identify critical intervention points to improve health-seeking behaviours. By understanding the perceptions of health risks, benefits of treatment and barriers to care, more effective and targeted interventions can be developed that address specific needs and constraints faced by street children. Individual perceptions : The construct of perceived threat of disease, as conceptualized within the Health Belief Model, encompasses two key dimensions: perceived vulnerability and perceived severity. In the context of street-connected children and youth (SCaY), this construct reflects their ability to recognize both the presence of disease risks in their environment and their personal susceptibility to those risks, as well as their understanding of the potential harm associated with such diseases. To assess perceived threat, SCaYs were first asked to identify diseases that they commonly associate with their daily lived experiences. This provided insight into their awareness of prevalent health conditions within their environment. Perceived vulnerability and severity were further examined by asking participants to describe specific environmental risk factors they believe contribute to disease exposure and to express their perceptions of the seriousness or potential consequences of these illnesses. This dual approach enabled a comprehensive evaluation of how SCaY conceptualizes health threats, grounded in both personal experience and contextual awareness. Cues for Action and Self-Efficacy The construct of cues for action refers to the recognition among street-connected children and youth (SCaY) that specific actions can be taken to address the health challenges they face. To explore this, participants were asked about the factors that would facilitate their use of healthcare services, including both internal motivations and external triggers. Importantly, the translation of these facilitators into actual health-seeking behaviour is influenced by SCaY’s perceived benefits and perceived barriers associated with accessing formal care. These perceptions were assessed through questions designed to identify key determinants influencing the decision to seek formal healthcare. Self-efficacy, another critical component of the Health Belief Model, reflects SCaY’s perceived ability to manage or cope with health challenges. This was measured by examining the specific coping strategies employed by street children in response to illness or injury. The responses provided insights into their confidence in managing health-related risks and navigating available resources, despite the structural and environmental constraints they encounter. Data Analysis Statistical analyses focused on evaluating the relationship between hospital attendance (defined as a binary outcome: yes vs. no) and a range of explanatory variables grouped into four categories based on the theoretical framework: sociodemographic factors, street-living conditions, risk behaviors, and laboratory test results. We first conducted descriptive analyses to summarize the distribution of each independent variable. Categorical variables (e.g., education level, drug use, HIV status) were described using frequencies and percentages, while continuous variables (e.g., age, time spent on the street) were summarized using means, standard deviations, or medians and interquartile ranges, depending on their distribution. To explore potential associations with hospital attendance, we performed univariate logistic regression analyses, modeling the outcome against each predictor individually. For each model, we reported the unadjusted odds ratio (OR), its 95% confidence interval (CI), and the p-value. All analyses were conducted using a significance level of 0.05. No multivariable models were used, in order to maintain a purely exploratory and descriptive approach Qualitative data were analysed via ATLAS.ti software, using thematic analysis guided by the six-phase framework outlined by Braun and Clarke ( 11 ). The analytic process began with multiple readings of the transcripts to ensure familiarization with the data, followed by the generation of initial codes. Coding was informed by constructs from the Health Belief Model (HBM) and relevant health-seeking behaviour (HSB) literature. Themes were then developed on the basis of the study’s central research questions related to the HSB and the components of the HBM. The emerging themes included perceptions of common diseases, perceived vulnerabilities, barriers to and facilitators of healthcare access, and coping strategies among street-connected children and youth (SCaY). Thematic analysis following coding enabled the identification of key patterns and insights. Ethical considerations This study received ethical approval from the Institutional Ethics Committee of the Institute of Medical Research and Medicinal Plants Studies (IMPM) and the Ethical Review Board of the Regional Delegation of Social Affairs under the Ministry of Social Affairs (MINAS), Cameroon. Participation in the study was entirely voluntary, and informed consent procedures were carefully adapted to the vulnerable nature of the study population. This is in line with the Declaration of Helsinki. To minimize coercion, participants received only minimal compensation in the form of meals, which were not conditional upon participation. Detailed information about the study, including its purpose, procedures, and ethical safeguards, was provided during initial outreach sessions and reiterated upon arrival at the Centre for Listening and Transition (CETY). The study objectives were explained in simple, age-appropriate language to all street children and youth (SCaY), with an emphasis on the voluntary nature of participation. Informed consent was obtained from participants aged 21 years and older. For those under the age of 21, oral informed assent was obtained in the presence of trusted adults. Informed consent for children under 21 was obtained from their legal guardians who in this case is the Ministry of Social Affairs. To maintain confidentiality and anonymity, each participant was assigned a unique code, and no identifying information was collected. To support the psychological safety of the participants, the research team worked closely with OCALUCOPER- an organization with longstanding experience in daily engagement with street children- and with trained social workers from CETY. Oversight was provided by the Regional Delegation of Social Affairs to ensure full compliance with ethical protocols. All data collection activities were conducted within the safe, street‒child-friendly environment of the CETY premises, rather than on the streets, to ensure participant comfort and security. Results Socio-demographic characteristics of the study participants A total of 147 male street children and youth (SCaY) participated in this study. Of these, 96% were Cameroonian nationals, whereas 4% originated from neighbouring countries, including the Central African Republic, Niger, and Nigeria. The youngest participant was 10 years old, and 38% of the respondents were under the age of 15. The most frequently reported age group (modal range) was 15–25 years. With respect to educational background, 25% of the participants had no formal education, 41% had attended primary school, and 33.8% had attained at least some secondary education. A small proportion (1.4%) reported having received vocational training. A summary of these socio-demographic characteristics is provided in Table 1 . Table 1 appears here Table 1 Sociodemographic characteristics of street children in Yaoundé Variables Age (years) n % Age group < 15 52 37.7 15 and above 86 62.3 Sex Male 147 100 Nationality Cameroon 134 95.7 Nigeria 1 0.7 Niger 2 1.4 Central African Republic 3 2.1 Educational Level Professional or Technical Training 2 1.4 No education 33 23.7 Primary School 57 41.0 Secondary School 47 33.8 Monthly income 50000 9 6.5 Living area type Open public spaces (markets, bus stations, etc.) 142 96.6 Roofed structures 5 3.4 Total 147 100 Sources of Revenue Nearly all participants (90%) reported having temporary sources of income derived from a variety of informal activities. These included car washing (22%), carrying goods in markets (22%), working as scrap metal dealers (18%), dish washing in restaurants (21%), begging (12%), ambulant vending (5%), and garbage collection (4%). Further analysis revealed that 70% of the participants engaged in two or more petty jobs, with a minority (4%) simultaneously managing up to four different income-generating activities. In contrast, 11% of the participants reported having no source of income at all. Monthly earnings varied considerably among participants. A majority (54%) earned less than 20,000 XAF (approximately 84 USD) per month. Qualitative interviews supported these findings, indicating that while some street children and youths (SCaYs) had no income at all, those with earnings often experienced irregular or inconsistent access to income-generating activities. Periods without work were commonly associated with food insecurity and difficulty meeting basic needs. Nonetheless, solidarity, among street youths begging and stealing emerged as a key coping mechanisms. With regards to solidarity, SCaY relied on peer support to endure times of financial hardship. “I have nowhere to work. Everywhere I go to ask for work, they refuse. It is this one (a fellow street child/youth) who even helps me eat every day. Without him, I wouldn’t eat... Even yesterday, I went to wash dishes, and they turned me away.” SCY 24 Living Conditions of Street-Connected Children and Youth (SCaY) The majority of participants ( 97% ) reported sleeping in open public spaces , including markets, train stations, bus terminals, abandoned vehicles, and public stands. Only 3% of the respondents reported sleeping in roofed or enclosed structures. Frequently mentioned sleeping areas included Gare Voyageur, Columbia, Mokolo, Bastos, Avenue Kennedy, Mvan, Poste Centrale , and Bata Nlongkak . Notably, Columbia was identified as a major hub for street families and former street children, many of whom reside in informal shelters locally referred to as "bunkers." Duration and Reasons for Street Involvement In terms of duration on the street, 41% of the respondents reported having lived on the street for 2–5 years, 20.6% for 5 months to 1 year, 17.5% for 1–2 years, and 15.4% for more than 5 years. The most frequently cited reasons for living on the street were the thrill of adventure (29.4%), followed by family violence (19.1%), family discord (11.8%), and inability or refusal of parents to pay school fees (11.8%). Qualitative responses also highlighted parental death and displacement due to conflict or war as contributing factors. Problematic