Title: NIHR Global Health Research Group on Nepal Injury Research, University of the West of England, Bristol
Funder: Department of Health and Social Care

Abstract: a)Strategic objectives of the host university and creating an environment for LMIC research At UWE research and knowledge exchange underpin the strategy to address real-world challenges [13]. UWE’s REF 2014 achievements show the excellent relationships researchers have with their collaborators enabling impact, and justify claims to be a ‘partnership university’. UWE has a breadth of research supporting sustainable growth and welfare development in LMICs, securing funding from Research Councils, DfID, Wellcome Trust, UNICEF and Bill & Melinda Gates Foundation. This has enabled strong partnering with LMIC students, researchers and NGOs to support impact. b)Why UWE is well placed to make this application UWE’s health research activities are supported by 144 staff within research centres/groups including; Health and Clinical Research; Floods, Communities and Resilience; Transport and Society; Public Health & Wellbeing and The WHO Collaborating Centre for Healthy Urban Environments. Research teams adhere to UWE governance on ethics, data management, equality and diversity, and have delivered multiple NIHR, ERDF and WHO projects, with an excellent record of achieving targets, on time and within budget. UWE is committed to continually enhancing its researchers with emphasis on career development, mentoring and forums for sharing best practice. c)Existing partnerships; plans to complement these and build capacity and capability Leading UWE and University of Bristol (UOB) researchers have collaborated on injury prevention since 2004, including co-supervision of LMIC students. Three Nepalese graduates are co-applicants; Pant (PhD 2013), Bhatta (PhD 2017) and Banstola (MSc Public Health 2015). Mytton, Emond, and Deave collaborate in the Children’s Burns Research Centre [14] and link with Potokar at the Centre for Global Burn Injury Policy and Research [15]. Bristol Randomised Trials Collaborative have the infrastructure to provide methodological training for the NIRC and a web-based database facility for injury surveillance. The Royal Society for the Prevention of Accidents (RoSPA) have funded research (Pant). We have a long track record of UK-LMIC partnerships. Our proposed academic partner in Nepal is Kathmandu Medical College, Kathmandu University. Joshi (published with Pant), will host the NIRC in the Department of Community Medicine. We work closely with the Centre for Injury Prevention Research Bangladesh (CIPRB)[16], who will provide operational and strategic guidance on establishing and sustaining a research centre in a LMIC. Strong links with WHO Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention will support the development, delivery and sustainability of the NIRC; Peden and Towner have written extensively on injury prevention publications from WHO [2,3,17], and Mytton, Deave, and Pant have peer reviewed WHO guidance. Mikton (UWE), previously Technical Officer at WHO, has expertise in capacity development in LMICs. Ivers works closely with the WHO and undertakes research with CIPRB and Potokar. The WHO Nepal Office have offered to work with us to engage ministers and stakeholders and develop a sustainability plan. We have worked with NGOs in Nepal for 24 years. d)Programme and fit with global health agenda. The NIRC will deliver 4 work streams: (1) Engaging with stakeholders to listen to communities, Government ministers, NGOs and other stakeholders, to identify priorities, develop interventions collectively and maximise potential to influence policy; (2) Evidence through data to measure the burden and nature of injuries and monitor intervention impacts. We will implement WHO and other injury surveillance guidelines [18-21] and collect risk data using methods trialled at CIPRB; (3) Effective and cost effective interventions. Based on identified priorities we will either adapt proven interventions (e.g. WHO Save LIVES technical package [22]) or co-create novel interventions to meet local needs. Our previous research and advice from Nepalese partners suggest three initial areas of focus; road danger reduction, home safety and first response to trauma; 4) Enhancing capacity and enabling sustainability, to develop leadership and researcher capacity and maximise potential for sustainability beyond 2020. The programme supports UN Sustainability Development Goal 3 (Healthy Lives), target 3.6; to halve the number of deaths and injuries from road traffic accidents by 2020. The Nepal Ministry of Health set this target in its Health Sector Strategy for 2015-2020 [23]. Injury affects the most disadvantaged and consequences of injury can induce poverty, so efforts to reduce injury may contribute to other SDGs; Reducing Inequality (SDG10) and Poverty (SDG1). The programme will address WHO World Reports on Child Injury and Road Traffic Injury Prevention recommendations i.e. to improve data quality, build the evidence base, support systems-based safety and inform policy, environmental change and education. International collaborations and capacity strengthening In the first 6 months we will prepare a contract between UWE and KMC, and build relationships with Government ministers, academics and Heads of NGOs. Whilst the NIRC main office will eventually be in Kathmandu, research activities will take place in Makwanpur district, 90km to the south, where we have previously completed injury studies with MIRA, a research NGO [24]. MIRA will provide a temporary office and access to research and support staff for up to 18 months. We will establish a field office in Hetauda, Makwanpur. This location, at the junction of the East-West Highway and the North-South road to Kathmandu, provides major road corridors, and both urban and rural communities, to conduct intervention development studies. The district includes the three distinct topographical areas typical of Nepal; research conducted here has the potential to be applicable to the whole country. Stakeholder workshops will inform the centre strategy and therefore the capacity needed. Development of research skills within NIRC and Nepal We will map the existing capability of Nepal researchers and the availability of governance and research support, leading to a capacity and capability development plan by end Year 1. We will foster local ownership of the plan through university and ministerial endorsement. Qualitative studies of researchers in Years 2 & 3 will inform the ongoing strategy. Training in Nepal will include research methods, governance, community engagement, securing funding, publication and knowledge transfer. We will support individuals to identify courses that meet their needs, and submit scholarship applications, where necessary. Meetings where projects and challenges can be discussed in a constructive manner will be encouraged. Joint project oversight by UK and Nepalese supervisors will support co-learning. Measurable 6-month delivery targets • Met executive and academic leaders in KMC leading to a contract with UWE • Met Government ministers, Heads of NGOs, and key stakeholders to understand priorities and record shared agendas • Agreed Terms of Reference for the Management Board, International Advisory Committee & National Injury Advisory Group • Drafted NIRC operating procedures; terminology, ethics, communications, publications and dissemination • Planned set up of Hetauda office and scoped potential study sites • CIPRB visited KMC to advise on NIRC • Reported a scoping study of existing policy and legislation, injury data sources, publications, and prevention agencies / initiatives Medium and long term aims and objectives By the end of Yr 1 we aim to have established the Makwanpur office and started projects; •Visited CIPRB to inform sustainable establishment of the NIRC •Mapped staff skills & resources to prepare capacity and capability plan •Agreed sites for road safety, home safety and first responder projects and engaged with local communities •Established a forum to develop a hospital based injury surveillance system •Held 1st National Injury Forum (NIF) to draft a Nepal injury prevention research action plan By the end of Year 2 we aim to have established the NIRC within KMC. We have: •Designed and be piloting a hospital based injury surveillance system •Completed literature review updates of prioritised interventions •Established data collection at road safety sites •Set up surveys, working with mother’s groups and health volunteers to identify home injury hazards •Developed a first responder training programme and planned Year 3 pilot •Held 2nd NIF to discuss progress and share research By 3 years we will have established a sustainable NIRC. We have: •Identified major injuries and risks, submitting a paper to a high impact journal on the epidemiology of injury in Nepal •Extended injury surveillance to communities, with management of the system led by the Nepal team •Identified financial and in-kind support for sustainability of the NIRC .Established fora with communities, academics and Government to disseminate evidence •Submitted at least 1 funding bid to test a selected intervention for effectiveness and cost effectiveness •Held 3rd NIF to plan future injury prevention research in Nepal e)We do not plan to commission external research within this application. f)Sustainability plans By 3 years we will have established the NIRC as credible, with robust surveillance, internationally recognised outputs, and able to secure ongoing support from the Nepal Government and KMC. With the WHO Nepal Office we will explore the potential for the NIRC to become a WHO Collaborating Centre. Mapping of skills will show progress in building research capacity and capability and inform future plans. We will seek funding from the Nepal Government, NGOs and external agencies and submit applications for specific studies e.g. MRC, UBS Optimus Foundation

