Effectiveness of Integrated Strategies in Reducing Socioeconomic Inequalities to Improve Healthcare-Seeking Behavior Among Pregnant Women and Newborn Mothers: Evidence from Sierra Leone

Abstract

Background: Maternal health inequities continue to be a major problem in Sierra Leone, where socioeconomic and geographic disparities continue to impede women's access to health care services during pregnancy and at the newborn stage. Community-based health education, financial protection mechanisms and telemedicine are among the integrated approaches that have shown promise for improving outcomes, but there is limited evidence from a local setting.

Objective: This study evaluated the perceived effectiveness of integrated strategies in reducing health inequalities and improving health care seeking behaviour of pregnant women and mothers of newborns in Bo District, Sierra Leone.

Methods: The study was a descriptive cross-sectional one involving 500 participants drawn from an urban tertiary facility (Bo Government Hospital) and a rural primary facility (Tikonko Maternity Home). Data were collected by using structured interviews and analyzed using SPSS Version 26. Descriptive analysis, ch2, Spearman correlation and exploratory factor analysis were used.

Results: The participants' top priorities were public funding (19.27%), comprehensive health insurance (13.51%) and community-based programs (12.27%). There was a significant relationship between geographic location and service utilization (ch2 = 64.48, p < 0.001). The preference for effective interventions correlated positively with education (r = 0.80, p = 0.20). Factor analysis showed financial and access-based strategies to be most contributory.

Conclusion: Mixed methods strategies that address financial and geographical barriers must be used to improve maternal health equity in Sierra Leone. Policymakers need to invest in scalable and community-led interventions and help close awareness gaps on culturally inclusive and supportive care practices