Global Surgery

Cameroon | Uganda | Armenia | Mozambique

Global Surgery doctors in a meeting

Cameroon

Building an Injury Surveillance System: Cameroon National Trauma Registry

A collaboration with the Ministry of Public Health in Cameroon to develop and expand a National Trauma Registry (NTR) with the aim of providing ongoing injury surveillance and to demonstrate the burden of trauma on the health system in Cameroon. Findings from this prospective, observational trauma registry will inform national injury prevention policy and will set the foundation for establishing hospital-based trauma care quality improvement programs. Currently, the NTR has launched in four hospital sites (Hopital Laquintinie de Douala, Hopital Regionale de Limbe, L'Hopital Catholique de Pouma and Hopital Regional d'Edea) where data are collected on admitted trauma patients.

Injury Control in Cameroon chart

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A Mobile Phone-based Triage Tool to Identify Discharged Trauma Patients in Need of Further Care in Cameroon

An NIH funded R21 project nested in the Cameroon National Trauma Registry. The overall objective of the project is to improve timely medical follow-up for injured patients in Cameroon to reduce the impact of injury. As injuries become an increasingly important public health priority in low- and middle-income settings, including sub-Saharan Africa (SSA), context-appropriate methods for improving trauma care are lacking. While over 60% of injured patients in Cameroon seek formal care, there is no mechanism to follow these patients for further care after they are discharged from the hospital. The growing network of mobile phones in Cameroon presents a novel opportunity to reach populations that have been previously lost to follow up. The study seeks to 1) establish the feasibility of mobile phones as a follow-up tool for hospitalized trauma patients after discharge in Cameroon; 2) cross-validate a mobile phone-based assessment tool to identify trauma patients who would benefit from further medical care; and 3) characterize the impact of timely follow-up on long-term disability and socioeconomic consequences associated with trauma in Cameroon.

Building Capacity for Trauma Quality Improvement: An Innovative Pilot Program in Cameroon to Address the Burden of Injury

An NIH funded R21 project utilizing data from the Cameroon National Trauma Registry. The overall objective of the project is to build on an existing centralized trauma registry by developing culturally relevant, peer-driven comprehensive trauma QI process appropriate for the Cameroonian context and generalizable to other similar SSA settings. The study will 1) establish and train a peer-driven trauma care QI committee in Cameroon that can perform comprehensive case review and root cause analysis to identify specific correctable deficiencies; 2) Train research personnel to develop research and analytic skills in QI methodology, monitoring, and evaluation; 3) Apply the QI process to refine the existing trauma registry data collection tool, enhancing its capacity to capture changes in the quality of clinical care delivery; and 4) Implement QI committee meetings to propose context-appropriate trauma QI interventions for future implementation in Cameroon and similar settings.

The Sustainable Trauma Research, Education, and Mentorship Program (STREaM)

The Sustainable Trauma Research, Education, and Mentorship Program (STREaM) Cameroon is an NIH/FIC funded D43 training program that will establish a cadre of graduate trainees with multidisciplinary expertise in Injury prevention and control, quality improvement, and quantitative methods that can address limitations posed by the time-dependent, dynamic, and incomplete nature of trauma-related data. The STREaM Training Program is a consortium among Cameroonian and US institutions including the University of Buea, UCLA, UC Berkeley and the African Institute of Mathematical Sciences (AIMS) Cameroon campus. The aims of STREaM Cameroon is 1)·Train a critical mass of multidisciplinary scientists in trauma research through MPH, PhD, and post-doctoral pathways who will form the foundation for an Injury Center at the Buea; 2) Develop and implement a combination of short, medium, and long-term quantitative and trauma research curricula co-taught by U.S. and Cameroonian faculty to sustainably strengthen existing offerings at the Buea; 3)  Provide mentored research opportunities for trainees to apply quantitative skills to trauma QI projects utilizing the partnership’s existing research and data collection infrastructure in Cameroon; and 4)  Integrate trainee scholars into a robust scientific network through existing international organizations and the creation of a Cameroonian Trauma Network to serve as an ongoing community of practice.

