HGOC Research

Our Approach

Fundamental to the work of HGOC is understanding the unique needs of the populations we aim to serve. HGOC uses rigorous scientific methodology to design and execute studies within five domains: burden and epidemiology of injury, health system navigation, health system capacity, economic impact of injury, and outcomes and cost-effectiveness of treatment. This improves our understanding of trauma care systems and the needs of patients and healthcare providers. Together with our partners, we share our findings with hospital leadership and national health ministries, publish peer-reviewed manuscripts in leading medical journals, and present our work at numerous international conferences. Using knowledge generated by our research, we work collaboratively with our partners to design feasible interventions to improve trauma and orthopaedic care. Research serves as the foundation upon which we build our educational curricula, our advocacy and policy agenda, and develop affordable innovations.

Recent projects

Improving access to musculoskeletal trauma care in Malawi
We are working in collaboration with Beit Cure Hospital, Queen Elizabeth Central Hospital, Kamuzu Central Hospital, Mzuzu Central Hospital, and the Malawian Ministry of Health on a variety of projects aimed at improving access to musculoskeletal trauma care in Malawi, particularly for the rural poor. We are examining risk factors for delayed presentation to hospital, health system navigation by patients, the financial impact of injury on patients, and the capacity to manage musculoskeletal trauma in the public hospitals. Specific projects have investigated femoral shaft, ankle, elbow/forearm/wrist, and proximal femoral fractures.

Bone Setting Associated Disability (BOSAD) in Ethiopia
In collaboration with the Department of Orthopaedic Surgery, Hawassa University Comprehensive Specialized Hospital, we are assisting in the analysis, interpretation, and policy recommendations for the multi-center BOSAD study that aims to prevent disabilities associated with traditional bonesetting practices in Ethiopia. The project includes a facility-based prospective study of patients managed by bonesetters prior to arrival at 8 tertiary centers from across Ethiopia: Bahirdar University, Gondar University, Assela University, Jimma University, Jigjiga University, Wachemo University, Haromiya University, and Hawassa University.

Low-cost negative pressure wound therapy in Cameroon
Learning from our colleagues in Haiti, and addressing a need expressed by our colleagues in Cameroon, we built low-cost negative pressure wound therapy pumps which are now being used for clinical care by our partners in the Cameroon Baptist Convention Health Services hospitals. We are investigating the feasibility and clinical efficacy of using these devices in the Cameroonian context to help manage open fractures. Check out our separate webpage on our project Vacuum-Assisted wound Therapy Affordable for All (VATARA).

The need for hand and upper extremity surgery in sub-Saharan Africa
This study is in collaboration with our partners in Queen Elizabeth Central Hospital, Malawi; Sourou Sanou University Hospital of Bobo-Dioulasso, Burkina Faso; CHU Aristide Le Dantec, Sénégal; Omdurman Islamic University, Sudan; and the AO Alliance. We are working with clinical providers across sub-Saharan Africa to identify the most common hand and upper extremity pathologies in each country and the local capacity to manage these conditions. We are developing priorities and core competencies for training in hand and upper limb trauma surgery by country and region.

The Roots of Pediatric Chronic Osteomyelitis in sub-Saharan Africa
Chronic osteomyelitis is a disease of poverty, unfortunately common among children living in rural areas with limited access to formal health services. We believe it is imperative to investigate the challenges associated with delayed diagnosis, management, and health systems navigation by affected patients. By identifying and addressing these causes, we can improve the quality of care for affected children. In partnership with colleagues in Malawi, Nigeria, Ethiopia, and Kenya, we are investigating socioeconomic barriers, limitations within healthcare systems, cultural influences, and parental factors, shedding light on the underlying causes contributing to delayed presentation.





Research informing Policy

We aim to translate our research findings into actionable policy initiatives. In Malawi, we worked with an expert panel of orthopaedic providers to create a consensus document defining technical priorities for orthopaedic trauma care development, and propose strategies to address the highest priority challenges. This document will be shared with the Malawian Ministry of Health and hopefully serve as a guide for foreign aid organizations and donors who seek to support orthopaedic system development in Malawi. This is a novel methodology that we will publish in a peer-reviewed journal and which we are replicating in collaboration with our partners in Ethiopia, South Sudan, and The Gambia.