Health Behaviours among Street Children and Youth (SCaY) Substance Use and Psychoactive Drugs A total of 91% of SCaY reported awareness of psychoactive substance use in their environment. Frequently mentioned substances included cannabis (Indian hemp), ‘bazza,’ cigarettes, glue, ‘stone,’ tramadol, and tramol. Most participants reported familiarity with at least three different types of drugs. With respect to personal use, 62% of the respondents reported current or past drug use. The most common reason cited for drug use was to escape personal problems. Other motivations included peer pressure, the desire to feel courageous, curiosity, and a wish to feel physically stronger. Among the minority who abstained from drug use, reasons included awareness of negative health consequences, religious beliefs (notably among Muslim participants), and personal disinterest. Alcohol Consumption Similarly, 62% of the participants reported alcohol consumption. The primary reason cited was the pursuit of joy or temporary relief from problems, with secondary motivations including peer influence and the need to increase self-confidence. Sexual Behavior Nearly half of the participants (49%) reported being sexually active, with 64% of this group indicating that they had engaged in unprotected sex, raising concerns about exposure to sexually transmitted infections among this vulnerable population. Desire to Return Home When asked about their willingness to return home, 73% of SCaYs expressed a desire for family reunification. Common motivations included longing to live with family and the recognition that street life was difficult and unsafe. Only 4% cited a desire to return to school as their primary reason for going home. Conversely, some SCaYs were not interested in returning home, either to nuclear or extended families. Their reasons included the perception that street life provided more independence and economic opportunity and the belief that home environments were less supportive or more restrictive. Perceived Common Diseases and Vulnerability to Illness Street children and youth (SCaY) identified a range of diseases as commonly affecting individuals in their living environments. Malaria was the most frequently reported condition and was mentioned by 54.7% of the participants. This was followed closely by stomach aches (53.3%), which are often attributed to poor nutrition, and skin infections (40.9%). Other less frequently reported but notable health concerns included diarrhoea, headache, cough, chest infections, and injuries resulting from accidents and fights. Table 2 appears here Table 2 Commonly perceived diseases in the living environments of street children and Youths Perceived Diseases n % Malaria 75 54.7 Diarrhoea 32 23.4 Headache 51 37.2 Stomach ache 73 53.3 Skin infections 56 40.9 Cough 29 21.2 Chest-related problems 39 28.5 Injury due to accidents 61 44.5 Others 25 18.2 The participants commonly associated the presence of these health issues with the poor hygiene conditions of their environment and the pervasive impact of poverty. The lack of access to clean water, nutritious food, and adequate shelter were seen as central contributors to their vulnerability. “ Even eating is a problem. Sometimes we look for leftover food to eat or empty the trash cans of women (who sell food). Therefore, I still have stomach ache problems every day.” SCaY 24 “ I sleep on the ground, and there are many mosquitoes. Every evening, I am cold (in Yaoundé) … especially since I am accustomed to the heat of the Northern region .” SCaY MV-14 Overall, SCaY perceived that sleeping in open spaces, exposure to elements, unsanitary conditions and poverty significantly increased their susceptibility to illness. However, they did not identify climate change or a lack of health knowledge as significant contributors to disease risk. Table 3 appears here Table 3 Reasons for disease presence Reasons for disease presence n % Poor hygiene conditions 87 65.4 Poverty 56 42.1 Climate 10 7.5 Lack of Knowledge 6 4.5 Other 6 4.5 Prompts to Action: Patterns of health-seeking behaviour Analysis revealed complex patterns of health-seeking behaviour among participants. Responses to questions regarding their health status in the past three months revealed that almost all of the respondents (98%) had experienced illness. The health issues reported were diverse and included conditions and diseases such as malaria, diarrhoea, headaches, flu, stomach pain, earaches, injuries, wounds, chest pain, nerve-related issues, toothaches, sore throats, perceived jaundice, and accidents, among others. Despite these health challenges, nearly 90% of these vulnerable respondents reported that they did not seek medical attention at a healthcare facility (formal healthcare services) because of limited accessibility and financial constraints. Consequently, self-medication emerged as the predominant disease-response strategy, with 86.1% of the respondents indicating that they typically practiced self-medication when faced with health challenges. A stepwise approach was reported by those who sought formal healthcare, beginning with self-medication and progressing to formal care only if symptoms persisted or worsened and if they were able to raise the required funds. Street vendors of medications (informal healthcare services) were a common source of medication for self-medication practices. “When I am sick, I do not go to the hospital, I buy medication from Kennedy” SCAY interview AK 23 (Avenue Kennedy is one of the neighbourhoods in Yaoundé and one of the areas where street children and youths live). “I buy the tablets at the pharmacy” (SCaY interview TR-19) “With money I make, I eat and keep, if I am sick, I buy tablets at the pharmacy or from people who sell in the streets” (SCaY interview TR-17) The primary reason for utilizing street vendors, reported by 78.2% of the respondents, was the affordability of their medications. “It’s cheaper…it’s not like the hospital” (SCaY interview TR 19) Other factors, such as the proximity of street vendors and the perceived effectiveness of their medications, were also mentioned. The interviews revealed a health facility accessible to SCaYs who had lung infections following their living conditions. However, SCAY reported that malaria was not considered severe enough to receive treatment at this facility: There is still Moly where they still treat street children, but I know they do that in relation to those who have lung infections, because most get free treatment at Moly, but I do not think that we can go there for simple malaria. Facilitators and Barriers to Utilizing Formal Healthcare Services Only 5.9% of SCaY reported seeking care from formal healthcare services. A total of 10.3% stated that they took no action in response to their health issues. This study identified key facilitators for seeking formal healthcare services as financial ability and type of disease. The main barrier to seeking care from formal healthcare services was financial constraints. This was confirmed in the qualitative part of the study. Notably, factors such as the type of illness and fear were not reported as major barriers to seeking formal medical care. “ I do not go to the hospital because I do not have enough money for that” (SCAY interview TR-17) Table 4 appears here Table 4 Facilitators and Barriers to Utilizing Formal Healthcare Services* n % Facilitators Having money 75 57.7 Type of disease 47 36.2 Fear 16 12.3 No particular reason 11 8.5 Barriers Financial constraints 112 84 Type of disease 22 16.5 Fear 5 3.8 *Multiple responses were possible Dynamics of health seeking behaviour among street children and youths Dynamics relating to health seeking behaviour among street children and youths, illustrated multifactorial influences on health seeking behaviour. Five key domains were highlighted—socio-demographic factors, risk behaviours, street-living conditions, laboratory-confirmed health status, and the political and socio-cultural environment—as interrelated determinants of formal health care use. The model illustrated in Fig. 1 , revealed how these structural, behavioural, and biomedical factors interact within a broader context of social marginalization. Figure 1 : Dynamics highlighting key factors associated to formal health care use among SCaYs Discussion This study explored the complex interplay of factors shaping disease perceptions and health-seeking behaviours among street-connected children and youths (SCaY) in Yaoundé, Cameroon. The combination of poverty, unstable living environments, substance use, and exposure to diseases creates a challenging context in which these youths must navigate to maintain their health. The Health Belief Model (HBM) provided a valuable framework for understanding the beliefs, barriers, and motivators influencing SCaY’s health behaviours. Our findings offer important insights for designing targeted interventions aimed at improving health outcomes in this vulnerable population. Street Survival and Economic Challenges Unlike most children living under parental care, SCaYs must independently navigate daily survival. Poverty emerged as a predominant challenge, limiting their ability to meet basic needs and manage health issues. To cope, SCaYs engage in precarious income-generating activities such as car washing, dish washing, scrap metal collection, begging, and sometimes stealing. These survival strategies, also reported in other contexts, such as Nepal ( 12 ) and Cameroon, often become more prevalent in the absence of stable employment, thereby exacerbating poverty. The harsh realities of street life, including mobile domiciliation and open-air living, result in poor hygiene and sanitation, further compromising their health ( 7 ) ( 3 ). Commonly Perceived Diseases and Health Risks Malaria, gastrointestinal problems (notably stomach ache and diarrheal diseases), and skin infections were identified by participants as the most common health concerns. Stomach aches were frequently attributed to the consumption of unsafe food discarded near restaurants, poor nutrition, and unhygienic living conditions—a pattern that is consistent with findings from Nigeria ( 13 ) and Ghana ( 14 ). Skin infections were visibly common and linked to poor hygiene practices, limited access to bathing facilities, and the constant wearing of unwashed clothes, which create ideal conditions for pathogens to thrive. While louse infestations have been documented among street children in Ethiopia ( 15 ) they were not reported in our study, highlighting contextual differences. Malaria was the most commonly perceived illness, likely due to frequent mosquito exposure in open living environments. However, reliance on fever as a proxy for malaria may lead to misdiagnosis