The Experts below are selected from a list of 1242 Experts worldwide ranked by ideXlab platform
Melissa H Watt - One of the best experts on this subject based on the ideXlab platform.
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delays contributing to the development and repair of Obstetric Fistula in northern tanzania
International Urogynecology Journal, 2018Co-Authors: Cody Cichowitz, Melissa H Watt, Bariki Mchome, Gileard MasengaAbstract:Delays in receiving Obstetric care during labor contribute to high rates of maternal morbidity in sub-Saharan Africa. This exploratory study was conducted to identify important delays experienced during the development and subsequent repair of Obstetric Fistula in northern Tanzania. Sixty women presenting to a tertiary hospital with Obstetric Fistula completed structured surveys about the birth experience that led to Fistula development and their experiences seeking surgical repair. A subset of 30 provided qualitative accounts. Clinical data were collected postsurgery. Data were analyzed according to a four-delay model, with iterative analysis allowing for triangulation of all sources. During the index pregnancy, women labored for a median of 48 h. Most women (53/60; 88.3%) delivered in a facility but labored for a median of 12.4 h before deciding to seek care (Delay 1). Women spent a median of 1.25 h traveling to a facility (Delay 2). After presenting to care, 15/51 (29.4%) waited at least an hour to see a medical provider, and 35/53 (66.0%) required transfer to another facility (Delay 3). Women lived with Fistula for a median of 10 years (Delay 4). Qualitative data provided context and a deeper understanding of the factors contributing to each delay. Critical delays exist both outside and within the healthcare system that contribute to the development and timely repair of Obstetric Fistula. Healthcare system strengthening, particularly with regard to emergency Obstetric care, is critical to reduce the burden of Obstetric Fistula in women in Tanzania.
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a nurse delivered mental health intervention for Obstetric Fistula patients in tanzania results of a pilot randomized controlled trial
Pilot and Feasibility Studies, 2017Co-Authors: Melissa H Watt, Sarah M Wilson, Kathleen J Sikkema, Mary V Mosha, Alyssa Platt, Elizabeth L Turner, Gileard MasengaAbstract:Background Obstetric Fistula has severe psychological consequences, but no evidence-based interventions exist to improve mental health in this population. This pilot trial evaluated a psychological intervention for women receiving surgical care for Obstetric Fistula.
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a nurse delivered mental health intervention for Obstetric Fistula patients in tanzania results of a pilot randomized controlled trial
Pilot and Feasibility Studies, 2017Co-Authors: Melissa H Watt, Sarah M Wilson, Kathleen J Sikkema, Mary Vincent Mosha, Alyssa Platt, Elizabeth L Turner, Gileard MasengaAbstract:Obstetric Fistula has severe psychological consequences, but no evidence-based interventions exist to improve mental health in this population. This pilot trial evaluated a psychological intervention for women receiving surgical care for Obstetric Fistula. A parallel two-armed pilot RCT was conducted between 2014 and 2016. The intervention was six individual sessions, based on psychological theory and delivered by a nurse facilitator. The study was conducted at a tertiary hospital in Moshi, Tanzania. Women were eligible if they were over age 18 and admitted to the hospital for surgical repair of an Obstetric Fistula. Sixty participants were randomized to the intervention or standard of care. Surveys were completed at baseline, post-treatment (before discharge), and 3 months following discharge. Standardized scales measured depression, anxiety, traumatic stress, and self-esteem. Feasibility of an RCT was assessed by participation and retention. Feasibility and acceptability of the intervention were assessed by fidelity, attendance, and participant ratings. Potential efficacy was assessed by exploratory linear regression and clinical significance analysis. Eighty-five percent met criteria for mental health dysfunction at enrollment. All eligible patients enrolled, with retention 100% post and 73% at 3 months. Participants rated the intervention acceptable and beneficial. There were sharp and meaningful improvements in mental health outcomes over time, with no evidence of differences by condition. A nurse-delivered mental health intervention was feasible to implement as part of in-patient clinical care and regarded positively. Mental health treatment in this population is warranted given high level of distress at presentation to care. ClinicalTrials.Gov NCT01934075 .
