Scaling Innovations From Healthcare Interventions for Street Children in Developing Countries: A Systematic Review Based on Evidence From Dodoma City

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Projest, LEONCE Mujwahuzi, ANNA MASELE This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6705013/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract The study examines the trend of publications related to health interventions for street children in Sub-Saharan African countries. It involved a systematic analysis of 637,686 documents sourced from the Dimension and Google Scholar databases, covering the period from 2020 to 2025. After a thorough process of identification, screening, and eligibility assessment, only six journal articles were included in this review. Further analysis aimed to identify study outcomes associated with the Ottawa health promotion framework, which focuses on developing personal health promotion skills for street children, strengthening community action, creating a supportive environment for accessing healthcare, and enhancing health public policy that effectively addresses the health of street children. The systematic review results indicate that mobilising financial resources for street children's healthcare, addressing tropical diseases through hospital treatment rather than self-medication, fostering collaboration between government social welfare departments and civil organisations, and utilising emergency health services collectively create a supportive environment for street children. However, limited knowledge about scaling these interventions has led to misallocation of resources aimed at addressing healthcare needs for street children. The review concludes by emphasising that effective interventions such as digital banking, collaboration between civil organisations and government, the use of emergency health services, and ensuring treatment adherence among street children should be scaled up in all activities involving street children to enhance uniformity and transparency. Street children Interventions Health promotion Health services Figures Figure 1 Introduction Healthcare intervention for street children globally remains a challenge that affects not only developing countries but also developed ones. United Nations estimates there about 150 million street children in the world without health access and social welfare services that increases physical, psychological, and social risks for street children(Deb et al., 2020 ). There is an increasing gap in health services accessibility among street children because most interventions that are designed to deliver health services for street children fail to indicate measurable health outcomes. Inadequate of health trained officials does corresponds with increasing trends of street children regardless of social interventions related to reproductive health, sexually transmitted diseases, respiratory problems, mental health and substance use issues (Dankyi & Huang, 2022 ).The initiatives of improving health outcomes through community-based interventions such as shelter and dropping centre are scaled up to link street children with health care in their respective countries (Doh, Kamara, Galukande, & Renzaho, 2022 ). Community-based health interventions interact with health systems to provide both informal and formal health services for the street children, especially in developing countries where health systems have failed to design appropriate health interventions that are appropriate for their needs. (Shafique et al., 2024 ).Efforts of delivering health services are directed to the grassroot which is the community which design friendly interventions which street children in health services while target families with low socioeconomic situations to prevent their children from joining street lives and connecting those who are on the street with healthcare (Shekhar & Rai, 2025 ). The collaborative efforts of delivering health services among street children also involve community members such as health volunteers, community case workers, and community champions who identify and connect street children with available health services. United Nations recognize health as a basic right for all children but street children are still facing challenges to health accessibility (Pimenta & United, 2023 ).The implementation of universal health for all people in the community has failed to cover street children because they're always moving from one place to another and they lack identity documents for registration, the study indicates that the universal health system has strategies that overlook non-institutionalized people such as street children(Hatloy & Huser, 2005 ).Street children in Tanzania lack policy inclusion because the health policy does not include street children as an at-risk community but they are mentioned as a whole group of vulnerable children who need care and protection (Solile, Nyanza, Mwanga, & Shangali, 2023 ). Therefore, achieving universal health coverage is an important aspect to be scaled up in street health interventions. Geographical obstacles, legal status, financial costs, and linguistic and cultural differences, disconnect street children from mainstream health services, mobility and lack of fixed place of living make it difficult because some health facilities are located far, (Shi & Singh, 2022). Mobile clinics have specifically reached street children to facilitate their access to primary health intervention for infectious and chronic diseases (Barr, 2023; Malone et al., 2020).). Street children are the type of community with low access to health care because most of them lack knowledge of where to get health services and those with knowledge are self-discriminating or segregated by hospital staff (Chikova & Chikova, 2019). Employing a community-based model together with other health promotion actions like skills training for the street children increases their chance to understand the importance of their health, but it is argued by Kontak, Caldwell, Kulczycki, Hancock Friesen, and Kirk (2023) highlighting that not all street will be able to acquire skill on health promotion because of their different experiences, low health education and lack of personal skills. Their mobility nature, working and sleeping in unhygienic environments, low nutrition and exposure to toxic materials early in their childhood contribute to lower immunity, morbidity, poor development delay and illness.(Navaneetham, Dharmalingam, & Caselli, 2008) Ali, Shahab, Ushijima, and de Muynck (2004) argued that poor nutrition weakens their immune systems and the harsh, unhygienic conditions expose them constantly to pathogens and environmental hazards, leading to higher morbidity rates compared to the general population. Substance, inhalant use and glue sniffing increase trauma and suicidal behaviours, and street children have 2.5 times of committing suicide(Swahn, Palmier, Kasirye, & Yao, 2012; Yohannes et al., 2023). The scholars such as Alam, Hossain, Islam, Murad, & Khan, (2021) argue that 90 per cent of all street children use inhalants as their life copying mechanism. As described by Ding, Loukaitou-Sideris, health services support needs significant resources collected in collaboration between the third sector and government agencies. Community engagement in health services is well known by the community members when they are involved in planning, decision-making, and allocating funds for street children (Wasserman (2022.Street children are more likely to trust community health workers because they are living together in the same community rather hospital staff, therefore community members can design effective healthcare interventions that focus on street children privacy and confidentiality. (Yuan et al., 2021). Community workers support street children by connecting them with shelters where basic health check-ups are conducted and reunite them with their families for better healthcare outcomes for those unable to reunite with their families, community workers encourage them to join shelter homes, where they receive long-term care and rehabilitation(Mokomane & Makoae, 2017). Shelter also provides essential support and opportunities for vulnerable children to access healthcare through community health interventions that are financed partly by the community members themselves central governments, local government and international donors and private foundations (Pallas et al., 2013).. Despite having more vibrant health insurance programs such as community health funds which are financed by community members still there no visibility of street children in the health care system(Fiasorgbor & Fiasorgbor, 2015 ). There is a need to scale up some innovations such as mobile clinics and outreach services for the wider population of street children. Other developing countries include street children healthcare interventions in health systems where community members, health volunteers and outreach services worker are blended in the new practices on healthcare. (Joseph et al., 2024; Rai & Shekhar). The mobile clinics and outreach services will reduce barriers such as discrimination costs and long waiting lines. Earlier studies such as those (Abekah-Carter, 2024; L Embleton et al., 2020)on street children have tried to study the health condition of street children by examining health inequality and their vulnerability to sexually transmitted diseases, but there are scant systematic analyses reviewed works of literature, the only available is a study conducted by Andrew et al. (2020) on effects of home visit for children living on the slums of India which is not the systematic review. Therefore, there is a blank knowledge of scaling effective interventions that identify street children and link them with healthcare in developing countries for uniform practices. This study is based on the review of the different articles that explore the implementation of the Ottawa Charter of 1986 linked with global health in 2030(Elliott, 2022; Saadati & Nadrian, 2024). The objective is to examine if five health promotion five actions are considered in developing health interventions for street children's health care. Those actions are