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Health-care availability, preference, and distance for women in urban Bo, Sierra Leone


  • Lila C. Fleming

    () (George Mason University)

  • Rashid Ansumana

    (Mercy Hospital Research Laboratory
    Njala University)

  • Alfred S. Bockarie

    (Mercy Hospital Research Laboratory)

  • Joel D. Alejandre

    (U.S. Naval Research Laboratory)

  • Karen K. Owen

    (George Mason University)

  • Umaru Bangura

    (Mercy Hospital Research Laboratory)

  • David H. Jimmy

    (Mercy Hospital Research Laboratory)

  • Kevin M. Curtin

    (George Mason University)

  • David A. Stenger

    (U.S. Naval Research Laboratory)

  • Kathryn H. Jacobsen

    (George Mason University)


Abstract Objectives To examine the diversity of the health-care providers in urban Bo, Sierra Leone, identify the types of health-care facilities preferred by women for fevers, and analyze the road network distances from homes to preferred health-care providers. Methods A population-based random sampling method was used to recruit 2419 women from Bo. A geographic information system was used to measure the road distance from each woman’s home to her preferred provider. Results Preferred health-care providers for acute febrile illnesses (commonly referred to as “malaria” in the study communities) were hospitals (62.3 %), clinics (12.6 %), and pharmacies (12.4 %). Participants lived a median distance of 0.6 km from the nearest provider, but on average each woman lived 2.2 km one-way from her preferred provider. Women living farther from the city center had preferred providers significantly farther from home than women living downtown. Conclusions The diverse health-care marketplace in Bo allows women to select clinical facilities from across the city. Most women prefer a malaria care provider farther from home than they could comfortably walk when ill.

Suggested Citation

  • Lila C. Fleming & Rashid Ansumana & Alfred S. Bockarie & Joel D. Alejandre & Karen K. Owen & Umaru Bangura & David H. Jimmy & Kevin M. Curtin & David A. Stenger & Kathryn H. Jacobsen, 2016. "Health-care availability, preference, and distance for women in urban Bo, Sierra Leone," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 61(9), pages 1079-1088, December.
  • Handle: RePEc:spr:ijphth:v:61:y:2016:i:9:d:10.1007_s00038-016-0815-y
    DOI: 10.1007/s00038-016-0815-y

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    References listed on IDEAS

    1. Nikièma, Béatrice & Haddad, Slim & Potvin, Louise, 2008. "Women Bargaining to Seek Healthcare: Norms, Domestic Practices, and Implications in Rural Burkina Faso," World Development, Elsevier, vol. 36(4), pages 608-624, April.
    2. Thaddeus, Sereen & Maine, Deborah, 1994. "Too far to walk: Maternal mortality in context," Social Science & Medicine, Elsevier, vol. 38(8), pages 1091-1110, April.
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