Abstract

Background: Malaria remains a leading cause of morbidity and mortality among women in rural Sierra Leone, where access to biomedical healthcare is limited. This study examines the use of herbal remedies for malaria treatment among women in Gbondapi, Pujehun District, focusing on gendered healthcare decision-making, economic barriers, and sociocultural influences. Methods: A mixed-methods approach was employed, including surveys (n=356 women), in-depth interviews (n=20 traditional healers), focus group discussions (4 FGDs, 8–10 participants each), and ethnobotanical surveys. Thematic analysis and descriptive statistics were used to analyze qualitative and quantitative data, respectively. Results: Women predominantly relied on herbal treatments due to affordability (72%), accessibility (68%), and cultural trust (59%). Key plants included “Azadirachta indica” (neem), “Vernonia amygdalina” (bitter leaf), and “Moringa oleifera”. Despite perceived efficacy, dosage inconsistencies and delayed biomedical care-seeking were reported. Financial constraints and caregiving responsibilities heavily influenced women’s treatment choices, with 86% serving as primary decision-makers for household malaria care. Conclusions: Rural women’s dependence on herbal medicine reflects systemic gender disparities in healthcare access. Policy interventions must address economic barriers, integrate traditional healers into malaria programs, and empower women through community-based education..