developing personal skills which involve hygiene training for street children through dropping centres, strengthening community action which examines community involvement in managing street children's health conditions, creating supportive environments which involve the collaboration between Civil organisations working with street children, building healthy public policy that recognizes the needs of street children toward attainments of Universal health services that will also include street children in health access. Methodology A total of 637,686 documents were retrieved from the Dimension and Google Scholar websites. After screening these documents based on their publication year, 80,687 were excluded because they were published before 2023. Additionally, 26,134 journal articles that were not based on peer review were excluded. The remaining articles were assessed according to their research category, focusing on health services and systems. Out of these, a total of 399 journal articles met the specified criteria. Further criteria included open access; therefore, all journal articles with restricted access were excluded, resulting in the removal of an additional 526,867 articles. Consequently, only 6 journal articles were deemed eligible for inclusion in the study. The search keywords included "street children," "street-connected children," "homeless children's health services," "health care," "community engagement," "community-based interventions," and "health promotion." The inclusion and exclusion criteria were applied to determine which journal articles were suitable for the study. Were based on the inclusion and exclusion of the journal articles that were eligible to be included in the study. Table number 1 indicating inclusion and exclusion criteria Criteria Inclusion Exclusion Accessibility Articles with open access Articles without open access Publication year Journal articles published from 2020–2025 Article published before 2020 Research category Articles focusing on street-connected health services Article out of street-connected children and health services Participants Street connected children, street youth, street adolescents Other participants out of street youth, and street children Language Articles written in English Articles not written in English Research fields Articles that were relevant to sociology, social work, and public health Articles that were not relevant to sociology, social work and public health Publication type Empirical articles from peer- reviewed journals The articles on book chapter review, conferences, pre-printing and monography Journal list All journal indexed in Dimension and google scholar Journal articles not found in Dimension and google scholar Source tittle Healthcare/health services All tittle that are not related to health care Figure 1 ; Indicates the systematic review process based on PRISM model showing how journal articles were obtained. Figures (1) indicates the four stages of identification showing the number of studies identified from two data bases, screening which indicates the record of document that were excluded from the review and the studies that were excluded from the study, eligibility indicates the articles that were accessed and excluded in the study by suing reason based on the revie criteria while the last part of inclusion indicates the study that were both qualitative and quantitative. However, figure (1) summarizes the process of PRISM diagram is simple ways to ensure methodological rigour. Results The final selection included studies about street children's healthcare accessibility, all included studies are from Africa which forms part of developing countries such as Nigeria, Togo, Ethiopia, Tanzania, Kenya and Malawi. The appraised studies included street children aged 6 to 17 years, Sub Saharan African countries are experiencing high rates of street children because of poverty and economic hardship which is a significant driver that pushes children to the streets, family breakout and separation, urbanization and rural migration, conflicts and political outbreaks of violence and violence and abuse of children that include physical, sexual and emotional(Ongowo, 2022 ). The reviewed studies also included Civil organisations, governmental departments, social welfare officers and family members. Based on the outcome of the search criteria the following article was identified as the result of the study, only 6 journal articles were identified and included in the study by analyzing the outcome of the study, the Author involved in writing the articles, the journal where the article was published, journal quartile and H index of the journal are shown and listed in the following table; - Table number 2 Quality appraisal of six selected journal articles outcome Author Journal Journal Quartile H/index 1 Physical, mental and healthcare issues of children on the street (Obimakinde & Shabir, 2023 ) African Journal of Primary Health Care & Family Medicine Q2 36 2 Digital micro-banking as a health and protection intervention for street-connected children (Howard, 2024 ) BMJ Paediatrics Q1 35 3 Addressing scabies among street children in Ethiopia (Zewude, Ayode, Davey, Zaman, & Tadele, 2025 ) Frontiers in public health Q1 119 4 Challenges in accessing health care and socio-protection services among children living and working in streets (Solile, Nyanza, Mwanga, & Shangali, 2023 ) PLOS Global Public Health Q1 24 5 Adherence to treatment intervention to improve HIV treatment outcomes among street-connected (Kibel et al., 2023 ) BMC Health Services Research Q1 157 6 Access and utilization of sexual abuse emergency healthcare services among street children (Kacheyo & Nyirenda, 2024 ) BMC Health Services Research Q1 157 Literature review Community volunteers are providing direct health services for street children for example they are connecting street children with Drop-in centre where healthcare are provided. It was found that, in Malawi street community health workers connect street children with health agencies, thereby promoting coping mechanisms, adherence, and referrals among street children. Community health workers are facilitating the truth building among the street children and workers because street children they tend to trust volunteers who are spending great time with theme in the street that trusting the service providers (LeBan, Kok, & Perry, 2021 ). The contradictory findings revealed that community health workers (CHWs) have limited information about the health programs they are implementing, low esteem in program ownership, and low documentation. Both social workers and community health workers encounter issues such as low health information, internal conflicts, gender beliefs, strong cultural beliefs, and low literacy skills. Despite these challenges, community health workers remain valuable in countries with weak and fragmented health systems to deliver adequate health services to street children(Hassan, Okoli, Azike, Okoye, & Adindu, 2024 ). In the same vein, Shrestha et al. ( 2024 )conducted a study on community health workers at the dawn of a new era which indicates that the relationship between the health system and community, the study revealed the visibility of community workers in serving as intermediaries between street children and health facilities, in facilitating access to essential health services by providing education in the streets, identifying the new street children and assisting in making referrals and advocating for the healthcare needs of street children within the community and healthcare system. To implement universal health coverage and eliminate the existing disparities in health provision discrimination against street children should be eliminated (Adekeye, 2024 ). According to (Badat, 2024 ; Bhuiyan & Haque, 2024 )community groups and non-governmental organisations play a crucial role in connecting street children with health services by bridging gaps in healthcare delivery. When healthcare systems are not inaccessible, these groups provide preventive care, treatment for common illnesses, health education, and referrals. They also support the well-being of street children through nutritional support, psychological counselling, and protection. According to Seth, MacRae, Goldhagen, and Raman ( 2024 ) revealed that NGOs working with street children provide quick access to health care, escort street children to hospitals, provide first aid and take children to outpatient or casualty departments, and support children who require admission. Embleton et al. (2020) identified that more than 25,000 street children are connected by health services through community groups. Street children are affected by poor health conditions, high rates of sexual transmitted diseases, respiratory diseases, skin conditions, diarrheal illnesses, malnutrition, mental health problems, and substance use. (Abate et al., 2022 ); Kusi-Mensah and Omigbodun ( 2020 ) highlighted that street children have high rate of infectious diseases, reproductive health and mental disorder that results into poor growth. They are excluded from health services but drop-in - centers connect them with health services through street-based outreach, health education, and rehabilitation programs(Adams & Ramsay, 2024 ). The case management model is used to coordinate and arrange medical services for street children by advocating and linking them with health services available from health centres where NGOs have established partnerships. Kaluku ( 2020 ) argued that the case management model coordinates services tailored for the health needs of street children through the participatory framework that includes social workers and doctor as a multidisciplinary team. The case management model of health promotion links street children with need resources from the community, including health services, counselling trauma-based intervention and drug use (Gursansky & Harvey, 2020 ). Mobile health clinics connect outreach services which reduce healthcare costs among street children where the cost of health services is too high to be afforded by street children. Seth et al. ( 2025 )indicate the scope and impact of mobile health clinics on health