NIHR Global Health Group on Global Injury

Aim: Across three Sub-Saharan Africa (SSA) nations (Malawi, Tanzania & South Africa) we will develop musculoskeletal (MSK) injury research capacity, centres of research excellence and promote equitable partnerships to address significant gaps in current knowledge of the burden, treatment resources and outcomes of MSK injuries. Improving the care of the injured through multidisciplinary applied health research at both individual and health system levels.

Background: Injuries are the leading cause of death in people aged between 10-49-years. For every death, up to 50 people sustain temporary or permanent disabilities. MSK injuries account for the majority (78%) of these injuries, with 90% occurring in low- and middle-income countries (LMIC).

SSA has a higher incidence of MSK injuries than any other world region. Despite this, there is little research addressing this critical global problem and a lack of evidence to guide the management of MSK injuries in LMIC. Objectives & Methods: Our project has four themes:

THEME 1. CAPACITY. Evaluate the available resources for conducting clinical research & develop research capacity and leadership.

We will identify opportunities for research capacity strengthening in three SSA nations and develop solutions to address country-specific challenges, to create a sustainable research environment. We will co-develop multimodal resources including research training programmes, mentorship and PhD fellowships, to address identified gaps, nurture a clinical research infrastructure and develop a network of research accomplished centres and leaders.

THEME 2. MAP. Quantify the incidence of MSK injuries & define the healthcare resources currently available for MSK injury care.

We will create a network of collaborating hospitals and undertake a multi-centre “snap-shot” cohort study to determine the incidence of five priority MSK injuries across our partner countries. Adapting the WHO Service Availability and Readiness Assessment framework we will describe the MSK injury healthcare resources in each partner country and identify factors that help or hinder the delivery of services.

THEME 3. OUTCOMES. Assess MSK injury treatment pathways, clinical & quality of life outcomes, and economic impact.

We will record patient-reported function and quality-of-life outcomes, mortality, and resource use for patients with each of the five priority injuries in the six-months following their injury. Evaluation of health economic outcomes will demonstrate the socioeconomic impact of injuries on patients, their family and community.

THEME 4. CHANGE. Implement a multi-centre feasibility study to inform a randomised control trial (RCT).

Focusing on the development of a collaborative research network, we will undertake a multi-centre feasibility study for a future RCT across our partner countries, addressing a MSK injury healthcare priority. Timeline: Year 1 Gain approvals, recruit and train research staff Year 2 Complete Theme 2-Year 3 Complete Theme 3

Year 4 Complete Theme 1 and 4

Impact: Our research will inform changes in MSK injury healthcare, creating a sustainable legacy of research leaders and centres across SSA for future years.

Dissemination: Project partners and our established Community Engagement Group will be at the forefront of output dissemination. We will consolidate existing relationships with policy makers and develop new relationships to drive improved MSK healthcare in LMIC.