{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T10:00:12Z","timestamp":1770544812572,"version":"3.49.0"},"reference-count":0,"publisher":"Global Health and Education Projects, Inc","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int J MCH AIDS"],"abstract":"<jats:p>Objectives: To determine the association between access to health care among pregnant women in Malawi and occurrence of obstetric vesicovaginal fistula (VVF).\r\nMethods: This was a case-control study using data obtained from patients\u2019 records documented by the \u2018Fistula Care Center-Bwaila Hospital\u2019 in Malawi. Socio-demo graph ic characteristics of women with VVF (study arm, n=1046) and perineal tear (control arm, n=37) were examined. A composite variable called \u201cMalawi Healthcare Access Index\u201d (MHAI) was created through summation of scores related to three factors of access to care: (1) walking distance to closest health center; (2) presence of trained provider at delivery; and (3) receipt of antenatal care. Binomial logistic regression models were built to determine the association between the MHAI and presence of VVF.\r\nResults: Obstetric VVF was more common in women from rural areas, mothers delivering at extremes of age, those with less education, and patients with long labor (&gt;12 hours). In adjusted models, women with \u201cinsufficient\u201d health access based on the MHAI were at greater risk (OR = 2.64, 95%CI = 1.07 \u2013 6.03) of obstetric VVF than women with \u201csufficient\u201d score on the MHAI.\r\nConclusion and Global Health Implications: Inadequate access to essential obstetric care increases the risk of VVF.\r\nKey words: \u2022 Health care index \u2022 Obstetric complications \u2022 Vesicovaginal fistula \u2022 Poverty \u2022 Malawi \u2022 Malawi Healthcare Access Index\r\n\u00a0\r\nCopyright \u00a9 2020 Rupley et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited<\/jats:p>","DOI":"10.21106\/ijma.292","type":"journal-article","created":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T04:45:49Z","timestamp":1612845949000},"page":"4-13","source":"Crossref","is-referenced-by-count":2,"title":["Healthcare Access as a Risk-Marker for Obstetric Vesicovaginal Fistula in Malawi"],"prefix":"10.21106","volume":"9","author":[{"given":"Devon Madelyn","family":"Rupley","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepa","family":"Dongarwar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamisu M.","family":"Salihu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allison M.","family":"Janda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Pope","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"8847","published-online":{"date-parts":[[2019,12,28]]},"container-title":["International Journal of Maternal and Child Health and AIDS (IJMA)"],"original-title":[],"link":[{"URL":"https:\/\/mchandaids.org\/index.php\/IJMA\/article\/download\/292\/142","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/mchandaids.org\/index.php\/IJMA\/article\/download\/292\/142","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T10:32:12Z","timestamp":1770028332000},"score":1,"resource":{"primary":{"URL":"https:\/\/mchandaids.org\/index.php\/ijma\/article\/view\/146"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,28]]},"references-count":0,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,12,29]]}},"URL":"https:\/\/doi.org\/10.21106\/ijma.292","relation":{},"ISSN":["2161-864X","2161-8674"],"issn-type":[{"value":"2161-864X","type":"electronic"},{"value":"2161-8674","type":"print"}],"subject":[],"published":{"date-parts":[[2019,12,28]]}}}