Harnessing Data Science to Promote Equity in Injury and Surgery for Africa

This is an NIH funded U54 grant, one of seven research hubs awarded under the DSI Africa Initiative.  This award supports the Data Science Center for the Study of Surgery, Injury, and Equity in Africa (D-SINE Africa), a strategic partnership between the University of Buea (Buea), the University of California (Los Angeles (UCLA) and Berkeley), the Cameroonian Ministry of Public Health, the African Institute for Mathematical Sciences in Cameroon, and the University of Cape Town in South Africa. D-SINE Africa Hub will focus on the intersection between injury and equity, leveraging data science to decrease the impact of trauma, surgical disease, and disparities on the population of Cameroon and SSA by promoting collaborative research, networking, and capacity building with an emphasis on equity. D-SINE Africa’s two main goals are;1) to decrease the burden of injuries and surgical diseases through improved surveillance, prevention, and treatment; and 2) to improve access to quality surgical care in Cameroon and other SSA countries. D-SINE Africa has three cores (Administrative, Data Management and Analysis, and Capacity Building Cores) and two Research Projects that will be conducted in Cameroon, South Africa, and Uganda. Research Project 1 - Health Equity Surveillance addresses the urgent gap in rapid socioeconomic (SES) estimation necessary to track health equity in acute care settings by applying a clustering algorithm to existing publicly available Demographic and Health Surveys data sets for SSA. Research Project 2 – Trauma Follow Up Prediction aims to improve trauma outcomes by using machine learning to optimize a mobile phone-based screening survey that will identify which trauma patients would benefit from further care after they are discharged from the hospital.

D-SINE Africa Research Project 1 - A novel cluster-based algorithm to estimate socioeconomic status for health equity surveillance in sub-Saharan Africa. (Health Equity Surveillance)

Measuring SES is a fundamental, but complex, aspect of monitoring equity that is especially challenging in low- and middle-income countries settings. The lack of rapid, easily implemented tools to accurately measure SES in acute care settings is a significant barrier to progress in monitoring and ultimately mitigating health disparities in trauma and other time-sensitive conditions. We developed a data-adaptive k-medoids clustering-based algorithm using Demographic Health Survey (DHS) asset variables that generates a model that can estimate SES with reduced variable inputs (EconomicClusters). The overall objective of this study is to facilitate broad SES surveillance by applying the EconomicClusters algorithm to all 37 countries in SSA that have DHS data available from 2010 or later; and to make the resulting methodology freely available. To accomplish this objective, we will pursue three specific aims: 1) Develop EconomicClusters models for the 37 sub-Saharan African countries that have available DHS data; 2) Validate the EconomicClusters models for each country using established DHS metrics known to be consistently correlated with SES; 3) Characterize inequity in trauma care access and outcomes in Cameroon, South Africa, and Uganda by implementing the EconomicClusters strategy in trauma registry data collection; 4) Develop a free, publicly available toolkit to support researchers to use EconomicClusters models strategy in their own research.

D-SINE Africa Research Project 2 - Using data-adaptive methods to optimize follow up of injured patients after hospital discharge in Cameroon. (Trauma Follow-Up Prediction project)

In SSA countries like Cameroon, injured people face multiple obstacles to trauma care, including potentially lifesaving follow-up care after hospital discharge. To significantly improve health in the SSA, there is an urgent need for effective, innovative, and scalable approaches to reduce morbidity and mortality from injury. Follow-up care of trauma patients is a neglected, but high-yield opportunity to improve injury outcomes, especially when coupled with mobile health technologies (mHealth) to better predict and implement post-discharge care. The long-term goal of this project is to improve trauma outcomes and reduce the burden associated with injury in Cameroon, with the overall objective of preventing disability and death. To accomplish our proposed objective, we will pursue three specific aims: 1) Scale-up an mHealth, phone-based screening tool to identify trauma patients in Cameroon who would benefit from further formal medical care; 2) Evaluate a machine learning-optimized, phone-based screening tool that predicts which trauma patients are most likely to benefit from follow-up care; and 3) Determine factors associated with compliance with recommendations for post-discharge follow-up care after injury. This novel approach to adaptive, integrative optimization of an intervention using machine learning has great potential to reliably identify individuals who would benefit from further care, therefore optimizing the use of scarce resources and time, and ensuring that patients are not asked to expend precious resources on care unless it is needed. The methodology developed in the proposed study holds significant promise for improving trauma outcomes and could be similarly applied across health settings and conditions to accelerate the development of targeted interventions.

