Fighting Surgical Infections: Community Collaboration at the GSU Nigeria Hub
One of the most frequent postoperative complications is surgical site infections (SSIs), which can result in substantial burden on patients and healthcare systems. The Community Engagement and Involvement (CEI) team of the NIHR Global Health Research Unit on Global Surgery in Nigeria took the lead in efforts to prevent SSIs by involving communities and healthcare providers across three sites: Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife, Lagos University Teaching Hospital (LUTH), and Lagos State University Teaching Hospital (LASUTH).
The CEI team implemented “PROJECT REACH” to reinforce the Community Health Extension Workers (CHEWs) knowledge on the importance of reducing SSIs at the community level through wound care training. CHEWs are formally trained individuals who provide basic primary care within Nigeria’s healthcare system which include preventive health education, immunisation, maternal and child health services, family planning, and basic medical care.
In Lagos, 103 CHEW leadership and primary healthcare facility participants attended the training.
In Ile-Ife, 146 healthcare providers received training including 31 (CHEWs) from primary healthcare centres, 36 (nurses, pharmacists and doctors) from secondary care facilities, and 78 (nurses and doctors) from OAUTHC’s surgical teams. To ensure accessibility, especially in rural and semi-urban regions, sessions were held in English and indigenous languages. Specially designed learning aids were used which included posters, leaflets, and short videos in English and Yoruba.
The community-focused training successfully bridged gaps in collaboration across different levels of Nigeria’s healthcare system. By leveraging training materials and SSI toolkits, participants showed significant improvements in their knowledge, as reflected in post training evaluations. Discussions also highlighted challenges in navigating patients through the healthcare system, leading to the development of strategies to improve timely access to care for SSIs.
Early signs of impact the training has had include integrating CHEW training on SSIs into routine practice, and providing patients with accessible resources like posters, leaflets, and videos in local languages.
Nigeria Hub starts 2025 working with NAFDAC
The GSU Nigeria team organised a meeting with National Agency for Food and Drug Administration and Control (NAFDAC) in Lagos, from January 8-10th.
The meeting was attended by over 60 professors and researchers from leading spoke hospitals, brought together one of the largest gatherings of surgical researchers in West Africa. This significant event provided an opportunity to reflect on past achievements, receive specialised training on clinical trials and studies from NAFDAC, and discuss exciting upcoming research.
Key highlights included presentations from senior leaders such as Professor Adesoji Ademuyiwa, Director of the NIHR GSU, College of Medicine, University of Lagos, who praised the strength of the research network, and Dr Kamil Soretire, the Director, Health Planning, Research and Statistics of the Federal Ministry of Health and Social Welfare, who discussed the growth of surgical research in tertiary institutions. Professor Aneel Bhangu also spoke about the potential to continue impactful surgical research through new trials, fostering a generation of new leaders and continuing high impact research. Cortland Linder, Research Fellow in GSU, mentioned ” It was fantastic to meet everyone and learn about all of the inspiring projects going on in the Nigeria Hub”.
The meeting featured updates on several groundbreaking trials, including the Dragon Trial, Penguin Trial, and ongoing studies like Alligator and I3P. Additionally, new pilot randomised controlled trials were introduced, and Dr Omolara Williams, Paediatric Surgeon at Lagos State University College of Medicine, provided valuable insights on community engagement.
The remarks made surrounding pioneering trials included:
Dragon Trial: Investigating the effectiveness of reusable versus disposable drapes and gowns. The trial has started recruiting in Mexico and is expected to launch soon in Nigeria.
Penguin Trial: Testing mouthwash and varying oxygen concentrations to reduce surgical site infections. Ongoing at Lagos University Teaching Hospital, led by anaesthetists.
Alligator Study: Global cohort study capturing data on the management of appendicitis. A total of 63 hospitals are already registered to participate across Nigeria.
I3P and IMPALA Projects: Focus on monitoring foetal and maternal health during childbirth.
New Pilot RCTs:
- Surgpass: Explores using simulation and a co-designed patient passport to reduce deaths after surgery.
- MeerCat: Investigates the use of CT scans before emergency surgery.
- Starling: Examines if stopping antibiotics earlier, when symptoms resolve, is more beneficial than standard treatment.
Following the event, two articles were quickly published in the Nigerian press, Leadership and Worldwide both praised the meeting, noting it would ‘boost surgical research in tertiary institutions.
