Improving global injury care through collaborative research
The Global Injury Group is an equitable partnership between collaborative researchers across
high-, middle- and low-income countries with the shared vision of improving the care of the injured through research.
Find out more about our group here, and our work packages here.
Here are Global Injury Group studies planned for 2024-2028:
Priorities & Objectives in Orthopaedic Trauma Research – A Modified Delphi Study
Study design: We will undertake a consensus exercise
using a modified Delphi method to identify areas and opportunities to strengthen MSK injury
research capacity across South Africa, Malawi, and Tanzania.
Study participants: Healthcare practitioners
(doctors, nurses, physiotherapists) and researchers providing MSK injury care or
involved in aspects of MSK injury research across Malawi, South Africa and Tanzania.
Musculoskeletal Injury and Polytrauma (MAP) Africa Study
Study design: Across Malawi, South Africa, and Tanzania, we will
undertake an observational “snap-shot” study to determine the number of WHO-priority MSK
injuries that occur during our research period.
Study participants: All adults (≥18 years) and children
presenting to participating healthcare facilities with an ankle fracture and/or fracture to the shaft of the humerus, forearm, femur or tibia.
Service Assessment of Fracture & Injury Care in Africa
Study design: We will adapt the WHO SARA framework to
"assess and monitor the service availability and readiness of the health sector and to generate
evidence to support the planning and managing of a health system" related to MSK injuries
across Malawi, South Africa, and Tanzania.
Study participants: All healthcare facilities providing
MSK injury care in Malawi, Tanzania, and South Africa.
Musculoskeletal injury Ethnographic Research to Understand fracture care
Study design: We will use ethnographic methods
to gain a deeper understanding of fracture care delivery across South Africa, Malawi, and Tanzania.
We Will: 1. Conduct an in-depth characterization of the organisation and delivery of care for injuries in different settings, 2. Understand organisational processes that help or hinder the implementation of services and 3. Identify patient and carer priorities, including barriers and facilitators to healthcare access.
Outcomes of a National Evaluation of FRACTURE care across Africa
Study design: Across South Africa, Malawi, and Tanzania,
we will undertake a prospective cohort study to determine the clinical, functional, and economical outcomes 5 WHO-priority
musculoskeletal injuries (femur, tibia, forearm, and humeral shaft fractures, and ankle fractures).
Study participants: All adults (≥18 years) presenting to participating centres with any of the five WHO-priority
MSK injuries.
Study Investigation Modes of antiBiotic delivery in open fractures across Africa
Study design: We will undertake a pragmatic, multicentre, two-arm randomised feasibility trial
comparing the use of prophylactic oral versus intravenous antibiotics in open fractures.
Setting: Six healthcare facilities providing an orthopaedic surgical service for open fracture care in
Malawi, South Africa, and Tanzania (2 within each country). These will include three specialist (1 in each country)
and three first level-hospitals (1 in each country), in both urban (3 sites) and rural (3 sites) areas.
Gun Related Injuries in Trauma (GRIT) Study
Study design: We will undertake a pragmatic, multicentre, two-arm randomised feasibility trial comparing
the use of prophylactic oral versus intravenous antibiotics in gunshot wound fractures.
Setting: Six healthcare facilities providing an orthopaedic surgical service for open fracture care
in South Africa .
About our group
Injuries are responsible for 8% of all global deaths (4.4 million people annually). For every
injury-related death, up to 50 people sustain temporary or permanent disabilities, resulting in
more than 220 million disability adjusted life years lost each year. This is estimated to be 10%
of all years lived with disability worldwide, more than tuberculosis, HIV and malaria combined.
Individuals sustain injuries at disproportionately higher rates in low and middle income
countries, accounting for approximately 90% of injuries and 83% injury-related global deaths.
Annually one billion people sustain a traumatic injury that requires healthcare treatment in
LMIC, which equates to over 12% of the global population.
Musculoskeletal injuries (fractures – broken bones) are the most common type of injury requiring
medical treatment and account for 78% of injury related disabilities. Africa has a higher
incidence of musculoskeletal injuries than any other region in the world and its population is
expected to double by 2050.
The Global Injury Group is an equitable partnership between collaborative researchers across high-, middle- and low-income
countries with the shared vision of improving the care of the injured through research.
Our project has four themes:
THEME 1. CAPACITY.
