title: The epidemiology of substance use among street children in resource-constrained settings: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To compile and analyze critically the literature published on street children and substance use in resource-constrained settings.
  
  
  METHODS
  We searched the literature systematically and used meta-analytical procedures to synthesize literature that met the review's inclusion criteria. Pooled-prevalence estimates and 95% confidence intervals (CI) were calculated using the random-effects model for life-time substance use by geographical region as well as by type of substance used.
  
  
  RESULTS
  Fifty studies from 22 countries were included into the review. Meta-analysis of combined life-time substance use from 27 studies yielded an overall drug use pooled-prevalence estimate of 60% (95% CI = 51-69%). Studies from 14 countries contributed to an overall pooled prevalence for street children's reported inhalant use of 47% (95% CI = 36-58%). This review reveals significant gaps in the literature, including a dearth of data on physical and mental health outcomes, HIV and mortality in association with street children's substance use.
  
  
  CONCLUSIONS
  Street children from resource-constrained settings reported high life-time substance use. Inhalants are the predominant substances used, followed by tobacco, alcohol and marijuana.
authors.affiliation: College of Health Sciences, Department of Medicine, Moi University, Eldoret, Kenya.
authors.forename: Lonnie
authors.initials: L
authors.lastname: Embleton
authors.forename: Ann
authors.initials: A
authors.lastname: Mwangi
authors.forename: Rachel
authors.initials: R
authors.lastname: Vreeman
authors.forename: David
authors.initials: D
authors.lastname: Ayuku
authors.forename: Paula
authors.initials: P
authors.lastname: Braitstein
mesh_terms: D002648:Child; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D018453:Homeless Youth / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015995:Prevalence; D019966:Substance-Related Disorders / Q000453:epidemiology*
keywords: Homeless youth; resource-constrained settings; street children; substance use; systematic review; volatile solvent use