Benin Hub Showcases Community-Led SSI Prevention at COPMAN 2025
At the 2nd edition of COPMAN 2025, held from 8- 11 October at the Palais des Congres in Cotonou, Benin, Covalic Melic Bokossa, Community Engagement and Involvement (CEI) Lead at the NIHR Global Surgery Unit (GSU) Benin Hub, presented a poster highlighting a transformative community-led initiative to prevent surgical site infections (SSIs) in rural Benin.
The poster, titled “Implementation of Training and Awareness Sessions on the Prevention of Surgical Site Infections (SSI) Among Community Relays and Qualified Community Health Workers in the Commune of Klouekanme, Benin,” was featured during the conference’s poster sessions. It detailed a collaborative programme that trained 76 Community Relays and 7 Qualified Community Health Workers (CHWs) in Klouekanme, a rural commune in the Couffo department.
COPMAN (Congres Panafricain des Maladies Neuromusculaires) is a scientific conference dedicated to addressing the diagnostic, therapeutic, and research challenges of neuromuscular diseases across Africa.
The initiative, coordinated by the GSU Benin Hub in partnership with local health authorities, aimed to address the high burden of SSIs in the community by empowering frontline health workers with knowledge and tools to educate households. The training covered key topics such as recognising signs of SSIs, wound self-care, and preventive practices. Notably, the programme employed a three-tiered assessment approach: pre-training, immediate post-training, and one-month post-training, to evaluate knowledge retention and impact.
Results were striking: average knowledge scores among CHWs rose from 52.88% before the training to 100% one month after. The use of digital tools like KoboToolbox for post-training assessments also demonstrated the feasibility of integrating technology into rural health interventions.
The Benin Hub’s work aligns with the GSU9’s broader mission to embed CEI in global surgery research and implementation. By equipping CHWs with practical knowledge and encouraging household-level awareness, the programme not only reduces the incidence of SSIs but also fosters long-term behavioural change.
CEI in Action: Ghana’s New Stoma Support Group
On 19th September 2025, the Ghana Hub hosted a landmark community engagement and involvement (CEI) event at Komfo Anokye Teaching Hospital, Kumasi, launching a stoma support group for ostomates and their caregivers. This initiative, led by the Ghana CEI team, is a direct outcome of the capacity-building supported by the UK’s National Institute for Health and Care Research (NIHR) through the Global Surgery Unit.
The event brought together 42 participants, including paediatric and adult ostomates, caregivers, surgeons, stoma nurses, and medical trainees. The group aims to provide psychosocial support, advocate for improved access to care, and create a platform for collaborative research and service delivery. Attendees shared powerful testimonies about the social and financial challenges they face, including stigma, school exclusion, and lack of insurance coverage for stoma care.
The Ghana team applied the NIHR CEI Guiding Principles to ensure the initiative was inclusive, contextually relevant, and co-designed with patients and carers from the outset. The support group will also serve as a national network via WhatsApp, enabling remote education and service provision.
This event exemplifies how CEI training has empowered Hubs to extend engagement beyond research, fostering sustainable, patient-led initiatives. It highlights the importance of NIHR’s investment in CEI and its ripple effect in improving surgical care and equity in LMICs.
The challenges of stoma care, particularly in LMICs, are an important topic for researchers within the Unit. Our mixed method paper published in 2024, looked at data from 446 patients in Malawi, India, Nigeria, and the Philippines, and revealed that only 13.9% received preoperative stoma counselling and only 44.4% received postoperative nursing care, despite most stomas being temporary and over half resulting from colorectal cancer. Interview data highlighted the lack of knowledge on stoma care, poor access to stoma equipment and resources and the lack of affordable stoma care supplies.
Millions denied life-saving surgery as global targets missed – study warns
Progress towards universal access to safe, affordable surgical care is dangerously off track as at least 160 million patients each year unable to receive surgery – with Low- and Middle-income Countries (LMICs) bearing the brunt of the crisis, a new study reveals.
