Faculty of Sociology, Anthropology and Folkloristics, University of Iceland, School of Social Sciences, Reykjavík, Iceland
University of Sidney, Sidney, New South Wales, Australia.
BMJ Paediatr Open. 2024 Oct 8;8(1):e002870. doi: 10.1136/bmjpo-2024-002870.
Street and working children (SWC) and young people (YP) are highly vulnerable to violence, exploitation, hazardous environments and human rights violations. While the UN Committee on the Rights of the Child and the International Labour Organisation provide some guidance, there is limited information on their right to healthcare. This study aims to identify enablers and barriers to healthcare access for SWC and document associated rights violations.
From 2000 to the present, we conducted systematic searches for SWC (0-18 years) in databases including MEDLINE, PsycINFO, EBSCO, PUBMED and PROQUEST, using broad search terms related to street children, working children, healthcare access and rights. The searches were supplemented by grey literature and hand searches. Two independent reviewers finalised the included studies, and data were analysed using a rights-based framework with narrative analysis and thematisation.
The initial search yielded 7346 articles (5972 for street children and 1374 for working children), with 35 studies (18 for street children and 17 for working children) included in the review. Most studies on working children (13/17) focused on trafficking/commercial exploitation. Studies were predominantly from Africa, followed by the USA, Asia, the UK and Canada, with only two employing a rights framework. SWC face barriers such as cost, distance, visibility/accessibility of services, stigma, seclusion, threats of violence, lack of legal documents, crisis-oriented healthcare use and self-medication. Enablers included agency, self-efficacy, positive relationships with adults and proactive healthcare use when accessible. Emergency departments are frequently accessed by SWC, indicating a need for healthcare professionals to be trained and sensitised. Holistic and comprehensive healthcare is essential.
Significant research gaps exist, with many SWC populations under-represented. SWC share healthcare access barriers with other marginalised groups. Healthcare for SWC must be tailored to their unique needs and strengths and be holistic and trauma-informed.
街头儿童和劳动儿童（SWC）以及青年（YP）极易遭受暴力、剥削、危险环境和侵犯人权的侵害。尽管联合国儿童权利委员会和国际劳工组织提供了一些指导，但关于他们获得医疗保健的权利的信息有限。本研究旨在确定 SWC 获得医疗保健的促进因素和障碍，并记录相关的权利侵犯。
从 2000 年至今，我们使用与街头儿童、劳动儿童、医疗保健获取和权利相关的广泛搜索词，在包括 MEDLINE、PsycINFO、EBSCO、PUBMED 和 PROQUEST 在内的数据库中对 SWC（0-18 岁）进行了系统搜索。搜索工作还补充了灰色文献和手工搜索。两名独立评审员最终确定了纳入的研究，数据采用基于权利的框架进行分析，采用叙述分析和主题化分析。
最初的搜索产生了 7346 篇文章（5972 篇与街头儿童有关，1374 篇与劳动儿童有关），其中 35 篇研究（18 篇与街头儿童有关，17 篇与劳动儿童有关）纳入了综述。大多数关于劳动儿童的研究（13/17）侧重于贩卖/商业剥削。这些研究主要来自非洲，其次是美国、亚洲、英国和加拿大，只有两项研究采用了权利框架。SWC 面临诸如费用、距离、服务的可见性/可及性、污名、隔离、暴力威胁、缺乏法律文件、以危机为导向的医疗保健使用和自我用药等障碍。促进因素包括机构、自我效能、与成年人的积极关系以及在可获得时主动寻求医疗保健。SWC 经常去急诊室，这表明医疗保健专业人员需要接受培训和提高认识。全面和综合的医疗保健是必不可少的。
存在重大的研究差距，许多 SWC 人群代表性不足。SWC 与其他边缘化群体共享医疗保健获取障碍。SWC 的医疗保健必须根据其独特的需求和优势进行定制，并且是全面的和创伤知情的。
