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 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.

Grantor dc:publisher.institution

Division of General Surgery

Year dc:date.issued

2026

Author dc:creator

• Jere, Khumbo

Advisors dc:contributor.advisor

• Maswime, Salome
• Adelowo, Amos

• Malawi
• obstetric fistula

Language dc:language.iso

en

Handle dc:identifier.uri

http://hdl.handle.net/11427/43352

OAI identifier oai:identifier

oai:open.uct.ac.za:11427/43352