Cervical cancer remains a major cause of cancer-related morbidity and mortality among women in low- and middle-income countries, despite being largely preventable through HPV vaccination, screening, timely follow-up, and treatment. While substantial attention has been given to increasing screening uptake, screening alone does not guarantee prevention. Women must also receive their results, understand their meaning, attend follow-up, and remain connected to appropriate care.

This thesis investigates continuity within cervical cancer screening pathways in Uganda and Bangladesh using a sequential explanatory mixed-methods design. Quantitative programme data were analysed through funnel analysis to identify where documented continuity loss occurred across screening and HPV-positive follow-up stages. Qualitative interviews with women, healthcare workers, programme stakeholders, and experts were analysed thematically to explain behavioural, social, organisational, and technological factors influencing continuity.

The findings show that continuity loss was concentrated after HPV-positive results, particularly at follow-up and management-action stages. Qualitative findings identified six themes shaping continuity: health literacy and awareness, fear and emotional barriers, family and social influence, practical access barriers, communication and trust, and continuity support mechanisms. The thesis argues that continuity should not be understood only as an individual behavioural outcome, but as a socio-technical capability produced through interactions between women, families, communities, healthcare workers, programme routines, information systems, communication practices, and technologies.

The study contributes to cervical cancer screening research, continuity of care literature, and Management of Technology by reframing pathway completion as a socio-technical system capability. It also proposes a Continuity Companion Ecosystem as an evidence-informed intervention concept combining human support, community engagement, trusted communication, follow-up tracking, and context-appropriate digital support. ... Read more

Vacuum extraction is a form of assisted vaginal birth where a vacuum cup is attached onto the fetal head by means of suction on which traction force is then exerted to facilitate birth. Vacuum extraction is often regarded as a safer option than the cesarean section and forceps delivery, due to decreased risk of maternal en fetal complications. The increase in popularity of handheld disposable vacuum extractors in low-resource clinical settings demonstrate the need for more ergonomic vacuum extraction solutions geared towards LMICs. In this report an ergonomic and affordable vacuum extraction system is developed by reinventing the pump mechanism of an existing vacuum extractor. Two types of manual pumping mechanisms more suitable with cleaning are explored and tested on their ability to create partial vacuum. One of which is able to reach the required partial vacuum of 0.08 MPa (0.02 MPa pressure) and poses as most promising for implementation. From this, a final prototype is developed and evaluated on usability in a modern clinical setting. The result of the functional validation and usability evaluation show that this pump mechanism can successfully be integrated in a vacuum extraction system to create a more affordability and convenient vacuum extraction system that may make vacuum extraction more accessible in LMICs. ... Read more