The Good Samaritan Inc

RESEARCH TRAINING PROGRAM FOR LOW- AND MIDDLE-INCOME COUNTRY INSTITUTIONS

THE TRECK PROGRAM: TRAUMA RESEARCH CAPACITY BUILDING IN KILIMANJARO, TANZANIA - PROJECT SUMMARY/ ABSTRACT EVERY YEAR, NEARLY 5 MILLION PEOPLE DIE FROM INJURIES AND HUNDREDS OF MILLIONS MORE SUSTAIN NON-FATAL INJURIES THAT REQUIRE MEDICAL ATTENTION WITH LOW AND MIDDLE INCOME COUNTRIES (LMICS), ACCOUNTING FOR 90% OF ALL INJURY RELATED DEATHS. REDUCING THE BURDEN OF INJURY REQUIRES A QUALITY TRAUMA CARE SYSTEM INCORPORATING SURVEILLANCE, PREHOSPITAL AND HOSPITAL BASED CARE AND REHABILITATION SERVICES; THESE SYSTEMS ARE POOR WITH LIMITED SERVICES IN LMICS LIKE TANZANIA. THIS TRAINING PROGRAM WILL TRAIN IMPLEMENTATION SCIENCE FOCUSED TRAUMA AND INJURY CARE RESEARCHERS TO IDENTIFY THE GAPS, BARRIERS AND FACILITATORS TO QUALITY CARE, AND ADAPT EVIDENCE BASED INTERVENTIONS TO TANZANIA SETTING. THE PROJECT BUILDS ON KILIMANJARO CHRISTIAN MEDICAL CENTER AND DUKE UNIVERSITY’S LONG STANDING COLLABORATIONS FOR CAPACITY BUILDING (MEPI/HEPI, D43S) AND INJURY RESEARCH (R21 AND R01) LEVEL PROJECTS. THE GOALS OF THIS PROPOSAL ARE TO TRAIN 2 DOCTORAL AND 10 MASTERS STUDENTS IN INNOVATIVE IMPLEMENTATION SCIENCE AND INJURY RESEARCH AND ESTABLISH A NETWORK OF INJURY FOCUSED STAKEHOLDERS TO SUPPORT MULTI-DISCIPLINARY RESEARCH IN THE REGION.