promotion trough provision of health services such as vaccination and health promotion education as it is building trust among the community members. The role of health mobile clinics has an impact on community health outcomes because it has developed innovative interventions by treating chronic diseases and promoting preventive strategies among street children that ensure continuity of health services(Seth et al., 2025 ). The study reveals that mobile health clinics are not widely implemented in helping street children, especially in developing countries that could help bridge gaps in health care among street children. According to, Kaiser and Sinanan ( 2020 )street children are tight with their livelihood activities influences their seeking behaviour, some intimidation from healthcare officials, hours of operation, and long waiting times are some of the factors excluding street children from accessing proper health care. Direct Outreach and education services help them to receive health services in the areas where are found working and living. As claimed by Lotko, Leikuma, and Battle ( 2016 ) that direct outreach provides health education and counseling about sexual health that improves street children sexual infections and sexual reproductives health However, it's questionable to see Outreach services facing the financial burden of reaching street children in the community where most of the referral cases are not fully cared for by fragmented health systems. Outreach services in India face challenges such as lack of coordination between different stakeholders, providers burnout and lack of specific legal guidelines that guides their operations(Coleman et al., 2022 ). Outreach services have been introduced in different areas of Tanzania to provide health services for the general population but there is no any clinic designed to satisfy the health needs of street children. The participatory client-centred approach focuses on the right of street children to access health services related to sexually transmitted diseases and drug use prevention education like other children as it was declared and ratified by the United Nations Convention on the Rights of the Child 1989(Van Bueren, 2021 ). Child rights and street children's self-determination are mandatory in making decisions on implementing some health interventions. The participatory client-centred street children were found to be important as it was noted by Bwambale, Bukuluki, Moyer, and Borne (2021) that street children encouraged to exercise their right to involve in planning which in turn plans were integrated into their survival strategies, improved outcomes on health access as it increase the participation of street children. Discussion of findings The finding indicated that street children have low financial serving for health services, one of the barriers that street children during illness is money to cover for the health services.Howard ( 2024 ) revealed that street children in Togo street children are using digital baking to keep their money which health them to solve their social problem including medical services because their neither covered by health insurance nor any welfare intervention that is connecting them with health services. However digital micro baking reduced their spending and reduced theft among them. Digital micro-baking among street children in a good intervention that need to be adopted everywhere where their street children because it reduces their further suffering when they are sick and increases their confidence to seek for health services because of the availability of money they are serving rather that depending on their network or support from the community. The similar study was conducted by Eliza et al. ( 2024 ) who observed that street children can use smartphone to access health information by searching where heath are located maintain supportive network and they are using phone banking to serve money they are using in health funding. It is the good intervention that reduce financial dependency for the street children when are ill, depending on their informal network for assistance and begging may increase the burden of diseases because their network is inconsistent support because of their lower knowledge for providing sustainable care for serious diseases. The study conducted by Awelewa ( 2023 ) indicates that lack of money for treatment influence street children to resort on self- medication by buying medicine without proper prescription, or using traditional herbs provided from traditional healers which is considered to be cheap than hospital based medicine. This results inconstancy findings that street children engage in begging in the street in order to raise money for health system while depends on their informal network where street children contributes a small money they have to cover the health expenses of their peers this increase the underutilization of health services provided from health facilities among street children (Amoah & Jørgensen, 2014 ; Khan et al., 2022 ).The effect of self-medication because of lack of money among street children increase the risk of drug resistance(Zeleke et al., 2024 ), While street children are at greater risk of suffering from different tropical diseases, Zewude et al. ( 2025 ) is emphasizing on street children healthcare interventions which connects street children affected by a neglected tropical disease with health services. A study Amoah, Phillips, Gyasi, Koduah, and Edusei ( 2017 ) notes that 78 percent of all street children in Ghana have limited health knowledge, have low access to healthcare, shaped by low educational attainment and the absence of targeted health education campaigns. The street children low access to health education have been contributed by their age, education, street life(Shekhar & Rai, 2025 ). In some developing countries such as Iran street children lack health access, have little use of health services because of low understanding where health can be accessed(Vameghi, Roshanfekr, Ghaedamini Harouni, Takaffoli, & Bahrami, 2023 ). The findings indicates that Civil societies organisations collaborate with government welfare department to provides health services for street children which increase the shared responsibility between street children stakeholders(Nassimbwa, Kakuru, & Mpamizo, 2022 ). Health system may not be friendly to provide sufficient services for street children, therefore the availability of donor funded welfare health services helps in bridging the gap of priding necessary support that cannot be provided by the government alone (Zewude, Tadele, & Davey, 2024 ). Civil societies organisations work with hospital staffs to facilitate street children access to health services including escorting injured street children to hospital and seeking for the exemptions for treatment(Solile et al., 2023 ).Inconsistently, Manomano, Nyanhoto, and Gutura ( 2021 ) reported that government and other stakeholder lack effective collaboration, coordination and capacity building. Additionally, lack of systematic funding challenges the provision of health services and interagency cooperation for street children health interventions. This is best intervention to be adopted in all street children best intervention, it is supposed to be scaled up in different parts of different countries because street children is the forgotten segment of society. Despite of having good collaboration between government and civil societies street children are still facing the problems of adherences and lacking health education(Zewude et al., 2025 ) Stret children are always affected by sexual abuse while they are sleeping in the streets that require immediate solution, they are access to emergency health services among street children is limited as it is argued by Chimdessa ( 2020 ) that 28.6 percent of male street children in Ads Ababa experiencing sexual abuse by their peers and adults. They are at risk of getting sexual transmitted diseases and early pregnancies. It is reported that, street children have low use sexual abuse emergency services,Kacheyo and Nyirenda ( 2024 ) indicates that sexual abuse emergency health services in Malawi was established following WHO guidelines include HIV Post Exposure Prophylaxis (PEP), Emergency Contraceptive Pills (ECP) within a critical timeframe of 72 hours followed by STI treatment, and psychosocial service.(Ewunetie et al., 2022 ) indicates that more than 65 percent of street children in Ethiopia have no access to sexual emergency centre despite having high rate of sexual transmitted diseases hence the need for scaling sexual educational and mobile clinic is paramount. Nath, Shannon, Georgiades, Sword, and Raina ( 2016 ) align than attending at the dropping centre provides additional services such as free lunch and health services in a welcoming means. Consequently, emergency health services increase the health outcome by providing first and immediate treatment under the international framework, while dropping centre which provides supplement services such health education, medical check-up and lunch which are necessary intervention to be scaled up in developing countries where street children are increasing. Conclusion and recommendation Street children's health interventions are implemented differently by different stakeholders; the review examined the implementation of street children's health interventions which are mobilising money to serve themselves and protect them in times of illness rather than begging in the streets, health intervention helps street children to seek for medical services rather than self-medication, the collaboration between civil societies and government departments have increase health accessibility among street children. The establishment of emergency health services and dropping centres have increased health access and prevention services after sexual violence. However different stakeholders such as donors and government measure the success of these health interventions by health outcome and impact indicators by reduced mortality, services utilization and behaviour and social change. The health interventions will be sustainable if they are integrated into national health systems, and