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experiences of social support among women presenting for Obstetric Fistula repair surgery in tanzania
International Journal of Women's Health, 2016Co-Authors: Alexis C Dennis, Sarah M Wilson, Kathleen J Sikkema, Gileard Masenga, Mary Vincent Mosha, Korrine E Terroso, Melissa H WattAbstract:Objective An Obstetric Fistula is a childbirth injury resulting in uncontrollable leakage of urine and/or feces and can lead to physical and psychological challenges, including social isolation. Prior to and after Fistula repair surgery, social support can help a woman to reintegrate into her community. The aim of this study was to preliminarily examine the experiences of social support among Tanzanian women presenting with Obstetric Fistula in the periods immediately preceding Obstetric Fistula repair surgery and following reintegration. Patients and methods The study used a mixed-methods design to analyze cross-sectional surveys (n=59) and in-depth interviews (n=20). Results Women reported widely varying levels of social support from family members and partners, with half of the sample reporting overall high levels of social support. For women experiencing lower levels of support, Fistula often exacerbated existing problems in relationships, sometimes directly causing separation or divorce. Many women were assertive and resilient with regard to advocating for their Fistula care and relationship needs. Conclusion Our data suggest that while some women endure negative social experiences following an Obstetric Fistula and require additional resources and services, many women report high levels of social support from family members and partners, which may be harnessed to improve the holistic care for patients.
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Psychological Symptoms and Social Functioning Following Repair of Obstetric Fistula in a Low-Income Setting
Maternal and Child Health Journal, 2016Co-Authors: Sarah M Wilson, Kathleen J Sikkema, Melissa H Watt, Gileard G. Masenga, Mary V MoshaAbstract:Objectives Obstetric Fistula is a maternal injury that causes uncontrollable leaking of urine or stool, and most women who develop it live in poverty in low-income countries. Obstetric Fistula is associated with high rates of stigma and psychological morbidity, but there is uncertainty about the impact of surgical treatment on psychological outcomes. The objective of this exploratory study was to examine changes in psychological symptoms following surgical Fistula repair, discharge and reintegration home. Methods Women admitted for surgical repair of Obstetric Fistula were recruited from a Tanzanian hospital serving a rural catchment area. Psychological symptoms and social functioning were assessed prior to surgery. Approximately 3 months after discharge, a data collector visited the patients’ homes to repeat psychosocial measures and assess self-reported incontinence. Baseline to follow-up differences were measured with paired t tests controlling for multiple comparisons. Associations between psychological outcomes and leaking were assessed with t tests and Pearson correlations. Results Participants ( N = 28) had been living with Fistula for an average of 11 years. Baseline psychological distress was high, and decreased significantly at follow-up. Participants who self-reported continued incontinence at follow-up endorsed significantly higher PTSD and depression symptoms than those who reported being cured, and severity of leaking was associated with psychological distress. Conclusions Fistula patients experience improvements in mental health at 3 months after discharge, but these improvements are curtailed when women experience residual leaking. Given the rate of stress incontinence following surgery, it is important to prepare Fistula patients for the possibility of incomplete cure and help them develop appropriate coping strategies.
Gileard Masenga - One of the best experts on this subject based on the ideXlab platform.
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delays contributing to the development and repair of Obstetric Fistula in northern tanzania
International Urogynecology Journal, 2018Co-Authors: Cody Cichowitz, Melissa H Watt, Bariki Mchome, Gileard MasengaAbstract:Delays in receiving Obstetric care during labor contribute to high rates of maternal morbidity in sub-Saharan Africa. This exploratory study was conducted to identify important delays experienced during the development and subsequent repair of Obstetric Fistula in northern Tanzania. Sixty women presenting to a tertiary hospital with Obstetric Fistula completed structured surveys about the birth experience that led to Fistula development and their experiences seeking surgical repair. A subset of 30 provided qualitative accounts. Clinical data were collected postsurgery. Data were analyzed according to a four-delay model, with iterative analysis allowing for triangulation of all sources. During the index pregnancy, women labored for a median of 48 h. Most women (53/60; 88.3%) delivered in a facility but labored for a median of 12.4 h before deciding to seek care (Delay 1). Women spent a median of 1.25 h traveling to a facility (Delay 2). After presenting to care, 15/51 (29.4%) waited at least an hour to see a medical provider, and 35/53 (66.0%) required transfer to another facility (Delay 3). Women lived with Fistula for a median of 10 years (Delay 4). Qualitative data provided context and a deeper understanding of the factors contributing to each delay. Critical delays exist both outside and within the healthcare system that contribute to the development and timely repair of Obstetric Fistula. Healthcare system strengthening, particularly with regard to emergency Obstetric care, is critical to reduce the burden of Obstetric Fistula in women in Tanzania.