  • Global

    Askew MR, Hinchman C, Rayel IM, Jenkins P, Dada A, Diallo M, Mengesha MG, Konadu-Yeboah D, Ndasi HT, Onyemaechi NO, Agarwal-Harding KJ. The Continued Role for Traditional Bonesetters in East and West Africa: an expert consensus statement. East Cent Afr J Surg. (Link)

    Dworkin M, Agarwal-Harding KJ, Joseph M, Cahill G, Konadu-Yeboah D, Makasa E, Mock C, the MSK Indicator Group. (2023) Indicators for the evaluation of musculoskeletal trauma systems: A scoping review and Delphi study. PLoS ONE. 2023;18(8): e0290816.

    Grisdela P Jr, Williams C, Challa S, Henson P, Agarwal-Harding K, Kwon JY. Screw-only fibular construct for Weber B ankle fractures: A retrospective clinical and cost comparison to assess feasibility for resource-limited settings. Injury. 2022 Oct 18:S0020-1383(22)00784-7.

    Agarwal-Harding KJ, Amlani LM, Ogawa T, Diallo M, Patel KR, Hamad H, Chokotho L, Coulibaly NF, Mudgal CS. Understanding the need for hand and upper extremity surgery in sub-Saharan Africa: a survey of providers [published online 2022 Aug 29]. East Cent Afr J Surg. 2022. (Link)

    Challa S, Agarwal-Harding KJ, Levy P, Barr-Walker J, Sabatini CS. Supracondylar humerus fractures in low- and lower middle-income countries: a scoping review of the current epidemiology, treatment modalities, and outcomes. Int Orthop. 2020 Nov;44(11):2443-2448.

    Bernstein DN, Agarwal-Harding KJ, Dyer GSM, Rozental TD. Outcomes Measurement in Global Hand Surgery. J Hand Surg Am. 2020 Jul 7;S0363-5023(20)30282-3.

    Dyer GSM. International Partnerships for Hand Surgery Education. Hand Clin. 2019 Nov;35(4):435-440.

    Usoro AO, Bhashyam A, Mohamadi A, Dyer GS, Zirkle L, von Keudell A. Clinical Outcomes and Complications of the Surgical Implant Generation Network (SIGN) Intramedullary Nail: A Systematic Review and Meta-Analysis. J Orthop Trauma. 2019 Jan;33(1):42-48.

    Agarwal-Harding KJ, von Keudell A, Zirkle LG, Meara JG, Dyer GS. Understanding and Addressing the Global Need for Orthopaedic Trauma Care. J Bone Joint Surg Am. 2016 Nov 2;98(21):1844-1853.

    Agarwal-Harding KJ, Meara JG, Greenberg SL, Hagander LE, Zurakowski D, Dyer GS. Estimating the global incidence of femoral fracture from road traffic collisions: a literature review. J Bone Joint Surg Am. 2015 Mar 18;97(6):e31.

    Kotagal M, Agarwal-Harding KJ, Mock C, Quansah R, Arreola-Risa C, Meara JG. Health and economic benefits of improved injury prevention and trauma care worldwide. PloS one. 2014;9(3):e91862.

    Haiti

    Ottesen TD, Montoya RL, Ogunleye TD, Brown KE, Woolley PM, Dejean JMCB, Qudsi RA, Agarwal-Harding KJ, Dyer GSM. Implementation and Impact Evaluation of a Virtual Orthopaedic Continuing Medical Education Conference in a Low-Resource Country. J Surg Educ. 2021 Sep-Oct;78(5):1629-1636.

    Dejean JMC, Pean JTM, Ottesen TD, Woolley PM, Qudsi RA, Dyer GSM. Advantages of a New Low-Cost Negative Pressure Wound Therapy Using the "Turtle VAC": A Case Series. JBJS Case Connect. 2021 Apr 15;11(2).

    Young JD, Bhashyam AR, Parisien RL, Van der Vliet Q, Qudsi RA, Fils J, Dyer GSM. Cross-Cultural Comparison of Nonopioid and Multimodal Analgesic Prescribing in Orthopaedic Trauma. J Am Acad Orthop Surg Glob Res Rev. 2020 May;4(5):e2000051.

    Ottesen TD, Qudsi RA, Kahanu AK, Baptiste BJ, Woolley PM, Socci AR, Dyer GSM. The Continued Utility and Viability of Dakin's Solution in Both High- and Low-resource Settings. Arch Bone Jt Surg. 2020 Mar;8(2):198-203.

    Young JD, Bhashyam AR, Qudsi RA, Parisien RL, Shrestha S, van der Vliet QMJ, Fils J, Losina E, Dyer GSM. Cross-Cultural Comparison of Postoperative Discharge Opioid Prescribing After Orthopaedic Trauma Surgery. J Bone Joint Surg Am. 2019 Jul 17;101(14):1286-1293.