INDEPENDENT INITIATIVE

CLINICAL DECISION SUPPORT ALGORITHM TO OPTIMIZE MANAGEMENT OF RESPIRATORY TRACT INFECTION IN CHILDREN ATTENDING PRIMARY HEALTH FACILITIES IN KILIMANJARO REGION, TANZANIA - ABSTRACT IN LOW- AND MIDDLE-INCOME COUNTRIES (LMICS), RESPIRATORY TRACT INFECTIONS (RTIS) ARE A LEADING CAUSE OF PREVENTABLE DEATH AMONG YOUNG CHILDREN (< 5 YEARS OF AGE). SEVERE RTIS, USUALLY INVOLVING THE LOWER RESPIRATORY TRACT, CONSTITUTE A POTENTIALLY LIFE-THREATENING MEDICAL PROBLEM THAT REQUIRES EFFECTIVE DIAGNOSIS AND MANAGEMENT, INCLUDING EVALUATION FOR ANTIBACTERIALS. AT THE SAME TIME, THE VAST MAJORITY OF RTIS IN YOUNG CHILDREN ARE NON-SEVERE AND OFTEN CAUSED BY VIRUSES. FOR THESE EXCEEDINGLY COMMON, NON-SEVERE VIRAL RTI CASES, ANTIBACTERIALS ARE NOT APPROPRIATE AND COULD CAUSE HARM. YET IN LMICS OF AFRICA AND ASIA, RESEARCH STUDIES HAVE SHOWN THAT ANTIBACTERIALS ARE PRESCRIBED FOR OVER 75% OF OUTPATIENT PEDIATRIC RTI VISITS. RTI MANAGEMENT IS THUS HIGHLY PROBLEMATIC: ON THE ONE HAND, A COMMON SYNDROME THAT IS GROSSLY OVER-TREATED WITH INAPPROPRIATE ANTIBACTERIALS; ON THE OTHER HAND, CLINICIANS IN LOW-RESOURCED LMIC SETTINGS CAN UNDERSTANDABLY BE CONCERNED THAT WITHHOLDING ANTIBACTERIALS COULD RUN THE RISK OF A PEDIATRIC RTI PROGRESSING TO A SEVERE, LIFE-THREATENING CONDITION. THIS K43 APPLICATION PRESENTS A CAREER DEVELOPMENT PROGRAM TO 1) DEVELOP A CLINICAL PREDICTION RULE THAT USES A PARSIMONIOUS COMPOSITE OF CLINICAL COVARIATES AND NOVEL BIOMARKERS TO ACCURATELY DIFFERENTIATE VIRAL FROM BACTERIAL RTI AND TO PROVIDE PROGNOSTIC RISK STRATIFICATION OF DISEASE SEVERITY IN YOUNG CHILDREN PRESENTING TO HEALTH FACILITIES IN KILIMANJARO REGION, TANZANIA; 2) CONDUCT FORMATIVE SOCIAL SCIENCE RESEARCH TO UNDERSTAND CAREGIVER AND HEALTHCARE PROVIDER EXPECTATIONS, ATTITUDES AND ACCEPTABILITY THRESHOLDS FOR WITHHOLDING ANTIBACTERIALS IN UNCOMPLICATED VIRAL RTI; 3) USE HUMAN-CENTERED DESIGN METHODOLOGY TO PACKAGE THE PREDICTION RULE AND THE ATTITUDES, EXPECTATIONS AND NEEDS OF CAREGIVERS AND HEALTHCARE PROVIDERS INTO A USER-FRIENDLY, EFFECTIVE CLINICAL DECISION SUPPORT ALGORITHM THAT COULD BE TESTED IN FUTURE STUDIES FOR FEASIBILITY, SAFETY, AND EFFICACY. THE CANDIDATE FOR THIS CAREER DEVELOPMENT AWARD IS A TANZANIAN MEDICAL DOCTOR WITH ADVANCED TRAINING IN CLINICAL RESEARCH, PUBLIC HEALTH, AND EPIDEMIOLOGY. HE HAS CONDUCTED CLINICAL RESEARCH ON RTI IN TANZANIA SINCE 2016. FOR THIS MENTORED RESEARCH AWARD, THE CANDIDATE HAS ASSEMBLED AN EXCEPTIONAL TEAM OF MENTORS WITH EXPERTISE IN CLINICAL-EPIDEMIOLOGIC RESEARCH OF INFECTIOUS DISEASES IN TANZANIA, CLINICAL PREDICTION ANALYSIS, HUMAN-CENTERED INTERVENTION DESIGN IN TANZANIA AND OTHER LMICS, AS WELL AS A COLLABORATOR WITH EXPERTISE IN ALGORITHM DEVELOPMENT FOR INNOVATIVE APPROACHES TO RTI MANAGEMENT IN LMICS. AT THE CONCLUSION OF THIS AWARD, THE CANDIDATE WILL HAVE DEVELOPED UNIQUE EXPERTISE 1) IN CLINICAL PREDICTION FOR INFECTIOUS DISEASE MANAGEMENT IN SUB-SAHARAN AFRICA AND 2) IN HUMAN-CENTERED DESIGN OF CLINICAL DECISION SUPPORT ALGORITHMS. HE WILL EMERGE AS A GLOBAL LEADER IN INTERVENTION DESIGN FOR MANAGEMENT OF INFECTIOUS DISEASES—A HIGHLY-SKILLED INDEPENDENT INVESTIGATOR FOCUSED ON IMPLEMENTATION OF STRATEGIES THAT WILL CONFRONT EARLY CHILDHOOD MORTALITY AND THE GROWING THREAT OF ANTIMICROBIAL RESISTANCE.

PROTECT-WAZEE: IMPROVING CARE FOR OLDER ADULT TRAUMA PATIENTS IN TANZANIA: GUIDELINE ADAPTATION FOR LOW -RESOURCE SETTING - ABSTRACT TRAUMA KILLS NEARLY 4.4 MILLION PEOPLE EVERY YEAR GLOBALLY WITH 95% OF DEATHS IN LOW-AND-MIDDLE INCOME COUNTRIES (LMICS).THE WORLD HEALTH ORGANIZATION PREDICTS 80% OF OLDER PEOPLE (>60 YEARS) WILL BE LIVING IN LMIC BY 2050. LIKE MANY LMIC, OLDER ADULTS HAVE MORE THAN DOUBLE THE MORTALITY RATE, LONGER HOSPITAL STAYS AND WORSE FUNCTIONAL OUTCOMES COMPARED TO ALL TRAUMA PATIENTS AFTER ACUTE INJURIES AT KILIMANJARO CHRISTIAN MEDICAL CENTER. WHILE HIGH INCOME SETTINGS HAVE CREATED CLINICAL PRACTICE GUIDELINES TO STANDARDIZE AND IMPROVE CARE, RESOURCES IN THESE GUIDELINES ARE UNAVAILABLE AND THEIR IMPLEMENTATION IS CHALLENGED BY CULTURAL PRACTICE. THIS PROPOSAL WILL ADAPT A HIGH RESOURCE SETTING CLINICAL PRACTICE GUIDELINE FOR MANAGING OLDER ADULT TRAUMA PATIENTS TO MAKE IT MORE APPROPRIATE AND FEASIBLE FOR A LOWER RESOURCED SETTING. THIS PROJECT WILL BENEFIT TANZANIAS WITH A GUIDELINE TO STANDARDIZE AND IMPROVE CARE, BUT ALSO ALL OLDER ADULT PATIENTS OF LOWER RESOURCE SETTINGS AS WE CREATE A FLEXIBLE CLINICAL PRACTICE GUIDELINE GENERALIZABLE TO A MYRIAD OF SETTINGS.