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a nurse delivered mental health intervention for Obstetric Fistula patients in tanzania results of a pilot randomized controlled trial
Pilot and Feasibility Studies, 2017Co-Authors: Melissa H Watt, Sarah M Wilson, Kathleen J Sikkema, Mary V Mosha, Alyssa Platt, Elizabeth L Turner, Gileard MasengaAbstract:Background Obstetric Fistula has severe psychological consequences, but no evidence-based interventions exist to improve mental health in this population. This pilot trial evaluated a psychological intervention for women receiving surgical care for Obstetric Fistula.
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a nurse delivered mental health intervention for Obstetric Fistula patients in tanzania results of a pilot randomized controlled trial
Pilot and Feasibility Studies, 2017Co-Authors: Melissa H Watt, Sarah M Wilson, Kathleen J Sikkema, Mary Vincent Mosha, Alyssa Platt, Elizabeth L Turner, Gileard MasengaAbstract:Obstetric Fistula has severe psychological consequences, but no evidence-based interventions exist to improve mental health in this population. This pilot trial evaluated a psychological intervention for women receiving surgical care for Obstetric Fistula. A parallel two-armed pilot RCT was conducted between 2014 and 2016. The intervention was six individual sessions, based on psychological theory and delivered by a nurse facilitator. The study was conducted at a tertiary hospital in Moshi, Tanzania. Women were eligible if they were over age 18 and admitted to the hospital for surgical repair of an Obstetric Fistula. Sixty participants were randomized to the intervention or standard of care. Surveys were completed at baseline, post-treatment (before discharge), and 3 months following discharge. Standardized scales measured depression, anxiety, traumatic stress, and self-esteem. Feasibility of an RCT was assessed by participation and retention. Feasibility and acceptability of the intervention were assessed by fidelity, attendance, and participant ratings. Potential efficacy was assessed by exploratory linear regression and clinical significance analysis. Eighty-five percent met criteria for mental health dysfunction at enrollment. All eligible patients enrolled, with retention 100% post and 73% at 3 months. Participants rated the intervention acceptable and beneficial. There were sharp and meaningful improvements in mental health outcomes over time, with no evidence of differences by condition. A nurse-delivered mental health intervention was feasible to implement as part of in-patient clinical care and regarded positively. Mental health treatment in this population is warranted given high level of distress at presentation to care. ClinicalTrials.Gov NCT01934075 .
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experiences of social support among women presenting for Obstetric Fistula repair surgery in tanzania
International Journal of Women's Health, 2016Co-Authors: Alexis C Dennis, Sarah M Wilson, Kathleen J Sikkema, Gileard Masenga, Mary Vincent Mosha, Korrine E Terroso, Melissa H WattAbstract:Objective An Obstetric Fistula is a childbirth injury resulting in uncontrollable leakage of urine and/or feces and can lead to physical and psychological challenges, including social isolation. Prior to and after Fistula repair surgery, social support can help a woman to reintegrate into her community. The aim of this study was to preliminarily examine the experiences of social support among Tanzanian women presenting with Obstetric Fistula in the periods immediately preceding Obstetric Fistula repair surgery and following reintegration. Patients and methods The study used a mixed-methods design to analyze cross-sectional surveys (n=59) and in-depth interviews (n=20). Results Women reported widely varying levels of social support from family members and partners, with half of the sample reporting overall high levels of social support. For women experiencing lower levels of support, Fistula often exacerbated existing problems in relationships, sometimes directly causing separation or divorce. Many women were assertive and resilient with regard to advocating for their Fistula care and relationship needs. Conclusion Our data suggest that while some women endure negative social experiences following an Obstetric Fistula and require additional resources and services, many women report high levels of social support from family members and partners, which may be harnessed to improve the holistic care for patients.