Injury and Care-Seeking Behavior in Southwest Cameroon: A Community-Based Survey

This community-based study was carried out to estimate the yearly incidence of injury in the Southwest region of Cameroon, with an emphasis on understanding patterns of injury and care-seeking behavior among households with injured persons who do not present to formal care. The study explored the determinants of therapeutic itinerary including barriers and facilitators of care. Furthermore, the study also carried out economic analyses to estimate household loss due to long-term disability. Data collection has been completed and dissemination of findings is ongoing through publication in peer reviewed journals.

National Surgical Plans

Initiative to develop country-specific surgical plans in partnership with national authorities, NGOs, and major donors with the aims of: gathering data on current surgical capacity; increasing resources for surgical services; providing sustainable models that can help guide policy makers in developing countries; and, ultimately elevating the status of surgery on the global public health agenda.


Uganda

Doctors in Uganda in an operating room

Trauma Surveillance at Soroti Regional Referral Hospital, (SRRH)

A prospective trauma registry collecting information on patients presenting with traumatic injury at SRRH. The registry is designed to serve as a trauma surveillance database to aid evaluation of trauma care at SRRH. The trauma registry is a prospective, observational study using hospital-based data sources. The study aims to improve the quality of essential and emergency surgical care at Soroti Regional Referral Hospital in Uganda.

Non-Trauma Surveillance at Soroti Regional Referral Hospital, (SRRH)

A prospective registry collecting information on obstetrics and gynecology patients and patients presenting for general surgical care at SRRH. The study aims to inform surgical care treatment priorities in SRRH for potential intervention. The non-trauma registry is designed to serve as a surgical surveillance database to aid evaluation of general surgical and obstetric/gynecologic care at SRRH.

Doctors in Uganda operating

In-hospital length of stay and the economic impact associated with surgical conditions at SRRH

This study is aimed at prospectively gathering baseline data and identifying the factors that affect the in-hospital Length of Stay (LoS), resource utilization, and costs associated with surgical conditions encountered at Soroti Regional Hospital. Follow-up of patients is also conducted by phone at 3 weeks, 3 months and 6 months to gather data on patient reported outcomes. There is an opportunity cost associated with excess LoS. In addition to identifying high-impact interventions that will optimize patient flow, LoS, and the quality of care at SRRH, this study seeks to generate evidence required to make a case for investing in the provision of specific surgical procedures.

Cost-Effectiveness of Exploratory Laparotomy in SRRH, Uganda

Globally, cost-effectiveness data are lacking for a wide range of essential surgical procedures. This study addresses this gap by defining the cost-effectiveness of exploratory laparotomies in a regional referral hospital in Uganda. A prospective observational economic analysis study was designed to determine the cost-effectiveness of exploratory laparotomies conducted at SRRH. The study determined the incremental cost-effectiveness ratio of exploratory laparotomies compared with the status quo in the Soroti region, which is alternative medical management with likely poor and probably fatal outcomes.


Armenia

Doctors in Armenia smiling

Establishing National Cancer Screening Programs in Armenia

Despite significantly high rates of lung, colon, breast, head and neck, and cervical cancers, no organized screening programs currently exist in the Southern Caucasus nation of Armenia.This project aims to study the feasibility of implementing organized national cancer screening programs int eh country. Active areas of research include: 1) the assessment of capacity and quality of such such services in both urban and rural areas of the country; 2) the assessment of knowledge, attitude, perceptions and barriers to adherence of screening modalities; 3) the development of contextually appropriate screening guidelines. 

Developing a Fetal Care Program in Armenia

The state of fetal care in Armenia is fragmented and in its infancy. Under the auspices of the Ministry of Health, a task force has been developed to coordinate and improve fetal care. As no data on practices, outcomes and attitudes towards fetal care exist, this project seeks to conduct further research to analyze the current situation and advise on necessary next steps. 


Mozambique

UCLA-Mozambique surgical partnership

The UCLA-Mozambique surgical partnership founded in 2010 and led by Dr. Daniel DeUgarte aims to facilitate training of Mozambican pediatric surgeons and anesthesiologists and to promote local research and quality improvement projects.  The partnership supports these aims by disseminating educational materials, proctoring surgeons, sponsoring courses, coordinating bilateral exchanges, promoting regional board certification, and providing opportunities to establish dedicated pediatric operating room facilities to support training.