Research collaboration envisages major gains in health care

Surgical research to support the work done by hospitals, mainly in rural and remote locations, is benefitting from seven research hubs in Africa, Mexico and India that were established during COVID to reduce the risk of infection during operations.

The universities of Birmingham and Edinburgh, in collaboration with the National Institute for Health and Care Research (NIHR) Global Health Research Unit on Global Surgery, were involved in the establishment of the five hubs in Africa, and one each in Mexico and India.

This is according to Stephen Tabiri, dean of the University for Development Studies’ school of medicine and health sciences in Tamale, Ghana, who told University World News in an interview about his involvement in ongoing research conducted as part of the project. He said there are African hubs in Benin, Ghana, Nigeria, Rwanda and South Africa.

They are currently engaged in a research trial to reduce wound infection after abdominal surgery, involving 6,000 patients across seven countries, and this has proved that some less expensive interventions are just as effective as more costly ones.

Tabiri said that, during the study, researchers found that, each year, 4.2 million people around the world die within 30 days of an operation, and half of these deaths occur in low- and middle-income countries, adding that, “if surgery could be made safe and affordable, 28% of the disease burden in low- and mid-income countries may be cured, treated, or palliated by safer and accessible surgery”.

He said the collaboration has brought together about 20,000 surgeons in more than 100 countries and they have had their initial work published in the May 2022 issue of The Lancet.

They indicated that patients in low- and middle-income countries will have access to cheaper and more deliverable surgery. It has also trained more than 500 surgeons, anaesthetists, nurses and other healthcare professionals in high-quality research methodology, both face-to-face and online.

Finding context-specific solutions

During the pandemic, the NIHR Global Health Research Unit on Global Surgery based in Birmingham created new guidelines for controlling COVID-19 infection, which avoided operations having to be put on hold altogether. The team is continuing work to reduce infection after surgery from all diseases, not just COVID-19, and to improve access to routine surgery, especially in rural areas.

Dion Morton, one of the co-directors of the unit, said: “Each country, even each area in a country, has its own unique circumstances, different resources, training systems, disease vulnerabilities, funding, cultures and so forth.

“Creating surgical guidelines based on one country and importing them into another country just does not work,” he said, adding that, “If we are to make surgery safer and more affordable for millions of people, the solutions need to be context-specific.

“That is why we are working with local surgeons and hospitals around the world, empowering them to research what really works for them.”

Tabiri said several research projects are under way to test methods for improving outcomes from surgery, including implementing telephone follow-ups, so that patients are not put out by difficulties and the costs of travelling to hospitals for post-surgery check-ups.

He said early findings indicate that there is greater uptake and engagement, resulting in better outcomes for patients.

Tabiri said that, where he works in Ghana, the research outcomes could make a huge difference, stating that, “three-quarters of people in the northern regions of Ghana are in scattered rural communities, with poor health infrastructure and not enough health professionals”.

“The unit’s next set of research trials is investigating how to reduce complications from wound infection, improve the outcomes from cancer surgery and to evaluate access to healthcare for patients requiring surgery,” he added.