and inappropriate self-medication, which carry potential health risks ( 9 , 16 ). Dynamics of Health-Seeking Behaviour Our findings showed that health-seeking behaviour among SCaYs was influenced by five key interrelated factors: socio-demographic factors, risk behaviours, street-living conditions, laboratory results and perceived illness, and the political and socio-cultural environment. These findings hardly reported, offer a comprehensive lens for analysing health service engagement in this vulnerable population. Socio-demographic factors in the form of financial constraints and poor living conditions, feed the practice of risk behaviours leading to different health challenges and illnesses which are hardly addressed because stigma/ labelling ( 8 ), political omissions, poverty etc creating a form of vicious cycle for ScaYs. When it comes to coping strategies, illnesses perceived as common such as malaria or perceived as not being severe were often self-managed through informal means. Street vendors were healthcare providers of choice for SCaYs because they were perceived as cheaper and more accessible. Our finding of restricted access to formal healthcare services due to financial limitations is consistent with studies in other low-resource settings ( 17 ) ( 14 ). Furthermore, negative attitudes and stigmatization by healthcare workers discouraged SCaY from seeking care at formal health facilities, fostering reliance on more affordable, proximal, and less judgmental sources. The widespread practice of self-medication, while common, raises concerns about inappropriate treatment and potential complications ( 16 , 18 ). These findings underscore the need for interventions that address economic barriers and health system stigma to facilitate timely and appropriate care. Application of the Health Belief Model (HBM) Using the HBM, our study elucidated how SCaYs perceived their susceptibility to illness, evaluated the severity of health problems, and responded to cues for health action. The participants demonstrated awareness of their vulnerability to diseases stemming from hazardous living conditions and substance use (perceived susceptibility) ( 15 , 19 ). The severity with which symptoms were viewed influenced whether formal care was sought; minor symptoms were often ignored, whereas life-threatening conditions prompted health-seeking (perceived severity and cues to action). The perceived benefits of accessing pharmacies and clinics and maintaining hygiene—along with confidence in their ability to act (self-efficacy)—motivated some positive health behaviours ( 20 ). However, structural barriers such as cost, stigma, and limited access frequently curtailed these actions, resulting in avoidance or informal treatment. This application of the HBM highlights the interplay between individual beliefs and systemic challenges shaping health behaviours in this population. Conclusion To the best of our knowledge, this study represents the first investigation of health-seeking behaviour among street-connected children and youth in Cameroon. Our findings indicate that street children and youths face complex health challenges shaped by poverty, unstable living conditions, stigma, socio-political factors,l. Using the Health Belief Model, our study revealed that these factors drive reliance on self-medication and informal care for common ailments such as malaria, gastrointestinal issues, and skin infections. Effective interventions must reduce financial and social barriers, improve living conditions, and provide accessible, non-judgmental healthcare to enhance health outcomes for this vulnerable group. Limitation Firstly, the cross-sectional design used in this study limits our ability to establish causal relationships between the identified factors and health-seeking behaviours. Second, we relied on self-reported data from street children and youth and this may be subject to recall bias or social desirability bias, and can potentially affect the accuracy of reported disease perceptions and health behaviours. Additionally, some health conditions were based on perceived symptoms without clinical confirmation, which could affect the precision of disease prevalence reported in this paper. However, we have reported actual prevalence data in an already published paper. Declarations Ethics approval and consent to participate This study was approved by the Institutional Ethics Committee of the Institute of Medical Research and Medicinal Plants Studies (IMPM) and the Ethical review board of the Regional Delegation of Social Affairs of the Ministry of Social Affairs (MINAS). Participation in the study was strictly voluntary. Informed consent and assent was obtained from participant as per their ages Precautions were taken to ensure individual information confidentiality. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding This study was supported by the Royal Society for Tropical Medicine and Hygiene (RSTMH) Small Grants Programme, with funding provided through the National Institute for Health Research (NIHR), United Kingdom Author Contribution VM, conceived and designed the study; V.M., J.P.M., D.T., R.R.D.N., O.V.A.T., G.T.K. and MMGL administered the survey and participated in the wider study. VM carried out the in-depth interviews. DT and VM analysed the data; VM wrote the first draft of the manuscript; all authors contributed to subsequent drafts and reviewed the final version of the manuscript. WM supervised the study. Acknowledgement The authors gratefully acknowledge the Royal Society for Tropical Medicine and Hygiene (RSTMH) for awarding the Small Grant that made this project possible. We also extend our sincere appreciation to the Regional Delegate of Social Affairs, the Director and staff of CETY, the members of OCALUCOPER, and, most importantly, the street-connected children and youth who generously shared their time and experiences in contributing to this study. Data Availability All data generated or analyzed as part of this study are included in this manuscript References Babawarun O, Okolo CA, Arowoogun JO, Adeniyi AO, Chidi R. Healthcare managerial challenges in rural and underserved areas: A Review. World J Biology Pharm Health Sci. 2024;17(2):323–30. Naghiloo Z. Global health interventions in resource-limited settings: successes and lessons learned. Health Nexus. 2023;1(3):56–60. Woan J, Lin J, Auerswald C. The health status of street children and youth in low-and middle-income countries: a systematic review of the literature. J Adolesc Health. 2013;53(3):314–21. e12. UNICEF. The state of the world’s children, 2012: Excluded and invisible: United Nations Publications Report No. 9280639161. 2012. Sanji WM. An In-Depth Investigation into the Street Children and Youth of Cameroon. Resilience and the Re-integration of Street Children and Youth in Sub-Saharan Africa: The Case of Cameroon. Springer; 2018. pp. 47–72. Edewor PA. Homeless children and youths in Lagos, Nigeria: Their characteristics, street life and sexual behaviour. Mediterranean J Social Sci. 2014;5(1):537–45. Cumber SN, Tsoka-Gwegweni JM. Characteristics of street children in Cameroon: A cross-sectional study. Afr J Prim health care family Med. 2016;8(1). Khalifah IN, Demartoto A, Salimo H. Health Belief Model and Labelling Theory in the Analysis of Preventive Behaviors to Address Biopsychosocial Impacts of Sexual Violence among Street Children in Yogyakarta. J Maternal Child Health. 2017;2(4):309–23. Makoge V, Ntale D, Nana RRD, Kamga GT, Molu J-P, Tangueu VO et al. Unveiling the hidden health challenges: malaria, helminths, STIs and other pathologies among street children, adolescents and young adults in Cameroon. Int Health. 2025:ihaf031. Strecher VJ, Rosenstock IM. The health belief model. Cambridge handbook of psychology. health Med. 1997;113:117. Clarke V, Braun V. Thematic analysis. Encyclopedia of critical psychology. Springer; 2014. pp. 1947–52. Ghimire L. Being on the street. Causes, survival strategy and societal perception. An empirical study of street children in Kathmandu 2014. Obimakinde AM, Shabir M. Physical, mental and healthcare issues of children on the street of Ibadan, Nigeria. Afr J Prim Health Care Fam Med. 2023;15(1):e1–10. Fiasorgbor DA, Fiasorgbor EK. Street children: our health and coping strategies when we are sick. J Health Med Nurs. 2015;15(1):45–50. Zewude B, Siraw G, Engdawork K, Tadele G. Health seeking behavior of street connected children in Addis Ababa, Ethiopia. Front Sociol. 2023;8:1188746. Jamdade N. A review on the health status of the street children: An exploratory study. Int J Nurs Med Invest. 2024;1(2):128–38. Jörgensen E, Napier-Raman S, Macleod S, Seth R, Goodman M, Howard N, et al. Access to health and rights of children in street situations and working children: a scoping review. BMJ Paediatrics Open. 2024;8(1):e002870. Nasiri N, Kostoulas P, Roshanfekr P, Kheirkhah Vakilabad AA, Khezri M, Mirzaei H, et al. Prevalence of HIV, hepatitis B virus, hepatitis C virus, drug use, and sexual behaviors among street children in Iran: A systematic review and meta-analysis. Health Sci Rep. 2023;6(11):e1674. Wassihun Y, Hunegnaw Z, Anagaw TF, Yigzaw ZA, Bogale EK. HIV preventive practice and its associated factors among street dwellers in Ethiopia: Application of health belief model. PLOS Global Public Health. 2024;4(5):e0003199. Chairani R, Hamid A, Sahar J, Budhi T, editors. Self efficacy of street children in JABODETABEK in utilizing health services. IOP Conference Series: Earth and Environmental Science; 2019: IOP Publishing. Additional Declarations No competing interests reported. Supplementary Files SupplementaryTable.docx InterviewFocusgroupdiscussionguideSCaY.