Elamu Daniel, MD
Nominated From: Indiana University
Research Site: Global Health Uganda
Research Area: HIV, malaria, traumatic brain injury
Primary Mentor: Dr. Dibyadyuti Datta
Research Project
Prevalence of malaria and HIV in Ugandan children with traumatic brain injury: Addressing a critical intersection in a resource-limited setting
Project Abstract: The rise in non-communicable disorders like traumatic brain injury (TBI), alongside widespread severe acute infections such as malaria and chronic conditions like HIV, represents a critical yet understudied public health crisis for children in low-income, malaria-endemic countries like Uganda, where this dual burden strains an already fragile healthcare system. HIV, malaria, and traumatic brain injury (TBI) each present significant public health challenges in sub-Saharan Africa, with malaria and HIV being major contributors to pediatric mortality and long-term disability. At the same time, injury-related disorders TBI increasingly adds to the burden of morbidity. Together, these conditions exacerbate the already high rates of child illness and death in the region. HIV compromises the immune system, potentially exacerbating the effects of malaria and complicating TBI management, while malaria can contribute to central nervous system (CNS) injuries that worsen TBI outcomes. Limited healthcare resources in low-income countries like Uganda necessitate a nuanced approach to diagnosis, treatment, and long-term care. Investigating the combined burden of these conditions will not only enhance clinical management strategies but also inform public health policies aimed at reducing the morbidity and mortality associated with these co-occurring diseases in children. While numerous studies have explored the individual impacts of malaria, HIV, and traumatic brain injury (TBI) on health-related quality of life (HRQoL) in both pediatric patients and their caregivers, no research to date has examined the combined effects of these conditions. To address this knowledge gap, the proposed study aims investigate the cumulative burden of HIV and malaria in 100 children presenting with mild or moderate TBI at the Mulago Casualty Unit in Kampala, Uganda. We will conduct comprehensive screenings for malaria and HIV in children with TBI and follow up 1-month post-discharge using the pediatric health-related quality-of-life (PedsQL) assessment tool. The proposed research will inform the development of targeted clinical management strategies, early screening tools, and public health interventions that can improve outcomes for children facing this triple burden and enhance psychosocial support for their caregivers.
Research Significance
Traumatic brain injury (TBI) is a significant cause of morbidity and mortality among children globally, with the burden being disproportionately higher in low-income countries. In Uganda, factors such as a high incidence of road traffic accidents, insufficient trauma care infrastructure, and limited resources for post-TBI rehabilitation exacerbate the challenge [Hyder et al., 2007; Demlie, 2023]. To address these issues, we conducted a pilot study at Mulago National Referral Hospital (MNRH) in Kampala, Uganda, funded by NIH/NINDS. This study aimed to identify critical needs, foster collaborations, and build capacity for sustained pediatric TBI research. During the pilot, we identified a significant gap: protocols for testing and managing HIV and malaria in pediatric TBI cases were absent in the MNRH Casualty Ward, a reflection of the resource limitations that often require prioritization of immediate trauma care over infectious disease management. Malaria and HIV are endemic in Uganda, posing additional challenges to managing TBI in children. Research indicates that HIV can worsen malaria outcomes, complicating the clinical management of TBI. For example, HIV-infected individuals may experience more severe malaria, exacerbating neurological damage caused by TBI [Tay et al., 2015]. Understanding the prevalence of these infections among children with TBI is crucial for anticipating and managing potential complications. Furthermore, the interaction between HIV and malaria can significantly increase morbidity and mortality. Studies show that while HIV-infected children may have a lower prevalence of malaria due to prophylactic treatments, co-infection can lead to severe anemia, further complicating TBI recovery [Kiggundu et al., 2013; Sanyaolu et al., 2013]. Since anemia can impair neurological function in TBI patients, addressing these infections is vital for improving outcomes [Pullan et al., 2010]. Although HIV is not traditionally considered a neurodegenerative disease, it is linked to cognitive impairments and cerebral metabolic changes, collectively known as HIV-associated neurocognitive disorders (HAND). The potential overlap between HIV and TBI requires further investigation to understand their combined impact on brain function better. Collecting epidemiological data on malaria and HIV co-infection in children with TBI can also inform public health policies and resource allocation in Uganda. As Adu-Gyasi et al. (2013) highlighted, community-based studies are essential for understanding malaria transmission and its influence on health outcomes. This data is crucial for implementing effective strategies that address both malaria control and HIV management in pediatric TBI cases. In conclusion, it is essential to assess the prevalence of malaria and HIV in children with TBI in Uganda and evaluate their health-related quality of life post-discharge. This research will guide the development of clinical protocols, improve patient outcomes, and inform public health strategies to optimize resource allocation in this high-burden setting.
Mentors
