Published: 25 April 2023
The NIHR has funded five new research projects to help tackle the global burden of unintentional injuries, urgent and emergency care.
Worldwide, more than 5 million people die every year as a result of road traffic accidents, falls, burns, drowning, snakebite and other unintentional injuries. Tens of millions more suffer harm from these injuries, often resulting in life-long disabilities.
Injuries and accidents account for nearly 10% of the global burden of disease, and around 90% of injury-related deaths and disability occur in low and middle income countries (LMICs). However, this area has long been under-researched and under-funded.
The new awards, each of between £1 million and £5 million over four years, are made through the NIHR's Research and Innovation for Global Health Transformation (RIGHT) programme. RIGHT Call 4 was developed by NIHR working with the World Health Organisation (WHO) to fund projects aimed at preventing injury and improving emergency care in LMICs eligible for Official Development Assistance.
The five projects focus on diverse challenges across eight countries:
- preventing poisoning in India, Bangladesh and Sri Lanka
- preventing drowning in children aged 1-2 in Bangladesh
- improving transport to hospital for injured people in Rwanda
- research to improve treatment and prevention for burns in Pakistan
- helping boost quality of life and reducing healthcare costs for people who have broken their hips in India, the Philippines, Sri Lanka, Thailand and Vietnam
The projects are all co-led by researchers based in LMICs, highlighting NIHR’s commitment to equitable partnerships between LMIC and UK researchers.
For the first time, one of the RIGHT projects is directly contracted with an LMIC organisation. Professor Nasim Chaudhry, of Pakistan Institute of Living and Learning, is leading the Burns Rehabilitation: A multidisciplinary program for burns management, treatment and prevention in low income countries project in Pakistan, with Dr Maria Panagioti of the University of Manchester.
Professor Chaudhry said: “Globally, burns are responsible for around 11 million injuries and 180,000 deaths yearly. 1 in 3 people admitted to hospitals with burn injuries die within 3 weeks and survivors face serious lifelong physical, emotional and social problems. We are working with burn survivors, family members and health professionals in hospitals and communities to develop prevention, care and rehabilitation that will be effective, culturally acceptable and affordable in Pakistan and we hope elsewhere in LMICs.”
Building greater capacity for research into injuries and accidents is a key part of all of the funded projects. The aim is to boost research in these areas beyond the lifetime of these individual studies.
The new RIGHT 4 awards complement projects already active in the NIHR Global Health Research portfolio. These include the NIHR Global Health Research Groups on Physical Trauma from Injury and Post-conflict, on Equitable Access to Quality Health Care for Injury, and Preventing injury and improving trauma care in Nepal.
Prof. Nhan Tran, Head of Safety and Mobility at the World Health Organisation (WHO), who chaired the RIGHT 4 funding committee, said: "Injuries and accidents cause over 5 million deaths every year globally, 90% of these in LMICs. These exciting new projects were selected from a very wide field, and we hope they will help health services and policy makers by providing the evidence needed to save lives and improve outcomes for people affected by accidents and injuries across the globe."
RIGHT 4 funded projects
Preventing Deaths from Acute Poisoning in Low- and Middle-Income Countries
Professor Michael Eddleston, University of Edinburgh, and Professor Indika Gawarammana, University of Peradeniya, Sri Lanka
Poisoning is a neglected problem that kills more than 300,000 people each year, many of them in LMICs. Prof Eddleston and Prof Gawarammana’s research will focus on two major problems: methanol and occupational pesticide poisoning. They will be studying new tests for methanol poisoning in major hospitals in India and Bangladesh. They will also investigate whether treatment for pesticide poisoning can be made directly available in Sri Lankan villages, before patients are transferred to hospital. Other parts of the work will focus on developing international guidelines with the WHO, and on developing increased capacity for poisoning research and Poison Information Centres worldwide. This work will be a collaboration witH partnering institutions in Bangladesh, Sri Lanka, India, Iran, South Africa, China, Australia, Denmark, Norway and the UK over the course of 5 years.