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 20 Oct, 2025 Reviewers agreed at journal 13 Oct, 2025 Reviewers agreed at journal 09 Oct, 2025 Reviewers invited by journal 06 Oct, 2025 Editor assigned by journal 01 Oct, 2025 Editor invited by journal 04 Sep, 2025 Submission checks completed at journal 03 Sep, 2025 First submitted to journal 03 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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1","display":"","copyAsset":false,"role":"figure","size":42270,"visible":true,"origin":"","legend":"\u003cp\u003eDynamics highlighting key factors associated to formal health care use among SCaYs\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7474433/v1/04c48c87820b608a1d2f2df9.jpg"},{"id":96257054,"identity":"6d90bded-e978-48cd-9fb0-5d99f519666b","added_by":"auto","created_at":"2025-11-19 07:51:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1248762,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7474433/v1/e74eaf06-2104-4ec3-b7b1-e2cbf6ab50ae.pdf"},{"id":96252713,"identity":"c0e321c2-708c-45fd-8471-92b22fd0d782","added_by":"auto","created_at":"2025-11-19 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Cameroon","fulltext":[{"header":"Background","content":"\u003cp\u003eImproving access to quality healthcare for underserved and resource-limited populations remains a critical development challenge (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Poverty not only increases the incidence of disease but also restricts the capacity of individuals and communities to respond to health threats effectively (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Among the vulnerable and underserved groups globally are street children and youths, whose numbers are estimated to be in the tens of millions (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In Cameroon, this demographic represents a significant yet marginalised population within urban settings. Cities such as Yaound\u0026eacute;, Bamenda, Bafoussam, and Douala are home to large numbers of street children and youths (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eStreet children and youths are typically those for whom the streets have become more of a home than their family environments. The United Nations Educational Fund categorises this population into three groups: children \u003cem\u003eon\u003c/em\u003e the street, \u003cem\u003eof\u003c/em\u003e the street, and those \u003cem\u003eat risk\u003c/em\u003e of becoming street children. Those \u003cem\u003eon the street\u003c/em\u003e may live with their families at night but work or spend most of their time on the streets during the day (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In contrast, children \u003cem\u003eof the street\u003c/em\u003e have left home due to a combination of factors, such as family poverty, domestic dysfunction, abuse, parental death, and a lack of educational opportunities. Regardless of classification, these children and youths are exposed daily to significant risks, including physical harm, abuse, exploitation, and a lack of adult supervision (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite the growing visibility of this issue, street children and youths are frequently excluded from national planning, healthcare service provision, and resource allocation (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). They are often stigmatised and stereotyped as delinquents, criminals, or public nuisances\u0026mdash;perceptions that further entrench their marginalisation (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Nevertheless, the presence of street children and youths continues to grow in Cameroon\u0026rsquo;s urban centres, where many live partially or entirely disconnected from familial support systems. In their daily struggle for survival, they often engage in informal and sometimes hazardous economic activities, from begging to forms of labour that jeopardise their health and safety (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe health challenges faced by street children and youths (SCaY) in Cameroon are numerous and closely tied to their precarious living conditions. Studies report high susceptibility to communicable and non-communicable diseases, including malaria, gastrointestinal illnesses, injuries, dermatological conditions, and respiratory complaints such as chest pain (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). These health problems are further exacerbated by environmental exposure, inadequate nutrition, limited access to clean water, and the absence of shelter.\u003c/p\u003e\u003cp\u003eUnderstanding the health-seeking behaviour of SCaY is essential for designing effective health interventions and service delivery models. Their patterns of healthcare \u0026mdash;shaped by factors such as poverty, stigma, mobility, distrust of formal institutions, and reliance on informal networks\u0026mdash;can significantly influence health outcomes. Without insight into how and why they choose to seek or avoid care, public health responses risk being misaligned with their needs and realities.\u003c/p\u003e\u003cp\u003eThis study aimed to investigate the health-seeking behaviour of street children and youths (SCaY) in urban Cameroon through the lens of the Health Belief Model (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Specifically, it sought to understand how perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy shaped individuals\u0026rsquo; (ScaY\u0026rsquo;s) decisions to access or avoid formal healthcare services within the context of their marginalisation and precarious living conditions. This understanding is essential for informing the development of responsive, context-appropriate health interventions.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy settings\u003c/h2\u003e\u003cp\u003eThis study took place in Yaound\u0026eacute;, the capital of Cameroon, and home to approximately 2.8\u0026nbsp;million people. Positioned on a plateau covered with hills and forests, Yaound\u0026eacute; lies between the Nyong and Sanaga rivers in the south-central part of the country. Participants were recruited across the six health districts of Yaound\u0026eacute;, namely, Mvan, Mokolo, Efoulan, Bastos, Gare Voyageur, Columbia, and Poste-Centrale.\u003c/p\u003e\u003cp\u003eParticipants were eligible if they were identified by the Ministry of Social Affairs as street children and youths. This study was carried out in partnership with the Cameroon Ministry of Social Affairs (MINAS), specifically through its Regional Delegation of Social Affairs (RDSA) in Yaound\u0026eacute;. Access to street children was facilitated by the RDSA in collaboration with the Yaound\u0026eacute; Listening and Transit Center (CETY). CETY is a public institution that facilitates the reinsertion of street children and youths in Yaound\u0026eacute;. RDSA and CETY liaised the research team and another association called OCALUCOPER (\u003cem\u003eOrganisation Camerounaise de Lutte Contre le Ph\u0026eacute;nom\u0026egrave;ne des Enfants de la Rue)\u003c/em\u003e. The role of OCALUCOPER is to eliminate the phenomenon of street children. It is founded and run by former street children.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eThe design of this study was cross-sectional and mixed-method in nature. A pretested semi-structured questionnaire and an interview guide were used to obtain information. It was part of a larger project focusing on a broader investigation of street children and youth health challenges, health profiles, infectious disease prevalence and ways in which they navigated these challenges. This study was carried out between March and July 2022 and sought to understand the health-seeking behaviour of street children and youths in the face of (perceived) diseases in their environment.\u003c/p\u003e\n\u003ch3\u003eParticipant recruitment and study procedure\u003c/h3\u003e\n\u003cp\u003ePreliminary meetings prior to the study were held at the RDSA presided over by the Delegate of Social Affairs. In attendance was her team, the Director of CETY and his team, the president of OCALUCOPER accompanied by some members and the research team. These meetings were geared at planning outreach sessions to the street to inform the SCaY about the study and invite them to participate. Participation was strictly voluntary, assent and consent were required before participation, and potential participants were informed that they could discontinue participation at any time with no repercussions. Street children and youths who agreed to participate were provided with transportation means to reach CETY. The members of OCALUCOPER, who are in direct contact with this population, facilitated this process. They hired cars and buses to pick the children from the street to CETY and back. CETY is an institution with which the street children are familiar, as it is a place they visit to be listened to and participate in other activities.\u003c/p\u003e\n\u003ch3\u003eHealth-seeking behaviour Questionnaire\u003c/h3\u003e\n\u003cp\u003eThis questionnaire was administered to SCaYs by the research team with the assistance of social workers who are part of the CETY team at the CETY premises. The HSB questionnaire was developed on the basis of a thorough review of previously published studies on the HSB of people in low-resource settings (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), the components of the health belief model, prior discussions with the RDSA, Director of CETY and subsequent outreach activities to the different areas where street children are found. The questionnaire had four parts and sought to identify perceived health challenges and response/coping strategies. The questionnaires were administered verbally since most of the SCaYs could not read or write. The first part of the HSB questionnaire included background or entry questions to ascertain the demographic characteristics of the respondents. Part 2 included questions related to the perceived common diseases in the SCaY environment (disease severity, susceptibility, cues to action), perceived reasons for the presence of diseases, disease history, response to diseases and facilitators and barriers to healthcare services. Part 3, sought to reveal the risk behaviours of street children and posed questions on their knowledge and use of narcotic drugs, psychoactive substances and other problematic behaviour tendencies among SCaYs. The last part of the questionnaire included questions related to getting off the street and the ambitions and dreams of street children.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eLaboratory Tests\u003c/strong\u003e\u003cp\u003eThe street children were screened for malaria, helminth infection, HIV, Hepatitis B and anaemia. The findings related to these tests are published elsewhere.\u003c/p\u003e\u003c/p\u003e\n\u003ch3\u003eQualitative Study: Interview Guide\u003c/h3\u003e\n\u003cp\u003eIn-depth, semi-structured interviews were conducted with street children and youths (SCaYs) using a systematically developed interview guide. This method was chosen to capture detailed, context-rich accounts while providing flexibility to explore emerging topics. The guide covered participants\u0026rsquo; lived experiences, trajectories into street life, and strategies for coping with diverse challenges. For this paper, our analysis focuses specifically on health-related challenges reported by SCaY and the strategies they employ to address them. The interview guide used for this study is attached as a supplementary file.