Traumatic Brain Injury Across the Lifespan in Uganda Research Initiative

 描述(申请人提供)：据估计，每年世界上有1000多万人遭受创伤性脑损伤(TBI)，在撒哈拉以南非洲地区，TBI的发生率远远高于全球平均水平。乌干达的颅脑损伤死亡率和致残率与整个南非南部非洲地区相似，但关于伤害负担的国家数据很少。乌干达的TBI负担巨大且日益严重，迫切需要作出回应，这反过来又需要填补关键的知识差距。我们提出了乌干达创伤性脑损伤(TBI-乌干达)计划，以确定乌干达创伤性脑损伤在整个寿命期间的健康和经济负担，这项合作研究工作将 确定TBI的负担，开发可持续的数据系统，并对乌干达人进行TBI研究方面的培训，以帮助发现和填补这些差距，并推进基于研究的应对措施。我们创新的可持续研究合作模式将涉及美国约翰霍普金斯大学彭博公共卫生学院(JHU)以及乌干达的Makerere大学公共卫生学院(MU)和穆拉戈国家转诊医院(MH)。我们将利用美国的专业知识来加强乌干达的机构，促进专注于TBI的可持续研究事业，并通过在乌干达提议一项更大规模的干预研究来进一步利用研究证据。该项目的研究将确定公共卫生专业知识和脑损伤患者临床护理方面的差距。我们将应用这些结果来减轻脑外伤在整个生命周期内日益增长的负担，并在两年结束前提出一项更大规模的干预研究。我们将首先为侧重于乌干达创伤性脑损伤的数据登记定义核心变量和互联网平台(具体目标1，1-6个月)。然后，我们将在MH对基于互联网的坎帕拉互联网创伤性脑损伤登记(KiTBIR)登记进行为期一年的试点测试(具体目标2，7-18个月)。这不仅将增进对坎帕拉全面发展倡议的了解，而且还将检验正在进行的数据系统的可行性和对这种基于互联网的安全登记册的人力资源支持的可行性，因为持续的数据收集系统将对未来干预措施的设计和评估至关重要。在整个项目中，我们将通过研究人员和利益相关者研讨会以及相关健康和政策主题的在线课程，在MH和MU(具体目标3，1-24个月)的TBI临床医生核心小组中培养研究技能和数据分析能力。最后，我们将为坎帕拉的脑外伤干预研究制定一项研究计划，作为JHU-MU的联合提案(R01)，用于研究使用KiTBIR评估一套干预措施(具体目标4，20-24个月)。在卫生部实施脑损伤登记将有助于清楚地确定乌干达脑损伤的负担以及与脑损伤发病率和结局相关的风险因素，并有助于确定治疗这一人群的可纠正因素。这项提案中概述的基于互联网的脑损伤登记处开发方法代表着发展中国家脑损伤患者数据收集方面的重大进步。

 DESCRIPTION (provided by applicant): Each year, it is estimated that more than 10 million people in the world suffer Traumatic Brain Injury (TBI), and in sub-Saharan Africa TBI rates are much higher than global averages. Rates of TBI mortality and disability in Uganda are similar to those throughout SSA, yet national data on the burden of injury are scarce. The large and growing burden of TBI in Uganda urgently requires a response, which in turn will require that critical knowledge gaps be addressed. We propose the Traumatic Brain Injury Across the Lifespan in Uganda (TBI-Uganda) Program to define the health and economic burden of traumatic brain injuries across the lifespan in Uganda in a collaborative research effort that will define the burden of TBI, develop sustainable data systems, and train Ugandans in TBI research to help find and fill these gaps and advance a research-based response. Our innovative model of sustainable research collaboration will involve the Johns Hopkins University Bloomberg School of Public Health (JHU), USA and Makerere University School of Public Health (MU) and Mulago National Referral Hospital (MH) in Uganda. We will use US expertise to strengthen the Ugandan institutions, promote a sustainable research enterprise focused on TBI, and enable further use of research evidence by proposing a larger intervention study in Uganda. The project's research will identify gaps in public health expertise and in clinical care o TBI patients. We will apply these results to reduce the growing burden of TBI across the lifespan and propose a larger intervention study by the end of two years. We will first define core variables and Internet platforms for a data registry focused on traumatic brain injuries in Uganda (Specific Aim 1, months 1-6). We will then pilot-test the Internet-based the Kampala internet-Traumatic Brain Injury Registry (KiTBIR) registry at MH for 1 year (Specific Aim 2, months 7-18). This not only will improve understanding of TBI in Kampala, but also will test the viability of ongoing data systems and human resources support for such a secure internet-based registry, because continuous data collection system will be crucial to the design and evaluation of future interventions. Throughout the project we will develop research skills and data analysis capacity among a core group of TBI clinicians at MH and MU (Specific Aim 3, months 1-24), through researcher and stakeholder workshops as well as online courses in relevant health and policy topics. Finally, we will develop a research plan for an intervention study on TBI in Kampala as a joint JHU-MU proposal (R01) for research to evaluate a set of interventions using the KiTBIR (Specific Aim 4, months 20-24). Implementation of a TBI registry at MH will help clearly define the burden of TBI in Uganda and the risk factors associated with TBI incidence and outcome, and help identify correctable factors in the treatment of this population. The Internet-based approach to TBI registry development outlined in this proposal represents a significant advancement in data collection for TBI patients in the developing world.