Drowning Prevention for newly mobile infants under 2 years in Bangladesh
Professor Edwin van Teijlingen, Bournemouth University, and Dr Aminur Rahman, Centre for Injury Prevention and Research Bangladesh (CIPRB)
Reducing the risk of drowning in young children in the north and south of Bangladesh is the aim of this project. It is a collaboration between Bournemouth University, the Royal National Lifeboat Institute (RNLI), the University of the West of England, the University of Southampton (all in the UK), and the Center for Injury Prevention & Research Bangladesh (CIPRB).
Globally, drowning is a major cause of injury and death and Bangladesh has one of the highest rates of drowning in the world, especially among children. CIPRB has developed a successful community daycare model that reduces drowning rates in preschool aged children.Hhowever, Prof van Teijlingen and Dr Rahman have found that families are reluctant to allow children under 2 years old (the highest risk group) to attend daycare. The research team will be working closely with communities in the north and south of Bangladesh to find out how to roll out successful interventions that are acceptable to those communities. The findings will feed into a national drowning and prevention programme, and will also be relevant to other South-East Asian countries, where over 30% of global drowning deaths occur.
Rwanda912: Use of an innovative electronic communications platform to improve pre-hospital transport of injured people in Rwanda.
Professor Justine Davies, University of Birmingham, and Dr Jean Claude Byiringiro, University of Rwanda
This 5 year project aims to improve communication between ambulance systems, patients and hospitals in Rwanda to ensure injured patients are transported to hospital as quickly as possible. In Rwanda, injury causes 9% of deaths; 47% of these deaths happen before the patient has reached the hospital. Similar to many LMICs, Rwanda experiences long delays in getting patients to a hospital which is suitable to treat their injuries, with all communication between patients, ambulances, and hospitals done using multiple phone calls.
This project will develop and test Rwanda912, a novel electronic communication tool for use in ambulances in low resource settings. Rwanda912 uses an ambulance Destination Decision Support Algorithm (DDSA) which matches injured patients with the nearest hospital based on information about availability of staff and equipment, and from the ambulance crew on patient status. This study will test whether Rwanda912 reduces delays in getting injured patients to hospital and improves outcomes, for example reducing the risk of death, time spent in hospital and need for specialist care. The study will test the tool in one urban and one rural setting. Although the study focuses on injured patients, if successful, the findings will apply to other emergency conditions requiring ambulance transport.
HIPCARE: a cluster randomised controlled trial with embedded process evaluation
Professor Matt Costa, University of Oxford, and Professor Sarath Lekamwasam, University of Ruhuna, Sri Lanka
The focus of this partnership is to improve the quality of life for hip fracture patients and to reduce healthcare costs in India, Philippines, Sri Lanka, Thailand and Vietnam. Older patients are particularly likely to break a bone (fracture) because of a fall from a standing height, as their bones are weakened by osteoporosis. In the UK, 25% of hip fracture patients die within a year and survivors see their quality of life reduced in a similar way to having a stroke. Outcomes may be even worse in LMICs without the same quality of healthcare. Asia is particularly affected by a rapidly ageing population, so improving care for patients with hip fracture is a priority in this region.
Hospitals will receive a training package called HIPCARE which has three main components: early surgery to fix the hip fracture, early assessment by a medical doctor and early walking with the help of a therapist to speed recovery. After tailoring the training materials to each country, a large study will take place to compare HIPCARE with usual care in 40 hospitals in LMICs in South Asia.
Burns Rehabilitation: A multidisciplinary program for burns management, treatment and prevention in low income countries
Professor Nasim Chaudhry, Pakistan Institute of Living and Learning, and Dr Maria Panagioti, University of Manchester
Globally, burns are responsible for around 11 million injuries and 180,000 burn related deaths yearly. Unfortunately 9 out of 10 injuries and deaths happen in LMICs such as Pakistan. 1 in 3 people admitted to hospitals with burn injuries will die within 3 weeks and survivors face serious lifelong physical, emotional and social problems. This project focuses on burn management, treatment and prevention in Pakistan.
Over the course of 4 years, researchers from Pakistan and the UK as well as burn survivors, family members and health professionals will work together to create culturally adapted prevention and multidisciplinary care quality and rehabilitation programmes for burns that can be implemented across LMICs.. This work will decide whether the rehabilitation programmes are effective, acceptable, helpful, affordable and manageable in Pakistan and elsewhere in LMICs.