Evaluating Interventions Aimed at Improving Neurosurgical Patient Outcomes in Uganda (2018-2019)
Surgery was catapulted into the global health spotlight with the publication of the Lancet Commission on Global Surgery report. The report discusses the importance of projects that not only focus on provision of surgical procedures, but also the need for holistic health systems strengthening.
Since 2007, Duke Global Neurosurgery and Neuroscience (DGNN) has been utilizing this concept of health systems strengthening to improve neurosurgical care for patients throughout Uganda. DGNN’s approach consists of provision of neurosurgical services, training, 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 excellence in East Africa.
Within this larger framework, a Bass Connections project will evaluate interventions directed at impacting neurosurgical patient outcomes.
This project team will address the research question, Which interventions aimed at neurosurgical patients actually improve patient outcomes and are efficient and cost effective? The team will apply this question to three foundational areas:
- Infection control: Has the intervention reduced pre-operative/post-operative infections? What is the target level of adherence to the infection control protocol to reduce infections in the ward?
- Medication management: Has the intervention improved patients’ adherence to medication and increased medication knowledge? What is the target level of medication adherence and medication knowledge?
- Patient family education: Has the intervention reduced aspiration deaths and the incidence of bedsores? What is the target level of knowledge for patients and caretakers?
The 2016-17 team quantified some of the specifics within these topic areas, and the 2017-18 team collaborated with in-country partners to develop and test multiple interventions. Preliminary data has shown promise on which interventions were best received and the general impressions of impact from the faculty and staff at Mulago National Referral Hospital in Kampala. The 2018-19 team will build on this work by evaluating the impact on patient outcomes from the best intervention(s) in each topic area. Successful interventions would be generalizable to most low- and middle-income countries.
Students will be split into three topic teams. Each topic team will contribute to development of an intervention evaluation plan that shows intervention effectiveness and to generation of data that will be utilized for improving patient care and setting targets.
Three interventions that are effective in Mulago National Referral Hospital with targets to be used for goal setting, future work and policy discussions; process improvement recommendations for DGNN’s work; abstracts, manuscripts and backing for future grant submissions
Summer 2018 – Spring 2019
- Summer 2018: Project starts in June; project development and implementation over six weeks in Uganda
- Fall 2018: Team meetings approximately every week for 1-2 hours
- Spring 2019: Continued meetings, completion of deliverables
Team Outcomes to Date
Infection Control from an Emic Perspective: Forming and Evaluating a Local Infection Control Team in a Low-resource Neurosurgery Ward (poster by Samantha Sadler, Anthony Fuller, Michael Haglund, Melissa Watt, presented at Bass Connections Showcase, Duke University, April 17, 2019)
Evaluating a Routine Program to Improve Patient Aspiration Rates in Mulago Hospital Neurosurgical Ward, Uganda (poster by Sherry Yang, Chinemerem Nwosu, Priyanka Rao, Amina Mohamed, Michael Haglund, Anthony Fuller, presented at Bass Connections Showcase, Duke University, April 17, 2019)
This Team in the News
See related teams, Benchmarking Interventions Aimed at Improving Neurosurgical Patient Outcomes in Uganda (2019-2020) and Interventions Improving Neurosurgery Patient Outcomes in Uganda (2017-2018).
- Anthony Fuller, School of Medicine-Neurosurgery
- Michael Haglund, Duke Global Health Institute|School of Medicine-Neurosurgery
/undergraduate Team Members
Suzanna Joseph, Neuroscience (BS)
Amina Mohamed, Public Policy Studies (AB), Global Health (AB2)
Chinemerem Nwosu, Program II (AB)
Praruj Pant, Neuroscience (BS)
Priyanka Rao, Neuroscience (BS)
Samantha Sadler, Neuroscience (BS), Global Health (AB2)
Jonah Sinclair, Neuroscience (BS)
Bruno Valan, Biology (BS)
Sherry Yang, Neuroscience (BS)
/yfaculty/staff Team Members
Shem Opolot, School of Medicine-Neurosurgery
Joao Vissoci, School of Medicine-Surgery: Emergency Medicine
/zcommunity Team Members
Alex Mugalu, Department of Neurosurgery, Mulago Hospital (Uganda)
Michael Muhumuza, Department of Neurosurgery, Mulago Hospital (Uganda)
Christine Muhumuza, Department of Public Health, Makerere University (Uganda)
Juliet Ssekabunga, Department of Neurosurgery, Mulago Hospital (Uganda)