Obstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula

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dc.contributor.advisorMaswime, Salome
dc.contributor.advisorAdelowo, Amos
dc.contributor.authorJere, Khumbo
dc.date.accessioned2026-06-22T13:44:52Z
dc.date.available2026-06-22T13:44:52Z
dc.date.issued2026
dc.date.updated2026-06-22T13:37:00Z
dc.description.abstractObstetric 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.
dc.identifier.apacitationJere, K. (2026). <i>Obstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula</i>. (). University of Cape Town ,Faculty of Health Sciences ,Division of General Surgery. Retrieved from http://hdl.handle.net/11427/43352en_ZA
dc.identifier.chicagocitationJere, Khumbo. <i>"Obstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula."</i> ., University of Cape Town ,Faculty of Health Sciences ,Division of General Surgery, 2026. http://hdl.handle.net/11427/43352en_ZA
dc.identifier.citationJere, K. 2026. Obstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula. . University of Cape Town ,Faculty of Health Sciences ,Division of General Surgery. http://hdl.handle.net/11427/43352en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Jere, Khumbo AB - 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. DA - 2026 DB - OpenUCT DP - University of Cape Town KW - Malawi KW - obstetric fistula LK - https://open.uct.ac.za PB - University of Cape Town PY - 2026 T1 - Obstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula TI - Obstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula UR - http://hdl.handle.net/11427/43352 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/43352
dc.identifier.vancouvercitationJere K. Obstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula. []. University of Cape Town ,Faculty of Health Sciences ,Division of General Surgery, 2026 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/43352en_ZA
dc.language.isoen
dc.language.rfc3066eng
dc.publisher.departmentDivision of General Surgery
dc.publisher.facultyFaculty of Health Sciences
dc.publisher.institutionUniversity of Cape Town
dc.subjectMalawi
dc.subjectobstetric fistula
dc.titleObstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula
dc.typeThesis / Dissertation
dc.type.qualificationlevelDoctoral
dc.type.qualificationlevelPhD
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