Browsing by Author "Viah, Rennie"

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Integrated Determinants of Maternal Healthcare Decisions: A Cross-Sectional Analysis of Predisposing, Enabling, and Illness-Level Factors in Bo District, Sierra Leone
(Elsevier BV, 2026-06-18) Viah, Rennie
**Background:** Maternal and child outcomes in Sierra Leone continue to reflect rural–urban inequities in access to care and timely healthcare-seeking. Understanding how predisposing, enabling, and illness-level determinants interact across settings is essential for explaining these disparities. **Objectives:** To examine how predisposing, enabling, and illness-level factors influence maternal and child healthcare-seeking decisions in Bo District, and to quantify rural–urban differences in these determinants. **Methods:** We conducted a facility-based cross-sectional study among 500 women attending antenatal, postnatal, or child health services at an urban tertiary hospital and a rural maternity facility. Descriptive statistics summarized participant characteristics. Rural–urban differences were assessed using Pearson’s chi-square tests, odds ratios with 95% confidence intervals, Mann–Whitney U tests for ordinal outcomes, and Cramér’s V to estimate effect sizes. **Findings:** Predisposing influences on maternal healthcare-seeking were ubiquitous (97.4%), with knowledge and health awareness most frequently reported. Predisposing influences didn’t differ by residence; however, cultural factors were significantly prominent among rural women (p = 0.004; Cramér’s V = 0.14). Enabling factors showed the strongest rural–urban differentiation, with small-to-moderate effect sizes. Urban respondents more often reported health insurance coverage, financial stability, proximity to facilities, and transportation availability, whereas rural respondents more frequently reported traditional social, language, and communication support, perceived infrastructure adequacy, preventive service availability, and community engagement. Pregnancy-/childbirth-related complications were common (68.2%) and didn’t differ by residence; however, the perceived influence of illness on care-seeking differed significantly between settings (p < 0.001; Cramér’s V ≈ 0.21). For childcare-seeking, knowledge and awareness were foundational across settings, while financial protection and prior healthcare experience exerted greater influence among urban caregivers. **Conclusions:** Rural–urban differences in maternal and child healthcare-seeking in Bo District appear driven less by awareness or illness occurrence and more by context-specific enabling conditions and differences in how illness is interpreted and acted upon.
Integrated Strategies Addressing Predisposing, Enabling, and Illness-Level Factors Influencing Healthcare-Seeking Behavior among Pregnant Women and Newborn Mothers: Insights from Sierra Leone
(Springer Science and Business Media LLC, 2025-08-27) Viah, Rennie
Background Maternal and newborn health outcomes in Sierra Leone remain among the poorest globally, driven by a complex interplay of socio-demographic, systemic, and behavioral factors. Understanding how integrated strategies influence healthcare-seeking behavior is critical for tailoring interventions that reduce delays and improve maternal outcomes. This study aimed to identify high-impact strategies addressing predisposing, enabling, and illness-level factors that affect maternal and newborn healthcare-seeking behavior in Bo District, Sierra Leone. Methods A descriptive cross-sectional study was conducted at Bo Government Hospital (urban) and Tikonko Maternity Home (rural) between January – May 2024. Using simple random sampling, 500 participants (294 pregnant women and 206 mothers of children under five) were selected from facility attendance lists. Quantitative data was collected through structured interviews using a digital questionnaire administered via the ONA platform. Descriptive analysis was performed using SPSS version 26 to identify patterns in healthcare-seeking preferences and perceived effectiveness of integrated health strategies. Results The mean age of pregnant participants was 24.83 years (SD = 4.74), and the average household income showed substantial disparity (Mean = 335.03 NLE; SD = 668.49). Regarding predisposing factors, the preferred strategies included prenatal education (25.91%) and community outreach for early antenatal care (24.12%). Enabling factors were most influenced by transportation support (24.6%) and access to affordable care (24.21%). Illness-level strategies prioritized by participants included strengthening maternal health surveillance systems (27.55%) and prenatal screening services (23.08%). Education level, income, and parity were key determinants of healthcare-seeking behavior. Conclusion Integrated strategies that combine health education, community outreach, logistical and financial support, and health system strengthening are the most effective in influencing maternal and newborn healthcare-seeking behavior. Culturally tailored, equitable, and evidence-informed approaches help improve maternal health service utilization in low-resource settings like Sierra Leone.
What urban–rural differences exist in cultural norms and maternity care preferences: a cross-sectional study among women receiving antenatal, postnatal, and child under 5 years health services in Bo District, Sierra Leone
(BMJ, 2026-10-01) Viah, Rennie
Introduction To assess rural–urban differences in cultural norms, traditional practices and preferences for culturally responsive maternity care in Bo District, Sierra Leone. Exploring urban–rural differences is essential because women living in these settings often experience distinct cultural influences and healthcare barriers that shape maternity care preferences and may require context-specific interventions. Methods Facility-based descriptive cross-sectional study at Bo Government Hospital (urban) and Tikonko Maternity Center (rural). Participants were 500 pregnant women, postpartum mothers and mothers of children under 5 years of age who attended maternal/child health services and resided in Bo for ≥6 months. Data were collected through interviewer-administered structured questionnaires using an Open Data Kit system called ONA—a mobile platform. Trained research assistants conducted face-to-face interviews in participants’ preferred language (Krio or Mende), recorded responses electronically in real time and obtained informed consent before data collection. Outcomes included religion, family type, marital status and 10 culturally responsive strategies (1866 multiple-response selections). χ 2 tests, proportion differences and 95% CIs assessed rural–urban differences. Results Residency was not associated with religion (p=0.901), family type (p=0.235) or marital status (p=0.541). Cultural competence training was most endorsed (26.6%). Urban women preferred integrating safe traditional practices into facility care (χ²=9.742, p=0.0018), whereas rural women preferred language-support services (χ²=26.044, p<0.001). Other strategies showed no meaningful rural–urban differences. Conclusions Both groups valued culturally respectful maternity care. Cultural competence training was a priority, while preferences for traditional-practice integration and language support indicated context-specific urban and rural needs, informing culturally responsive interventions and policy in Sierra Leone.