Paul Bangirana, MSc, PhD
Nominated From: University of Minnesota
Research Site: Uganda
Research Area: HIV/AIDS; Traumatic Brain Injury
Primary Mentor: Dr. Chandy John
Research Project
Developing long-term neuropsychological interventions for survivors of traumatic brain injury (TBI) in urban hospitals in Uganda
Studies in high income countries show that head injury in children and adults is associated with impaired cognitive functioning, poor academic functioning, occupational difficulties and overall poor quality of life. Children’s use of safety precautions during the accident, for example wearing helmets, results in fewer cases with traumatic brain injury on a CT scan. Knowledge of these short and long-term outcomes is important in determining what form of rehabilitation is needed. For example, our studies looking at non¬traumatic head injury in Ugandan children resulting from cerebral malaria have documented the cognitive effects and have gone on to successfully pilot cognitive rehabilitation for these children. In addition, documenting whether patient characteristics during the accident (e.g. use of alcohol, wearing a seatbelt or helmet) are associated with outcome at six months will provide more information that can be used in public health campaigns to prevent brain injury and the long-term negative outcomes. The proposed study is aimed at addressing this gap in traumatic head injury by describing the cognitive, functional and psychological outcomes six months after traumatic brain injury in Uganda and the factors associated with these outcomes.
Specific aims:
1. To determine the prevalence of traumatic brain injuries and the cognitive, functional, and psychological outcomes of traumatic head injury in patients at Mulago Hospital at six-months follow-up.
2. To examine the association between the use of safety precautions during the injury and patient outcomes.
3. To determine the neuropsychological rehabilitation needs of children and adults presenting with traumatic brain injuries at an urban hospital in Uganda.
Research Significance
In Uganda, road traffic accidents are the most common cause of injuries, contributing to 27-60% of the cases seen in both rural and urban settings. Two recent studies conducted at Mulago Hospital studied the short-term outcomes of head trauma. In a prospective study of admissions over a four-month period, Kituuka found a mortality rate of 10.5% and open head injuries were associated with poorer rehabilitation outcomes. Another study found a mortality rate of 9% with low coma score, intracranial hemorrhage, and skull fractures being associated with death. These two studies only followed up patients at discharge and at two weeks respectively. They fail to describe the long-term outcomes of head injury, which have import implications for quality of life and the development of rehabilitation programs for TBI patients in Uganda. The proposed study is aimed at addressing this gap in traumatic head injury rehabilitation and treatment programs, by describing the cognitive, functional, and psychological outcomes six months post-injury.
Mentors
- Chandy John, MD, MS
- Bruno Giordani, PhD
- Charles Mock, MD, PhD, MPH
- Richard Idro, MBCHb, PhD
- Olive Kobusingye
Publications