if will are implemented by using sectoral and finally training local leaders and volunteers to link them with child protection to address the root causes of street children. The review of the paper acknowledges the presence of good interventions that have been summarized 6 papers published from 2020 to 2025, those interventions are to be scaled up in other developing countries where the phenomenon of street children is prevailing, the objective is not to create the creating their safe platform for them to stay in the street but to keep them in good health and prepare them for the family unification or looking the alternative families where they enjoy good health services. Declarations Ethics approval and consent to participate Not applicable because this is a review study Consent for publication The study has received the consent for publication because it the fulfilment of PhD studies from the University of Dodoma, the research permit letter was released, from the University, from the Ministry of Local government and local administration and Dodoma City Council. Availability of data and materials The data that support the findings are available in two databases, dimension https://app.dimensions.ai/exports and google scholar. Competing interests Authors declares that they no commenting interest. Funding The study did not receive any fund from any agency; the study is academic based for the requirement the completion of PhD Programme. Authors' contributions The corresponding author is student based on the department of the University of Dodoma, the first and corresponding author (Projest Bernard) searched the journal articles from electronic databases and prepared this review, the second and the third authors helped on supervision of this manuscript. Acknowledgements We would like to express our sincere gratitude to the librarians at the University of Dodoma for their valuable assistance in retrieving and organizing journal articles, which significantly contributed to the success of this study. 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Kusi-Mensah, K., & Omigbodun, O. (2020). Children left behind by parental migration in sub-Saharan Africa. The Lancet Child & Adolescent Health, 4 (4), 261-262. LeBan, K., Kok, M., & Perry, H. B. (2021). Community health workers at the dawn of a new era: 9. CHWs’ relationships with the health system and communities. Health Research Policy and Systems, 19 , 1-19. Lotko, M., Leikuma, L., & Battle, M. G. (2016). Comparative analysis of outreach work with street children in Latvia, the Czech Republic and India. Paper presented at the SHS Web of Conferences. Manomano, T., Nyanhoto, R., & Gutura, P. (2021). The Challenges Faced by Children Living on the Streets. African Journal of Development Studies, 11 (1). Nassimbwa, J., Kakuru, D. M., & Mpamizo, M. T. (2022). Locating state actors in violence against children (VAC) networks in Kenya: A complexity leadership lens. International Journal of Child, Youth and Family Studies, 13 (2), 123-142. Nath, R., Shannon, H., Georgiades, K., Sword, W., & Raina, P. (2016). The impact of drop-in centres on the health of street children in New Delhi, India: A cross-sectional study. Child Abuse & Neglect, 62 , 122-131. Obimakinde, A. M., & Shabir, M. (2023). Physical, mental and healthcare issues of children on the streets of Ibadan, Nigeria. African Journal of Primary Health Care & Family Medicine, 15 (1), 3819. Ongowo, E. O. (2022). A qualitative analysis of the effects of social protection programmes for street children on social cohesion in Kenya. The European Journal of Development Research, 34 (3), 1308-1319. Pimenta, J., & United, S. C. (2023). Children in street situations’ access to healthcare: Findings from the Street Child World Cup 2022. Seth, R., Girotra, T. G., Mohammad, I., Qaiyum, Y., Taneja, I., & Raman, S. (2025). Mobile health van as an intervention to provide clinical support and health promotion to street children and marginalised populations in the National Capital Region of Delhi: a mixed-methods evaluation. BMJ Paediatrics Open, 9 (1), e002988. Seth, R., MacRae, P., Goldhagen, J., & Raman, S. (2024). Street and working children: a call for a rights-based approach to their health and well-being. BMJ Paediatrics Open, 8 (1), e002486. Shafique, S., Bhattacharyya, D. S., Nowrin, I., Sultana, F., Islam, M. R., Dutta, G. K., Reidpath, D. D. (2024). Effective community-based interventions to prevent and control infectious diseases in urban informal settlements in low- and middle-income countries: a systematic review. Systematic Reviews, 13 (1), 253. Shekhar, C., & Rai, P. (2025). Addressing the Crisis of Street Children in South Asia: Challenges, Interventions, and Policy Recommendations. Shrestha, P., Afsana, K., Weerasinghe, M. C., Perry, H. B., Joshi, H., Rana, N., . . . Bhardwaj, S. (2024). Strengthening primary health care through community health workers in South Asia. The Lancet Regional Health-Southeast Asia, 28 . Solile, L., Nyanza, E. C., Mwanga, J. R., & Shangali, D. L. (2023). Challenges in accessing health care and socio-protection services among children living and working in streets in northwestern Tanzania: A qualitative study. PLOS Global Public Health, 3 (5), e0001916. Vameghi, M., Roshanfekr, P., Ghaedamini Harouni, G., Takaffoli, M., & Bahrami, G. (2023). Street children in Iran: what are their living and working conditions? Findings from a survey in six major cities. International Journal of Environmental Research and Public Health, 20 (7), 5271. Van Bueren, G. (2021). The international law on the rights of the child (Vol. 35): Martinus Nijhoff Publishers. Zeleke, T. K., Alamirew, B. D., Bazezew, Z. A., Alemu, M. A., Jara, A. G., & Abebe, R. B. (2024). The magnitude and predictors of self-medication amongst street dwellers in Ethiopia: a multicentre study. Drugs in Context, 13 , 2023-2027-2022. Zewude, B., Ayode, D., Davey, G., Zaman, S., & Tadele, G. (2025). Addressing scabies among street children in Ethiopia: an ethnographic study of acceptable interventions by prospective recipients and deliverers. Frontiers in Public Health, 13 , 1529012. Zewude, B., Tadele, G., & Davey, G. (2024). Neglected tropical disease meets neglected community: Street children’s susceptibility to scabies in Addis Ababa, Ethiopia. PLOS Neglected Tropical Diseases, 18 (9), e0012475. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 12 Aug, 2025 Reviewers agreed at journal 01 Aug, 2025 Reviewers invited by journal 01 Aug, 2025 Editor invited by journal 13 Jun, 2025 Editor assigned by journal 27 May, 2025 Submission checks completed at journal 27 May, 2025 First submitted to journal 20 May, 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. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6705013","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":465758566,"identity":"b7c586e8-5410-44bb-8b3b-6e5fc10b833f","order_by":0,"name":"Bernard. Projest","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYBACAwbGxgMPDBgY+EG8hALitDQcSABqkWwAaTEgSgsDw4EEEOMAjEsImEskA20pqJM3Pr868QPQhfL8Ygfwa7GckQhyGJvhthtvN0sAHWY4c3YCAYfdBmvhYdx24+wGkJYEg9vEaZGw3zzj7OYfpGgxSNzA37uNOFss5z8EaUlInnGDd5sF0DrCfjHnOf7wwYc/dbb9/Wc33/xRYSPPL01ACwJIgFVKEKscBPgPkKJ6FIyCUTAKRhIAAJXpSrxJT4fWAAAAAElFTkSuQmCC","orcid":"","institution":"Moshi Co-operative University","correspondingAuthor":true,"prefix":"","firstName":"Bernard.","middleName":"","lastName":"Projest","suffix":""},{"id":465758567,"identity":"9dec752d-2744-46f3-a1d6-82a303aac0c8","order_by":1,"name":"LEONCE Mujwahuzi","email":"","orcid":"","institution":"Insitutute of development studies,The university of dodoma","correspondingAuthor":false,"prefix":"","firstName":"LEONCE","middleName":"","lastName":"Mujwahuzi","suffix":""},{"id":465758568,"identity":"152856f9-2bbf-415c-9872-293f8fa82362","order_by":2,"name":"ANNA MASELE","email":"","orcid":"","institution":"Insitutute of development studies,The university of dodoma","correspondingAuthor":false,"prefix":"","firstName":"ANNA","middleName":"","lastName":"MASELE","suffix":""}],"badges":[],"createdAt":"2025-05-20 07:38:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6705013/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6705013/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84423335,"identity":"68763d0b-b261-46d2-98a1-eec9baaa08f1","added_by":"auto","created_at":"2025-06-11 18:46:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":26365,"visible":true,"origin":"","legend":"\u003cp\u003ethe PRISMA model showing the process how journal articles were retrieved from two data bases\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6705013/v1/bf61cb866b4ca4f2fae4051b.png"},{"id":84424192,"identity":"c00c8bbc-bc31-4b1e-8513-19dacdc8ac7f","added_by":"auto","created_at":"2025-06-11 19:02:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":565107,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6705013/v1/246a302f-b6fd-4342-aed9-fa9d9522f1ad.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eScaling Innovations From Healthcare Interventions for Street Children in Developing Countries: A Systematic Review Based on Evidence From Dodoma City\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHealthcare intervention for street children globally remains a challenge that affects not only developing countries but also developed ones. United Nations estimates there about 150\u0026nbsp;million street children in the world without health access and social welfare services that increases physical, psychological, and social risks for street children(Deb et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). There is an increasing gap in health services accessibility among street children because most interventions that are designed to deliver health services for street children fail to indicate measurable health outcomes. Inadequate of health trained officials does corresponds with increasing trends of street children regardless of social interventions related to reproductive health, sexually transmitted diseases, respiratory problems, mental health and substance use issues (Dankyi \u0026amp; Huang, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).The initiatives of improving health outcomes through community-based interventions such as shelter and dropping centre are scaled up to link street children with health care in their respective countries (Doh, Kamara, Galukande, \u0026amp; Renzaho, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCommunity-based health interventions interact with health systems to provide both informal and formal health services for the street children, especially in developing countries where health systems have failed to design appropriate health interventions that are appropriate for their needs. (Shafique et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).Efforts of delivering health services are directed to the grassroot which is the community which design friendly interventions which street children in health services while target families with low socioeconomic situations to prevent their children from joining street lives and connecting those who are on the street with healthcare (Shekhar \u0026amp; Rai, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). The collaborative efforts of delivering health services among street children also involve community members such as health volunteers, community case workers, and community champions who identify and connect street children with available health services.