Conference report: NIHR Global Surgery Unit: Lagos, Nigeria 2023

Purpose

The NIHR Global Surgery Unit annual meeting is the highlight of the network, giving the chance for face-to-face contact between the leadership and delivery teams from around the world. This year, it took place in the city of Lagos in Southern Nigeria. We met for 3 days with over 150 participants predominantly from Nigeria, but with representation from 13 other countries: Benin, Canada, Ghana, Guatemala, India, Mexico, Philippines, Rwanda, Senegal, South Africa, Switzerland, UK, and the USA. Although there is a financial and carbon cost to such a meeting, it is incredibly high value in-terms of communication, direction, strategy setting, and capacity building for the future.

Policy change

We discussed how to implement our completed research and create wider policy change. Three key studies were discussed by panels of policymakers and surgical leaders: CHEETAH (changing gloves and instruments prior to wound closure to prevent wound infections), EAGLE (educational modules to reduce anastomotic leak after right hemicolectomy), and HIPPO (access to and quality of surgery around inguinal hernia repair). The need for bottom-up and top-down regional and national engagement was made clear, with different countries needing to adopt different strategies. We plan to measure this implementation, to demonstrate impact and cost-effectiveness.

New research

We launched three new trials: DRAGON, MARLIN and LIONESS:

• DRAGON will compare reusable versus disposable drapes and gowns in reducing surgical site infection in 26,800 patients (134 hospitals) across 8 countries, for clean-contaminated, contaminated, and dirty surgery.
• MARLIN will establish a multi-arm multi-stage trial evaluating interventions in the different stages of the surgical pathway to reduce surgical site infection: pre-, intra- and post-operative.
• LIONESS will test neoadjuvant immunotherapy in locally advanced colorectal cancer patients to test safety of the intervention, improve resectability of the tumour and evaluate the pathological response.

We provided teams with training, and engaged policymakers ahead of starting these major randomised trials.

Capacity building

A major element of our annual meeting is to provide capacity building across the network, with a focus on tailored training for in-country research teams. We delivered face-to-face training for 100 Nigerian and international surgical researchers across a range of topics including Health Economics, Qualitative Research, Quantitative Research, Risk Management in Clinical Trials, and Community Engagement and Involvement. We also launched our new online Education Centre (https://globalsurgeryunit.org/education/) hosting surgical research training materials freely available to all.  The newly opened data centre facility at Lagos University Teaching Hospital equipped with networked computers to support data-driven research provided an opportunity for in-depth data management training for local teams from Nigeria and Benin. Further small delegations conducted site specific activities in Nigeria:

• Members of the University of Birmingham management team visited the College of Medicine, University of Lagos, for a management and finance visit with the Nigeria hub team.
• Birmingham Clinical Trials Unit and a data science team from the University of Edinburgh delivered training to Data Managers from across Nigeria and from Benin in the Lagos data centre.
• A senior delegation met with the Federal Ministry of Health in Abuja, to discuss the potential impact on healthcare policies for the people of Nigeria, including changes to the Surgical Safety Checklist incorporating evidence from CHEETAH.
• A Birmingham University delegation hosted a surgical research symposium for 400 medical students and healthcare professionals in Obafemi Awolowo University, in Ile-Ife.

Links:

• GSU website: https://www.globalsurgeryunit.org
• GSU Education Centre https://globalsurgeryunit.org/education/

GSU portfolio:  https://www.globalsurgeryunit.org/wp-content/uploads/2023/09/yearbook-pdf-online-version.pdf

Funding

The work presented is funded by a National Institute for Health and Care Research (NIHR) Global Health Research Unit Grant (NIHR 133364) and an advanced clinician scientist award from the NIHR Academy. The views expressed are those of the authors and not necessarily those of the NIHR or the UK Department of Health and Social Care.

Acknowledgments:

Thanks to Adewale Adisa, Audrey Nganwa, Aneel Bhangu, Catherine Shaw, Dion Morton, Emmanuel Williams and Omar Omar for the input into this summary of the highlights of the meeting.