A major study led by BHP founder-member the University of Birmingham will help reduce unnecessary deaths in developing countries from injuries caused by accidents or violence.

Every year five million people die due to injuries like road traffic accidents, burns, falls, or violence – with 90% of these deaths in Low- or Middle-income Countries (LMICs).

Backed by £2.9 million of NIHR funding, University of Birmingham (UK) and University of Stellenbosch (South Africa) researchers will build on partnerships with experts in Ghana, South Africa, Rwanda, and Pakistan to explore how to overcome barriers to accessing quality care after injury and reduce the likelihood of death or disability.

Experts will use a ‘four delays framework’, which looks at where delays occur in people seeking, reaching, receiving, and remaining in good quality care after injuries, to collect information on delays and their effects on patient outcomes. They will develop visualisations for policy makers to see where to intervene to reduce delays suffered after injury and produce maximum health benefits.

The project builds on a recent study funded by the NIHR led by University of Birmingham and experts in Rwanda which identified 121 barriers to access to quality injury care in three countries across sub-Saharan Africa: Ghana, South Africa and Rwanda.

Researchers discovered that whilst there were a large number of barriers in total, only 31 (25.6%) of these were shared across all three countries, suggesting that solutions to improve access to quality care after injuries may be highly contextually dependent.

Also, only just over half of these common factors (18/31, 58%) were related to delays in receiving quality care at the healthcare facility, suggesting that investment needs to be made in overcoming delays in seeking or reaching care.

Justine Davies, Professor of Global Health Research at the University of Birmingham, explained: “Injuries in LMICs are common and their number is expected to increase, but death and disability after injury can be substantially reduced if people reach healthcare facilities in a timely manner. Understanding access to quality injury care is critical to improving patient outcomes. By partnering with organisations in Ghana, South Africa, Rwanda, and Pakistan, we will develop solutions for future study in these, and similar countries. Our research has already identified many barriers to quality care in Rwanda, Ghana and South Africa. However, as few of these are shared across countries, solutions to reduce the risk of post-injury death and disability will need to reflect circumstances in each country.”

The diversity of cultures, economies, and injuries in partner countries will allow researchers to identify delays and solutions that can be applied across different settings and others that are transferable outside of the four countries of this study.

Study leaders will also train four PhD students and 14 junior researchers in countries with low resources. Training will be done through the development of research hubs in partner countries – these hubs will continue and train future LMIC researchers beyond the project’s end.

Researchers will also work closely with patients, community members and leaders, healthcare providers, and policy makers to understand how to translate the findings of the study into real world solutions.

Information reported directly by patients can be invaluable for assessing the impact of disease and treatment on patients’ symptoms and quality of life -but more needs to be done to include under-served groups to avoid rising inequalities in healthcare, say experts at BHP founder-member the University of Birmingham.

The information is commonly collected in both clinical trials and clinical practice and ensures that the patient’s perspective is at the heart of decision making. As use of these data become more commonplace, however, researchers in the University’s Centre for Patient-Reported Outcomes Research are calling for more to be done to ensure such information can be provided by everybody.

In an article published 5 May 2022 in Nature Medicine, researchers in collaboration with patients, regulators and international experts identify some of the barriers to participation such as access to technology, disability, language and cultural requirements and call for these to be addressed.

Lead author, Professor Melanie Calvert, said: “When we start to embrace new approaches to healthcare, such as use of patient-reported outcomes, we need to make sure that barriers to participation are addressed at an early stage. If we don’t do this, the gaps between advantaged and disadvantaged populations will only get worse.

“Representative diversity in clinical trials is vital to ensure new medicines and technologies are applicable to the population they are intended to serve. Targeted initiatives are needed to ensure that no groups are excluded from participation in patient-reported outcome data collection, both in research settings and routine clinical care.”

Specific recommendations in the article include:

• • • Improve diversity by involving individuals who represent target populations when designing patient questionnaires.
    • Consider the type and severity of disease when seeking patient views, including cognitive or functional impairment that would limit participation.
    • Be aware of cultural needs or languages that might be a barrier, and address these sensitively and appropriately.
    • Include individuals with all levels of reading, writing and problem solving abilities by ensuring material is accessible and that assistance is available, if required.
    • Provide alternative methods of participation to promote digital inclusion
    • Where information is being used in drug development, make sure inclusivity is included early on in discussions about data collection.