\u003c/p\u003e \u003cp\u003eUnited Nations recognize health as a basic right for all children but street children are still facing challenges to health accessibility (Pimenta \u0026amp; United, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).The implementation of universal health for all people in the community has failed to cover street children because they're always moving from one place to another and they lack identity documents for registration, the study indicates that the universal health system has strategies that overlook non-institutionalized people such as street children(Hatloy \u0026amp; Huser, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2005\u003c/span\u003e).Street children in Tanzania lack policy inclusion because the health policy does not include street children as an at-risk community but they are mentioned as a whole group of vulnerable children who need care and protection (Solile, Nyanza, Mwanga, \u0026amp; Shangali, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Therefore, achieving universal health coverage is an important aspect to be scaled up in street health interventions.\u003c/p\u003e \u003cp\u003eGeographical obstacles, legal status, financial costs, and linguistic and cultural differences, disconnect street children from mainstream health services, mobility and lack of fixed place of living make it difficult because some health facilities are located far, (Shi \u0026amp; Singh, 2022). Mobile clinics have specifically reached street children to facilitate their access to primary health intervention for infectious and chronic diseases (Barr, 2023; Malone et al., 2020).).\u003c/p\u003e \u003cp\u003eStreet children are the type of community with low access to health care because most of them lack knowledge of where to get health services and those with knowledge are self-discriminating or segregated by hospital staff (Chikova \u0026amp; Chikova, 2019). Employing a community-based model together with other health promotion actions like skills training for the street children increases their chance to understand the importance of their health, but it is argued by Kontak, Caldwell, Kulczycki, Hancock Friesen, and Kirk (2023) highlighting that not all street will be able to acquire skill on health promotion because of their different experiences, low health education and lack of personal skills.\u003c/p\u003e \u003cp\u003eTheir mobility nature, working and sleeping in unhygienic environments, low nutrition and exposure to toxic materials early in their childhood contribute to lower immunity, morbidity, poor development delay and illness.(Navaneetham, Dharmalingam, \u0026amp; Caselli, 2008) Ali, Shahab, Ushijima, and de Muynck (2004) argued that poor nutrition weakens their immune systems and the harsh, unhygienic conditions expose them constantly to pathogens and environmental hazards, leading to higher morbidity rates compared to the general population. Substance, inhalant use and glue sniffing increase trauma and suicidal behaviours, and street children have 2.5 times of committing suicide(Swahn, Palmier, Kasirye, \u0026amp; Yao, 2012; Yohannes et al., 2023). The scholars such as Alam, Hossain, Islam, Murad, \u0026amp; Khan, (2021) argue that 90 per cent of all street children use inhalants as their life copying mechanism.\u003c/p\u003e \u003cp\u003eAs described by Ding, Loukaitou-Sideris, health services support needs significant resources collected in collaboration between the third sector and government agencies. Community engagement in health services is well known by the community members when they are involved in planning, decision-making, and allocating funds for street children (Wasserman (2022.Street children are more likely to trust community health workers because they are living together in the same community rather hospital staff, therefore community members can design effective healthcare interventions that focus on street children privacy and confidentiality. (Yuan et al., 2021).\u003c/p\u003e \u003cp\u003eCommunity workers support street children by connecting them with shelters where basic health check-ups are conducted and reunite them with their families for better healthcare outcomes for those unable to reunite with their families, community workers encourage them to join shelter homes, where they receive long-term care and rehabilitation(Mokomane \u0026amp; Makoae, 2017). Shelter also provides essential support and opportunities for vulnerable children to access healthcare through community health interventions that are financed partly by the community members themselves central governments, local government and international donors and private foundations (Pallas et al., 2013)..\u003c/p\u003e \u003cp\u003eDespite having more vibrant health insurance programs such as community health funds which are financed by community members still there no visibility of street children in the health care system(Fiasorgbor \u0026amp; Fiasorgbor, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). There is a need to scale up some innovations such as mobile clinics and outreach services for the wider population of street children. Other developing countries include street children healthcare interventions in health systems where community members, health volunteers and outreach services worker are blended in the new practices on healthcare. (Joseph et al., 2024; Rai \u0026amp; Shekhar). The mobile clinics and outreach services will reduce barriers such as discrimination costs and long waiting lines.\u003c/p\u003e \u003cp\u003eEarlier studies such as those (Abekah-Carter, 2024; L Embleton et al., 2020)on street children have tried to study the health condition of street children by examining health inequality and their vulnerability to sexually transmitted diseases, but there are scant systematic analyses reviewed works of literature, the only available is a study conducted by Andrew et al. (2020) on effects of home visit for children living on the slums of India which is not the systematic review. Therefore, there is a blank knowledge of scaling effective interventions that identify street children and link them with healthcare in developing countries for uniform practices.\u003c/p\u003e \u003cp\u003eThis study is based on the review of the different articles that explore the implementation of the Ottawa Charter of 1986 linked with global health in 2030(Elliott, 2022; Saadati \u0026amp; Nadrian, 2024).\u003c/p\u003e \u003cp\u003eThe objective is to examine if five health promotion five actions are considered in developing health interventions for street children's health care. Those actions are developing personal skills which involve hygiene training for street children through dropping centres, strengthening community action which examines community involvement in managing street children's health conditions, creating supportive environments which involve the collaboration between Civil organisations working with street children, building healthy public policy that recognizes the needs of street children toward attainments of Universal health services that will also include street children in health access.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eA total of 637,686 documents were retrieved from the Dimension and Google Scholar websites. After screening these documents based on their publication year, 80,687 were excluded because they were published before 2023. Additionally, 26,134 journal articles that were not based on peer review were excluded.\u003c/p\u003e \u003cp\u003eThe remaining articles were assessed according to their research category, focusing on health services and systems. Out of these, a total of 399 journal articles met the specified criteria. Further criteria included open access; therefore, all journal articles with restricted access were excluded, resulting in the removal of an additional 526,867 articles. Consequently, only 6 journal articles were deemed eligible for inclusion in the study.\u003c/p\u003e \u003cp\u003eThe search keywords included \"street children,\" \"street-connected children,\" \"homeless children's health services,\" \"health care,\" \"community engagement,\" \"community-based interventions,\" and \"health promotion.\" The inclusion and exclusion criteria were applied to determine which journal articles were suitable for the study. Were based on the inclusion and exclusion of the journal articles that were eligible to be included in the study.