A global coalition of 60 health experts representing 20 countries is calling for urgent action to resolve the crisis – warning that only 26% of LMICs are on track to meet a target for everyone to be able to access essential surgery within 2 hours, and none have achieved the recommended surgical volume of 5,000 procedures per 100,000 people per year.
Quality of surgical care remains a key concern, with 3.5 million adults worldwide dying within 30 days of surgery, considerably more than the combined 2 million adult deaths attributable to HIV/AIDS, tuberculosis, and malaria. Overall, 50 million patients worldwide suffer postoperative complications every year, with wound infection the most frequent complication. Surgery is a key contributor to antimicrobial resistance, with up to 96% of infected wounds in LMICs being linked to antimicrobial resistance.
“Surgery is not a luxury. It is a lifesaving, cost-effective intervention that underpins resilient health systems. Without urgent investment, millions will continue to suffer and die from treatable conditions.”
Professor Aneel Bhangu – Professor of Surgery
‘Surgical Health Policy 2025–2035: Strengthening Essential Services for Tomorrow’s Needs’ is published today in The Lancet by the University of Birmingham-led NIHR Global Health Research Unit on Global Surgery.
Senior author Professor Aneel Bhangu, from NIHR Global Surgery Unit (GSU), commented: “Surgery is not a luxury. It is a lifesaving, cost-effective intervention that underpins resilient health systems. Without urgent investment, millions will continue to suffer and die from treatable conditions.”
Researchers in the group, which is backed by funding from the UK’s National Institute for Health and Care Research (NIHR) have made several key recommendations including:
- Reframing surgery as a foundational component of well-integrated health systems, rather than a siloed intervention; investing in surgery can boost patient care across numerous diseases by increasing access to diagnostics, intensive care, and critical drugs.
- Unlocking a ‘surgical prosperity dividend’ by increasing access to essential surgery; for example, scaling up breast, stomach, colon, and rectal cancer surgery in LMICs could enable 884,000 people to return to work and boost the global economy by over $80 billion each year.
- Developing innovative funding models for surgery; currently half of patients undergoing cancer surgery in LMICs make out-of-pocket payments which can result in catastrophic expenditure and poverty.
- Focussing efforts on making surgical services more resilient to future emergencies, including pandemics, climate change, natural disasters, and armed conflict.
- Adopting circular economy principles in surgical systems to reduce both waste and carbon emissions from operating theatres, which currently account for up to 25% of total hospital emissions.
- Addressing gender disparities in surgical leadership and improving access for marginalised populations to address inequalities in health outcomes.
The report also emphasizes the role of surgery in achieving the Sustainable Development Goals (SDGs), citing its impact on health, economic productivity, and national security. It proposes a new set of benchmarks for 2025–2035 to guide global efforts and ensure accountability.
Co-lead author Dr Dmitri Nepogodiev, from the NIHR Global Surgery Unit (GSU), commented: “With widespread cuts to global health funding this year, we are at a pivotal moment for surgery. We must continue to secure funding to expand access to surgery while maintaining quality.
“At the same time, we must prepare surgical systems for an increasingly unpredictable world. Pandemics, climate change, and armed conflict all threaten to disrupt care in the future, but most countries have made little progress in their preparedness since the COVID-19 pandemic.”
Strategic Engagements with TETFUND and the Federal Ministry of Health
On June 25, 2025, the NIHR Global Surgery Unit (GSU) Nigeria Hub led a strategic visit to the Tertiary Education Trust Fund (TETFUND) headquarters in Abuja, Nigeria. The visit marked a significant milestone in advancing surgical research and strengthening healthcare systems across the country.
The NIHR GSU delegation, led by Professor Adesoji Ademuyiwa, was warmly received by Arc. Sonny S.T. Echono, Executive Secretary of TETFUND, alongside Dr. Salihu Girei Bakare, Director of Research & Development and Centres of Excellence, and other senior members of the TETFUND leadership.
