Evaluating Interventions Aimed at Improving Neurosurgical Patient Outcomes in Uganda (2018-2019)

Background

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.

Project Description

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.

Anticipated Outcomes

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

Student Opportunities

Team leaders would like to engage biomedical engineering students, global health master’s students, medical students and undergraduates with diverse educational backgrounds and perspectives. Students interested in program evaluation and program improvement, and/or with a desire to work in a low-resource setting and a passion for surgical care (does not have to be neurosurgery) are encouraged to apply.

Students will have an opportunity to work on health systems strengthening within a low-income country. Additionally, they will work within the larger research group at DGNN and gain insights and exposure from attending those meetings. Students will also get a chance to join a team that has worked well together and has been productive for the past two years, allowing them a chance to present at multiple conferences and be part of manuscript writing.

The team will ideally include 6-9 undergraduates, 3-5 master’s students, 3-4 medical students and 1-2 postdocs. Topic teams will be led by one postdoc and/or one medical student with guidance from team leaders. Area-specific team members will include 2-3 master’s and/or medical students and 2-3 undergraduates. Master’s and medical students will serve as mentors. Erin Delionbach will serve as project manager.

The team will meet nearly every week within three domains: full team, topic team and DGNN meetings. Team leaders will develop a syllabus and use it to provide students with guidance and a grade for their independent study courses.

Timing

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

Crediting

Independent study credit available for fall and spring semesters; summer funding

See earlier related team, Interventions Improving Neurosurgery Patient Outcomes in Uganda (2017-2018).

Faculty/Staff Team Members

Anthony Fuller, School of Medicine-Surgery: Neurosurgery*
Michael Haglund, School of Medicine-Surgery: Neurosurgery|Duke Global Health Institute*
Shem Opolot, School of Medicine-Surgery: Neurosurgery
Joao Vissoci, School of Medicine-Surgery: Emergency Medicine

Undergraduate Team Members

Kelsey Graywill, Program II (BS)
Raahina Malik, Neuroscience (AB)
Jonah Sinclair, Neuroscience (BS)
Sherry Yang, Neuroscience (BS)

Community Team Members

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

* denotes team leader

Status

Active, New