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable number 1 indicating inclusion and exclusion criteria\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCriteria\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInclusion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExclusion\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAccessibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArticles with open access\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eArticles without open access\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublication year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJournal articles published from 2020\u0026ndash;2025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eArticle published before 2020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResearch category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArticles focusing on street-connected health services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eArticle out of street-connected children and health services\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStreet connected children, street youth, street adolescents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOther participants out of street youth, and street children\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLanguage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArticles written in English\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eArticles not written in English\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResearch fields\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArticles that were relevant to sociology, social work, and public health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eArticles that were not relevant to sociology, social work and public health\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublication type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmpirical articles from peer-\u003c/p\u003e \u003cp\u003ereviewed journals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe articles on book chapter review, conferences, pre-printing and monography\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJournal list\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll journal indexed in Dimension and google scholar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJournal articles not found in Dimension and google scholar\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSource tittle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealthcare/health services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAll tittle that are not related to health care\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\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e; Indicates the systematic review process based on PRISM model showing how journal articles were obtained. Figures\u0026nbsp;(1) indicates the four stages of identification showing the number of studies identified from two data bases, screening which indicates the record of document that were excluded from the review and the studies that were excluded from the study, eligibility indicates the articles that were accessed and excluded in the study by suing reason based on the revie criteria while the last part of inclusion indicates the study that were both qualitative and quantitative. However, figure (1) summarizes the process of PRISM diagram is simple ways to ensure methodological rigour.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe final selection included studies about street children's healthcare accessibility, all included studies are from Africa which forms part of developing countries such as Nigeria, Togo, Ethiopia, Tanzania, Kenya and Malawi. The appraised studies included street children aged 6 to 17 years, Sub Saharan African countries are experiencing high rates of street children because of poverty and economic hardship which is a significant driver that pushes children to the streets, family breakout and separation, urbanization and rural migration, conflicts and political outbreaks of violence and violence and abuse of children that include physical, sexual and emotional(Ongowo, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The reviewed studies also included Civil organisations, governmental departments, social welfare officers and family members.\u003c/p\u003e \u003cp\u003eBased on the outcome of the search criteria the following article was identified as the result of the study, only 6 journal articles were identified and included in the study by analyzing the outcome of the study, the Author involved in writing the articles, the journal where the article was published, journal quartile and H index of the journal are shown and listed in the following table; -\u003c/p\u003e \u003cp\u003eTable number 2 Quality appraisal of six selected journal articles\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eoutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJournal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eJournal Quartile\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eH/index\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysical, mental and healthcare issues of children on the street\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(Obimakinde \u0026amp; Shabir, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAfrican Journal of Primary Health Care \u0026amp; Family Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDigital micro-banking as a health and protection intervention for street-connected children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(Howard, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBMJ Paediatrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAddressing scabies among street children in Ethiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(Zewude, Ayode, Davey, Zaman, \u0026amp; Tadele, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrontiers in public health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChallenges in accessing health care and socio-protection services among children living and working in streets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(Solile, Nyanza, Mwanga, \u0026amp; Shangali, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePLOS Global Public Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdherence to\u0026nbsp;treatment intervention to\u0026nbsp;improve HIV treatment outcomes among\u0026nbsp;street-connected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(Kibel et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBMC Health Services Research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAccess and\u0026nbsp;utilization of\u0026nbsp;sexual abuse emergency healthcare services among\u0026nbsp;street children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(Kacheyo \u0026amp; Nyirenda, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBMC Health Services Research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Literature review","content":"\u003cp\u003eCommunity volunteers are providing direct health services for street children for example they are connecting street children with Drop-in centre where healthcare are provided. It was found that, in Malawi street community health workers connect street children with health agencies, thereby promoting coping mechanisms, adherence, and referrals among street children. Community health workers are facilitating the truth building among the street children and workers because street children they tend to trust volunteers who are spending great time with theme in the street that trusting the service providers (LeBan, Kok, \u0026amp; Perry, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe contradictory findings revealed that community health workers (CHWs) have limited information about the health programs they are implementing, low esteem in program ownership, and low documentation. Both social workers and community health workers encounter issues such as low health information, internal conflicts, gender beliefs, strong cultural beliefs, and low literacy skills. Despite these challenges, community health workers remain valuable in countries with weak and fragmented health systems to deliver adequate health services to street children(Hassan, Okoli, Azike, Okoye, \u0026amp; Adindu, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the same vein, Shrestha et al. (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)conducted a study on community health workers at the dawn of a new era which indicates that the relationship between the health system and community, the study revealed the visibility of community workers in serving as intermediaries between street children and health facilities, in facilitating access to essential health services by providing education in the streets, identifying the new street children and assisting in making referrals and advocating for the healthcare needs of street children within the community and healthcare system. To implement universal health coverage and eliminate the existing disparities in health provision discrimination against street children should be eliminated (Adekeye, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to (Badat, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Bhuiyan \u0026amp; Haque, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)community groups and non-governmental organisations play a crucial role in connecting street children with health services by bridging gaps in healthcare delivery. When healthcare systems are not inaccessible, these groups provide preventive care, treatment for common illnesses, health education, and referrals. They also support the well-being of street children through nutritional support, psychological counselling, and protection. According to Seth, MacRae, Goldhagen, and Raman (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) revealed that NGOs working with street children provide quick access to health care, escort street children to hospitals, provide first aid and take children to outpatient or casualty departments, and support children who require admission.