Evaluate the available resources for conducting clinical research & develop research capacity and leadership.
We will identify opportunities for research capacity strengthening in three SSA nations and develop solutions to address country-specific challenges,
to create a sustainable research environment. We will co-develop multimodal resources including research training programmes,
mentorship and PhD fellowships, to address identified gaps, nurture a clinical research infrastructure and develop a network of research accomplished centres and leaders.
THEME 2. MAP.
Quantify the incidence of MSK injuries & define the healthcare resources currently available for MSK injury care.
We will create a network of collaborating hospitals and undertake a multi-centre snap-shot cohort study to determine the incidence of five priority MSK injuries
across our partner countries. Adapting the WHO Service Availability and Readiness Assessment framework we will describe the MSK injury healthcare resources
in each partner country and identify factors that help or hinder the delivery of services.
THEME 3. OUTCOMES.
Assess MSK injury treatment pathways, clinical & quality of life outcomes, and economic impact.
We will record patient-reported function and quality-of-life outcomes, mortality, and resource use for patients with each of the five priority injuries in the six-months following their injury.
Evaluation of health economic outcomes will demonstrate the socioeconomic impact of injuries on patients, their family and community.
THEME 4. CHANGE.
Implement a multi-centre feasibility study to inform a randomised control trial (RCT).
Focusing on the development of a collaborative research network, we will undertake a multi-centre feasibility study for a future RCT across our partner countries,
addressing a MSK injury healthcare priority.
Find out about our studies on these 4 themes here.
Timeline 2024-2028:
- Year 1 Gain approvals, recruit and train research staff
- Year 2 Complete Theme 2 Year 3 Complete Theme 3
- Year 4 Complete Theme 1 and 4
Impact:
Our research will inform changes in MSK injury healthcare, creating a sustainable legacy of research leaders and centres across SSA for future years.
Dissemination:
Project partners and our established Community Engagement Group will be at the forefront of output dissemination.
We will consolidate existing relationships with policy makers and develop new relationships to drive improved MSK healthcare in LMIC.
Collaborators
Malawi
Linda Chokotho
Malawi University of Science and Technology
Project and Country Lead
Nyengo Mkandawire
University of Malawi
Joint Project Lead
Marc Henrion
Malawi Liverpool Wellcome Research Programme
Statistics Lead
Chipiliro Moffat
The Lilongwe Institute of Orthopaedics and Neurosurgery
Country Nurse Care lead
Chiku Mpanga
Ministry of Health, Queen Elizabeth Central Hospital
Orthopaedic Surgeon
Vincent Mkochi
Kamuzu University of Health Sciences
Orthopaedic Surgeon
South Africa
Maritz Laubscher
University of Cape Town
Country Lead
Sithombo Maqungo
University of Cape Town
Co-Country and CEI Lead
Robyn Waters
Orthopaedic Research Unit
Project Coordinator for South Africa & Senior Researcher
Nosipho Mncwabe
Orthopaedic Research Unit
Country Nurse Care Lead
Kirsty Berry
Orthopaedic Research Unit
Orthopaedic Surgeon
Bruce Biccard
Groote Schuur Hospital and the University of Cape Town
Perioperative Care Lead
Richard Matzopoulos
University of Cape Town
Epidemiology lead
Tracey Smythe
London School of Hygiene & Tropical Medicine and Stellenbosch University
Rehabilitation Lead
Tanzania
Billy Haonga
Muhimbili University of Health and Allied Sciences
Country Lead
George Njambilo
Muhimbili University of Health and Allied Sciences
Co-country Lead and Orthopaedic Surgeon
Deogratias Patrick Ngunyale
Muhimbili Orthopaedic Institute
Orthopaedic Surgeon
Dorkasi Mwakawanga
Muhimbili University of Health and Allied Sciences
Country Nurse Care Lead
Obedi Emmanuel
Muhimbili University of Health and Allied Sciences
Project Coordinator for Tanzania
United Kingdom
Simon Graham
University of Oxford
Project and Country Lead
Matthew Costa
University of Oxford
Joint Project Lead
Juul Achten
University of Oxford
Project Management and Monitoring, Evaluation & Learning Lead
Molly Glaze
University of Oxford
Project Manager
Grace Drury
University of Oxford
Project Manager
Duncan Appelbe
University of Oxford
Information Specialist
Sarah Drew
University of Bristol
Social Science Lead
Jonathan Cook
University of Oxford
