Title: NIHR Global Health Research Group on Burn Trauma, Swansea University
Funder: Department of Health and Social Care

Abstract: Swansea University has demonstrated significant upwards trajectory over the past decade, evidenced by its performance in REF2014 where it was cited as making the biggest lead by an UK research intensive institution in its research performance, ranking 26th in the UK. In 2016, it was rated best University in Wales and has a radical and ambitious programme in place to become one of the top 200 Universities in the World by 2020. This commitment to global impact was underlined in 2016 by the creation of the CGBIPR, the only such centre focused specifically on the pressing global health issue of burns in resource-poor settings. As a major international public health challenge, the global burns field extends far beyond the setting of clinical capacity and requires input from a diverse range of disciplines and actors with relevant expertise. The Centre has in place rapid access to enable interdisciplinary collaboration across a range of disciplines, with health economics, outcomes research, nursing, social care, public health, health psychology, implementation science and social policy, with strong established links with teams within Swansea University Medical School and in and School of Management. A key element of the CGBIPR is to build capacity in the area of global burns research. This initiative will directly contribute to a number of key Strategic Aims defined in the Strategic Plan 2014-2019 for the College of Human and Health Sciences at Swansea University: -Increase the quantity and quality of novel, rigorous and applied research that has international reach and significance -Foster strong collaborative links with other research centres -Form new initiatives with third sector and governments to help synergise research into policy, practice and commercial opportunities -Develop and maintain international partnerships and networks that will enhance student recruitment and support research and teaching opportunities The CGBIPR’s overall strategy is based on 3 main research pillars: Research Pillar 1: Using systems thinking and implementation science to transform burn care in resource poor and conflict environments. - Stream 1.1: Evaluating the impact and effectiveness of a comprehensive quality improvement approach to burn care and an implementation strategy for scaling up and replication in other countries. Since 2013, Interburns has developed a QI approach, based on consensus international standards for burns services in LMICs. A DfID funded programme from 2013-2016 delivered this programme in Nepal and Bangladesh and received a final project score of A+ for its impact on over 15,000 burn patients. This project will evaluate this approach and also create a participatory toolkit for developing integrated national systems of burn care in resource-poor countries. - Stream 1.2: Measuring the impact of quality improvement on end beneficiaries: There are currently no effective outcome measures for burn patients using the biopsychosocial model that are applicable in a resource-poor setting. This Stream will develop and pilot simplified outcome measures that can be used at scale to analyse the true impact of capacity-building on end beneficiaries. - Stream 1.3: Quantifying the long-term costs of burn injuries and the cost benefits of improved care and prevention. The Swansea Centre for Health Economics (SCHE), which is based within the College of Human and Health Sciences, will provide health economics support. Understanding the economic drivers is vital for estimating the economic impact of burns and the consequences for individuals, communities and countries. This work will provide the foundation for utilising economic modelling techniques to estimate optimal use of available resources to deliver cost effective interventions in resource poor settings. - Stream 1.4: Developing Research Skills: The CGBIPR will develop and deliver a portfolio of innovative educational and training tools specifically designed to develop skills in implementation science and burns research in LMICs. These programmes will be used to train an international network of researchers to work in the global burns and trauma field. Research Pillar 2: Developing effective national systems of burn prevention at the primary health care and community levels. - Stream 2.1: Research into the epidemiology and aetiology of burns in resource-poor countries. This data will inform the development of community- and national-level prevention initiatives. - Stream 2.2: Piloting a Basic Burn Care and Community Burn Prevention programme, which includes community-level primary prevention programmes and the training of primary-level health care providers in first aid and prevention of burns, to reduce the incidence and impact of burn injuries in target communities. - Stream 2.3: Development of a model for country-specific national burn prevention strategies: Based on the evidence base from the 2 other streams, our team will develop a framework for local actors to create country-specific national strategies. Research Pillar 3: Emergency preparedness and conflict related burn care: Stream 3.1: Identifying priority areas for research and policy development in conflict-related burn care: The CGBIPR and Interburns have developed strong international collaborations with WHO and agencies involved in emergency and disaster response such as the UKIETR. Work has already begun to establish a working group to establish priorities for research and policy development in this field and this grant will enable the CGBIPR to take the lead role in this process, complementing the investment that has already begun. Stream 3.2: Establishing guidelines for clinical management and emergency preparedness for burns in conflict environments: The CGBIPR and Interburns have strong working relationships with agencies involved in humanitarian aid in conflict areas, including ICRC, MSF and MAP. There is a mutually agreed need for developing guidelines in this area and for establishing evidence based practice for both clinical management and emergency preparedness. Programme Goals -Short – 0 to 6 months (Year 1, first 6 months) Development of a detailed research plan and implementation strategy for each Research Pillar with accompanying allocation of resources, and identification of target countries, partners and collaborating organisations / institutions. All key partnerships discussed and formally agreed (through signed MOUs) with international and overseas partners. Face-to-face meetings completed with key partners. -Intermediate - 6 to 12 months (Year 