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development of an intervention to improve mental health for Obstetric Fistula patients in tanzania
Evaluation and Program Planning, 2015Co-Authors: Melissa H Watt, Sarah M Wilson, Kathleen J Sikkema, Gileard Masenga, Mary V Mosha, Jennifer Velloza, Margaret Bangser, Andrew BrowningAbstract:Obstetric Fistula is a debilitating childbirth injury that has been associated with high rates of psychological distress. Global efforts have helped to link women to surgical repair, but thus far no evidence-based interventions exist to address the psychological needs of these women during the hospital stay. In this paper, we describe the development of a psychological intervention for women in Tanzania who are receiving surgical care for an Obstetric Fistula. The intervention was developed based on theories of cognitive behavioral therapy and coping models. Content and delivery were informed by qualitative data collection with a range of stakeholders including women with Fistula, and input from a study advisory board. The resulting intervention was six individual sessions, delivered by a trained community health nurse. The session topics were (1) recounting the Fistula story; (2) creating a new story about the Fistula; (3) loss, grief and shame; (4) specific strategies for coping; (5) social relationships; and (6) planning for the future. A trial run of the intervention revealed that the intervention could be delivered with fidelity and was acceptable to patients. A future randomized control trial will evaluate the efficacy of this intervention to address the mental health symptoms of this population.
Sarah M Wilson - One of the best experts on this subject based on the ideXlab platform.
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a nurse delivered mental health intervention for Obstetric Fistula patients in tanzania results of a pilot randomized controlled trial
Pilot and Feasibility Studies, 2017Co-Authors: Melissa H Watt, Sarah M Wilson, Kathleen J Sikkema, Mary V Mosha, Alyssa Platt, Elizabeth L Turner, Gileard MasengaAbstract:Background Obstetric Fistula has severe psychological consequences, but no evidence-based interventions exist to improve mental health in this population. This pilot trial evaluated a psychological intervention for women receiving surgical care for Obstetric Fistula.
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a nurse delivered mental health intervention for Obstetric Fistula patients in tanzania results of a pilot randomized controlled trial
Pilot and Feasibility Studies, 2017Co-Authors: Melissa H Watt, Sarah M Wilson, Kathleen J Sikkema, Mary Vincent Mosha, Alyssa Platt, Elizabeth L Turner, Gileard MasengaAbstract:Obstetric Fistula has severe psychological consequences, but no evidence-based interventions exist to improve mental health in this population. This pilot trial evaluated a psychological intervention for women receiving surgical care for Obstetric Fistula. A parallel two-armed pilot RCT was conducted between 2014 and 2016. The intervention was six individual sessions, based on psychological theory and delivered by a nurse facilitator. The study was conducted at a tertiary hospital in Moshi, Tanzania. Women were eligible if they were over age 18 and admitted to the hospital for surgical repair of an Obstetric Fistula. Sixty participants were randomized to the intervention or standard of care. Surveys were completed at baseline, post-treatment (before discharge), and 3 months following discharge. Standardized scales measured depression, anxiety, traumatic stress, and self-esteem. Feasibility of an RCT was assessed by participation and retention. Feasibility and acceptability of the intervention were assessed by fidelity, attendance, and participant ratings. Potential efficacy was assessed by exploratory linear regression and clinical significance analysis. Eighty-five percent met criteria for mental health dysfunction at enrollment. All eligible patients enrolled, with retention 100% post and 73% at 3 months. Participants rated the intervention acceptable and beneficial. There were sharp and meaningful improvements in mental health outcomes over time, with no evidence of differences by condition. A nurse-delivered mental health intervention was feasible to implement as part of in-patient clinical care and regarded positively. Mental health treatment in this population is warranted given high level of distress at presentation to care. ClinicalTrials.Gov NCT01934075 .
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experiences of social support among women presenting for Obstetric Fistula repair surgery in tanzania
International Journal of Women's Health, 2016Co-Authors: Alexis C Dennis, Sarah M Wilson, Kathleen J Sikkema, Gileard Masenga, Mary Vincent Mosha, Korrine E Terroso, Melissa H WattAbstract:Objective An Obstetric Fistula is a childbirth injury resulting in uncontrollable leakage of urine and/or feces and can lead to physical and psychological challenges, including social isolation. Prior to and after Fistula repair surgery, social support can help a woman to reintegrate into her community. The aim of this study was to preliminarily examine the experiences of social support among Tanzanian women presenting with Obstetric Fistula in the periods immediately preceding Obstetric Fistula repair surgery and following reintegration. Patients and methods The study used a mixed-methods design to analyze cross-sectional surveys (n=59) and in-depth interviews (n=20). Results Women reported widely varying levels of social support from family members and partners, with half of the sample reporting overall high levels of social support. For women experiencing lower levels of support, Fistula often exacerbated existing problems in relationships, sometimes directly causing separation or divorce. Many women were assertive and resilient with regard to advocating for their Fistula care and relationship needs. Conclusion Our data suggest that while some women endure negative social experiences following an Obstetric Fistula and require additional resources and services, many women report high levels of social support from family members and partners, which may be harnessed to improve the holistic care for patients.