In conclusion, the meeting launched the Nigeria Hub’s research programme for 2025, uniting prominent experts and researchers to share knowledge, showcase innovative trials, and explore new avenues for impactful studies. The event not only highlighted the impressive progress of ongoing projects but also emphasised the importance of collaboration and community engagement in advancing healthcare. With ground-breaking trials like Dragon and Penguin at the forefront, the gathering reaffirmed the commitment to reducing surgical mortality, improving patient outcomes, and fostering the next generation of surgical leaders. The enthusiastic participation and positive media coverage underscore the significance of this meeting in driving the future of surgical research and practice in Nigeria and beyond.
Scientific Writing Workshop Equips Researchers with Essential Skills
The University of Rwanda, through the Global Surgery Research Hub, in partnership with the Center for Equity in Global Surgery (CEGS) at the University of Global Health Equity (UGHE) and Duke University, successfully hosted a two-day Scientific Writing Workshop. Held on January 20th and 22nd, 2025, this online event was designed to help participants enhance their skills in writing original research manuscripts in healthcare and associated sciences.
The workshop focused on the essentials of scientific writing, including structure, storytelling, and clarity of presentation. It was aimed at young researchers, individuals seeking to improve their writing, and participants from diverse healthcare backgrounds. The sessions incorporated practical writing exercises, lectures, and real-world examples from literature to strengthen participants’ writing abilities.
This comprehensive course also included valuable online learning materials from the Global Surgery Unit. Attendees were highly encouraged to participate in both sessions, as the content built progressively.
The workshop was conducted in English and held virtually via the UGHE Butaro Campus in Rwanda.
Workshop Details:
- Session 1: Monday, January 20th, 2025, 2–5 PM CAT (7–10 AM EST)
- Session 2: Wednesday, January 22nd, 2025, 2–5 PM CAT (7–10 AM EST)
This event provided a valuable opportunity for participants to develop their scientific writing skills and advance their research in global health.
Research for Greener Surgery Conference 2024
What better way to wrap up 2024 than an inspiring conference?
In December, we hosted our Research for Greener Surgery Conference at the University of Birmingham, inspiring 400+ UK and international clinicians and academics to make surgery more sustainable. It was great to gather and discuss the latest research advancements in the field, from reusable drapes and gowns to, clean energy for healthcare, sustainability across the patient pathway, reducing the environmental impact of anaesthesia and many more.
A prominent theme across the conference was the need to enforce change and the small ways in which we could make a large impact. Research shows positive changes are taking place – however, there is room for improvement as clinicians, academics, and patients, and events like these offer a unique platform for engagement, dialogue and shared learning.
A highlight from the event was the address from Dr Adewale Adisa, Professor of Surgery from our NIHR(National Institute for Health Research) Global Surgery Unit, Nigeria Hub who spoke about the launch of a world-wide campaign to raise $100 million to equip 100 hospitals across the Global South with secure, clean energy that will help them maintain vital health services and save lives. Obafemi Awolowo University Teaching Hospital Complex, Nigeria, have been chosen as a pilot site for the initiative. Adewale expressed his excitement and encouragement to be involved with the project.
It was remarkable to see multiple networks communicating in the same space and sharing their innovative way to make surgery more sustainable. In his final remarks, University of Birmingham Professor Aneel Bhangu said “we are a community with power”. We hope this resonates with all that were in attendance and look forward to continuing to work together to advance sustainability within surgery.
GSU Hosts Webinar on Implementing Community Engagement in the Global South
The Global Surgery Unit (GSU) hosted a webinar on the 5th of November 2024, on delivering Community Engagement and Involvement (CEI) across multiple settings.
During this event, GSU presented three case studies of how it made its research relevant to local communities. The first case study involved patient and carer input in the design of TIGER- an inguinal hernia trial repair that aims to task-shift this procedure to non-surgeon physicians such as GPs in Ghana. You can read more about these findings here and here.
The second case study involved upskilling community health workers on the early signs of cancer in India and surgical site infections in Rwanda. Finally, the third case study involved a discussion on the development and implementation of the GSU patient and community education toolkit.
The event was hosted by the Unit’s funders, the National Institute for Health and Care Research (NIHR), and co-presented by RESPIRE, a global health research group on respiratory health based at the University of Edinburgh.
If you are interested in knowing more about CEI as it relates to global surgical research, you can access our free, self-guided online course HERE.
Community Engagement Focus Shines at Benin Hub Surgical Conference
Community Engagement and Involvement (CEI) took centre stage during the 2nd day of the Second Beninese Surgical Conference, held from August 19-21, 2024 at Millenium Popo Beach Hotel in Agoué. Organised by the GS Benin Hub in partnership with the Beninese Society for Surgery and the Beninese Society of Paediatric Surgery, the session aimed to enhance the capacity of local CEI groups and key stakeholders in promoting effective community participation in health initiatives.
