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Obstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula
Obstetric fistula remains a severe maternal morbidity in low-resource settings, reflecting persistent inequities in access to timely, safe obstetric care. This doctoral study examines Malawi's preparedness to prevent and manage obstetric fistula using a mixed-methods approach anchored in the Thaddeu...
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| Format: | Thesis |
| Language: | English English |
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Division of General Surgery
2026
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| _version_ | 1869483655876837376 |
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| access_status_str | Open Access |
| author | Jere, Khumbo |
| author2 | Maswime, Salome |
| author_browse | Jere, Khumbo Maswime, Salome |
| author_facet | Maswime, Salome Jere, Khumbo |
| author_sort | Jere, Khumbo |
| collection | Thesis |
| description | Obstetric fistula remains a severe maternal morbidity in low-resource settings, reflecting persistent inequities in access to timely, safe obstetric care. This doctoral study examines Malawi's preparedness to prevent and manage obstetric fistula using a mixed-methods approach anchored in the Thaddeus and Maine Three Delays Model. Quantitative analysis integrated 2015–16 DHS data, national health facility datasets, and a ten-year surgical audit (n = 2,430 repairs) from the Bwaila Fistula Care Centre. Geographic Information Systems (GIS) were applied to model accessibility to antenatal and surgical care, identify service gaps, and assess equity. Findings reveal that while antenatal care attendance is high, disparities persist in timely intrapartum care, surgical availability, and workforce distribution—contributing to the ongoing burden. Rural women face disproportionate geographic barriers, with median travel times exceeding WHO thresholds. Literature and regional evidence indicate a growing proportion of surgically induced high fistulas in comparable settings, underscoring the need for strengthened surgical safety, supervision, and competency-based training in Malawi. Recommendations include decentralised surgical hubs, retention of skilled providers, improved intrapartum monitoring, and integration of fistula prevention into national maternal health programmes. These insights contribute evidence to inform Malawi's 2023–2030 National Fistula Strategy and broader Universal Health Coverage goals. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/43352 |
| institution | University of Cape Town (South Africa) |
| language | English eng |
| last_indexed | 2026-07-01T04:02:27.550Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2026 |
| publishDateRange | 2026 |
| publishDateSort | 2026 |
| publisher | Division of General Surgery |
| publisherStr | Division of General Surgery |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/43352 Obstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula Jere, Khumbo Maswime, Salome Adelowo, Amos Malawi obstetric fistula Obstetric fistula remains a severe maternal morbidity in low-resource settings, reflecting persistent inequities in access to timely, safe obstetric care. This doctoral study examines Malawi's preparedness to prevent and manage obstetric fistula using a mixed-methods approach anchored in the Thaddeus and Maine Three Delays Model. Quantitative analysis integrated 2015–16 DHS data, national health facility datasets, and a ten-year surgical audit (n = 2,430 repairs) from the Bwaila Fistula Care Centre. Geographic Information Systems (GIS) were applied to model accessibility to antenatal and surgical care, identify service gaps, and assess equity. Findings reveal that while antenatal care attendance is high, disparities persist in timely intrapartum care, surgical availability, and workforce distribution—contributing to the ongoing burden. Rural women face disproportionate geographic barriers, with median travel times exceeding WHO thresholds. Literature and regional evidence indicate a growing proportion of surgically induced high fistulas in comparable settings, underscoring the need for strengthened surgical safety, supervision, and competency-based training in Malawi. Recommendations include decentralised surgical hubs, retention of skilled providers, improved intrapartum monitoring, and integration of fistula prevention into national maternal health programmes. These insights contribute evidence to inform Malawi's 2023–2030 National Fistula Strategy and broader Universal Health Coverage goals. 2026-06-22T13:44:52Z 2026-06-22T13:44:52Z 2026 2026-06-22T13:37:00Z Thesis / Dissertation Doctoral PhD http://hdl.handle.net/11427/43352 en eng application/pdf Division of General Surgery Faculty of Health Sciences University of Cape Town |
| spellingShingle | Malawi obstetric fistula Jere, Khumbo Obstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula |
| thesis_degree_str | Doctoral |
| title | Obstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula |
| title_full | Obstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula |
| title_fullStr | Obstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula |
| title_full_unstemmed | Obstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula |
| title_short | Obstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula |
| title_sort | obstetric fistula in malawi preparedness for prevention and management of obstetric fistula |
| topic | Malawi obstetric fistula |
| url | http://hdl.handle.net/11427/43352 |
| work_keys_str_mv | AT jerekhumbo obstetricfistulainmalawipreparednessforpreventionandmanagementofobstetricfistula |