Our Work

Development of Mental Health Treatment for Obstetric Fistula Patients in Tanzania

Project Objectives

PI: Melissa Watt
Co-investigator: Kathleen J. Sikkema
Funder: NICHD, R21, 2013-2015 (Supplementary funding by the Fistula Foundation)
Partner: KCMC in Moshi, Tanzania

Obstetric fistula is a hole between the bladder and the vagina, which develops when obstructed labor is not relieved by cesarean section and results in uncontrollable leaking of urine and/or feces. The only cure for obstetric fistula is surgical repair, but many women suffer for years without treatment. Multiple studies have documented the social and psychological impact of obstetric fistula, which includes social isolation, stigma, depression, and mental health dysfunction. However, to date no intervention studies have evaluated empirically-supported therapies to assist in psychological healing among fistula patients. The proposed study aims to fill this gap by developing and pilot-testing a theoretically informed mental health intervention for women receiving surgical repair for obstetric fistula at KCMC Hospital in Moshi, Tanzania.

The study has three specific aims: 1) To develop the nurse-delivered mental health intervention, built on theories of coping and cognitive behavioral therapy, 2) To assess feasibility and acceptability of implementing the intervention in the KCMC fistula ward, considering: intervention fidelity, patient satisfaction, provider feedback and cost of delivery, 3) To assess effectiveness of the intervention by comparing immediate and short term outcomes in 30 women who receive the experimental intervention with 30 women receiving the standard of care counseling, examining differences in primary outcomes (depression, PTSD and somatic symptoms) and secondary outcomes (coping, perceived stigma, social support, social participation, efficacy to engage with providers, adherence to clinical recommendations and social reintegration).

The proposed research directly responds to the needs specified by NIH because it expands the 'evidence base for improving social outcomes' of women with obstetric fistula and develops a 'sustainable intervention' that complements existing local care (PA-11-143).

Project Outcomes

The study is complete. The intervention development process was published in a paper in the journal Evaluation and Program Planning. There, we describe the 6-session individual-level intervention, based on principles of cognitive behavioral therapy and coping theory, that was developed for delivery by a community-health nurse. We are now completing analysis of intervention outcomes.


Department & School

Duke Global Health Institute



  • NIH-National Institute of Child Health and Human Development


  • Kilimanjaro Christian Medical Centre

Project Status


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