International Injury Research Unit
Successful Capacity-Building Programs Lead to New Grants and New Initiatives
The disproportionately heavy burden injuries place on low- and middle-income country (LMIC) populations was the impetus for founding the Johns Hopkins International Injury Research Unit (JH-IIRU) 5 years ago. To combat this burden, the Unit, which is led by Professor Adnan Hyder, strives to build a critical mass of local experts in low- and middle-income countries who can respond to injuries on all levels—from monitoring and treating severe injuries to data analysis and influencing policy.
Workshop participants learning how to conduct
observational studies in Cambodia practice
monitoring helmet use.
Photo Credit:Abdulgafoor Bachani
The group’s overall capacity-building activities can be divided broadly into three main categories:
- Research and data collection strategy workshops and mentoring
- Trainings on care for the injured, including emergency trauma care
- Academic course development
JH-IIRU has quickly made great strides in these areas. In 2010, for instance, IIRU was named a WHO Collaborating Center for Injuries, Violence and Accident Prevention in recognition of its work in LMICs—one of only three such centers in the U.S. And over the past 2 years they have continued to build on their portfolio and broaden their reach both here at Hopkins and abroad.
Professional Workshops: Building Research Capacity
While many factors contribute to the burden of injuries in the developing world, one prevailing cause is that cost-effective injury interventions are not prioritized in many low- and middle-income countries. To change this, IIRU has set out to improve the availability and uptake of quality evidence on the economic and societal consequences of injuries by training local health professionals and policymakers in the most affected countries.
Participants from the National Workshop on
Evaluation Methods for Road Safety in Cambodia.
Assistant Scientist Abdulgafoor Bachani front left.
Photo Credit: Abdulgafoor Bachani
Road traffic crashes are one of the major causes of injury and injury-related deaths in the world, and in recent years the global health community has been directing more resources to preventing them. In 2010, IIRU became one of six core partners in the international consortium working on the
Bloomberg Global Road Safety Program, or the Road Safety in 10 Countries (RS-10) project, as it is more commonly known. The project was developed to combat the dearth of road safety data and expertise in the 10 countries that account for almost half of all traffic deaths globally: Brazil, Cambodia, China, Egypt, India, Kenya, Mexico, Russia, Turkey, and Vietnam.
So far, IIRU-sponsored workshops and training seminars have trained more than 600 individuals from the project’s 10 focus countries. The trainings focus on a variety of topics including data collection and management; evaluation methods for road safety; public health research methods and data analysis; data management; handling of data for injury surveillance; and advanced data analysis.
As part of the road safety project this spring, Assistant Scientist Abdulgafoor Bachani, the Associate Director for Training and Capacity Development, and Assistant Scientist Aruna Chandran, Associate Director for Monitoring and Evaluation, hosted the "National Workshop on Evaluation Methods for Road Safety" in collaboration with Handicap International (HIB) in Cambodia. This workshop, held in Phnom Penh, provided an overview of monitoring and evaluation for national road safety programs, including evaluation designs for road safety and data collection options. The workshop was attended by faculty from the Hanoi School of Public Health and representatives from the National and Provincial Road Safety Committees in Cambodia. A hands-on workshop, participants learned how to collect data for observational studies. To hone their skills, the participants took to the streets of Phnom Penh to record motorcycle helmet use, an area in which the Cambodian government would like to see improvements.
In India, Assistant Scientist Shivam Gupta has conducted several training workshops in Hyderabad and the Punjab for local data collection. And, in Kenya this fall, the IIRU, along with the Kenya Ministry of Health and the US Centers for Disease Control, hosted the National EMS Symposium– Connecting the DOTS: A Unified EMS System in Kenya. The attendees included emergency medical technicians as well as representatives from the Kenyan Ministry of Medical Services, the Ministry of Public Health and Sanitation, the Kenyatta National Hospital, non-governmental organizations and academics.
Assistant Professor Kent Stevens, Associate Director of Trauma Systems and Clinical Services for IIRU, from the Department of Surgery in the School of Medicine with a joint appointment in IH, represented Hopkins and presented on the importance of developing trauma registries. He highlighted three key areas of trauma care that lack systematic data collection in many countries: pre-hospital care, hospital care, and post-hospital care. Currently, the mortality rate from severe injuries in low-income countries is already many times higher than in high-income countries. As car ownership rates rise, road traffic injuries are projected to increase. Increased injuries and mortality could deal a severe blow to these developing economies, given that injuries are a major cause of death for adults in their most economically productive years. To make sure that the burden of injuries does not go overlooked by the public and government alike, good evidence can reveal the true scale of the impact, thus creating awareness and a push for action.
IIRU’s Senior Technical Advisor, Professor David Bishai from the Department of Population Family and Reproductive Health, has estimated the potential of RS-10 to save thousands of lives. You can read more about the IIRU’s RS-10 activities and results in a special issue of Traffic Injury Prevention, entitled, "Public Health Burden of Road Traffic Injuries: An Assessment from Ten Low- and Middle-Income Countries," which is available for free online: http://www.tandfonline.com/toc/gcpi20/13/sup1
Training Trauma Care Professionals
The WHO estimates that 90 percent of road traffic deaths occur in low- and middle-income countries, even though they account for less than 50 percent of the world's registered automobiles (WHO 2009). One cause for the higher mortality is the lack of emergency care at the crash site and a lack of specialized trauma care at hospitals.
