Benchmarking Interventions Aimed at Improving Neurosurgical Patient Outcomes in Uganda (2019-2020)


Since 2007, Duke’s Division of Global Neurosurgery and Neurology (DGNN) has been utilizing a health systems strengthening approach to improve neurological and neurosurgical care for patients throughout Uganda. This approach consists of provision of neurosurgical services, training of medical staff, research, twinning and advocacy. The long-term vision includes having 20 Uganda-trained neurosurgeons equitably spread across the country, increasing the number of facilities capable of providing neurosurgical operations, improving the infrastructure for neurosurgical care delivery and developing a Uganda Neuroscience Institute to serve as a center of neurosurgical and neurological excellence in East Africa.

Since 2016-2017, a Bass Connections project team has been working within DGNN’s framework to analyze challenges in neurosurgical care. In collaboration with partners in Uganda, the team has developed, tested and adapted multiple interventions to improve patient outcomes in the neurosurgery ward at Mulago National Referral Hospital in Kampala. Now, the team needs to set benchmarks to assess the performance of its interventions.

Project Description

In 2019-2020, this Bass Connections project team will begin benchmarking, a process through which internal controls are developed to evaluate whether an intervention is truly working. Once benchmarks are set, team members will conduct a study to test whether the use of benchmarking will increase the impact of interventions aimed at improving neurosurgical patient outcomes.

Team members will be divided into three subgroups and apply this research question to one of three strategic areas:

  • Infection Control: How far are we from reaching our benchmark of 85% staff hand sanitization compliance? What can we do to improve the impact of our intervention to reach this benchmark?
  • Medication Management: How far are we from reaching our benchmark of >90% correct medication prescription and >80% patient medication compliance? What can we do to improve the impact of our intervention to reach this benchmark?
  • Patient Family Education: How far are we from reaching our benchmark of >90% correct feeding technique (normal feeding, nasogastric tube feeding, gastrostomy tube feeding) on the ward? What can we do to improve the impact of our intervention to reach this benchmark?

Anticipated Outputs

Benchmarking processes for patient outcome interventions; shareable data that will offer insight into improving interventions; abstract for submission to Duke-specific and external conferences; manuscript for publication; grant development


Summer 2019 – Spring 2020

  • Summer 2019: Begin weekly project team meetings; attend topic team meetings and DGNN meetings as scheduled; review previous team’s work and develop benchmarks for each intervention; participate in lecture series; engage in project implementation in Kampala, Uganda, from mid-July to mid-August
  • Fall 2019: Begin evaluation of project and research data
  • Spring 2020: Continue meetings; prepare and submit research abstracts, posters and manuscripts

Team Outputs to Date

Evaluating a Routine Education Program to Improve Patient Aspiration Rates in Mulago Hospital Neurosurgical Ward, Uganda (poster by Sherry Yang, Chinemerem Nwosu, Priyanka Roa, Amina Mohamed, Michael Haglund, Anthony Fuller)

Improving Hand Hygiene through Accessibility in an LMIC Neurosurgical Ward (poster by Samantha Sadler, Bruno Valan, Praruj Pant, Akash D. Patel, Kelsey Graywill, Margaret Lund, Joao Ricardo Nickenig Vissoci, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Michael Haglund, Anthony Fuller)

Interventions to Improve Medication Adherence Among Neurosurgical Patients at Mulago National Referral Hospital (poster by Suzanna Joseph, Jonah Sinclair, Sarah Rapaport, Garrett Holmes, Hyun Keun Ahn, Raahina Malik, Winnie Nambatya, M. Pharm, Michael Muhumuza, Michael Haglund, Anthony Fuller)

This Team in the News

Patient-Caretaker Education Improves Neurosurgical Outcomes in Uganda

Neurosurgical Care in Uganda (Fortin Foundation Bass Connections Virtual Showcase 2020)

Distancing Lessons from Faculty Who Travel to Remote Places

Bass Connections Teams Share Research Highlights in a Virtual Showcase

Our Favorite Global Health Stories from 2019

See related teams, Sustainably Improving Neurosurgical Patient Outcomes in Uganda (2020-2021) and Evaluating Interventions Aimed at Improving Neurosurgical Patient Outcomes in Uganda (2018-2019).


Image: Mulago National Referral Hospital, courtesy of Chinemerem Nwosu

Mulago National Referral Hospital.

Team Leaders

  • Anthony Fuller, School of Medicine-Neurosurgery
  • Michael Haglund, Duke Global Health Institute|School of Medicine-Neurosurgery

/undergraduate Team Members

  • Stephan Beauge, Biology (BS)
  • Veronica Brtek, Biomedical Engineering (BSE), Neuroscience (BS2)
  • Taylor Horowitz
  • Suzanna Joseph, Neuroscience (BS)
  • Amina Mohamed, Public Policy Studies (AB), Global Health (AB2)
  • Rifah Nanjiba
  • Oluwaseun Oguntunmibi
  • Sarah Perez, Neuroscience (AB)
  • Priyanka Rao, Neuroscience (BS)
  • Jein Seo
  • Annika Sharma, Neuroscience (BS), Evolutionary Anthropology(AB2)
  • Jonah Sinclair, Neuroscience (BS)
  • Bruno Valan, Biology (BS)

/yfaculty/staff Team Members

  • Shem Opolot, School of Medicine-Neurosurgery

/zcommunity Team Members

  • Makerere University
  • Alex Mugalu, Department of Neurosurgery, Mulago Hospital (Uganda)
  • Christine Muhumuza, Department of Public Health, Makerere University (Uganda)
  • Michael Muhumuza, Department of Neurosurgery, Mulago Hospital (Uganda)
  • Juliet Ssekabunga, Department of Neurosurgery, Mulago Hospital (Uganda)