\u003c/p\u003e \u003cp\u003eEmbleton et al. (2020) identified that more than 25,000 street children are connected by health services through community groups. Street children are affected by poor health conditions, high rates of sexual transmitted diseases, respiratory diseases, skin conditions, diarrheal illnesses, malnutrition, mental health problems, and substance use. (Abate et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e); Kusi-Mensah and Omigbodun (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) highlighted that street children have high rate of infectious diseases, reproductive health and mental disorder that results into poor growth. They are excluded from health services but drop-in - centers connect them with health services through street-based outreach, health education, and rehabilitation programs(Adams \u0026amp; Ramsay, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe case management model is used to coordinate and arrange medical services for street children by advocating and linking them with health services available from health centres where NGOs have established partnerships. Kaluku (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) argued that the case management model coordinates services tailored for the health needs of street children through the participatory framework that includes social workers and doctor as a multidisciplinary team. The case management model of health promotion links street children with need resources from the community, including health services, counselling trauma-based intervention and drug use (Gursansky \u0026amp; Harvey, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMobile health clinics connect outreach services which reduce healthcare costs among street children where the cost of health services is too high to be afforded by street children. Seth et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)indicate the scope and impact of mobile health clinics on health promotion trough provision of health services such as vaccination and health promotion education as it is building trust among the community members. The role of health mobile clinics has an impact on community health outcomes because it has developed innovative interventions by treating chronic diseases and promoting preventive strategies among street children that ensure continuity of health services(Seth et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). The study reveals that mobile health clinics are not widely implemented in helping street children, especially in developing countries that could help bridge gaps in health care among street children.\u003c/p\u003e \u003cp\u003eAccording to, Kaiser and Sinanan (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)street children are tight with their livelihood activities influences their seeking behaviour, some intimidation from healthcare officials, hours of operation, and long waiting times are some of the factors excluding street children from accessing proper health care. Direct Outreach and education services help them to receive health services in the areas where are found working and living. As claimed by Lotko, Leikuma, and Battle (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) that direct outreach provides health education and counseling about sexual health that improves street children sexual infections and sexual reproductives health However, it's questionable to see Outreach services facing the financial burden of reaching street children in the community where most of the referral cases are not fully cared for by fragmented health systems. Outreach services in India face challenges such as lack of coordination between different stakeholders, providers burnout and lack of specific legal guidelines that guides their operations(Coleman et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Outreach services have been introduced in different areas of Tanzania to provide health services for the general population but there is no any clinic designed to satisfy the health needs of street children.\u003c/p\u003e \u003cp\u003eThe participatory client-centred approach focuses on the right of street children to access health services related to sexually transmitted diseases and drug use prevention education like other children as it was declared and ratified by the United Nations Convention on the Rights of the Child 1989(Van Bueren, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Child rights and street children's self-determination are mandatory in making decisions on implementing some health interventions. The participatory client-centred street children were found to be important as it was noted by Bwambale, Bukuluki, Moyer, and Borne (2021) that street children encouraged to exercise their right to involve in planning which in turn plans were integrated into their survival strategies, improved outcomes on health access as it increase the participation of street children.\u003c/p\u003e"},{"header":"Discussion of findings","content":"\u003cp\u003eThe finding indicated that street children have low financial serving for health services, one of the barriers that street children during illness is money to cover for the health services.Howard (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) revealed that street children in Togo street children are using digital baking to keep their money which health them to solve their social problem including medical services because their neither covered by health insurance nor any welfare intervention that is connecting them with health services. However digital micro baking reduced their spending and reduced theft among them. Digital micro-baking among street children in a good intervention that need to be adopted everywhere where their street children because it reduces their further suffering when they are sick and increases their confidence to seek for health services because of the availability of money they are serving rather that depending on their network or support from the community.\u003c/p\u003e \u003cp\u003eThe similar study was conducted by Eliza et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) who observed that street children can use smartphone to access health information by searching where heath are located maintain supportive network and they are using phone banking to serve money they are using in health funding. It is the good intervention that reduce financial dependency for the street children when are ill, depending on their informal network for assistance and begging may increase the burden of diseases because their network is inconsistent support because of their lower knowledge for providing sustainable care for serious diseases.\u003c/p\u003e \u003cp\u003eThe study conducted by Awelewa (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) indicates that lack of money for treatment influence street children to resort on self- medication by buying medicine without proper prescription, or using traditional herbs provided from traditional healers which is considered to be cheap than hospital based medicine. This results inconstancy findings that street children engage in begging in the street in order to raise money for health system while depends on their informal network where street children contributes a small money they have to cover the health expenses of their peers this increase the underutilization of health services provided from health facilities among street children (Amoah \u0026amp; J\u0026oslash;rgensen, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Khan et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).The effect of self-medication because of lack of money among street children increase the risk of drug resistance(Zeleke et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2024\u003c/span\u003e),\u003c/p\u003e \u003cp\u003eWhile street children are at greater risk of suffering from different tropical diseases, Zewude et al. (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) is emphasizing on street children healthcare interventions which connects street children affected by a neglected tropical disease with health services. A study Amoah, Phillips, Gyasi, Koduah, and Edusei (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) notes that 78 percent of all street children in Ghana have limited health knowledge, have low access to healthcare, shaped by low educational attainment and the absence of targeted health education campaigns. The street children low access to health education have been contributed by their age, education, street life(Shekhar \u0026amp; Rai, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). In some developing countries such as Iran street children lack health access, have little use of health services because of low understanding where health can be accessed(Vameghi, Roshanfekr, Ghaedamini Harouni, Takaffoli, \u0026amp; Bahrami, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe findings indicates that Civil societies organisations collaborate with government welfare department to provides health services for street children which increase the shared responsibility between street children stakeholders(Nassimbwa, Kakuru, \u0026amp; Mpamizo, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Health system may not be friendly to provide sufficient services for street children, therefore the availability of donor funded welfare health services helps in bridging the gap of priding necessary support that cannot be provided by the government alone (Zewude, Tadele, \u0026amp; Davey, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Civil societies organisations work with hospital staffs to facilitate street children access to health services including escorting injured street children to hospital and seeking for the exemptions for treatment(Solile et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).Inconsistently, Manomano, Nyanhoto, and Gutura (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) reported that government and other stakeholder lack effective collaboration, coordination and capacity building. Additionally, lack of systematic funding challenges the provision of health services and interagency cooperation for street children health interventions.