Health problems and healthcare service utilisation amongst homeless adults in Africa- a scoping review

Abstract

Background: Homelessness is a growing concern as it affects a large number of people worldwide. Individuals and families experiencing homelessness are vulnerable in terms of health and underutilise health services. Despite being a global problem, not much is known about the range and breath of literature exploring health problems and health care service utilisation among homeless adults in Africa.Objectives: To identify the nature and scope of existing evidence on physical and mental health, and health service utilisation among homeless adults in Africa. The review aimed to examine how research is conducted, identify gaps, guide future research, and make recommendations for development and implementation of policies and practices. . Studies published between 1980 and 2019 that examined the health problems and health service utilisation among homeless adults in Africa were considered. Manual search in reference lists and grey literature was also done to add reports. Data was extracted manually using a charting developed. A descriptive analysis and narrative synthesis were performed.Results: Of 761 records found, 14 satisfied the pre-determined inclusion and exclusion criteria. Three themes emerged from the studies: Physical health problems, mental health problems; and healthcare services utilisation. Of the 14 included studies, nine studied and reported physical health problems such as sexually transmitted infections, injuries and disabilities, respiratory and cardiac diseases. Five studies explored mental health problems such as psychotic disorders, mood disorders, self-harm and suicidal behaviour. Only five studies investigated utilisation of different types of health care services among homeless people.Conclusions: Evidence shows that homeless adults suffered from a range of physical and mental health problems, and underutilisation of health care services. However, there is lack of information on the complex interrelationship between homelessness and health, as well as differences in prevalence of health problems among the various sub-groups of homeless. There is also lack of information regarding utilisation other important healthcare services such as mental health services, alcohol and drugs services, and accident and emergency service, and future researches should address that. Also, attention should be given to intervention models for complex and effective physical and psychiatric care as well as social support to address the homeless people's health vulnerabilities.

Substance abuse and violence among homeless youth in Fayoum governorate

“…There are 12 million homeless persons in Egypt. Poverty and other socioeconomic challenges beyond the individual's control, as well as migration to cities, contribute to Egypt's high prevelence of homelessness [11]. Homeless youth have higher all-cause mortality and higher prevalence of multiple morbidities, infectious diseases and disabilities [12].…”

Assessing psychosocial distress associated with homelessness in Ghana: A springboard for interventional policy design

“…Homelessness is an undesirable life circumstance that results in psychosocial distress. It is characterized by economic deprivations, social marginalization, poor mental health, and negative self-concept (Embleton et al, 2016; Osei Asibey et al, 2020; Schütz, 2016; Smartt et al, 2019). Homelessness usually limits individuals’ access to resources, employment opportunity, and social network (Calvo et al, 2018; Nishio et al, 2017; Vázquez et al, 2018).…”

“…Homelessness is considered a major social and public health issue in developing countries (Abekah-Carter and Oti, 2022; Osei Asibey et al, 2020), and more so in developed countries (Toro, 2007). Research on homelessness and associated health challenges have received increased attention in developed countries.…”

“…Homelessness poses a consistent challenge to health systems, especially to mental health practitioners, policymakers, and researchers (Cleverley and Kidd, 2011; Osei Asibey et al, 2020). Several studies have shown that homeless individuals are at extreme risk of abuse and victimization, poor physical and mental health, and high premature mortality (e.g., Balasuriya et al, 2020; Fox et al, 2016; Osei Asibey et al, 2020; Urbanoski et al, 2018). Compared to the non-homeless, homeless people suffer worse mental health (Hwang, 2001; Lippert and Lee, 2015; Public Health Agency of Canada, 2006).…”

The Effects of Obesity-Related Anthropometric Factors on Cardiovascular Risks of Homeless Adults in Taiwan

“…It can also easily lead to various diseases including mental illness, respiratory disease, cardiovascular disease, and various infectious diseases, as well as the inability to pay for medical expenses [ 5 ]. These complex medical and social issues have resulted in low life expectancy and high all-cause mortality among homeless people [ 6 , 7 , 8 ]. Medical care of the homeless is always an important public health issue.…”