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Psychological Symptoms and Social Functioning Following Repair of Obstetric Fistula in a Low-Income Setting
Maternal and Child Health Journal, 2016Co-Authors: Sarah M Wilson, Kathleen J Sikkema, Melissa H Watt, Gileard G. Masenga, Mary V MoshaAbstract:Objectives Obstetric Fistula is a maternal injury that causes uncontrollable leaking of urine or stool, and most women who develop it live in poverty in low-income countries. Obstetric Fistula is associated with high rates of stigma and psychological morbidity, but there is uncertainty about the impact of surgical treatment on psychological outcomes. The objective of this exploratory study was to examine changes in psychological symptoms following surgical Fistula repair, discharge and reintegration home. Methods Women admitted for surgical repair of Obstetric Fistula were recruited from a Tanzanian hospital serving a rural catchment area. Psychological symptoms and social functioning were assessed prior to surgery. Approximately 3 months after discharge, a data collector visited the patients’ homes to repeat psychosocial measures and assess self-reported incontinence. Baseline to follow-up differences were measured with paired t tests controlling for multiple comparisons. Associations between psychological outcomes and leaking were assessed with t tests and Pearson correlations. Results Participants ( N = 28) had been living with Fistula for an average of 11 years. Baseline psychological distress was high, and decreased significantly at follow-up. Participants who self-reported continued incontinence at follow-up endorsed significantly higher PTSD and depression symptoms than those who reported being cured, and severity of leaking was associated with psychological distress. Conclusions Fistula patients experience improvements in mental health at 3 months after discharge, but these improvements are curtailed when women experience residual leaking. Given the rate of stress incontinence following surgery, it is important to prepare Fistula patients for the possibility of incomplete cure and help them develop appropriate coping strategies.
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development of an intervention to improve mental health for Obstetric Fistula patients in tanzania
Evaluation and Program Planning, 2015Co-Authors: Melissa H Watt, Sarah M Wilson, Kathleen J Sikkema, Gileard Masenga, Mary V Mosha, Jennifer Velloza, Margaret Bangser, Andrew BrowningAbstract:Obstetric Fistula is a debilitating childbirth injury that has been associated with high rates of psychological distress. Global efforts have helped to link women to surgical repair, but thus far no evidence-based interventions exist to address the psychological needs of these women during the hospital stay. In this paper, we describe the development of a psychological intervention for women in Tanzania who are receiving surgical care for an Obstetric Fistula. The intervention was developed based on theories of cognitive behavioral therapy and coping models. Content and delivery were informed by qualitative data collection with a range of stakeholders including women with Fistula, and input from a study advisory board. The resulting intervention was six individual sessions, delivered by a trained community health nurse. The session topics were (1) recounting the Fistula story; (2) creating a new story about the Fistula; (3) loss, grief and shame; (4) specific strategies for coping; (5) social relationships; and (6) planning for the future. A trial run of the intervention revealed that the intervention could be delivered with fidelity and was acceptable to patients. A future randomized control trial will evaluate the efficacy of this intervention to address the mental health symptoms of this population.
Scovia N Mbalinda - One of the best experts on this subject based on the ideXlab platform.
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community awareness about risk factors presentation and prevention and Obstetric Fistula in nabitovu village iganga district uganda
BMC Pregnancy and Childbirth, 2013Co-Authors: Nassar Kasamba, Dan K Kaye, Scovia N MbalindaAbstract:Background Obstetric Fistula is a worldwide problem that is devastating for women in developing countries. The cardinal cause of Obstetric Fistula is prolonged obstructed labour and delay in seeking emergency Obstetric care. Awareness about Obstetric Fistula is still low in developing countries. The objective was to assess the awareness about risk factors of Obstetric Fistulae in rural communities of Nabitovu village, Iganga district, Eastern Uganda.