\u003c/p\u003e \u003cp\u003eThis is best intervention to be adopted in all street children best intervention, it is supposed to be scaled up in different parts of different countries because street children is the forgotten segment of society. Despite of having good collaboration between government and civil societies street children are still facing the problems of adherences and lacking health education(Zewude et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eStret children are always affected by sexual abuse while they are sleeping in the streets that require immediate solution, they are access to emergency health services among street children is limited as it is argued by Chimdessa (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) that 28.6 percent of male street children in Ads Ababa experiencing sexual abuse by their peers and adults. They are at risk of getting sexual transmitted diseases and early pregnancies. It is reported that, street children have low use sexual abuse emergency services,Kacheyo and Nyirenda (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) indicates that sexual abuse emergency health services in Malawi was established following WHO guidelines include HIV Post Exposure Prophylaxis (PEP), Emergency Contraceptive Pills (ECP) within a critical timeframe of 72 hours followed by STI treatment, and psychosocial service.(Ewunetie et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) indicates that more than 65 percent of street children in Ethiopia have no access to sexual emergency centre despite having high rate of sexual transmitted diseases hence the need for scaling sexual educational and mobile clinic is paramount.\u003c/p\u003e \u003cp\u003eNath, Shannon, Georgiades, Sword, and Raina (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) align than attending at the dropping centre provides additional services such as free lunch and health services in a welcoming means. Consequently, emergency health services increase the health outcome by providing first and immediate treatment under the international framework, while dropping centre which provides supplement services such health education, medical check-up and lunch which are necessary intervention to be scaled up in developing countries where street children are increasing.\u003c/p\u003e"},{"header":"Conclusion and recommendation","content":"\u003cp\u003eStreet children's health interventions are implemented differently by different stakeholders; the review examined the implementation of street children's health interventions which are mobilising money to serve themselves and protect them in times of illness rather than begging in the streets, health intervention helps street children to seek for medical services rather than self-medication, the collaboration between civil societies and government departments have increase health accessibility among street children. The establishment of emergency health services and dropping centres have increased health access and prevention services after sexual violence.\u003c/p\u003e \u003cp\u003eHowever different stakeholders such as donors and government measure the success of these health interventions by health outcome and impact indicators by reduced mortality, services utilization and behaviour and social change. The health interventions will be sustainable if they are integrated into national health systems, and if will are implemented by using sectoral and finally training local leaders and volunteers to link them with child protection to address the root causes of street children. The review of the paper acknowledges the presence of good interventions that have been summarized 6 papers published from 2020 to 2025, those interventions are to be scaled up in other developing countries where the phenomenon of street children is prevailing, the objective is not to create the creating their safe platform for them to stay in the street but to keep them in good health and prepare them for the family unification or looking the alternative families where they enjoy good health services.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable because this is a review study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study has received the consent for publication because it the fulfilment of PhD studies from the University of Dodoma, the research permit letter was released, from the University, from the Ministry of Local government and local administration and Dodoma City Council.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings are available in two databases, dimension https://app.dimensions.ai/exports and google scholar.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors declares that they no commenting interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study did not receive any fund from any agency; the study is academic based for the requirement the completion of PhD Programme.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe corresponding author is student based on the department of the University of Dodoma, the first and corresponding author (Projest Bernard) searched the journal articles from electronic databases and prepared this review, the second and the third authors helped on supervision of this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere gratitude to the librarians at the University of Dodoma for their valuable assistance in retrieving and organizing journal articles, which significantly contributed to the success of this study. Also special thanks to the University of Dodoma which hosting more trainings on systematic analysis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbate, D., Eyeberu, A., Adare, D., Negash, B., Alemu, A., Beshir, T., Heluf, H. (2022). Health status of street children and reasons for being forced to live on the streets in Harar, Eastern Ethiopia. Using mixed methods. \u003cem\u003ePLOS ONE, 17\u003c/em\u003e(3), e0265601.\u003c/li\u003e\n\u003cli\u003eAdams, E. A., \u0026amp; Ramsay, S. E. (2024). Exploring what works well and less well in a community-based drop-in hub providing health and wellbeing services for people experiencing homelessness: a participatory action evaluation of service coordination. \u003cem\u003eBMC Health Services Research, 24\u003c/em\u003e(1), 1423.\u003c/li\u003e\n\u003cli\u003eAdekeye, A. P. (2024). 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(2021). \u003cem\u003eThe international law on the rights of the child\u003c/em\u003e (Vol. 35): Martinus Nijhoff Publishers.\u003c/li\u003e\n\u003cli\u003eZeleke, T. K., Alamirew, B. D., Bazezew, Z. A., Alemu, M. A., Jara, A. G., \u0026amp; Abebe, R. B. (2024). The magnitude and predictors of self-medication amongst street dwellers in Ethiopia: a multicentre study. \u003cem\u003eDrugs in Context, 13\u003c/em\u003e, 2023-2027-2022.\u003c/li\u003e\n\u003cli\u003eZewude, B., Ayode, D., Davey, G., Zaman, S., \u0026amp; Tadele, G. (2025). Addressing scabies among street children in Ethiopia: an ethnographic study of acceptable interventions by prospective recipients and deliverers. \u003cem\u003eFrontiers in Public Health, 13\u003c/em\u003e, 1529012.\u003c/li\u003e\n\u003cli\u003eZewude, B., Tadele, G., \u0026amp; Davey, G. (2024). Neglected tropical disease meets neglected community: Street children\u0026rsquo;s susceptibility to scabies in Addis Ababa, Ethiopia. \u003cem\u003ePLOS Neglected Tropical Diseases, 18\u003c/em\u003e(9), e0012475.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"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, Interventions, Health promotion, Health services","lastPublishedDoi":"10.21203/rs.3.rs-6705013/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6705013/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe study examines the trend of publications related to health interventions for street children in Sub-Saharan African countries. It involved a systematic analysis of 637,686 documents sourced from the Dimension and Google Scholar databases, covering the period from 2020 to 2025. After a thorough process of identification, screening, and eligibility assessment, only six journal articles were included in this review. Further analysis aimed to identify study outcomes associated with the Ottawa health promotion framework, which focuses on developing personal health promotion skills for street children, strengthening community action, creating a supportive environment for accessing healthcare, and enhancing health public policy that effectively addresses the health of street children. The systematic review results indicate that mobilising financial resources for street children's healthcare, addressing tropical diseases through hospital treatment rather than self-medication, fostering collaboration between government social welfare departments and civil organisations, and utilising emergency health services collectively create a supportive environment for street children. However, limited knowledge about scaling these interventions has led to misallocation of resources aimed at addressing healthcare needs for street children. The review concludes by emphasising that effective interventions such as digital banking, collaboration between civil organisations and government, the use of emergency health services, and ensuring treatment adherence among street children should be scaled up in all activities involving street children to enhance uniformity and transparency.\u003c/p\u003e","manuscriptTitle":"Scaling Innovations From Healthcare Interventions for Street Children in Developing Countries: A Systematic Review Based on Evidence From Dodoma City","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-11 18:46:48","doi":"10.21203/rs.3.rs-6705013/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"289482149594755046107983193193286959442","date":"2025-08-12T17:13:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97155308847911543421150659548297428267","date":"2025-08-01T13:44:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-01T13:33:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-13T16:54:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-27T07:01:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-27T06:57:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-05-20T07:34:27+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":"0a0faeeb-bdc5-420f-869e-ee890dbf7dfe","owner":[],"postedDate":"June 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-01T13:38:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-11 18:46:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6705013","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6705013","identity":"rs-6705013","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}