International Journal of Public Health

, Volume 61, Issue 9, pp 1079–1088 | Cite as

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

  • Lila C. FlemingEmail author
  • 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
Original Article



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.


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.


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.


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.


Health services accessibility Choice behavior Urban population Sierra Leone West Africa 



This work was supported by the U.S. Office of Naval Research; the Office of the Secretary of Defense for Acquisition, Technology and Logistics; and the Defense Threat Reduction Agency. The views expressed therein are those of the authors and do not represent those of the Department of the Navy, the Department of Defense, or any government agency. The authors have no conflicts of interest to declare.


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Copyright information

© Swiss School of Public Health (SSPH+) 2016

Authors and Affiliations

  • Lila C. Fleming
    • 1
    Email author
  • Rashid Ansumana
    • 2
    • 3
  • Alfred S. Bockarie
    • 2
  • Joel D. Alejandre
    • 4
  • Karen K. Owen
    • 5
  • Umaru Bangura
    • 2
  • David H. Jimmy
    • 2
  • Kevin M. Curtin
    • 5
  • David A. Stenger
    • 6
  • Kathryn H. Jacobsen
    • 7
  1. 1.Department of Environmental Science and Public PolicyGeorge Mason UniversityFairfaxUSA
  2. 2.Mercy Hospital Research LaboratoryBoSierra Leone
  3. 3.Njala UniversityBoSierra Leone
  4. 4.Information Technology DivisionU.S. Naval Research LaboratorySW Washington, DCUSA
  5. 5.Department of Geography and Geoinformation ScienceGeorge Mason UniversityFairfaxUSA
  6. 6.Center for Bio/Molecular Science and EngineeringU.S. Naval Research LaboratorySW Washington, DCUSA
  7. 7.Department of Global and Community HealthGeorge Mason UniversityFairfaxUSA

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