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Table 2 Domains, categories, themes, and sub-themes from interviews with Malawian women 1–2 years post fistula repair surgery

From: Long-term outcomes for women after obstetric fistula repair in Lilongwe, Malawi: a qualitative study

Domain Category/level Theme Sub-theme
Overall Quality of Life (QOL) Greatest concerns before surgery Death during surgery  
Irreparable Fistula  
   Marital discord (1) Partner abandonment
  (2) Polygamy
  (3) Fistula affected sexual intercourse
  Greatest concerns after surgery Financial challenges  
Additional surgery  
Reproductive health and fertility (1) Desire to have children
Relationship challenges (1) Unsupportive relationships
(2) Fear of being unmarried
(3) Challenges with sexual intercourse
  Individual Level Compared to before surgery, QOL had improved (1) QOL after surgery is similar to QOL before fistula developed
  Interpersonal Level Relationships with family and friends before fistula repair (1) Stigma from family, friends, and community
Relationships with family and friends after fistula repair (1) Few with ongoing stigma after repair
Participation in social activities before surgery (1) Isolation because of urine leakage
  (2) Inability to work or attend activities
Participation in social activities after surgery (1) Reintegration back into social and work activities
  (2) Holding positions within groups
Fertility and pregnancy after repair   Fertility desires and pregnancy outcomes (1) Fear of fistula recurrence from future pregnancy
  (2) Confusion about ability to bear children
(3) Consequences of not being able to have children
   Family planning use  
Understanding of fistula   Knowledge of fistula (1) Delay seeking hospital care contributes to fistula development
  (2) Understanding prolonged labor as a cause of fistula but poor understanding of cause of prolonged labor
(3) Cultural beliefs
Fistula advocacy to others (1) Assisted women with fistula to seek repair
(2) Advocating for fistula prevention in communities
Suggestions for helping women/with fistula