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community awareness about risk factors presentation and prevention and Obstetric Fistula in nabitovu village iganga district uganda
BMC Pregnancy and Childbirth, 2013Co-Authors: Nassar Kasamba, Dan K Kaye, Scovia N MbalindaAbstract:Obstetric Fistula is a worldwide problem that is devastating for women in developing countries. The cardinal cause of Obstetric Fistula is prolonged obstructed labour and delay in seeking emergency Obstetric care. Awareness about Obstetric Fistula is still low in developing countries. The objective was to assess the awareness about risk factors of Obstetric Fistulae in rural communities of Nabitovu village, Iganga district, Eastern Uganda. A qualitative study using focus group discussion for males and females aged 18-49 years, to explore and gain deeper understanding of their awareness of existence, causes, clinical presentation and preventive measures for Obstetric Fistula. Data was analyzed by thematic analysis. The majority of the women and a few men were aware about Obstetric Fistula, though many had misconceptions regarding its causes, clinical presentation and prevention. Some wrongly attributed Fistula to misuse of family planning, having sex during the menstruation period, curses by relatives, sexually transmitted infections, rape and gender-based violence. However, others attributed the Fistula to delays to access medical care, induced abortions, conception at an early age, utilization of traditional birth attendants at delivery, and some complications that could occur during surgical operations for difficult deliveries. Most of the community members interviewed were aware of the risk factors of Obstetric Fistula. Some respondents, predominantly men, had misconceptions/myths about risk factors of Obstetric Fistula as being caused by having sex during menstrual periods, poor usage of family planning, being a curse.
Kathleen J Sikkema - One of the best experts on this subject based on the ideXlab platform.
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a nurse delivered mental health intervention for Obstetric Fistula patients in tanzania results of a pilot randomized controlled trial
Pilot and Feasibility Studies, 2017Co-Authors: Melissa H Watt, Sarah M Wilson, Kathleen J Sikkema, Mary V Mosha, Alyssa Platt, Elizabeth L Turner, Gileard MasengaAbstract:Background Obstetric Fistula has severe psychological consequences, but no evidence-based interventions exist to improve mental health in this population. This pilot trial evaluated a psychological intervention for women receiving surgical care for Obstetric Fistula.
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a nurse delivered mental health intervention for Obstetric Fistula patients in tanzania results of a pilot randomized controlled trial
Pilot and Feasibility Studies, 2017Co-Authors: Melissa H Watt, Sarah M Wilson, Kathleen J Sikkema, Mary Vincent Mosha, Alyssa Platt, Elizabeth L Turner, Gileard MasengaAbstract:Obstetric Fistula has severe psychological consequences, but no evidence-based interventions exist to improve mental health in this population. This pilot trial evaluated a psychological intervention for women receiving surgical care for Obstetric Fistula. A parallel two-armed pilot RCT was conducted between 2014 and 2016. The intervention was six individual sessions, based on psychological theory and delivered by a nurse facilitator. The study was conducted at a tertiary hospital in Moshi, Tanzania. Women were eligible if they were over age 18 and admitted to the hospital for surgical repair of an Obstetric Fistula. Sixty participants were randomized to the intervention or standard of care. Surveys were completed at baseline, post-treatment (before discharge), and 3 months following discharge. Standardized scales measured depression, anxiety, traumatic stress, and self-esteem. Feasibility of an RCT was assessed by participation and retention. Feasibility and acceptability of the intervention were assessed by fidelity, attendance, and participant ratings. Potential efficacy was assessed by exploratory linear regression and clinical significance analysis. Eighty-five percent met criteria for mental health dysfunction at enrollment. All eligible patients enrolled, with retention 100% post and 73% at 3 months. Participants rated the intervention acceptable and beneficial. There were sharp and meaningful improvements in mental health outcomes over time, with no evidence of differences by condition. A nurse-delivered mental health intervention was feasible to implement as part of in-patient clinical care and regarded positively. Mental health treatment in this population is warranted given high level of distress at presentation to care. ClinicalTrials.Gov NCT01934075 .
