Intersecting Health Vulnerabilities among Marginalised Urban Children in Kuala Lumpur, Malaysia

<title>Abstract</title> <p>Marginalised urban children often experience physical illness, psychological distress and barriers to healthcare as interconnected problems. This study examined these intersecting vulnerabilities among participants recruited from an alternative school and community outreach settings in Kuala Lumpur. A convergent mixed-methods design combined questionnaire data from 303 participants aged 10–18 years with semi-structured interviews with 10 participants. Descriptive analyses examined self-reported physical morbidity, 21 health conditions, healthcare receipt and 12 psychological or emotional symptoms. Robust logistic and Poisson regressions assessed associations with demographic, material and socio-ecological conditions. Overall, 58.4% reported physical morbidity and 62.7% reported receiving healthcare; 27.1% of those reporting morbidity had not received treatment. Fever (46.9%), headache (37.6%), cough (33.3%), stomach-ache (30.7%) and toothache (23.8%) were common. Frequently reported psychological symptoms included trauma (64.0%), anxiety (59.7%), sadness (48.5%), emotional pressure (46.9%) and fear (44.9%). Female sex and food insecurity were associated with higher odds of physical morbidity. Housing problems and cumulative ecological adversity were associated with greater psychological symptom burden. Older age and food insecurity were associated with lower odds of healthcare receipt, whereas physical morbidity increased care-seeking. Interviews linked distress and avoidance of formal services to violence, exclusion, family conflict, insecure public environments and substance use. The findings demonstrate that health vulnerability is socially and spatially patterned, supporting integrated, trauma-informed and child-friendly responses that connect primary care and psychosocial support with food, housing, outreach and social protection.</p>