Title: Collecting Data on hip fracture surgery in sub-saharan africa (Hip fracturE surGery In sub-sahaRan Africa-HEGIRA)
Funder: The Academy of Medical Sciences

Abstract: Aims: To map, collect, review pilot data around integrated care pathways for patients with hip fracture(HF). Objective: 1. Design a Beta version tool to capture inpatient care pathway data for HF in South Africa. 2. Test collection of preliminary HF inpatient care pathway data and outcome. 3. Present early version to stakeholders including testing and feedback. Growing life expectancy is Sub-Saharan Africa is expected to leave 150 million older adults in the region by 2050. The diseases associated with age, will add to the needs of a population that already has significant healthcare challenges. One of the most important sequelae of ageing is osteoporosis and subsequent hip fracture. This injury is associated with major morbidity, mortality and costs. Most patients receive surgery for hip fracture to restore mobility. By studying and formalising treatment and outcomes, great improvements have been made in early mortality in the UK setting. Given the predicted numbers of patients with osteoporosis the burden of hip fracture in Sub-Saharan Africa is expected to rise dramatically. This will interact with existing challenges such as the lack of affordable surgical care. My proposal is to develop a platform, and collect pilot data around inpatient care pathways and outcome for hip fracture. This pilot work will be undertaken with collaborators in South Africa, with a view to expand (with future fellowship funding) to multinational data collection and analysis working with local stakeholders. Ultimately I expect to collect enough information to model possible changes and develop interventional studies.

Lay abstract: In Sub-Saharan Africa, life expectancy is growing significantly. This means that we can expect there to be over 150 million ‘older’ adults in the region by 2050. With ageing, a number of diseases become more common. Amongst these is osteoporosis-where the bone becomes 'spongy' and thin. Fractures in osteoporotic bones can happen after very minor falls, so called fragility fractures. The most devastating of these fractures is a ‘hip fracture’ where the top of the thigh bone breaks next to the hip joint. The consequences of hip fracture are major, with up to 10% dying within 30 days of injury, and many not able to return to their previous living arrangement. One of the most important parts of treatment for hip fracture is an operation to allow the patient to weight bear. In the UK this is done for over 98% of all hip fracture patients. In Sub-Saharan Africa, with its growing elderly population, we can expect a major increase in the number of hip fractures. However little is known about how these patients are cared for, and what outcomes they have after their injury. My proposal is to make the first steps in recording how hip fracture patients are looked after in South Africa, focussing on the surgery, by making a digital platform to capture the information. The early information will support a larger roll out of this work to other countries, to help understand how patients are cared for and how care may be improved.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MUSCULOSKELETAL