    Karhade AV, Qudsi RA, Usoro AO, Dejean CB, Dyer GSM. Education Improves Musculoskeletal Radiology Interpretation by Trainees in a Low-Resource Setting. J Surg Educ. 2019 Jun 17. pii: S19317204(18)30944-9.

    Qudsi RA, Selzer F, Hill SC, Lerner A, Hippolyte JW, Jacques E, Alexis F, May CJ, Cady RB, Losina E. Clinical outcomes and risk-factor analysis of the Ponseti Method in a low-resource setting: Clubfoot care in Haiti. PLoS One. 2019 Mar 14;14(3):e0213382.

    Dyer GSM. Haitian Annual Conference on Orthopaedic Traumatology: Building Surgical Capacity Through Academic Collaboration. J Orthop Trauma. 2018 Oct;32 Suppl 7:S16-S17.

    Qudsi RA, Roberts HJ, Bhashyam AR, Losina E, Bae DS, Alexis F, Dyer GS. A Self-Reported Needs Assessment Survey of Pediatric Orthopaedic Education in Haiti. J Surg Educ. 2018 Jan - Feb;75(1):140146.

    Bhashyam AR, Logan C, Roberts HJ, Qudsi RA, Fils J, Dyer GSM. A Randomized Controlled Pilot Study of Educational Techniques in Teaching Basic Arthroscopic Skills in a Low-income Country. Arch Bone Jt Surg. 2017 Mar;5(2):82-88.

    Fils J, Bhashyam AR, Pierre Pierre JB, Meara JG, Dyer GS. Short-Term Performance Improvement of a Continuing Medical Education Program in a Low-Income Country. World J Surg. 2015 Oct;39(10):2407-12.

    Bhashyam AR, Fils J, Lowell J, Meara JG, Dyer GS. A novel approach for needs assessment to build global orthopedic surgical capacity in a low-income country. J Surg Educ. 2015 Jul-Aug;72(4):e2-8.

    Shah S, Dalal A, Smith RM, Joseph G, Rogers S, Dyer GS. Impact of portable ultrasound in trauma care after the Haitian earthquake of 2010. Am J Emerg Med. 2010 Oct;28(8):970-1.

    Smith RM, Dyer GS, Antonangeli K, Arredondo N, Bedlion H, Dalal A, Deveny GM, Joseph G, Lauria D, Lockhart SH, Lucien S, Marsh S, Rogers SO, Salzarulo H, Shah S, Toussaint RJ, Wagoner J. Disaster triage after the Haitian earthquake. Injury. 2012 Nov;43(11):1811-5.

    Malawi

    Dworkin M, Harrison WJ, Chidothi P, Mbowuwa F, Martin C Jr, Agarwal-Harding K, Chokotho L. Epidemiology and Treatment of Distal Radius Fractures at Four Public Hospitals in Malawi. J Am Acad Orthop Surg Glob Res Rev. 2024 Mar 26;8(4):e23.00282.

    Mody KS, Wu HH, Chokotho LC, Mkandawire NC, Young S, Lau BC, Shearer D, Agarwal-Harding KJ. The Socioeconomic consequences of femoral shaft fracture for patients in Malawi. Malawi Med J. 2023 Sep;35(3):141-150.

    Agarwal-Harding KJ, Chokotho LC, Young S, Kamalo, PD, Makasa EM, Mkandawire N. The presence and availability of essential diagnostics in Malawian district and central hospitals. East Cent Afr J Surg. 2021;26(3):120-129.

    Agarwal-Harding KJ, Atadja L, Chokotho LC, Banza LB, Mkandawire N, Katz JN. The experiences of adult patients receiving treatment for femoral shaft fractures at Kamuzu Central Hospital, Malawi: a qualitative analysis East Cent Afr J Surg. 2022;27(1):1-9.

    Mlinde E, Amlani LM, May CJ, Banza LN, Chokotho L, Agarwal-Harding KJ. Outcomes of Nonoperatively Treated Pediatric Supracondylar Humeral Fractures at the Nkhotakota District Hospital, Malawi. JBJS Open Access. 2021 Aug 11;6(3):e21.00011.

    Chokotho L, Donnelley CA, Young S, Lau BC, Wu HH, Mkandawire N, Gjertsen JE, Hallan G, Agarwal-Harding KJ, Shearer D. Cost utility analysis of intramedullary nailing and skeletal traction treatment for patients with femoral shaft fractures in Malawi. Acta Orthop. 2021 Aug;92(4):436-442.

