ORIGINAL ARTICLE Health-care availability, preference, and distance for women in urban Bo, Sierra Leone Lila C. Fleming . Rashid Ansumana . Alfred S. Bockarie . Joel D. Alejandre . Karen K. Owen . Umaru Bangura . David H. Jimmy . Kevin M. Curtin . David A. Stenger . Kathryn H. Jacobsen Received: 26 November 2014 / Revised: 20 March 2016 / Accepted: 21 March 2016 / Published online: 30 March 2016 Ó Swiss School of Public Health (SSPH+) 2016 Abstract Objectives To examine the diversity of the health-care providers in urban Bo, Sierra Leone, identify the types of health-care facilities preferred by women for fevers, and analyze the road network distances from homes to pre- ferred health-care providers. Methods A population-based random sampling method was used to recruit 2419 women from Bo. A geographic information system was used to measure the road distance from each woman’s home to her preferred provider. Results Preferred health-care providers for acute febrile illnesses (commonly referred to as ‘‘malaria’’ in the study communities) were hospitals (62.3 %), clinics (12.6 %), and pharmacies (12.4 %). Participants lived a median dis- tance of 0.6 km from the nearest provider, but on average each woman lived 2.2 km one-way from her preferred provider. Women living farther from the city center had preferred providers significantly farther from home than women living downtown. Conclusions The diverse health-care marketplace in Bo allows women to select clinical facilities from across the city. Most women prefer a malaria care provider farther from home than they could comfortably walk when ill. Keywords Health services accessibility Á Choice behavior Á Urban population Á Sierra Leone Á West Africa Introduction Studies of access to health care in low- and middle-income countries (LMICs) have suggested that the distance from homes to health-care facilities is a critical factor for accessing preventive, diagnostic, and therapeutic health services. However, most of these previous studies on dis- tance to health-care providers in LMICs were conducted in rural settings (Acharya and Cleland 2000; Akin and Rous 1997; Amaghionyeodiwe 2008; Amuge et al. 2004; Bigogo L. C. Fleming (&) Department of Environmental Science and Public Policy, George Mason University, 4400 University Drive 5B7, Fairfax, VA 22030, USA e-mail: lflemin1@gmu.edu R. Ansumana Á A. S. Bockarie Á U. Bangura Á D. H. Jimmy Mercy Hospital Research Laboratory, Kulanda Town, Bo, Sierra Leone R. Ansumana Njala University, Bo, Sierra Leone J. D. Alejandre Information Technology Division, U.S. Naval Research Laboratory, 4555 Overlook Avenue, SW Washington, DC 20375, USA K. K. Owen Á K. M. Curtin Department of Geography and Geoinformation Science, George Mason University, 4400 University Drive, Fairfax, VA 22030, USA D. A. Stenger Center for Bio/Molecular Science and Engineering, U.S. Naval Research Laboratory, 4555 Overlook Avenue, SW Washington, DC 20375, USA K. H. Jacobsen Department of Global and Community Health, George Mason University, 4400 University Drive 5B7, Fairfax, VA 22030, USA Int J Public Health (2016) 61:1079–1088 DOI 10.1007/s00038-016-0815-y 123