EMTs case-scenario training in Kenya. EMT students
learned important trauma care skills for use in
road traffic injuries. Photo credit: Fatima Paruk
To address this, JH-IIRU is piloting a 9-point plan for building comprehensive trauma-care capacity on a national scale in Kenya.
Assistant Professor Stevens and IIRU’s Director, Professor Adnan Hyder, are spearheading this initiative. The plan’s scope ranges from training Emergency Medical Technicians (EMTs) to setting up a national trauma registry and advising the government on legislation. IIRU currently has 6 EMT fellows undergoing training and has conducted training for medical professionals at the Naivasha District Hospital on a range of issues, including data collection and proper use of equipment for severely injured patients.
New Courses at JHSPH and Online
Beyond training professionals already in the field, IIRU is committed to preparing the next generation of injury prevention researchers and policymakers. For instance IIRU is involved in three courses:
Participants of the Kenya training of hospital medical
professionals practicing trauma care techniques.
Photo credit: Fatima Paruk
- Confronting the Burden of Injuries: A Global Perspective (Adnan Hyder)
- Using Summary Measures of Population Health to Improve Health Systems (Adnan Hyder, Abdulgafoor M. Bachani and Richard Morrow)
- Poverty, Economic Development and Health (David Bishai)
The first two are currently available on the School’s OpenCourseWare for free online.
In addition, two new courses are being developed by IIRU faculty:
- Evaluation of Road Safety Interventions in Low- and Middle-Income Countries (Aruna Chandran, Adnan Hyder)
- Hospital Based Injury/Trauma Surveillance in Low- and Middle-Income Countries (Abdulgafoor M. Bachani and Kent A. Stevens)
To further supplement researchers’ skills, IIRU is developing a 7-module training program on road traffic injury prevention and control in low- and middle-income countries which will be available for free online via the school’s TRAMS system. The modules cover a broad range of injury-prevention research topics:
- Fundamentals of Road Traffic Injury Prevention
- Concepts in Injury Prevention
- Assessing the Health and Economic Burden of Road Traffic Injuries
- Risk Factors and Choosing Interventions for Road Traffic Injuries
- Injury Surveillance Systems
- Evaluation of Road Safety Interventions
- Influencing Policy for Road Traffic Injury Prevention
In addition to formal course work, over 50 students have worked with JH-IIRU. Currently, over a dozen students are involved with the Unit (see table). They help faculty and program staff in areas such as writing reports and articles, literature reviews, data analysis, research, and administration. Many doctoral students have also been able to use their experiences with the Unit to complete their dissertations.
Since JH-IIRU works with faculty from across the University, it participates in the Global Health Field Placement program run by the Johns Hopkins Center for Global Health. The Center competitively awards travel stipends to university students so they can pursue work on dissertations, master’s theses, or Capstone essays. Three students have earned placement awards while working with IIRU.
New Capacity-Building Grant: Chronic TRIAD
A new grant from the National Institutes of Health brings together JH-IIRU with a long-time Department of International Health collaborator: Makerere University School of Public Health. The project—Chronic Consequences of Trauma, Injuries and Disability (Chronic TRIAD)—will strengthen research capacity on the long-term health and economic consequences of trauma, injuries and disability in Uganda. The collaboration is exactly in line with IIRU’s mission of training local researchers to produce and promote data use that can ultimately lead to interventions that reduce burden of disability from trauma and injuries. In addition, the team will establish a sustainable training program—a track within the MPH program, which will provide a home for faculty across Makerere University. A mechanism will also be set up to collaborate with the Ugandan Ministry of Health for research-to-policy dialogue on the chronic consequences of trauma, injuries and disabilities.
Current Student Involvement in IIRU
Kate Allen, PhD candidate
Management: Bloomberg Global Road Safety Program (RS-10)
Casey Branchini, PhD candidate
Edward Galvez, MPP candidate
Huan He, PhD candidate
Connie Hoe, PhD candidate
Turkey and Egypt: RS-10
Yuenwai Hung, PhD candidate
Aisha Jafri, PhD candidate
Chronic Consequences of Trauma, Injuries and Disability in Uganda
Nasreen Jessani, PhD candidate
Cambodia and Vietnam: RS-10
Rabia Karani, Undergraduate
Development of an Innovative Tool for Emergency Care Surveillance System in Pakistan
Qingfeng Li, PhD candidate
China: RS-10 and The Burden of Hospitalized Injuries in China
Ripudaman Minhas, MPH candidate
Data analysis: Center for Global Health Field Placement Grant
Andrés Vecino Ortiz, PhD candidate
Pooja Sripad, PhD candidate
Brazil and Mexico: RS-10
Pratiksha Vaghela, MPH candidate
Nukhba Zia, MPH candidate
Pakistan: Fogarty International Collaborative Trauma and Injury Research Training
Fatima Paruk, Postdoctoral Fellow
Trauma Care in Kenya