The CEI session focused on training local community representatives on CEI principles, methods, and tools. The goal was to equip them with the skills to mobilise their communities effectively for health studies and projects such as Project REACH (REsources for surgical cAre training of Community Health workers), a program designed to disseminate community and patient educational resources on surgical site infections (SSIs). Additionally, the session sought to establish a National CEI Steering Committee to coordinate and harmonise community mobilisation efforts nationwide
A total of 93 participants from various backgrounds, including surgeons, gynaecologists, medical residents, general physicians, community members and students, attended the session. International attendees from Senegal, Martinique and Mali were also present.
A delegation from Rwanda, comprising the National CEI Lead and the International Patient Representative, enriched the discussions with their valuable insights and experience on community health worker training.
Key outcomes of the CEI session included:
- Enhanced capacity of Local CEI Groups: Members gained a deeper understanding of CEI principles and tools, strengthening their ability to mobilize their communities.
- Clarified roles and responsibilities: The National CEI Committee's functions were clearly defined, ensuring effective coordination of CEI initiatives at the national level.
- Establishment of the National CEI Committee: A representative committee was formed to coordinate and harmonize community mobilization efforts.
- Shared experiences and best practices: Participants benefited from the Rwandan delegation's insights into community mobilization and the REACH project, providing valuable lessons for Benin.
The session was a significant step towards CEI capacity building in the country. By equipping local groups with the necessary skills and establishing a National CEI Steering Committee, the Benin Hub has laid the foundation for more inclusive and effective community involvement in future projects.
Benin Hub Expands CEI Network
The GSU Benin Hub has successfully expanded its Community Engagement and Involvement (CEI) network by establishing groups in two partner hospitals, aiming to strengthen local healthcare capacities and improve patient outcomes through targeted education programs.
The CEI expansion began with visits to Klouékanmè District Hospital on 24 June and Hôpital de zone de Dassa-Zoumè on 26 June. These visits attracted diverse attendees, including hospital staff, qualified community health workers (QCHWs), and patients, totalling 44 participants across both locations.
The initiative's central focus involved training attendees on the fundamentals of CEI in global health research, focusing on preventing surgical site infections, understanding the patient's surgical journey, and managing post-operative wounds. These participatory sessions were conducted in local languages (Fon, Adja, and Idatcha) to ensure comprehensive understanding, particularly among patient representatives.
A pre-training assessment revealed a significant knowledge gap, with 93% of participants initially unaware of the CEI concept. Post-training evaluations showed a dramatic improvement, with 82% of participants indicating a clear understanding of CEI principles and their practical applications in healthcare settings.
At each site, a core CEI group was formed comprising five democratically selected individuals. These groups are tasked with continuing the work of educating and involving the community in health research initiatives, enhancing local healthcare delivery, and fostering a collaborative environment between healthcare providers and the community.
Community sensitisation efforts on wound care and surgical site infections (SSIs) were also done. This included showing participants an animated SSI prevention video in French. Visual aids such as leaflets and posters were also shared with the group. The focus on practical, relatable content helped demystify medical procedures and post-operative care, encouraging better health practices within the community.
The session was received enthusiastically by attendees, who expressed a keen interest in the topics covered and a commitment to future CEI activities. The establishment of local CEI groups is expected to facilitate ongoing education and support such as translation of the SSI animated video in local languages.
Mexico Hub Community Engagement Roundup for June-July 2024
The GSU Mexico Hub has made strides in community engagement through a series of five educational events conducted in June and July 2024. These initiatives, aimed at different groups, focused on critical health topics such as heatstroke, addiction prevention, hepatitis, and surgical wound care, reinforcing the hub’s commitment to public health and safety.
On June 7th, GSU Mexico Hub held its first event at SEMPRA, a leading oil company, addressing the increasing concern of heatstroke, particularly relevant given the recent heatwaves affecting Veracruz. The session, attended by 32 staff members, emphasised the importance of early recognition and intervention to prevent fatalities. Practical demonstrations equipped employees with the skills to handle heatstroke incidents, prompting a follow-up invitation due to positive feedback. A subsequent training on June 27th at SEMPRA delved deeper into heatstroke management, showcasing new equipment acquired by the company, such as ice packs and fans. This session highlighted the significance of immediate action and proper use of the equipment in preventing severe outcomes. The interactive session featured case studies and simulations, fostering a proactive safety culture among the 30 attendees.
On June 19th, the focus shifted to addiction prevention at the Veracruz branch of NUVOIL- another oil company, with 20 staff members participating. The training covered the nature of addiction, risk factors, and prevention strategies. Engaging activities and discussions underscored the importance of early intervention and the availability of support systems, enhancing the company's supportive work environment.
