{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T09:52:54Z","timestamp":1781776374999,"version":"3.54.5"},"reference-count":15,"publisher":"Ubiquity Press, Ltd.","issue":"1","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["89"],"abstract":"<jats:p>Background: Maternal and child outcomes in Sierra Leone continue to reflect rural\u2013urban 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.\nObjectives: To examine how predisposing, enabling, and illness-level factors influence maternal and child healthcare-seeking decisions in Bo District, and to quantify rural\u2013urban differences in these determinants.\nMethods: 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\u2013urban differences were assessed using Pearson\u2019s chi-square tests, odds ratios with 95% confidence intervals, Mann\u2013Whitney U tests for ordinal outcomes, and Cram\u00e9r\u2019s V to estimate effect sizes.\nFindings: Predisposing influences on maternal healthcare-seeking were ubiquitous (97.4%), with knowledge and health awareness most frequently reported. Predisposing influences didn\u2019t differ by residence; however, cultural factors were significantly prominent among rural women (p = 0.004; Cram\u00e9r\u2019s V = 0.14). Enabling factors showed the strongest rural\u2013urban 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\u2019t differ by residence; however, the perceived influence of illness on care-seeking differed significantly between settings (p &lt; 0.001; Cram\u00e9r\u2019s V \u2248 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.\nConclusions: Rural\u2013urban 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.<\/jats:p>","DOI":"10.5334\/aogh.5148","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T07:21:32Z","timestamp":1781767292000},"page":"57","source":"Crossref","is-referenced-by-count":0,"title":["Integrated Determinants of Maternal Healthcare Decisions: A Cross-Sectional Analysis of Predisposing, Enabling, and Illness-Level Factors in Bo District, Sierra Leone"],"prefix":"10.5334","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3330-6526","authenticated-orcid":false,"given":"Rennie","family":"Viah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1973-7200","authenticated-orcid":false,"given":"Rashid","family":"Ansumana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7894-4383","authenticated-orcid":false,"given":"Emmanuel Komba","family":"Finoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3285","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"key20260618072127_r16","unstructured":"World Health Organization, United Nations Children\u2019s Fund, United Nations Population Fund, World Bank Group, United Nations Department of Economic and Social Affairs. Trends in maternal mortality 2000\u20132020 [Internet]. Geneva: World Health Organization; 2023. Accessed May 8, 2026. https:\/\/www.who.int\/publications\/i\/item\/9789240068759?utm_source=chatgpt.com."},{"issue":"1","key":"key20260618072127_r12","doi-asserted-by":"crossref","first-page":"e076256","DOI":"10.1136\/bmjopen-2023-076256","article-title":"Causes of maternal deaths in Sierra Leone from 2016 to 2019: Analysis of districts\u2019 maternal death surveillance and response data","volume":"14","year":"2024","journal-title":"BMJ Open"},{"key":"key20260618072127_r15","unstructured":"World Bank. Maternal mortality ratio (modeled estimate, per 100,000 live births)\u2014Sierra Leone [Internet]. World Bank. Published 2025. Accessed May 8, 2026. https:\/\/data.worldbank.org\/indicator\/SH.STA.MMRT?locations=SL&utm_source=chatgpt.com."},{"key":"key20260618072127_r11","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1186\/s13690-024-01430-1","article-title":"Trends and inequalities in adequate antenatal care coverage among women in Sierra Leone, 2008\u20132019","volume":"82","year":"2024","journal-title":"Arch Public Health"},{"key":"key20260618072127_r13","first-page":"1208","article-title":"Status of the WHO\u2011recommended antenatal care contacts in Sierra Leone","volume":"22","year":"2022","journal-title":"BMC Health Serv Res"},{"issue":"10","key":"key20260618072127_r14","doi-asserted-by":"crossref","first-page":"e0276102","DOI":"10.1371\/journal.pone.0276102","article-title":"Inequalities in maternal healthcare use in Sierra Leone","volume":"17","year":"2022","journal-title":"PLoS One"},{"key":"key20260618072127_r9","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1186\/s12913-025-12363-y","article-title":"Determinants of poor access to health care among women of reproductive age in Sierra Leone","volume":"25","year":"2025","journal-title":"BMC Health Serv Res"},{"key":"key20260618072127_r8","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1186\/s12884-025-07711-z","article-title":"\u201cIt shows that I belong\u201d: Birth companionship of choice in a maternity clinic in Freetown, Sierra Leone","volume":"25","year":"2025","journal-title":"BMC Pregnancy Childbirth"},{"issue":"11","key":"key20260618072127_r4","first-page":"e0260622","article-title":"Adopting Andersen\u2019s behavioral model to identify factors influencing maternal healthcare service utilization","volume":"16","year":"2021","journal-title":"PLoS One"},{"issue":"1","key":"key20260618072127_r5","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1186\/s12884-025-08356-8","article-title":"Determinants of antenatal care utilization among Saudi females: Application of Andersen\u2019s behavioral model: A cross\u2011sectional study","volume":"25","year":"2025","journal-title":"BMC Pregnancy Childbirth"},{"issue":"7","key":"key20260618072127_r1","first-page":"1346","article-title":"Application and use of Andersen\u2019s behavioral model as theoretical framework: A systematic literature review from 2012\u20132021","volume":"52","year":"2023","journal-title":"Iran J Public Health"},{"key":"key20260618072127_r2","first-page":"27","article-title":"Health seeking behaviour and knowledge on neonatal danger signs among neonatal caregivers in Upper Denkyira East Municipality, Ghana","volume":"23","year":"2023","journal-title":"BMC Pediatr"},{"key":"key20260618072127_r7","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1186\/s12913-021-06529-7","article-title":"Measuring coverage of maternal and child health services using routine health facility data: A Sierra Leone case study","volume":"21:","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"key20260618072127_r6","first-page":"6","article-title":"Determinants of quality antenatal care among adolescent girls and women in Sierra Leone: Insights from the 2019 Demographic and Health Survey","volume":"23","year":"2026","journal-title":"Reprod Health"},{"issue":"7","key":"key20260618072127_r10","first-page":"e0323538","article-title":"Health insurance non\u2011enrollment among women in Sierra Leone","volume":"20","year":"2025","journal-title":"PLoS One"}],"container-title":["Annals of Global Health"],"original-title":[],"link":[{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/5148\/files\/6a33ad1a00e1e.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/5148\/files\/6a33ad35ceee9.xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/5148\/files\/6a33ad1a00e1e.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T09:02:35Z","timestamp":1781773355000},"score":1,"resource":{"primary":{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/10.5334\/aogh.5148"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,18]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,2]]}},"URL":"https:\/\/doi.org\/10.5334\/aogh.5148","relation":{},"ISSN":["2214-9996"],"issn-type":[{"value":"2214-9996","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,18]]}}}