Statistician and Clinical Trials Lead
Stavros Petrou
University of Oxford
Health Economic Lead
James Masters
University of Oxford
Orthopedic Surgeon
Dan Perry
University of Liverpool
Paediatric Trauma lead
William Harrison
Countess of Chester NHS Foundation Trust, AO Alliance
Research Training Lead
United States
David Shearer
University of California, IGOT
Collaborator
Madeline Mackechnie
University of California, IGOT
Collaborator
Oversight Committee
Prof Leonard Marais
University of Kwazulu-Natal
Consultant Orthopaedic Surgeon
Prof Samual Manda
University of Pretoria
Professor of Statistics, Department of Statistics
Prof Chris Lavy
University of Oxford
Professor of Orthopaedic and Tropical Surgery and
Consultant Orthopaedic and Spine Surgeon
Dr Claude Martin
Switzerland
AO Alliance Managing Director
Mr Austen Matemba
Patient representative
Dr Yankho Luwe
Ministry of Health Malawi
Director, Emergency Response and Disaster Management Division
Students
Abigail Shaw
University of Oxford
Plastic Surgeon and Global Injury Group Research Fellow
Early career researcher writing workshop: October 2026
This workshop aims to support early career researchers by enhancing their knowledge, skills, confidence, and professional networks through writing sessions, mentorship, and collaborative opportunities.
By the end of the 5-day workshop, we expect that participants will improve their ability to publish research in scientific journals and become part of a network of future leaders with valuable research collaborations.
If you are interested in attending, please email us at ghg-globalinjury@ndorms.ox.ac.uk
Basic Orthopaedic Principles:
If you are a Global Injury Group collaborator and are keen to learn more about basic orthopaedic principles,
we will support a selection of applicants to take a course created by Four
Minute Medicine.
This course introduces core orthopaedic concepts, with a focus on functional anatomy, fracture diagnosis, basic physiology, and fracture management.
If you are interested, please email us at ghg-globalinjury@ndorms.ox.ac.uk.
We look forward to hearing from you.
Publications
Injury: a neglected global health challenge in low-income and
middle-income countries
Authors: Simon Matthew Grahama, Linda Chokothob, Nyengo Mkandawiree,
Maritz Laubscherc, Sithombo Maqungod, Billy Haongaf, George Njambilof, William J Harrisong,
Matt L Costa, on behalf of the National Institute for Health and Care
28 April 2025, The Lancet
Global Health
An injury is any harm or damage to the body that disrupts its normal
structure or function, whether accidental or intentional.
Injuries can arise from various causes, including road traffic collisions,
falls, drowning, burns, poisoning, and acts of violence—whether
self-inflicted or directed at others.
The Global Injury Group was established in August 2024, with funding from
the global health programme of the UK’s National Institute for Health and
Care Research and the Medical Research Council.
Outcomes of femoral shaft fractures in Sub-Saharan Africa:
A systematic review
Authors: Patrick Birkenhead, Paul Joseph Birkenhead, Clara Vella, Maritz
Laubscher, Sithombo Maqungo & Simon Matthew Graham
07 March 2025, International
Orthopaedics
Femoral shaft fractures are significant injuries and if not managed
appropriately can result in high complication
rates and long-term disability. These complex injuries occur at a higher
rate across low and middle income
countries and sub-Saharan Africa is thought to have a higher incidence
than other regions across the world.
This study aims to summarise the most up to date evidence surrounding
the treatment and associated outcomes of adult femoral shaft
fractures in sub-Saharan Africa – giving a clear understanding of
current practices and highlighting potential areas for further research.
Outcomes following lower limb long bone intramedullary nail fixation in South Africa
Authors: Simon M. Graham, Tracey Smythe, Maritz Laubscher, Nando Ferreira, Sithomobo Maqungo
01 May 2025, The Bone & Joint Journal
Musculoskeletal injuries are more common in sub-Saharan Africa than anywhere else in the world,
yet there is limited evidence to guide the management of these injuries in low- and middle-income countries.
We aimed to evaluate the outcomes of lower limb intramedullary nailing (IMN) for long bone fractures in
South Africa and identify predictors of these outcomes.
Prof Leonard Marais
Prof Samual Manda
Prof Chris Lavy
Dr Claude Martin
Mr Austen Matemba
Dr Yankho Luwe
