Intersectional experiences of non-communicable diseases and health seeking strategies in informal settlements in Freetown, Sierra Leone

This paper takes an intersectional approach to explore the burdens of non-communicable diseases (NCDs) and their interactions with gendered inequities and poverty, in shaping health seeking practices. The study explores the lived experiences of men and women living with NCDs in three informal settlements in Freetown, Sierra Leone. As Low- and Middle-Income Countries (LMICs) grapple with increased NCD risk factors, evidence gaps limit understanding of the complex ways in which gendered vulnerabilities are shaped. This study provides insights into the multiple axes of inequity which shape NCD outcomes and healthcare access barriers and suggests ways to improve NCD services. This study therefore adapts and applies the Intersectional Gender Analysis Framework for Infectious Diseases of Poverty in an informal settlement context to understand how NCDs impact men and women differently and influence different health seeking and treatment outcomes. We conducted narrative interviews with 15 participants living with diabetes, hypertension, and disability related to stroke through three household visits for a period of 12 weeks. Findings highlight lived experience of NDCs, coping strategies and healthcare seeking patterns, influenced by poverty, gender inequities, and NCD comorbidities. Women’s lived experiences of NCDs reflect historical and patriarchal disadvantages through their limited financial autonomy, barriers to healthcare decision making and treatment access, compounded by gendered impacts of conflict and migration. Men’s experiences included an erosion of social status and financial autonomy, limiting access to healthcare and coping. Gender differences and patriarchal norms influenced household and healthcare decision making, reflecting the division of roles and access to resources by men and women, which shaped different care seeking pathways and treatment outcomes. Our study shows that the burden of NCDs and healthcare decision making are influenced by intersecting structural barriers, which requires that NCD healthcare must be approached from bio-social, rather than solely a biomedical perspective.