Postpartum Obstetric Fistula Repair Wait Time and Trauma-Related Mental Health Symptom Trajectories in Tanzanian Referral Hospitals: A Target-Trial Emulation of Surgical Scheduling Thresholds

Obstetric fistula repair wait times in Tanzanian referral hospitals vary widely, yet the threshold at which surgical scheduling delay becomes psychologically harmful remains unquantified. The analysis is methodological: no observational data are used or claimed. Under a declared variance structure with between-cluster standard deviation of 6.0, residual standard deviation of 4.5, and intraclass correlation of 0.64, power was estimated across 2000 replications per design cell for cluster counts of 8, 16, 24 and 32 and effect sizes of 3, 5 and 8 percentage points. The design achieves 80% power at 54 clusters for a 5-percentage-point effect. Minimum detectable effects at 80% power are reported for each cluster count, and the implications for scheduling-threshold trials in fistula care are discussed. The contribution is a design specification that links surgical scheduling policy to mental health outcomes through a formally defined estimand, with explicit boundary conditions and power requirements.