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eTheoretical framework:\u003c/h2\u003e\u003cp\u003eThe health belief model was used to obtain valuable insights into decision-making processes regarding health among street children and youths. In the case of SCaY in Cameroon, the model helped to identify critical intervention points to improve health-seeking behaviours. By understanding the perceptions of health risks, benefits of treatment and barriers to care, more effective and targeted interventions can be developed that address specific needs and constraints faced by street children.\u003c/p\u003e\u003cp\u003e\u003cb\u003eIndividual perceptions\u003c/b\u003e: The construct of perceived threat of disease, as conceptualized within the Health Belief Model, encompasses two key dimensions: perceived vulnerability and perceived severity. In the context of street-connected children and youth (SCaY), this construct reflects their ability to recognize both the presence of disease risks in their environment and their personal susceptibility to those risks, as well as their understanding of the potential harm associated with such diseases.\u003c/p\u003e\u003cp\u003eTo assess perceived threat, SCaYs were first asked to identify diseases that they commonly associate with their daily lived experiences. This provided insight into their awareness of prevalent health conditions within their environment. Perceived vulnerability and severity were further examined by asking participants to describe specific environmental risk factors they believe contribute to disease exposure and to express their perceptions of the seriousness or potential consequences of these illnesses. This dual approach enabled a comprehensive evaluation of how SCaY conceptualizes health threats, grounded in both personal experience and contextual awareness.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eCues for Action and Self-Efficacy\u003c/h3\u003e\n\u003cp\u003eThe construct of cues for action refers to the recognition among street-connected children and youth (SCaY) that specific actions can be taken to address the health challenges they face. To explore this, participants were asked about the factors that would facilitate their use of healthcare services, including both internal motivations and external triggers. Importantly, the translation of these facilitators into actual health-seeking behaviour is influenced by SCaY\u0026rsquo;s perceived benefits and perceived barriers associated with accessing formal care. These perceptions were assessed through questions designed to identify key determinants influencing the decision to seek formal healthcare.\u003c/p\u003e\u003cp\u003eSelf-efficacy, another critical component of the Health Belief Model, reflects SCaY\u0026rsquo;s perceived ability to manage or cope with health challenges. This was measured by examining the specific coping strategies employed by street children in response to illness or injury. The responses provided insights into their confidence in managing health-related risks and navigating available resources, despite the structural and environmental constraints they encounter.\u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses focused on evaluating the relationship between hospital attendance (defined as a binary outcome: yes vs. no) and a range of explanatory variables grouped into four categories based on the theoretical framework: sociodemographic factors, street-living conditions, risk behaviors, and laboratory test results.\u003c/p\u003e\u003cp\u003eWe first conducted descriptive analyses to summarize the distribution of each independent variable. Categorical variables (e.g., education level, drug use, HIV status) were described using frequencies and percentages, while continuous variables (e.g., age, time spent on the street) were summarized using means, standard deviations, or medians and interquartile ranges, depending on their distribution.\u003c/p\u003e\u003cp\u003eTo explore potential associations with hospital attendance, we performed univariate logistic regression analyses, modeling the outcome against each predictor individually. For each model, we reported the unadjusted odds ratio (OR), its 95% confidence interval (CI), and the p-value. All analyses were conducted using a significance level of 0.05. No multivariable models were used, in order to maintain a purely exploratory and descriptive approach\u003c/p\u003e\u003cp\u003e\u003cb\u003eQualitative data\u003c/b\u003e were analysed via \u003cem\u003eATLAS.ti\u003c/em\u003e software, using thematic analysis guided by the six-phase framework outlined by Braun and Clarke (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The analytic process began with multiple readings of the transcripts to ensure familiarization with the data, followed by the generation of initial codes. Coding was informed by constructs from the Health Belief Model (HBM) and relevant health-seeking behaviour (HSB) literature. Themes were then developed on the basis of the study\u0026rsquo;s central research questions related to the HSB and the components of the HBM. The emerging themes included perceptions of common diseases, perceived vulnerabilities, barriers to and facilitators of healthcare access, and coping strategies among street-connected children and youth (SCaY). Thematic analysis following coding enabled the identification of key patterns and insights.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eEthical considerations\u003c/h2\u003e\u003cp\u003e This study received ethical approval from the Institutional Ethics Committee of the Institute of Medical Research and Medicinal Plants Studies (IMPM) and the Ethical Review Board of the Regional Delegation of Social Affairs under the Ministry of Social Affairs (MINAS), Cameroon. Participation in the study was entirely voluntary, and informed consent procedures were carefully adapted to the vulnerable nature of the study population. This is in line with the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003eTo minimize coercion, participants received only minimal compensation in the form of meals, which were not conditional upon participation. Detailed information about the study, including its purpose, procedures, and ethical safeguards, was provided during initial outreach sessions and reiterated upon arrival at the Centre for Listening and Transition (CETY).\u003c/p\u003e\u003cp\u003eThe study objectives were explained in simple, age-appropriate language to all street children and youth (SCaY), with an emphasis on the voluntary nature of participation. Informed consent was obtained from participants aged 21 years and older. For those under the age of 21, oral informed assent was obtained in the presence of trusted adults. Informed consent for children under 21 was obtained from their legal guardians who in this case is the Ministry of Social Affairs. To maintain confidentiality and anonymity, each participant was assigned a unique code, and no identifying information was collected.\u003c/p\u003e\u003cp\u003eTo support the psychological safety of the participants, the research team worked closely with OCALUCOPER- an organization with longstanding experience in daily engagement with street children- and with trained social workers from CETY. Oversight was provided by the Regional Delegation of Social Affairs to ensure full compliance with ethical protocols. All data collection activities were conducted within the safe, street‒child-friendly environment of the CETY premises, rather than on the streets, to ensure participant comfort and security.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eSocio-demographic characteristics of the study participants\u003c/h2\u003e\u003cp\u003eA total of 147 male street children and youth (SCaY) participated in this study. Of these, 96% were Cameroonian nationals, whereas 4% originated from neighbouring countries, including the Central African Republic, Niger, and Nigeria. The youngest participant was 10 years old, and 38% of the respondents were under the age of 15. The most frequently reported age group (modal range) was 15\u0026ndash;25 years.\u003c/p\u003e\u003cp\u003eWith respect to educational background, 25% of the participants had no formal education, 41% had attended primary school, and 33.8% had attained at least some secondary education. A small proportion (1.4%) reported having received vocational training. A summary of these socio-demographic characteristics is provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e appears here\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic characteristics of street children in Yaound\u0026eacute;\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eNationality\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCameroon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNigeria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNiger\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCentral African Republic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eEducational Level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfessional or Technical Training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eMonthly income\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;20000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20000\u0026ndash;50000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;50000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eLiving area type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOpen public spaces (markets, bus stations, etc.)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRoofed structures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eSources of Revenue\u003c/h2\u003e\u003cp\u003eNearly all participants (90%) reported having temporary sources of income derived from a variety of informal activities. These included car washing (22%), carrying goods in markets (22%), working as scrap metal dealers (18%), dish washing in restaurants (21%), begging (12%), ambulant vending (5%), and garbage collection (4%). Further analysis revealed that 70% of the participants engaged in two or more petty jobs, with a minority (4%) simultaneously managing up to four different income-generating activities. In contrast, 11% of the participants reported having no source of income at all.\u003c/p\u003e\u003cp\u003eMonthly earnings varied considerably among participants. A majority (54%) earned less than 20,000 XAF (approximately\u0026thinsp;\u0026lt;\u0026thinsp;33 USD), while 30% reported earnings between 20,000 and 30,000 XAF (33\u0026ndash;50 USD), and only 7% earned above 50,000 XAF (\u0026gt;\u0026thinsp;84 USD) per month.\u003c/p\u003e\u003cp\u003eQualitative interviews supported these findings, indicating that while some street children and youths (SCaYs) had no income at all, those with earnings often experienced irregular or inconsistent access to income-generating activities. Periods without work were commonly associated with food insecurity and difficulty meeting basic needs. Nonetheless, solidarity, among street youths begging and stealing emerged as a key coping mechanisms. With regards to solidarity, SCaY relied on peer support to endure times of financial hardship.