The delegation included Professor Dion Morton, Co-Director of the Global Surgery Unit and representative of the University of Birmingham, as well as Professors Adewale Adisa, Lukman Abdur-Rahman, Abubakar Auwal, Shina Ogunbiyi (Major Gen Rtd), Associate Professors Hyginus Ekwunife and Doyin Ogunyemi, and Mr. Emmanuel Ojo Williams.
Presenting the Modified Clean-Cut Trial
Central to the meeting was the presentation of the Modified Clean-Cut Trial, a nationally coordinated, multimodal intervention aimed at reducing surgical site infections (SSI) through a stepped-wedge cluster randomised controlled trial. The trial is projected to reduce SSI rates in Nigeria by up to 50%, a goal that resonated strongly with TETFUND leadership.
The trial’s inclusive design, featuring equitable representation from centres across all six geopolitical zones, was particularly praised. The NIHR GSU team emphasised the importance of locally led research and the potential for this initiative to serve as a model for future Nigeria-driven studies.
Exploring Strategic Collaboration
Beyond the trial, discussions focused on long-term collaboration between TETFUND and the NIHR GSU Nigeria Hub. Both parties explored how their respective strengths could be harnessed to maximise research impact and sustainability.
The NIHR GSU team highlighted the Hub’s strategic position within the global NIHR network, which enables access to international advisory support and global best practices. The goal: to improve surgical safety, enhance patient outcomes, and strengthen Nigeria’s health system through high-impact research and innovation.
Data-Driven Futures: NIHR GSU Lagos Hosts Transformative Training-of Trainers Workshop
On June 4 to 5, 2025, the NIHR Global Surgery Unit (GSU) Lagos Hub hosted a high-impact, two-day residential Training-of-Trainers (ToT) programme focused on Data Analysis using Microsoft Excel and R Programming. This initiative marked a significant step in strengthening data capacity and promoting evidence-based decision-making in health research across Nigeria and beyond.
The training, held at the Lagos Hub’s Data Centre, brought together 23 healthcare professionals for an intensive, hands-on learning experience aimed at empowering trainers with the skills to manage, clean, and analyse health data, and to confidently pass these skills on to others.
Building Data Skills for Health Impact
The programme covered a range of essential topics, including:
- Cleaning messy datasets: Addressing missing entries, typographical errors, and inconsistent formatting.
- Basic data analysis techniques: Using Excel and R to generate summaries, charts, and statistical outputs.
- Introduction to statistical thinking: Helping participants interpret patterns in health data to inform clinical and research decisions.
Interactive Learning and Real-World Application
The training adopted a practical, interactive approach, with participants working on real-world datasets and engaging in peer discussions. Live demonstrations and Q&A sessions added depth to the learning experience, reinforcing the critical role of data analysis in shaping healthcare outcomes.
Sustaining Momentum Through Mentorship
Following the success of the ToT programme, the Data Centre plans to initiate follow-up mentorship sessions and advanced workshops to reinforce learning and provide ongoing support. These efforts aim to build a sustainable network of data-savvy trainers who can drive high-quality research and innovation within their institutions.
A Strategic Step Forward
This Training-of-Trainers programme represents a strategic investment in the future of health research in Nigeria. By equipping professionals with robust data analysis skills, the NIHR GSU Lagos Hub is contributing to a more data-driven culture in surgical and global health research, aligned with the broader goals of the NIHR Global Surgery Unit.
Green Surgery Goes Hands-On at UoB’s 125th Anniversary Open Day
The University of Birmingham marked its 125th Anniversary with a vibrant Community Open Day on Saturday, 21 June 2025, drawing visitors from across the region. Among the many highlights was the Green Surgery team’s engaging and educational booth, which attracted attention from alumni, local residents, and families alike.
The team presented their pioneering research into sustainable surgical practices, with a particular focus on the DRAGON trial, which explores the use of eco-friendly surgical drapes and gowns. Informative banners and displays provided insight into the project’s goals and progress.