Rav Verdi, a patient partner who co-authored the work, said: “As a patient and living in a cosmopolitan society it’s encouraging to see that all walks of life have been considered and a means of communication thought about to glean information from the patient and to provide information to the patient regarding their care and treatment. As worldwide issue, information could be shared with treatment centres to provide better care and understanding of different groups of the population.”

Roger Wilson, a patient partner adds: “Listening to patients reveals the range of diversity which must be understood and allowed for by careful design if a study is to offer benefits to society equitably.”

Professor Calvert adds: “Patient-reported outcome measures and data collection must be reflective of diverse and multicultural societies, to improve research and promote equitable clinical care for the benefit of all patients and the public as a whole.”

The team are supported by a number of funders including the National Institute for Health and Care Research (NIHR) Biomedical Research Centre Birmingham and Applied Research Collaboration West Midlands, Health Data Research UK and UK SPINE.

A world-leading global surgical research team led from BHP founder member the University of Birmingham has received £7 million of funding to continue its life-saving work in developing countries – finding ways of increasing surgical capacity and preventing post-operative complications.

The NIHR Global Health Research Unit on Global Surgery (NIHR GSU) will focus on training non-surgeons to perform essential hernia operations – hernias posing a major problem with five million patients awaiting surgery in sub-Saharan Africa, stopping young men from providing for their families.

The team will also continue its work in boosting post-operative recovery in Low- and Middle-income Countries (LMICs) – testing simple innovations such as the use of high-dose oxygen, mouthwashes and inhalers.

Researchers are also looking to bring innovation back into the health systems of high-income countries by piloting innovative practices in LMICs – proving their worth ahead of wider roll-out.

Established in 2017, the new NIHR funding will allow the GSU to continue its global research for at least a further five years. The Unit co-ordinates a global network of surgeons that includes over 20,000 clinicians from over 100 countries.

Based at the University of Birmingham, it is co-directed by Professor Dion Morton OBE, Barling Chair of Surgery and Professor Stephen Tabiri, Dean of the Medical School at University for Development Studies in Tamale, Ghana.

Professor Dion Morton commented: “Delivering safe and effective surgical care across the world is one of the greatest challenges facing global health today. Our work impacts the most disadvantaged and vulnerable populations of the world – we are training surgeons in these countries to continue the research drive that is helping to save lives.

“Surgical capacity is a critical issue – a matter of life and death. In many developing countries, there are simply not enough surgeons to deliver the operations that are needed – there are less than 100 general surgeons working in the Benin health service to serve a population of 12 million people.

“Equally, it’s no use performing more operations if patients are at risk of dying from post-operative complications. Simple but effective steps in reducing risks such as surgical site infection (SSI) – the most common post-surgical complication – will be vital in ensuring improved health outcomes for people living in LMICs.”

The GSU’s international cohort studies are open to all collaborators – whether medical students, clinical officers, doctors, nurses or researchers. The team works across clinical disciplines with healthcare professionals, policy makers, epidemiologists, economists, patients and community members.

The GSU provides the tools and infrastructure to help surgeons around the world to sustain the research drive that will increase surgical capacity in LMICs.

A ‘hub and spoke model’ helps the GSU co-ordinate surgical research globally in seven LMICs: India, South Africa, Rwanda, Nigeria, Benin, Ghana and Mexico. Each hub acts as an independent research centre for conducting clinical trials and cohort studies, as well as supporting local and international research training and education. The network consists of more than 100 urban and rural hospitals in these seven countries, some in the most remote parts of the world.

The GSU runs a range of cohort studies, qualitative research and clinical trials aimed at:

• • Reducing complications from surgical wound infection;
  • Improving outcomes from cancer surgery;
  • Improving perioperative care;
  • Developing the surgical workforce;
  • Providing a roadmap for resilient surgical systems during and post pandemics;
  • Evaluating access to healthcare for surgical patients; and
  • Developing surgical research relevant to rural surgery