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I have nowhere to work. Everywhere I go to ask for work, they refuse. It is this one (a fellow street child/youth) who even helps me eat every day. Without him, I wouldn\u0026rsquo;t eat... Even yesterday, I went to wash dishes, and they turned me away.\u0026rdquo;\u003c/em\u003e SCY 24\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eLiving Conditions of Street-Connected Children and Youth (SCaY)\u003c/h2\u003e\u003cp\u003eThe majority of participants (\u003cb\u003e97%\u003c/b\u003e) reported sleeping in \u003cb\u003eopen public spaces\u003c/b\u003e, including markets, train stations, bus terminals, abandoned vehicles, and public stands. Only \u003cb\u003e3%\u003c/b\u003e of the respondents reported sleeping in roofed or enclosed structures. Frequently mentioned sleeping areas included \u003cem\u003eGare Voyageur, Columbia, Mokolo, Bastos, Avenue Kennedy, Mvan, Poste Centrale\u003c/em\u003e, and \u003cem\u003eBata Nlongkak\u003c/em\u003e. Notably, Columbia was identified as a major hub for street families and former street children, many of whom reside in informal shelters locally referred to as \"bunkers.\"\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eDuration and Reasons for Street Involvement\u003c/h2\u003e\u003cp\u003eIn terms of duration on the street, 41% of the respondents reported having lived on the street for 2\u0026ndash;5 years, 20.6% for 5 months to 1 year, 17.5% for 1\u0026ndash;2 years, and 15.4% for more than 5 years. The most frequently cited reasons for living on the street were the thrill of adventure (29.4%), followed by family violence (19.1%), family discord (11.8%), and inability or refusal of parents to pay school fees (11.8%). Qualitative responses also highlighted parental death and displacement due to conflict or war as contributing factors.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eProblematic Health Behaviours among Street Children and Youth (SCaY)\u003c/h2\u003e\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\u003ch2\u003eSubstance Use and Psychoactive Drugs\u003c/h2\u003e\u003cp\u003eA total of 91% of SCaY reported awareness of psychoactive substance use in their environment. Frequently mentioned substances included cannabis (Indian hemp), \u0026lsquo;bazza,\u0026rsquo; cigarettes, glue, \u0026lsquo;stone,\u0026rsquo; tramadol, and tramol. Most participants reported familiarity with at least three different types of drugs.\u003c/p\u003e\u003cp\u003eWith respect to personal use, 62% of the respondents reported current or past drug use. The most common reason cited for drug use was to escape personal problems. Other motivations included peer pressure, the desire to feel courageous, curiosity, and a wish to feel physically stronger. Among the minority who abstained from drug use, reasons included awareness of negative health consequences, religious beliefs (notably among Muslim participants), and personal disinterest.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eAlcohol Consumption\u003c/h2\u003e\u003cp\u003eSimilarly, 62% of the participants reported alcohol consumption. The primary reason cited was the pursuit of joy or temporary relief from problems, with secondary motivations including peer influence and the need to increase self-confidence.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eSexual Behavior\u003c/h2\u003e\u003cp\u003eNearly half of the participants (49%) reported being sexually active, with 64% of this group indicating that they had engaged in unprotected sex, raising concerns about exposure to sexually transmitted infections among this vulnerable population.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eDesire to Return Home\u003c/h2\u003e\u003cp\u003eWhen asked about their willingness to return home, 73% of SCaYs expressed a desire for family reunification. Common motivations included longing to live with family and the recognition that street life was difficult and unsafe. Only 4% cited a desire to return to school as their primary reason for going home. Conversely, some SCaYs were not interested in returning home, either to nuclear or extended families. Their reasons included the perception that street life provided more independence and economic opportunity and the belief that home environments were less supportive or more restrictive.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003ePerceived Common Diseases and Vulnerability to Illness\u003c/h2\u003e\u003cp\u003eStreet children and youth (SCaY) identified a range of diseases as commonly affecting individuals in their living environments. Malaria was the most frequently reported condition and was mentioned by 54.7% of the participants. This was followed closely by stomach aches (53.3%), which are often attributed to poor nutrition, and skin infections (40.9%). Other less frequently reported but notable health concerns included diarrhoea, headache, cough, chest infections, and injuries resulting from accidents and fights.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e appears here\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCommonly perceived diseases in the living environments of street children and Youths\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived Diseases\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMalaria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiarrhoea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeadache\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStomach ache\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSkin infections\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCough\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChest-related problems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInjury due to accidents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e44.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe participants commonly associated the presence of these health issues with the poor hygiene conditions of their environment and the pervasive impact of poverty. The lack of access to clean water, nutritious food, and adequate shelter were seen as central contributors to their vulnerability.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eEven eating is a problem. Sometimes we look for leftover food to eat or empty the trash cans of women\u003c/em\u003e (who sell food). \u003cem\u003eTherefore, I still have stomach ache problems every day.\u0026rdquo; SCaY 24\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eI sleep on the ground, and there are many mosquitoes. Every evening, I am cold\u003c/em\u003e (in Yaound\u0026eacute;)\u003cem\u003e\u0026hellip; especially since I am accustomed to the heat of the Northern region\u003c/em\u003e.\u0026rdquo; \u003cem\u003eSCaY MV-14\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOverall, SCaY perceived that sleeping in open spaces, exposure to elements, unsanitary conditions and poverty significantly increased their susceptibility to illness. However, they did not identify climate change or a lack of health knowledge as significant contributors to disease risk.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e appears here\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eReasons for disease presence\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReasons for disease presence\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor hygiene conditions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoverty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClimate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLack of Knowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003ePrompts to Action: Patterns of health-seeking behaviour\u003c/h2\u003e\u003cp\u003eAnalysis revealed complex patterns of health-seeking behaviour among participants. Responses to questions regarding their health status in the past three months revealed that almost all of the respondents (98%) had experienced illness. The health issues reported were diverse and included conditions and diseases such as malaria, diarrhoea, headaches, flu, stomach pain, earaches, injuries, wounds, chest pain, nerve-related issues, toothaches, sore throats, perceived jaundice, and accidents, among others. Despite these health challenges, nearly 90% of these vulnerable respondents reported that they did not seek medical attention at a healthcare facility (formal healthcare services) because of limited accessibility and financial constraints. Consequently, self-medication emerged as the predominant disease-response strategy, with 86.1% of the respondents indicating that they typically practiced self-medication when faced with health challenges. A stepwise approach was reported by those who sought formal healthcare, beginning with self-medication and progressing to formal care only if symptoms persisted or worsened and if they were able to raise the required funds. Street vendors of medications (informal healthcare services) were a common source of medication for self-medication practices.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;When I am sick, I do not go to the hospital, I buy medication from Kennedy\u0026rdquo;\u003c/em\u003e SCAY interview AK 23 (Avenue Kennedy is one of the neighbourhoods in Yaound\u0026eacute; and one of the areas where street children and youths live).\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I buy the tablets at the pharmacy\u0026rdquo;\u003c/em\u003e (SCaY interview TR-19)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;With money I make, I eat and keep, if I am sick, I buy tablets at the pharmacy or from people who sell in the streets\u0026rdquo;\u003c/em\u003e (SCaY interview TR-17)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe primary reason for utilizing street vendors, reported by 78.2% of the respondents, was the affordability of their medications.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;It\u0026rsquo;s cheaper\u0026hellip;it\u0026rsquo;s not like the hospital\u0026rdquo;\u003c/em\u003e (SCaY interview TR 19)\u003c/p\u003e\u003cp\u003eOther factors, such as the proximity of street vendors and the perceived effectiveness of their medications, were also mentioned.\u003c/p\u003e\u003cp\u003eThe interviews revealed a health facility accessible to SCaYs who had lung infections following their living conditions. However, SCAY reported that malaria was not considered severe enough to receive treatment at this facility:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThere is still Moly where they still treat street children, but I know they do that in relation to those who have lung infections, because most get free treatment at Moly, but I do not think that we can go there for simple malaria.