Improving Neurosurgery Patient Outcomes in Uganda (2016-2017)


Around the world the average neurosurgeon-to-population ratio is one neurosurgeon for every 230,000 people. The United States has one neurosurgeon per 88,000 people. However, in 2007 Uganda’s ratio was one per six million, with only five neurosurgeons in the entire country. Since that time, the Duke Division of Global Neurosurgery and Neuroscience (DGNN) has created a health system improvement program with three key principles: technology, twinning and training. Through this effort we have made significant strides, particularly in building surgical capacity, complexity of cases being performed and establishing a training program in the country. However, surgical outcomes for patients in Uganda still need improvement.

Project Description

Based on the research conducted by global health master’s students as part of the DGNN, we have identified pre-/post-operative management of neurosurgical patients as a critical area in need of improvement and a major factor contributing to poor outcomes both before and after surgery. Approximately 30 percent of pre-operative patients and 30 percent of post-operative patients contract an infection. Patient infections and poor outcomes have been linked in multiple studies pointing directly at handwashing between patient encounters. Surprisingly, data on causes of death on the neurosurgery ward indicate that almost 80 percent actually succumb while awaiting their planned operation. This finding identified the need for patient family education, as patient’s families shoulder the majority of the burden in caring for their loved one throughout the entire stay at the hospital in most East African countries. They do this without adequate education on the disease process or on critical observations to report to nursing staff. An important part of care involves administration of medications, and through our multiple personal observations, we have seen that many patients are either not on the right medication, don’t have the medication or aren’t taking the proper dose.

This project addresses the research question, How can we improve the management of neurosurgical patients to improve patient outcomes? We are focusing on three foundational areas with the greatest need of improvement: 1) infection control; 2) patient family education; and 3) medication management.

Project goals are to identify gaps in our current program implementation; develop novel ideas, approaches and research to address improvement areas; and generate data for process improvement (measuring our own internal and external outcomes), and dissemination of the data to contribute to other providers in low- and middle-income countries.

In Summer 2016 each of three topic teams had two or three members who went to Uganda for a month and collected data. Those data have been analyzed, with three abstracts submitted and three posters presented at the Duke Global Health Institute Global Health Showcase. Three manuscripts are in development. Student team members are aiming to present findings at one or two conferences and have their manuscripts published before next summer.

Anticipated Outcomes

Research projects that generate important data on neurosurgical pre-/post-operative management and possible manuscripts; improvements in the program implementation from ideas presented to address areas of improvement


Summer 2016 – Spring 2017

Team Outcomes to Date

Identifying the Needs and Barriers to Patient-Family Education to Improve Neurosurgery Patient Outcomes in Mulago National Referral Hospital (MNRH), Uganda (Joao Ricardo Vissoci, Chinemerem Nwosu, Sandra Batakana, Silvia Vaca, Stephanie Lim, Linda Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Emily Smith, Anthony Fuller, Gerald Grant, Michael Haglund)

Medication Management and Adherence in Uganda (Garrett Holmes, Hyun Keun Ahn, Joan Nambuba, Charis Spears, Sarah Rapaport, Anthony Fuller, Michael Haglund)

Cultural Context and Accessibility of Sanitization Pumps Affect Hand Hygiene Practices in a Ugandan Neurosurgery Ward (Meggie Lund, Kelsey Graywill, Akash Patel, Sam Sadler)

Identifying the Needs and Barriers to Patient-Family Education to Improve Neurosurgery Patient Outcomes in Mulago National Referral Hospital, Uganda (Chinemerem Nwosu, Sandra Batakana, Joao Vissoci)

Improving Hand Hygiene Compliance in a Ugandan Neurosurgery Ward through Implementation of Hand Sanitization Interventions (Kelsey Graywill, Meggie Lund, Akash Patel and Sam Sadler)

Improving Medication Management in Uganda (Hyun Keun Ahn, Garrett Holmes, Joan Nambuba, Charis Spears, Anthony Fuller)

This Team in the News

Student Laurels and Honors for 2017

Students Present Their Research and Learn from Each Other at the Bass Connections Showcase

Student Research Shared, Awards Announced at Bass Connections Showcase

Bass Connections Poster Awards Highlight Neurosurgery and Energy Research

Two Graduate Students Honored for Excellence in Mentoring Their Bass Connections Team Members

Reflections on Mentoring from Bass Connections Graduate Students

New Projects Invigorate Bass Connections Program

Bass Connections Team Members Share Their Global Health Research and Win Awards

Medical Student Forges New Collaborations in Global Health and Neurosurgery

Faculty/Staff Team Members

Michael Haglund, School of Medicine - Neurosurgery; DGHI; DGNN*
Rae Jean Proeschold-Bell, Duke Global Health Institute*
William Reichert, Pratt School - Biomedical Engineering*
Emily Smith, School of Medicine - Division of Global Neurosurgery and Neuroscience
Joao Vissoci, School of Medicine - Department of Emergency Medicine, DGNN

Graduate Team Members

Tony Fuller, School of Medicine - MD; DGHI; DGNN*

Undergraduate Team Members

Sandra Batakana
Kelsey Graywill, Program II (BS)
Garrett Holmes, Biology (BS)
Margaret Lund, Biomedical Engineering
Chinemerem Nwosu, Biology (AB)

Community Team Members

Alex Mugalu, Mulago Hospital, Department of Neurosurgery (Uganda)
Michael Muhumuza, Mulago Hospital, Department of Neurosurgery (Uganda)
Joan Nambuba, Multicultural Resource Center
Juliet Ssekabunga, Mulago Hospital, Department of Neurosurgery (Uganda)

* denotes team leader