1, second 6 months) Pillar 1: Evaluation and analysis of integrated quality improvement programmes delivered between 2013-2017. (1.1). Consensus development of first draft of outcome measures (1.2). Design of and agreement of target sites for health economics study (1.3). Pillar 2: Systematic review of current knowledge of epidemiology and aetiology of burn injury in LMICs (2.1). Implementation of community basic burn prevention model in target country (2.2) Pillar 3: Agreement of priority research areas with international partners and hosting first consensus meeting -Medium - 12 to 24 months (Year 2) Pillar 1: Publication of evaluation of integrated quality improvement programme. (1.1). Production of final draft of outcome measures (1.2) . Commence health economic study (1.3). Development +/- delivery of implementation research training module. (1.4) Pillar 2: Evaluation of community based prevention programme (2.2) Pillar 3: Creation of guidelines for management of burns in conflict scenario and framework for burn disaster management training. -Long – 24 to 36 months (Year 3) Pillar 1: Development of toolkit for dissemination of integrated quality improvement model (1.1). Effectiveness implementation study of outcome measures (1.2). Completion and write up of health economic study (1.3). Development and delivery of quality improvement training module (1.4). Pillar 2: Publication of results of community based prevention programme (2.2) and development of generic model (2.3) Pillar 3: Delivery of burn disaster training program, dissemination and translation of guidelines, assessment of effectiveness in preparedness. Our team has a strong track record of accessing additional funding and support from both international and national agencies to ensure effective programmes can be sustained and replicated: •The National Health Training Centre (NHTC) of Nepal has continued to fund further EBC training programmes in remote regions of rural Nepal. •The National Institute for Burns and Plastic Surgery (NIBPS) in Bangladesh has adopted many recommendations from our quality improvement programme, both in the hospital and in the national strategy for Bangladesh approved by the MOH. •Our local partner Acid Survivors Foundation has accessed additional national and international funding for ongoing EBC training. •DFID has funded a 3-year follow-up project (2016-9) based on the success of this programme in Bangladesh and Nepal and progress made in advocating with key ministries and agencies. The aim of all joint research by the Centre and Interburns is to create long-term sustainable solutions that can be scaled-up in target countries and replicated globally. All research streams will produce normative international guidelines and practical tools for quality improvement, prevention, outcome measurement, burn disaster preparedness and health economics, which can be utilised by other actors in the burns field globally. Our formal partnerships with other NGOs and health agencies are formed with the expectation of a 5 to 10-year commitment, reflecting the timeframe typically required to develop context-specific solutions, put these into practice, seek alternative funding for long-term sustainability and evaluate the full impact of interventions.

Lay abstract: The NIHR Global Health Research Group on Burn Trauma brings together a unique partnership of an academic university centre (the Centre for Global Burn Injury Policy & Research at Swansea University) and Interburns - an international organisation delivering education, training and capacity building in burn care and prevention across the globe. By harnessing the academic approach of a University Centre with the experience and international network of Interburns we will be able to ensure that the link from knowledge creation to delivering real change is robust and timely. This means improving services and outcomes for burns patients in some of the poorest and most conflict affected regions of the world. The objectives of this project are under three main pillars. Pillar one focuses on evaluating a comprehensive integrated approach to capacity building and quality improvement in burn care and prevention and creating a toolbox of learning materials that will enable others to use the same approach. This means that the success of programs already delivered in Nepal and Bangladesh can be replicated by others working in burn care in low resource environments - and this means improved care for patients. Pillar two will work with country partners to assess the burden of burns in selected communities and to draw on this information to develop community led prevention programs. This means finding out what causes burns, why they happen, when they happen, who is most likely to get burnt etc and then using this information to create appropriate prevention strategies. We will co-create a basic burn care training package that will provide the necessary knowledge and skills to frontline workers in some of the poorest and remotest regions of the world and then deliver this to 600 staff in three countries and evaluate the effectiveness and impact. Pillar three will look at burns in conflict and the management of mass casualty burns. Every year there are fire disasters involving hundreds of casualties and more often than not they occur in resource poor environments.We are working very closely with the World Health Organisation through the WHO Emergency Medical Teams Technical Working Group on Burns to establish evidence based recommendations for managing mass fire disasters. Aside from these major work streams we will also have a number of flexible research projects to allow us to respond to evolving situations and to opportunities that arise that can add value to our other research activities. The majority of our work will focus on Nepal, Ethiopia and the Palestinian Territories, however, one of the advantages working with an organisation such as Interburns is that lessons learnt can then be applied to other countries outside of the specific project sites, thus adding value to this applied research. We are fortunate to have a wealth of highly experienced and dedicated partners and colleagues to work with including Sagun a participatory research organisation who have been working in development for many years in Nepal, Medical Aid for Palestinians and through them colleagues within Al Quds University faculty of Public Health and AMREF in Ethiopia who have extensive experience working in the field of both research and delivery of care in East Africa.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;3.5 RESOURCES AND INFRASTRUCTURE (PREVENTION)
Health categories: INJURIES AND ACCIDENTS