{"id":{"repo_id":"cape-town","oai_identifier":"oai:open.uct.ac.za:11427/43352"},"canonical_url":"https://search.dev.ndltd.org/etd/cape-town/oai:open.uct.ac.za:11427/43352","repository":{"repo_id":"cape-town","name":"University of Cape Town","base_url":"https://open.uct.ac.za/oai/request"},"display":{"title":"Obstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula","abstract":"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.","abstract_html":"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.","abstract_has_math":false,"creators":["Jere, Khumbo"],"institution":"Division of General Surgery","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":["Maswime, Salome","Adelowo, Amos"],"committee_chairs":[],"committee_members":[],"year":2026,"date_issued":"2026","date_published":"2026","updated_at":"2026-07-24T01:34:09Z","subjects":["Malawi","obstetric fistula"],"languages":["en"],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"http://hdl.handle.net/11427/43352","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Maswime, Salome","Adelowo, Amos"]},{"key":"dc:creator","label":"Author","values":["Jere, Khumbo"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2026-06-22T13:44:52Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2026-06-22T13:44:52Z"]},{"key":"dc:date.issued","label":"Date","values":["2026"]},{"key":"dc:publisher.department","label":"Dc Publisher Department","values":["Division of General Surgery"]},{"key":"dc:publisher.institution","label":"Dc Publisher Institution","values":["University of Cape Town"]},{"key":"dc:type","label":"Dc Type","values":["Thesis / Dissertation"]},{"key":"dc:type.qualificationlevel","label":"Dc Type Qualificationlevel","values":["Doctoral","PhD"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Malawi","obstetric fistula"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language.iso","label":"Language (ISO)","values":["en"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["http://hdl.handle.net/11427/43352"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["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."]},{"key":"dc:title","label":"Title","values":["Obstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula"]}]}],"canonical_facts":{"dc:contributor.advisor":["Maswime, Salome","Adelowo, Amos"],"dc:creator":["Jere, Khumbo"],"dc:date.accessioned":["2026-06-22T13:44:52Z"],"dc:date.available":["2026-06-22T13:44:52Z"],"dc:date.issued":["2026"],"dc:description.abstract":["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."],"dc:identifier.uri":["http://hdl.handle.net/11427/43352"],"dc:language.iso":["en"],"dc:publisher.department":["Division of General Surgery"],"dc:publisher.institution":["University of Cape Town"],"dc:subject":["Malawi","obstetric fistula"],"dc:title":["Obstetric fistula in Malawi: preparedness for prevention and management of obstetric fistula"],"dc:type":["Thesis / Dissertation"],"dc:type.qualificationlevel":["Doctoral","PhD"]},"updated_at":"2026-07-24T01:34:09Z"}