    Mlinde E, Chokotho L, Agarwal-Harding KJ. Clinical and functional outcomes of Paediatric femoral shaft fractures managed non-operatively at Nkhotakota District Hospital, Malawi. Malawi Med J. 2021 Mar;33(1):7-14.

    Agarwal-Harding KJ, Kapadia A, Banza LN, Chawinga M, Mkandawire N, Kwon JY. Improving Management of Adult Ankle Fractures in Malawi: An Assessment of Providers' Knowledge and Treatment Strategies. J Bone Joint Surg Am. 2021 Feb 17;103(4):326-334.

    Agarwal-Harding KJ, Chokotho LC, Young S, Mkandawire N, Losina E, Katz JN. A nationwide survey investigating the prevalence and incidence of adults with femoral shaft fractures receiving care in Malawian district and central hospitals. East and Central African Journal of Surgery. 2020 5(3):e20200003.

    Agarwal-Harding KJ, Chokotho LC, Young S, Mkandawire N, Chawinga M, Losina E, Katz JN. Assessing the capacity of Malawi’s district and central hospitals to manage traumatic diaphyseal femoral fractures in adults. PLoS ONE. 2019 Nov 14(11):e0225254.

    Agarwal-Harding KJ, Chokotho LC, Mkandawire NC, Martin C Jr, Losina E, Katz JN. Risk Factors for Delayed Presentation Among Patients with Musculoskeletal Injuries in Malawi. J Bone Joint Surg Am.2019 May 15;101(10):920-931. doi: 10.2106/JBJS.18.00516.

    Lau BC, Wu HH, Mustafa M, Ibrahim J, Conway D, Agarwal-Harding K, Shearer DW, Chokotho L. Developing Research to Change Policy: Design of a Multicenter Cost-Effectiveness Analysis Comparing Intramedullary Nailing to Skeletal Traction in Malawi. J Orthop Trauma. 2018 Oct;32 Suppl 7:S52-S57.

    Uganda

    Alves K, Katz JN, Sabatini CS. Gluteal Fibrosis and Its Surgical Treatment. J Bone Joint Surg Am. 2019 Feb 20;101(4):361-368.

    Alves K, Godwin CL, Chen A, Akellot D, Katz JN, Sabatini CS. Gluteal fibrosis, post-injection paralysis, and related injection practices in Uganda: a qualitative analysis. BMC Health Serv Res. 2018 Nov 26;18(1):892.

    Alves K, Penny N, Ekure J, Olupot R, Kobusingye O, Katz JN, Sabatini CS. Burden of gluteal fibrosis and post-injection paralysis in the children of Kumi District in Uganda. BMC Musculoskelet Disord. 2018 Sep 24;19(1):343.

    Alves K, Penny N, Kobusingye O, Olupot R, Katz JN, Sabatini CS. Paediatric musculoskeletal disease in Kumi District, Uganda: a cross-sectional survey. Int Orthop. 2018 Aug;42(8):1967-1973.

    India

    Kanumuri S, Subhansab SK, Agarwal-Harding KJ, Vamsi Krishna S. Open Exploration and Reduction of Paediatric Supracondylar Humerus Fracture with Pink, Pulseless Hand in Resource-Limited Settings. J Hand Surg Asian Pac Vol. 2024 Apr;29(2):118-124.

    United States

    Ottesen TD, Amick M, Kapadia A, Ziatyk EQ, Joe JR, Sequist TD, Agarwal-Harding KJ. The Unmet Need for Orthopaedic Services Among American Indian and Alaska Native Communities in the United States. J Bone Joint Surg Am. 2022 Feb 1.

    Other Publications with our Collaborators

    Roberts HJ, Albright PD, Shearer DW, Won N, MacKechnie MC, Richard Coughlin R, Miclau T 3rd, Morshed S, Sabharwal S; COACT Resident Rotation Study Group. Motivations and impact of international rotations in low- and middle-income countries for orthopaedic surgery residents: Are we on the same page? Am J Surg. 2021 Feb;221(2):245-253.

    Miclau T, MacKechnie MC, Born CT, MacKechnie MA, Dyer GSM, Yuan BJ, Dawson J, Lee C, Ishmael CR, Schreiber VM, Tejwani NC, Ulmer T, Shearer DW, Agarwal-Harding KJ, Johal H, Khormaee S, Sprague S, Whiting PS, Roberts HJ, Coughlin R, Gosselin R, Rosenwasser MP, Johnson A, Babu JM, Dworkin M, Makhni MC, McClellan T, Nwachuku CO, Miclau E, Morshed S. International Orthopaedic Volunteer Opportunities in Low and Middle-Income Countries. J Bone Joint Surg Am. 2021 Dec 21.