Younger attendees, and the young at heart, enjoyed an interactive recycling game, where participants sorted various types of waste into miniature bins, reinforcing the importance of sustainability in healthcare.
A standout attraction was the laparoscopy box trainer, which allowed guests to test their keyhole surgery skills. Successful participants were rewarded with a bamboo coaster featuring the Green Surgery logo, a sustainable keepsake from the day.
In keeping with the team’s commitment to environmental responsibility, all materials used during the event will be repurposed for future outreach activities.
Monitoring visit to NIHR GSU Nigeria Hub and University College Hospital Ibadan: Strengthening clinical trials
Note to reader: This article was co-written by Emmanuel Williams- GSU Nigeria Hub Manager
From 3 to 7 March 2025, the University of Birmingham’s Trial Management Team travelled to Ibadan, Nigeria, to conduct a monitoring visit to the National Institute for Health and Care Research (NIHR) Global Surgery Unit (GSU) Nigeria Hub and the city’s University College Hospital (UCH) – one of the Nigeria Hub’s spoke hospitals. The visit aimed to ensure the success and integrity of the ongoing PENGUIN trial while enhancing the efficiency of clinical research in the region. During the three days, the team engaged in a series of collaborative and insightful sessions that provided improvements to the way clinical trials are managed in Nigeria’s medical institutions.
Kicking off at the NIHR GSU Nigeria Hub
The visit began at the NIHR GSU Nigeria Hub with a warm welcome by Adesoji Ademuyiwa, Professor of Paediatric Surgery at the University of Lagos and Head of the Paediatric Surgery Unit at Lagos University Teaching Hospital. Here, the University of Birmingham (UoB) team met with local researchers and medical professionals.
The team kicked off with an intensive monitoring and evaluation training session, which focused on ensuring that clinical data is captured accurately and entered in real-time. Monitoring exercises followed, where the UoB team checked case report forms for participants of the PENGUIN trial, cross-referencing them with hospital records, ensuring that the trial remains in full compliance with global research standards.
Diving into excellence at Ibadan’s University College Hospital
The second day of the visit saw the UoB team traveling to the renowned University College Hospital (UCH) in Ibadan, where they were greeted by the Spoke Principal Investigator (PI), Professor Taiwo Lawal, and his team. After several productive meetings with hospital leadership, including Professor Jesse Otegbayo, Provost of the University of Ibadan’s College of Medicine and UCH’s Chief Medical Director, everyone affirmed their commitment to supporting the ongoing PENGUIN trial and future research collaborations.
At the Medical and Dental Consultants Association of Nigeria Lounge, the UoB team turned their attention to reviewing more clinical trial records. They identified opportunities to improve anaesthetic data tracking and suggested including detailed anaesthetic records in the monitoring system. Dr Muyiwa Rotimi, part of the PENGUIN trial team, from the Intensive Care Unit at Lagos University Teaching Hospital, led the charge in collecting data for potential future implementation, showing how small adjustments can bring in big improvements across sites.
Empowering data managers
Day three brought a key opportunity for the UoB team to share their expertise with data managers from multiple centres participating in the PENGUIN trial. A hands-on training session, led by Felicity Brant, University of Birmingham Trial Manager, addressed common data entry challenges such as empty fields and pre-programmed errors, helping participants sharpen their skills. The training emphasised the importance of continuous data validation, timely data entry into REDCap, and efficient query resolution. Participants were encouraged to engage in regular data management meetings to enhance efficiency and consistency across centres.
Looking ahead: A bright future for clinical trials in Nigeria
As the visit concluded, the UoB team had efficient data management practices and enhanced the capacity of local teams. The collaboration between Nigerian researchers and international experts has laid a strong foundation for improving clinical trials in the country, with the PENGUIN trial set to play a key role in advancing global health research.
