Intersectional inequalities in healthcare utilisation in informal settlements in Freetown, Sierra Leone: a multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).

Ibrahim Juldeh Sesay¹, Samira Sesay², Haja Wurie-Kamara², Sia Morenike Tengbe¹, Sullaiman Fullah¹, Dora Vangahun¹, Ibrahim Gandi³, Noemia Teixeira de Siqueira Filha⁴, Rajith Lakshman⁵, Abu Conteh^1,6, Samuel Saidu^2,6, Braima Koroma¹, Bintu Mansaray², Helen Elsey⁴, Lana Whittaker⁶, Laura Dean⁶, Neele Wiltgen Georgi⁶, Motto Nganda⁶, Francis Refell³, Joseph M Macarthy¹, Alastair H Leyland⁷, Rachel Tolhurst⁶, Eliud Kibuchi⁸

¹Sierra Leone Urban Research Center, Freetown, Sierra Leone.

²College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.

³Centre of Dialogue on Human Settlement and Poverty Alleviation, Freetown, Sierra Leone.

⁴Department of Health Sciences, Hull and York Medical School, University of York, York, UK.

⁵Institute of Development Studies (IDS), Falmer, UK.

⁶Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.

⁷School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, UK.

⁸School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, UK. Eliud.Kibuchi@glasgow.ac.uk.

PubMed PMC DOI PDF

Abstract

INTRODUCTION: Residents of informal settlements face significant intersectional inequalities, due to the overlapping and compounding effects of multiple social factors. This study aims to explore how these intersecting social factors, identified by community members, combine to shape household-level inequalities healthcare utilisation (HU) among residents of informal settlements in Freetown, Sierr…

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Mentioned Companies

Dialogue
affiliation

Other Funding

UKRI Collective Fund award(ES/S00811X/1)
Scottish Government Chief Scientist Office(SPHSU17)
Medical Research Council(MC_UU_00022/2)
United Kingdom

MeSH Terms

Humans0Sierra Leone0Cross-Sectional Studies0Female0Patient Acceptance of Health Care*Multilevel Analysis0Healthcare Disparities*Male0Socioeconomic Disparities in Health0Adult0Socioeconomic Factors0Residence Characteristics0Family Characteristics0Middle Aged0

Keywords

Healthcare utilisationInformal settlementsIntersectional inequalitiesMAIHDAQuantitative intersectionality

Article Info

PMID: 41975471
PMCID: PMC13185398
DOI: 10.1186/s12939-026-02851-w
Received: January 15, 2025
Accepted: April 2, 2026

How to Cite

Sesay IJ et al. Intersectional inequalities in healthcare utilisation in informal settlements in Freetown, Sierra Leone: a multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Int J Equity Health2026;25(1) doi:10.1186/s12939-026-02851-w

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