Lay abstract: Injuries are the predictable and preventable outcome of particular circumstances. Injury is one of the world’s most preventable and pressing public health problems, although currently both neglected and underfunded. One third of the world’s morbidity and mortality due to injuries occur in the 11 countries of the South East Asia Region , of which Nepal is one of the poorest. Nepal has very high rates of unintentional injury, including from natural disasters road injury and others. In 2015 earthquakes killed almost 9000 and injured over 22000 people. Globally, road traffic injuries are projected to rise from the 8th to the 5th leading cause of death by 2030, with the majority occurring in low and middle income countries (LMICs). A huge road building programme in Nepal over the last decade has seen 80078km of roads built and vehicle numbers increased by 800000 in the last 4 years. Many new roads do not have proven safety features and are poorly maintained. Nepal lacks a national road safety agency, vehicle safety standards and there is limited enforcement of traffic safety legislation. Road traffic injuries and deaths are increasing but without any injury surveillance, robust death registration or complete traffic police injury systems, the true numbers are unknown. Household surveys and hospital data suggest that home injuries (e.g. falls, burns, poisoning), occupational and animal injuries are significant but true estimates are unclear. In addition, there are poor emergency services, so injured people often travel for hours to the nearest hospital without any stabilisation of their injuries, and many deteriorate or die during the journey.

Research activity codes: 3.5 RESOURCES AND INFRASTRUCTURE (PREVENTION);8.5 RESOURCES AND INFRASTRUCTURE (HEALTH SERVICES)
Health categories: INJURIES AND ACCIDENTS