Rachel Lillywhite, Team Leader for Global Surgery Trials, University of Birmingham and Atul Suroy, India Hub Manager said: ‘Our visit concluded that the standard of trial delivery at Lagos University Teaching Hospital (LUTH) and UCH Ibadan is consistently high, in accordance with good clinical practice, the PENGUIN protocol and regulatory standards. The teams were welcoming and keen to discuss their experiences of running GSU trials, conveying thought-provoking information which will inform how we develop and deliver trials in the future.’
The trip wasn’t all business, though. The team wrapped up their visit with a cultural outing to the Nike Art Gallery, embracing the culture of Nigeria and enjoying a unique opportunity to appreciate the rich artistic heritage of the region.
With key lessons learned and an action plan in place to ensure accurate and timely data collection and efficient running of the PENGUIN trial, the future of clinical trials in Nigeria looks promising, with rigorous standards and stronger collaborations driving the way forward.
World’s biggest appendicitis study gives insight into emergency healthcare
Study will collect data from over 2,000 hospitals in 135 countries – identifying areas for strengthening emergency care systems globally.
University of Birmingham experts working with the National Institute of Health and Care Research (NIHR) Global Surgery Unit, are enlisting the help of medics across the globe to investigate the effectiveness of health systems by studying the outcomes of patients undergoing surgery for acute appendicitis.
The Appendicitis Global Outcomes Study (AlliGatOr) will collect data on patients undergoing appendicectomy for suspected appendicitis from over 2,000 hospitals in 135 countries. The aim is to identify areas for strengthening emergency care systems globally.
The new trainee-led, collaborative cohort study is funded by the National Institute for Health and Care Research (NIHR) and managed by the team behind the successful delivery of the NIHR-funded GlobalSurg, COVIDSurg, HIPPO, and GECKO studies.
Acute appendicitis is one of the most common surgical emergencies worldwide. The presentation and management of this condition offer a valuable benchmark for evaluating the efficiency and effectiveness of emergency healthcare systems.
Project lead Mr Theophilus Teddy Kojo Anyomih, from the University of Birmingham, commented: “Acute appendicitis is one of the most common surgical emergencies worldwide. The presentation and management of this condition offer a valuable benchmark for evaluating the efficiency and effectiveness of emergency healthcare systems.
“The AlliGatOr study aims to generate detailed data on the global variability in the management and outcomes of appendicectomy. The world’s biggest appendicitis study, it will provide critical insights into access to emergency care, imaging techniques, and the use of minimally invasive surgery.
“The findings will inform policy recommendations for both high- and low- to middle-income countries, contributing to improved healthcare delivery and patient outcomes worldwide. We encourage all interested healthcare professionals, surgeons, scientists, and academics to get involved in this exciting and important study.”
Hospital teams, consisting of up to three collaborators, will gather data over 14-day periods, with patients followed up at 30 days to collect outcome data. Researchers will use this information to assess global emergency system performance.
No changes will be made to routine patient care pathways or management as part of the observational study, which runs alongside two optional sub-studies exploring waste management and financing models.
The AlliGatOr study will provide critical insights into access to emergency care, imaging techniques, and the use of minimally invasive surgery. These findings will inform policy recommendations for both high- and low- to middle-income countries, contributing to improved healthcare delivery and patient outcomes worldwide.
Study leaders are still recruiting hospital leads and co-leads globally – with ample opportunities for institutions to participate in this ground breaking research. Discover how to join as a hospital lead or co-lead.
Knowledge Exchange Between India and Mexico: Enriching Community Engagement
Note to reader: This news article was written by Nallely Ortiz and Alex Ordaz- the GSU Mexico Hub CEI Lead and Deputy Lead, respectively.
As part of the Community Engagement and Involvement (CEI) program in Mexico, our team visited Punjab and Kolkata, to learn from our Indian colleagues’ experience. This trip allowed us to witness first hand their work in the community, focused on three key actors: ASHA Workers, women who help connect rural communities to health services, Community Health Workers, and non-government organisations (NGOs), and their crucial role in health promotion.
The structure and organisation of the India team provided valuable lessons on how to adapt these models to the Mexican context. While we do not have the same conditions, we were able to see ways to tailor the approach to our health and social care system.