SEMPRA hosted another significant event on July 5th, focusing on hepatitis awareness. This session educated 30 employees on the various types of hepatitis, transmission methods, and preventive measures like vaccination and hygiene practices. The interactive format encouraged participants to adopt healthier lifestyles and reinforced SEMPRA's commitment to employee health.
The final event, held on July 10th at Hospital Español de Veracruz, targeted 15 undergraduate medical interns. The training provided crucial insights into surgical wound care and infection prevention, enhancing the interns' ability to manage postoperative care effectively. This initiative aimed to improve patient outcomes through better-trained healthcare providers.
Benin Hub Community Engagement Immersion Visit to Rwanda
Members of the GSU Benin Hub visited the GSU Rwanda Hub from 8-12th July 2024, to learn about community engagement and involvement (CEI) practices.
The visit focused on Project REACH (REsources for surgical cAre training of Community Health workers), a program designed to disseminate a community and patient education toolkit on surgical site infections (SSIs) in two districts: Kacyiru, located in Kigali, and Rwamagana in the Eastern Province. The Benin team also met with the Rwanda National CEI Steering Committee to discuss strategies for enhancing community involvement in promoting surgical care and research.
Project REACH aims to train community health workers (CHWs) on recognising and managing symptoms of surgical site infections (SSIs). CHWs, often unpaid volunteers trusted by the community, play a critical role in healthcare, especially in remote areas where hospital access is limited. These volunteers typically have basic literacy skills and serve as the first point of contact for health issues in low-to-middle-income countries.
The project involves an initial assessment of CHWs' knowledge about SSIs, followed by a training session led by the local research team. Immediately after the training, another assessment is conducted to gauge understanding. A final assessment occurs 3-6 months later to measure information retention.
As a community-driven research project, CHWs are consented to the study, and assessed by senior CHWs. This process includes Hub-directed training of senior CHWs on the research protocol, guiding them through informed consent forms, addressing participants' questions, and using data collection software for assessments.
The visit concluded with the Benin Hub presenting its observations, recommendations, and future plans to the Rwanda Hub.
New CEI Updates Published in Impact Surgery
Our Community Engagement and Involvement (CEI) teams across our partner countries have recently published updates of their work in the journal Impact Surgery.
The GSU Benin Hub reported on patients’ perceptions of anaemia, pre-operative iron treatment and blood transfusion in preparation for an upcoming trial. You can read the article here.
The GSU Ghana Hub looked into the patient acceptability of a quality-of-life tool for our TIGER trial which aims to task shift inguinal hernia repair to non-surgeon physicians. Patients were also asked to advise researchers on the best participant recruitment strategy. Read the report here.
The GSU India Hub discussed their experience training female community health workers (also called ASHAs) in the Punjab region on various surgical care topics such as surgical site infections (SSIs), early cancer detection and stoma care. Read the report here.
Similarly, the GSU Rwanda Hub write about their work training community workers in representative urban and rural settings on SSI detection and wound care. Read the report here.
Finally, the GSU Mexico Hub based in Veracruz reports on the various community outreach activities conducted in the last few months including talks at health fairs and schools. Read the report here.
Cite these papers:
I Lawani, YI Souaibou, JB Gnele, S Lawani, C Bokossa, C Fadonougbo, et al. Community consultation in a regional hospital in the Republic of Benin to co-develop the PUMA randomised trial. Impact Surgery. 2024;1(3):102-104. Doi: https://doi.org/10.62463/surgery.55
S Tabiri, NB Sam, E Amofa. Co-developing research for inguinal hernia repair in Ghana. Impact Surgery. 2024;1(3):98-99.Doi: https://doi.org/10.62463/surgery.68
Suroy, A., Jain, D., Gulrez, A., Kaur, A., Shukla, P., Mathai, S., Ghosh, D. Transforming Health Advocate Initiatives in Punjab and beyond through surgical community engagement. Impact Surgery. 2024;1(4):158-161. Doi: https://doi.org/10.62463/surgery.7
Munyaneza, E., Umutesi, V., Muhawenayo, E., Mwungura Ngabo, E., Nshumuyiki, J., Imanishimwe, A., ... Ntirenganya, f.. Surgical Site Infection Prevention Training of Community Health workers in Rwanda. Impact Surgery. 2024;1(4):161-162. Doi: https://doi.org/10.62463/surgery.78
LMP Maldonado, NO Borrell, NMF Ortega, CO Brenis, ID Sanchez, APG Duran, et al. Report of Surgical Community Engagement in Veracruz, Mexico. Impact Surgery. 2024;1(3):100-101. Doi: https://doi.org/10.62463/surgery.63