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eFacilitators and Barriers to Utilizing Formal Healthcare Services\u003c/h2\u003e\u003cp\u003eOnly 5.9% of SCaY reported seeking care from formal healthcare services. A total of 10.3% stated that they took no action in response to their health issues. This study identified key facilitators for seeking formal healthcare services as financial ability and type of disease.\u003c/p\u003e\u003cp\u003eThe main barrier to seeking care from formal healthcare services was financial constraints. This was confirmed in the qualitative part of the study. Notably, factors such as the type of illness and fear were not reported as major barriers to seeking formal medical care.\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eI do not go to the hospital because I do not have enough money for that\u0026rdquo;\u003c/em\u003e (SCAY interview TR-17)\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e appears here\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFacilitators and Barriers to Utilizing Formal Healthcare Services*\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFacilitators\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHaving money\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eType of disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo particular reason\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBarriers\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFinancial constraints\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eType of disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e*Multiple responses were possible\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eDynamics of health seeking behaviour among street children and youths\u003c/h2\u003e\u003cp\u003eDynamics relating to health seeking behaviour among street children and youths, illustrated multifactorial influences on health seeking behaviour. Five key domains were highlighted\u0026mdash;socio-demographic factors, risk behaviours, street-living conditions, laboratory-confirmed health status, and the political and socio-cultural environment\u0026mdash;as interrelated determinants of formal health care use. The model illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, revealed how these structural, behavioural, and biomedical factors interact within a broader context of social marginalization.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: Dynamics highlighting key factors associated to formal health care use among SCaYs\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the complex interplay of factors shaping disease perceptions and health-seeking behaviours among street-connected children and youths (SCaY) in Yaound\u0026eacute;, Cameroon. The combination of poverty, unstable living environments, substance use, and exposure to diseases creates a challenging context in which these youths must navigate to maintain their health. The Health Belief Model (HBM) provided a valuable framework for understanding the beliefs, barriers, and motivators influencing SCaY\u0026rsquo;s health behaviours. Our findings offer important insights for designing targeted interventions aimed at improving health outcomes in this vulnerable population.\u003c/p\u003e\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e\u003ch2\u003eStreet Survival and Economic Challenges\u003c/h2\u003e\u003cp\u003e Unlike most children living under parental care, SCaYs must independently navigate daily survival. Poverty emerged as a predominant challenge, limiting their ability to meet basic needs and manage health issues. To cope, SCaYs engage in precarious income-generating activities such as car washing, dish washing, scrap metal collection, begging, and sometimes stealing. These survival strategies, also reported in other contexts, such as Nepal (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) and Cameroon, often become more prevalent in the absence of stable employment, thereby exacerbating poverty. The harsh realities of street life, including mobile domiciliation and open-air living, result in poor hygiene and sanitation, further compromising their health (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003eCommonly Perceived Diseases and Health Risks\u003c/h2\u003e\u003cp\u003eMalaria, gastrointestinal problems (notably stomach ache and diarrheal diseases), and skin infections were identified by participants as the most common health concerns. Stomach aches were frequently attributed to the consumption of unsafe food discarded near restaurants, poor nutrition, and unhygienic living conditions\u0026mdash;a pattern that is consistent with findings from Nigeria (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) and Ghana (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Skin infections were visibly common and linked to poor hygiene practices, limited access to bathing facilities, and the constant wearing of unwashed clothes, which create ideal conditions for pathogens to thrive. While louse infestations have been documented among street children in Ethiopia (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) they were not reported in our study, highlighting contextual differences. Malaria was the most commonly perceived illness, likely due to frequent mosquito exposure in open living environments. However, reliance on fever as a proxy for malaria may lead to misdiagnosis and inappropriate self-medication, which carry potential health risks (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003eDynamics of Health-Seeking Behaviour\u003c/h2\u003e\u003cp\u003eOur findings showed that health-seeking behaviour among SCaYs was influenced by five key interrelated factors: socio-demographic factors, risk behaviours, street-living conditions, laboratory results and perceived illness, and the political and socio-cultural environment. These findings hardly reported, offer a comprehensive lens for analysing health service engagement in this vulnerable population. Socio-demographic factors in the form of financial constraints and poor living conditions, feed the practice of risk behaviours leading to different health challenges and illnesses which are hardly addressed because stigma/ labelling (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), political omissions, poverty etc creating a form of vicious cycle for ScaYs. When it comes to coping strategies, illnesses perceived as common such as malaria or perceived as not being severe were often self-managed through informal means. Street vendors were healthcare providers of choice for SCaYs because they were perceived as cheaper and more accessible. Our finding of restricted access to formal healthcare services due to financial limitations is consistent with studies in other low-resource settings (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Furthermore, negative attitudes and stigmatization by healthcare workers discouraged SCaY from seeking care at formal health facilities, fostering reliance on more affordable, proximal, and less judgmental sources. The widespread practice of self-medication, while common, raises concerns about inappropriate treatment and potential complications (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). These findings underscore the need for interventions that address economic barriers and health system stigma to facilitate timely and appropriate care.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eApplication of the Health Belief Model (HBM)\u003c/h3\u003e\n\u003cp\u003eUsing the HBM, our study elucidated how SCaYs perceived their susceptibility to illness, evaluated the severity of health problems, and responded to cues for health action. The participants demonstrated awareness of their vulnerability to diseases stemming from hazardous living conditions and substance use (perceived susceptibility) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The severity with which symptoms were viewed influenced whether formal care was sought; minor symptoms were often ignored, whereas life-threatening conditions prompted health-seeking (perceived severity and cues to action). The perceived benefits of accessing pharmacies and clinics and maintaining hygiene\u0026mdash;along with confidence in their ability to act (self-efficacy)\u0026mdash;motivated some positive health behaviours (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). However, structural barriers such as cost, stigma, and limited access frequently curtailed these actions, resulting in avoidance or informal treatment. This application of the HBM highlights the interplay between individual beliefs and systemic challenges shaping health behaviours in this population.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTo the best of our knowledge, this study represents the first investigation of health-seeking behaviour among street-connected children and youth in Cameroon. Our findings indicate that street children and youths face complex health challenges shaped by poverty, unstable living conditions, stigma, socio-political factors,l. Using the Health Belief Model, our study revealed that these factors drive reliance on self-medication and informal care for common ailments such as malaria, gastrointestinal issues, and skin infections. Effective interventions must reduce financial and social barriers, improve living conditions, and provide accessible, non-judgmental healthcare to enhance health outcomes for this vulnerable group.\u003c/p\u003e\u003cdiv id=\"Sec32\" class=\"Section2\"\u003e\u003ch2\u003eLimitation\u003c/h2\u003e\u003cp\u003eFirstly, the cross-sectional design used in this study limits our ability to establish causal relationships between the identified factors and health-seeking behaviours. Second, we relied on self-reported data from street children and youth and this may be subject to recall bias or social desirability bias, and can potentially affect the accuracy of reported disease perceptions and health behaviours. Additionally, some health conditions were based on perceived symptoms without clinical confirmation, which could affect the precision of disease prevalence reported in this paper. However, we have reported actual prevalence data in an already published paper.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e This study was approved by the Institutional Ethics Committee of the Institute of Medical Research and Medicinal Plants Studies (IMPM) and the Ethical review board of the Regional Delegation of Social Affairs of the Ministry of Social Affairs (MINAS). Participation in the study was strictly voluntary. Informed consent and assent was obtained from participant as per their ages Precautions were taken to ensure individual information confidentiality.