Improving Neurosurgery Patient Outcomes in Uganda (2016-2017)

The United States has one neurosurgeon per 88,000 people. Around the world the average neurosurgeon-to-population ratio is one per 230,000. However, in 2007 Uganda’s ratio was one per six million, with only five neurosurgeons in the entire country. Since that time, Duke Global Neurosurgery and Neuroscience (DGNN) has created a health system improvement program with three key principles: technology, twinning and training. Through this effort Uganda has 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 still need improvement.

DGNN identified pre- and 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; observations have shown that many patients are either not on the right medication, don’t have the medication or aren’t taking the proper dose.

This Bass Connections project focused on infection control, patient family education and medication management. In Summer 2016 members of each of these three topic teams spent a month in Uganda to collect data at Mulago National Referral Hospital in Kampala.

One study evaluated the needs and barriers to patient-family education in a Ugandan tertiary hospital neurosurgical ward. Following surveys and interviews with hospital staff and family members, the team developed a framework for an intervention addressing key barriers of ward overcrowding and multiple caregivers. Educational content will focus on caregiver responsibilities, medication management, symptoms and report to hospital staff.

Another study analyzed factors that affect the medication management of neurosurgery inpatients in order to provide suggestions for gap improvement, and attempt to quantify the issues at hand. Findings suggest the presence of a number of determinants that impact self-reported confidence levels. Moreover, inability to pay for prescribed medications was identified as the primary barrier to medication acquisition.

A third study addressed hand sanitation for infection control. The hospital’s neurosurgery ward has only one sink in the nurses’ station for about 30 patient beds, hindering the feasibility of sanitizing between every patient. Hand sanitization gel provides a transportable, low-cost solution to this problem and is equally effective as hand washing at killing disease-spreading bacteria. The team aimed to facilitate proper hand hygiene through the installation of hand sanitization gel pumps by implementing two intervention types. Team members analyzed the relationship between pump location and usage, as well as changes in mass usage with each intervention type to evaluate the most effective methods for improving hand hygiene compliance.

Timing

Summer 2016 – Spring 2017

Team Outcomes

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) (judges’ selection for best Bass Connections poster)

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) (audience choice for best Bass Connections poster)

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)

Improving Hand Hygiene Compliance in a Ugandan Neurosurgery Ward through Implementation of Hand Sanitization Interventions (K. Graywill, M. Lund, A. D. Patel, S. Sadler, E. Smith, A. Fuller, J. Vissoci, M. Haglund) (abstract submitted to 2017 CUGH conference)

Medication Management of Neurosurgery Patients at Mulago National Referral Hospital in Kampala, Uganda (Joan Nambuba, Garrett Holmes, Hyun Keun Ahn, Charis Spears, Emily Smith, Joao Ricardo Nickenig Vissoci, Anthony Fuller, Michael Haglund) (abstract submitted to 2017 CUGH conference)

Identifying the Needs and Barriers to Patient-Family Education to Design Educational Interventions That Will Improve Neurosurgery Patient Outcomes in Mulago Hospital, Uganda (Chinemerem Nwosu, Sandra Batakana, Joao Ricardo Nickenig Vissoci, Silvia Vaca, Stephanie Lim, Emily Smith, Anthony Fuller, Michael Haglund) (abstract submitted to 2017 CUGH conference)

Cultural Context and Accessibility of Sanitization Pumps Affect Hand Hygiene Practices in a Ugandan Neurosurgery Ward (Emily Smith, Margaret Lund, Kelsey Graywill, Akash D. Patel, Samantha Sadler, Anthony Fuller, Joao Ricardo Nickenig Vissoci, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Michael M. Haglund) (manuscript submitted for publication)

Analysis of Factors Affecting Medication Management and Patient and Caregiver Confidence in Treatment Plan for Neurosurgical Inpatients at Mulago National Referral Hospital in Kampala, Uganda (Anthony Fuller, Garrett Holmes, Hyun Keun Ahn, Joan Nambuba, Charis Spears, Sarah Rapaport, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Joao Ricardo Nickenig Vissoci, Emily Smith, Michael Haglund) (manuscript submitted for publication)

Identifying the Needs and Barriers to Patient-family Education to Design Educational Interventions That Will Improve Neurosurgery Patient Outcomes in Mulago Hospital, Uganda (Chinemerem Nwosu, Sandra Martha Batakana, Silvia Vaca, Joao Ricardo Nickenig Vissoci, Stephanie Lim, Linda Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Emily Smith, Anthony Fuller, Gerald Grant, Michael Haglund) (manuscript submitted for publication)

Bass Connections Award for Outstanding Mentorship (Tony Fuller)

Strategies to Strengthen Health Systems Globally: A Duke Showcase (event at Duke on April 4, 2017, featuring presentations by Tony Fuller, Meggie Lund, Garrett Holmes, Sherry Yang, Michael Haglund)

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

You walk into Bass Connections and walk out a different person. In terms of research, you’re doing what you love, you’re doing it with people that you love, you’re doing it where you want to do it…Bass puts all of that in one experience. —Chinemerem Nwosu

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

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 Martha 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

Status

Completed, Archived