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experiences of social support among women presenting for Obstetric Fistula repair surgery in tanzania
International Journal of Women's Health, 2016Co-Authors: Alexis C Dennis, Sarah M Wilson, Kathleen J Sikkema, Gileard Masenga, Mary Vincent Mosha, Korrine E Terroso, Melissa H WattAbstract:Objective An Obstetric Fistula is a childbirth injury resulting in uncontrollable leakage of urine and/or feces and can lead to physical and psychological challenges, including social isolation. Prior to and after Fistula repair surgery, social support can help a woman to reintegrate into her community. The aim of this study was to preliminarily examine the experiences of social support among Tanzanian women presenting with Obstetric Fistula in the periods immediately preceding Obstetric Fistula repair surgery and following reintegration. Patients and methods The study used a mixed-methods design to analyze cross-sectional surveys (n=59) and in-depth interviews (n=20). Results Women reported widely varying levels of social support from family members and partners, with half of the sample reporting overall high levels of social support. For women experiencing lower levels of support, Fistula often exacerbated existing problems in relationships, sometimes directly causing separation or divorce. Many women were assertive and resilient with regard to advocating for their Fistula care and relationship needs. Conclusion Our data suggest that while some women endure negative social experiences following an Obstetric Fistula and require additional resources and services, many women report high levels of social support from family members and partners, which may be harnessed to improve the holistic care for patients.
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Psychological Symptoms and Social Functioning Following Repair of Obstetric Fistula in a Low-Income Setting
Maternal and Child Health Journal, 2016Co-Authors: Sarah M Wilson, Kathleen J Sikkema, Melissa H Watt, Gileard G. Masenga, Mary V MoshaAbstract:Objectives Obstetric Fistula is a maternal injury that causes uncontrollable leaking of urine or stool, and most women who develop it live in poverty in low-income countries. Obstetric Fistula is associated with high rates of stigma and psychological morbidity, but there is uncertainty about the impact of surgical treatment on psychological outcomes. The objective of this exploratory study was to examine changes in psychological symptoms following surgical Fistula repair, discharge and reintegration home. Methods Women admitted for surgical repair of Obstetric Fistula were recruited from a Tanzanian hospital serving a rural catchment area. Psychological symptoms and social functioning were assessed prior to surgery. Approximately 3 months after discharge, a data collector visited the patients’ homes to repeat psychosocial measures and assess self-reported incontinence. Baseline to follow-up differences were measured with paired t tests controlling for multiple comparisons. Associations between psychological outcomes and leaking were assessed with t tests and Pearson correlations. Results Participants ( N = 28) had been living with Fistula for an average of 11 years. Baseline psychological distress was high, and decreased significantly at follow-up. Participants who self-reported continued incontinence at follow-up endorsed significantly higher PTSD and depression symptoms than those who reported being cured, and severity of leaking was associated with psychological distress. Conclusions Fistula patients experience improvements in mental health at 3 months after discharge, but these improvements are curtailed when women experience residual leaking. Given the rate of stress incontinence following surgery, it is important to prepare Fistula patients for the possibility of incomplete cure and help them develop appropriate coping strategies.
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development of an intervention to improve mental health for Obstetric Fistula patients in tanzania
Evaluation and Program Planning, 2015Co-Authors: Melissa H Watt, Sarah M Wilson, Kathleen J Sikkema, Gileard Masenga, Mary V Mosha, Jennifer Velloza, Margaret Bangser, Andrew BrowningAbstract:Obstetric Fistula is a debilitating childbirth injury that has been associated with high rates of psychological distress. Global efforts have helped to link women to surgical repair, but thus far no evidence-based interventions exist to address the psychological needs of these women during the hospital stay. In this paper, we describe the development of a psychological intervention for women in Tanzania who are receiving surgical care for an Obstetric Fistula. The intervention was developed based on theories of cognitive behavioral therapy and coping models. Content and delivery were informed by qualitative data collection with a range of stakeholders including women with Fistula, and input from a study advisory board. The resulting intervention was six individual sessions, delivered by a trained community health nurse. The session topics were (1) recounting the Fistula story; (2) creating a new story about the Fistula; (3) loss, grief and shame; (4) specific strategies for coping; (5) social relationships; and (6) planning for the future. A trial run of the intervention revealed that the intervention could be delivered with fidelity and was acceptable to patients. A future randomized control trial will evaluate the efficacy of this intervention to address the mental health symptoms of this population.
