Inequalities in self-reported problems in accessing healthcare among women aged 15-29 years in Sierra Leone, 2008-2019: a time-trend study

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BACKGROUND: Sierra Leone is a low-income country with a high burden of maternal and child mortality. Access to healthcare for women remains a major challenge, with disparities across socioeconomic and geographic groups. This study examines the trends and inequalities in women's access to healthcare in Sierra Leone, from 2008 to 2019. METHODS: This study employed a time-trend design using data from the Sierra Leone Demographic Health Survey conducted in 2008, 2013, and 2019. The World Health Organization's Health Equity Assessment Toolkit software calculated inequality measures, including difference, ratio, population-attributable risk, and population-attributable fraction. An inequality assessment was performed for eight stratifiers: age, economic status, educational attainment, location of residence, marital status, employment status, number of living children, and sub-national province. RESULTS: Problems in accessing healthcare declined from 87.2% in 2008 to 71.9% in 2013 and 2019, in Sierra Leone. The inequality between women aged 25-29 and those aged 15-19 narrowed, with the percentage difference decreasing from -3.4% in 2008 to -6.9% in 2019. The disparity between women in the richest quintile and those in the poorest quintile increased from 26.2% in 2008 to 41.3% in 2019. In contrast, the inequality between women with higher education and those without education decreased from 35.9% in 2008 to 28.3% in 2019. Furthermore, the disparity between employed women and those without employment declined from 10% in 2008 to 4.9% in 2019, while the inequality between women residing in urban areas and those in rural areas increased from 9% in 2008 to 14.5% in 2019. Finally, the percentage difference in the problem of accessing healthcare at the subnational level between women in the Western area compared to those in other provinces increased from 23.8 to 41.4% in 2019. CONCLUSION: This study identified a positive overall trend in the problem of women's access to healthcare in Sierra Leone between 2008 and 2019. While the inequality narrowed for age and employment, inequalities persisted and widened for wealth, education, marital status, and location (rural vs. urban, specific provinces). These findings underscore the need for targeted interventions to address these persistent disparities and ensure equitable access to healthcare for all women in Sierra Leone.

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