In India, significant efforts are made to improve access to health information in remote communities. One of the most remarkable aspects is the adaptation of health education materials into indigenous languages, which helps bridge communication gaps and ensures that information is accessible to all.
This is highly useful for communities, as India has 22 languages spoken by millions of people. The same happens in Mexico, which has great linguistic diversity with 68 languages spoken in indigenous communities across the country.
Additionally, the team are closely involved in community activities, ensuring that programs are effective and well received by the population.
One of the main lessons learned was the importance of having community intermediaries who serve as a bridge between health services and the population. In India, ASHA Workers and Community Health Workers have made a significant impact by providing health education and facilitating access to medical services in marginalized areas to more than 200,000 people. Despite not having medical training, their close relationship with the community and continuous education have been key to the program’s success.
The Indian model also demonstrated the importance of collaboration with the government. Through a strong relationship with the Punjab State Ministry of Health, the CEI in India has successfully achieved the systematic and effective implementation of health programs. Moreover, the Indian sub-hubs in Kolkata and Velore play a crucial role in replicating the model in other states where they are present, ensuring that the impact of these initiatives extends to more regions and benefits more people.
To implement these learnings in Mexico, and inspired by the knowledge gained from our experience, we plan to design an action plan focused on four main pillars: 1) training health promoters; 2) collaborating with NGOs specialising in cancer; 3) raising awareness in schools and communities, and 4) localise our patient educational materials to include indigenous languages
In the short term, we will prioritise the dissemination of health information in educational and workplace settings. In the medium term, we will work with NGOs on training programs for cancer prevention and public health. Finally, in the long term, we will establish a network of community health promoters to expand the program’s impact, with a special focus on indigenous communities.
This journey allowed us to reflect on the similarities and differences between both nations. India and Mexico share immense cultural wealth and common challenges in accessing healthcare. Adapting a model like India’s in Mexico will strengthen our communities and foster a more equitable and inclusive healthcare approach.
Our commitment is to continue building bridges between science, research and the community, learning from international best practices to transform public health in Mexico.
GSU Calls for Urgent Action on Surgical Site Infections and Sustainable Practices
The National Institute for Health and Care Research (NIHR) Global Surgery Unit (GSU) has recently contributed a compelling letter to the British Journal of Surgery (BJS), highlighting the urgent need for more evidence in the fight against surgical site infections (SSIs) and advocating for environmentally sustainable practices in surgery. As surgical site infections remain prevalent, costly, and detrimental both to patient health and the environment, addressing these issues through research is more crucial than ever.
The letter responds to a recently published journal article by Humphreys and Hill, in agreement with the need for more evidence in critical areas at the intersection of SSIs and environmental sustainability. These include changing gloves and instruments before wound closure, reusable drapes and gowns, triclosan coated sutures, and internal based cost effectiveness analyses.
Professor Aneel Bhangu, Virginia Ledda, Cortland Linder and Liam Phelan, researchers at the GSU and the University of Birmingham and authors of the letter, highlight how this is already being done in ongoing clinical trials such as DRAGON trial, a large-scale study led by the GSU and involving 26,800 patients from eight countries, aims to provide vital evidence on the clinical, cost, and environmental outcomes of practices related to personal protective equipment, both inside and outside the operating theatre. The trial is also looking at sterilisable equipment, such as laparoscopy ports.
The authors also comment on the importance of expanding research into areas such as behavioural change to ensure best practices are implemented. An example is the GSU CHEETAH trial, which demonstrated that changing gloves and instruments before wound closure can reduce SSIs and is cost-effective.
In conclusion, the need for more rigorous, evidence-based research in the fight against SSIs and the push for more sustainable surgical practices cannot be overstated. The GSU’s letter is a timely reminder that advancing surgical safety and sustainability is essential for both patient outcomes and environmental health and calls for a concerted effort to integrate new evidence into practice for the benefit of patients worldwide.