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003e This study was supported by the Royal Society for Tropical Medicine and Hygiene (RSTMH) Small Grants Programme, with funding provided through the National Institute for Health Research (NIHR), United Kingdom\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eVM, conceived and designed the study; V.M., J.P.M., D.T., R.R.D.N., O.V.A.T., G.T.K. and MMGL administered the survey and participated in the wider study. VM carried out the in-depth interviews. DT and VM analysed the data; VM wrote the first draft of the manuscript; all authors contributed to subsequent drafts and reviewed the final version of the manuscript. WM supervised the study.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors gratefully acknowledge the Royal Society for Tropical Medicine and Hygiene (RSTMH) for awarding the Small Grant that made this project possible. We also extend our sincere appreciation to the Regional Delegate of Social Affairs, the Director and staff of CETY, the members of OCALUCOPER, and, most importantly, the street-connected children and youth who generously shared their time and experiences in contributing to this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data generated or analyzed as part of this study are included in this manuscript\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBabawarun O, Okolo CA, Arowoogun JO, Adeniyi AO, Chidi R. Healthcare managerial challenges in rural and underserved areas: A Review. World J Biology Pharm Health Sci. 2024;17(2):323\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNaghiloo Z. Global health interventions in resource-limited settings: successes and lessons learned. Health Nexus. 2023;1(3):56\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWoan J, Lin J, Auerswald C. The health status of street children and youth in low-and middle-income countries: a systematic review of the literature. J Adolesc Health. 2013;53(3):314\u0026ndash;21. e12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUNICEF. The state of the world\u0026rsquo;s children, 2012: Excluded and invisible: United Nations Publications Report No. 9280639161. 2012.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSanji WM. An In-Depth Investigation into the Street Children and Youth of Cameroon. Resilience and the Re-integration of Street Children and Youth in Sub-Saharan Africa: The Case of Cameroon. Springer; 2018. pp. 47\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEdewor PA. Homeless children and youths in Lagos, Nigeria: Their characteristics, street life and sexual behaviour. Mediterranean J Social Sci. 2014;5(1):537\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCumber SN, Tsoka-Gwegweni JM. Characteristics of street children in Cameroon: A cross-sectional study. Afr J Prim health care family Med. 2016;8(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhalifah IN, Demartoto A, Salimo H. Health Belief Model and Labelling Theory in the Analysis of Preventive Behaviors to Address Biopsychosocial Impacts of Sexual Violence among Street Children in Yogyakarta. J Maternal Child Health. 2017;2(4):309\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMakoge V, Ntale D, Nana RRD, Kamga GT, Molu J-P, Tangueu VO et al. Unveiling the hidden health challenges: malaria, helminths, STIs and other pathologies among street children, adolescents and young adults in Cameroon. Int Health. 2025:ihaf031.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStrecher VJ, Rosenstock IM. The health belief model. Cambridge handbook of psychology. health Med. 1997;113:117.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eClarke V, Braun V. Thematic analysis. Encyclopedia of critical psychology. Springer; 2014. pp. 1947\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGhimire L. Being on the street. Causes, survival strategy and societal perception. An empirical study of street children in Kathmandu 2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eObimakinde AM, Shabir M. Physical, mental and healthcare issues of children on the street of Ibadan, Nigeria. Afr J Prim Health Care Fam Med. 2023;15(1):e1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFiasorgbor DA, Fiasorgbor EK. Street children: our health and coping strategies when we are sick. J Health Med Nurs. 2015;15(1):45\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZewude B, Siraw G, Engdawork K, Tadele G. Health seeking behavior of street connected children in Addis Ababa, Ethiopia. Front Sociol. 2023;8:1188746.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJamdade N. A review on the health status of the street children: An exploratory study. Int J Nurs Med Invest. 2024;1(2):128\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJ\u0026ouml;rgensen E, Napier-Raman S, Macleod S, Seth R, Goodman M, Howard N, et al. Access to health and rights of children in street situations and working children: a scoping review. BMJ Paediatrics Open. 2024;8(1):e002870.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNasiri N, Kostoulas P, Roshanfekr P, Kheirkhah Vakilabad AA, Khezri M, Mirzaei H, et al. Prevalence of HIV, hepatitis B virus, hepatitis C virus, drug use, and sexual behaviors among street children in Iran: A systematic review and meta-analysis. Health Sci Rep. 2023;6(11):e1674.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWassihun Y, Hunegnaw Z, Anagaw TF, Yigzaw ZA, Bogale EK. HIV preventive practice and its associated factors among street dwellers in Ethiopia: Application of health belief model. PLOS Global Public Health. 2024;4(5):e0003199.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChairani R, Hamid A, Sahar J, Budhi T, editors. Self efficacy of street children in JABODETABEK in utilizing health services. IOP Conference Series: Earth and Environmental Science; 2019: IOP Publishing.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":true,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Street children and youths, Health-seeking Behaviour, Health Belief Model, street children, Cameroon, Malaria","lastPublishedDoi":"10.21203/rs.3.rs-7474433/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7474433/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eImproving access to quality healthcare for underserved and resource-limited populations (like street children and youths- SCaYs) remains a critical development challenge. In Cameroon, street children represent a vulnerable and marginalized population, facing numerous health risks exacerbated by poverty, precarious living conditions, and social exclusion. Despite growing recognition of their health challenges, these SCaYs remain underrepresented in health service planning and interventions. This study applies the Health Belief Model (HBM) to explore disease perceptions, risk factors, and health-seeking behaviours among SCaYs in Yaound\u0026eacute;, Cameroon.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA mixed-methods study was carried out with 147 male SCaYs. Data was collected using a pretested semi-structured questionnaire, in-depth interviews and focus group discussions to determine perceived diseases, health behaviours, barriers and facilitators to healthcare access. Participants were also screened for malaria, helminths, HIV and Hepatitis B. Quantitative data were analysed using Microsoft Excel and IBM SPSS Statistics, version 24. A cross-sectional analysis was conducted to explore factors associated with hospital health-seeking behaviour among respondents. Descriptive statistics were used to summarize sociodemographic characteristics, street-living conditions, risk behaviors, and laboratory test results. Univariate logistic regression models were then applied to assess the individual association of each variable with hospital attendance. Odds ratios (OR), 95% confidence intervals (CI), and p-values were reported.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe majority of participants (96%) were Cameroonian, aged primarily between 10\u0026ndash;25 years. Poverty-driven unstable informal employment and open-air living conditions heightened their exposure to health risks. Malaria (54.7%), stomach aches (53.3%), and skin infections (40.9%) were the most commonly perceived illnesses. Despite 98% reporting illness in the prior three months, only 5.9% sought formal healthcare due to substantial financial constraints and stigma. Self-medication via street vendors was the predominant coping strategy (86.1%), driven by affordability and accessibility. Participants demonstrated awareness of susceptibility and severity of some illnesses (HBM constructs), but perceived barriers and social stigma limited healthcare engagement.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe study highlights a complex interaction of individual perceptions and systemic barriers influencing SCaYs health-seeking behaviours in Cameroon. Interventions should prioritize reducing financial obstacles, addressing stigma within health facilities, and improving living conditions to enable accessible, respectful, and effective healthcare for this marginalized group. The Health Belief Model provides a useful framework for understanding and addressing these multifactorial challenges.\u003c/p\u003e","manuscriptTitle":"Disease Perceptions, Risks, and Responses: Using the Health Belief Model to Understand Street Children and Youths Health-Seeking Behaviour in Cameroon","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-18 12:56:49","doi":"10.21203/rs.3.rs-7474433/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-10-20T16:56:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"138810903755631007499804850934629970575","date":"2025-10-13T10:12:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"116128920040615484959648920651901204993","date":"2025-10-09T11:08:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-06T10:24:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-01T16:29:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-04T05:19:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-03T21:24:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-09-03T21:22:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e19b8476-03a8-4110-86bc-a326b83cc7c5","owner":[],"postedDate":"November 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-18T12:56:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-18 12:56:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7474433","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7474433","identity":"rs-7474433","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}