    Shapiro LM, Global-Quest Investigators. Measuring and Improving the Quality of Care During Global Outreach Trips: A Primer for Safe and Sustainable Surgery. J Hand Surg Am. 2020 Sep;45(9):851-856.e2.

    Roberts HJ, Albright PD, Shearer DW, Won N, MacKechnie MC, Richard Coughlin R, Miclau T 3rd, Morshed S, Sabharwal S; COACT Resident Rotation Study Group. Motivations and impact of international rotations in low- and middle-income countries for orthopaedic surgery residents: Are we on the same page? Am J Surg. 2020 Sep 12:S0002-9610(20)30538-9.

    Miclau T, MacKechnie MC, Shearer DW; COACT group. Consortium of Orthopaedic Academic Traumatologists: A Model for Collaboration in Orthopaedic Surgery. J Orthop Trauma. 2018 Oct;32 Suppl 7:S3-S7.

    Ng-Kamstra JS, Greenberg SLM, Abdullah F, Amado V, Anderson GA, Cossa M, Costas-Chavarri A, Davies J, Debas HT, Dyer GSM, Erdene S, Farmer PE, Gaumnitz A, Hagander L, Haider A, Leather AJM, Lin Y, Marten R, Marvin JT, McClain CD, Meara JG, Meheš M, Mock C, Mukhopadhyay S, Orgoi S, Prestero T, Price RR, Raykar NP, Riesel JN, Riviello R, Rudy SM, Saluja S, Sullivan R, Tarpley JL, Taylor RH, Telemaque LF, Toma G, Varghese A, Walker M, Yamey G, Shrime MG. Global Surgery 2030: a roadmap for high income country actors. BMJ Glob Health. 2016 Apr 6;1(1):e000011.

HGOC Research Fellowship


The Harvard Global Orthopaedics Collaborative has multiple opportunities for medical students and residents to get involved in research, education, and policy initiatives. If you are interested in working with us, please contact harvardglobalortho@gmail.com.

Full-time Research Fellows:

  • Ami Kapadia - UT Southwestern Medical School (Malawi, Summer 2019)

  • Louis Atadja - UT Southwestern Medical School (Boston, Summer 2019)

  • Lahin Amlani - Johns Hopkins School of Medicine (Malawi, Full year, 2022-2023)

  • Leon Zhou - Warren Alpert Medical School of Brown University (Boston, Summer 2024)

  • Samuel Paek - Geisinger Commonwealth School of Medicine (Malawi, Full year, 2023-2024)

  • Shravya Kakulamarri - UT Southwestern Medical School (Malawi, Summer 2024)

  • Emily Powis - Harvard Medical School (Malawi, Summer 2024)

  • Jerry Zhang - Harvard Medical School (Boston, Summer 2024)

Research Associates:

  • Cameron Almeida - Northeast Ohio Medical University

  • Krishna Anand - Texas A&M College of Medicine

  • Morgan Askew, MD - Warren Alpert Medical School of Brown University

  • Benjamin Cassidy - Virginia Commonwealth University School of Medicine

  • Antoinette Charles, MPH - Duke University School of Medicine

  • Bianca Dua - University of Rochester School of Medicine and Dentistry

  • Nikhil Gattu - McGovern Medical School at UTHealth Houston

  • Carrie Hinchman - New York Medical College

  • Catherine Hua - Harvard Medical School

  • Samhita Kadiyala - Harvard Medical School

  • Sanjana Kanumuri - University of Washington School of Medicine

  • Sophia Mavrommatis - University of Minnesota Medical School

  • Yak Nak - University of Missouri-Columbia School of Medicine

  • Isaiah Michael Rayel - National University Ireland Galway, School of Medicine

  • Raisa Rauf - Boston University School of Medicine

  • Nathan Saxby, MD, MPH - Dartmouth-Hitchcock Medical Center

  • Shahnur Shah, MBChB - Kiambu Referral Hospital, Kenya

  • Oscar Shen - Chinese University of Hong Kong Faculty of Medicine

  • Sam Simister, MD - University of California - Davis

  • Rafat Solaiman - University of Minnesota Medical School

  • Teja Yeramosu - Virginia Commonwealth University School of Medicine

  • Louise Atadja 2018-2020

    Ami Kapadia 2018-2020

    Kush Mody 2018-2020

    Kenneth Nanyumba 2018-2021

    Preston Jenkins 2020-2023

    Ahsia Clayton - 2021-2022

    Noe Treviño 2022-2023

    Iryna Ivasyk 2022-2023