Duke Emergency Medicine and Global Health

Duke’s Emergency Medicine Global Health section and program specializes in conducting healthcare quality improvement and public health minded research specifically in low and middle income settings.
providers at kilimanjaro christian medical centre
Kilimanjaro Christian Medical Center

Led by Dr. Catherine Staton, the EM Global Health research program works mainly in Moshi, Tanzania at Kilimanjaro Christian Medical Center and with collaborators in Brazil.

Research endeavors span from epidemiology and injury prevention to prehospital and hospital based quality improvement to secondary prevention and disability assessment. Methodologically, we conduct multiple methods including basic epidemiology, geographic information systems, mixed methods approaches, dynamic system modeling and network analyses. Currently, Dr. Staton is funded on an NIH K01 Career Development Award to create a Brief Negotiational Intervention for alcohol use among injury patients at Kilimanjaro Christian Medical Center in Moshi Tanzania.   

Program Highlights

  • Developing a Brief Negotiational Intervention for alcohol use among injury patients in Moshi, Tanzania
  • Assessing Mental Health among Traumatic Brain Injury Patients treated at Kilimanjaro Christian Medical Center, Moshi Tanzania
  • Improving Outcomes of Traumatic Brain Injury in Moshi, Tanzania:
    • Adult TBI Registry and Clinical Practice Guideline Implementation
    • Pediatrics TBI Registry and Clinical Practice Guideline Implementation
  • Vulnerable Road User, Road Traffic Injury Hotspots and Build Environmental Analysis (Tanzania, Rwanda, Sri Lanka)
  • Exploring Prisoner Health in Southern Brazil
  • Understanding Traumatic Brain Injury, its epidemiology and socioeconomic factors in Brazil


Vice Chair of Research Strategy & Faculty Development
Chief, Division of Translational Health Science
Associate Professor of Emergency Medicine


Joseph Reardon, MD, EM Resident
Daniel Shogilev, MD EM Resident
Deena El-Gabri, Masters of Science in Global Health student
Adriana Lein, Masters of Science in Global Health student
Roselyn Appenteng, Duke Medical Student

Selected Achievements

Health System Strengthening and Quality of Care Improvements

Quality care administration is a key pillar of health system strengthening. In many countries, especially Tanzania, quality improvement processes are not included in standard health systems. Therefore, in order to learn about multi-level quality improvement processes, we collaborated with colleagues to conduct the following studies. With Murano et al., I constructed the project, collected and analyzed data, and determined mortality rates in order to better inform limiting needless and costly end-of-life care for gunshot wound victims. With Dr. de Andrade, we used multi-modal research in order to understand limitations in access to treatment for myocardial infarction patients and I assisted in project creation, data analysis, and interpretation, as well as manuscript development.

a. Staton CA, M. D., Kiwango G, Vissoci VR, Andrade L, Lester R, Hocker M, Gerardo CJ, Mvungi M. (2015). A prospective registry evaluating the epidemiology and clinical care of Traumatic Brain Injury patients presenting to a Regional Referral Hospital in Moshi, Tanzania: challenges and the way forward. International Journal of Injury Control & Safety Promotion. doi: 10.1080/17457300.2015.1061562. PMID: 26239625

b. De Andrade L, Lynch C, Carvalho E, Rodrigues CG, Vissoci JR, Passos GF, Pietrobon, R, Nihei, OK, de Barros Carvalho, MD.  System dynamics modeling in the evaluation of delays of care in ST-segment elevation myocardial infarction patients within a tiered health system. PloS One 2014;9(7):e103577. PMCID: PMC4117497

Road Traffic Injury Prevention Initiatives

Currently, there are limited road traffic injury prevention initiatives which have been adopted to low and middle income settings. We have collaborated with colleagues internationally in order to increase knowledge about road traffic injury data limitations, create improved methods of road safety audits, and evaluate road traffic injury interventions.

a. De Andrade L, Vissoci JRN, Finato K, Rodrigues CG, Carvalho E, Pietrobon R, de Souza EM, Nihei OK, Lynch CA, Carvalho MDB. Brazilian Road Traffic Fatalities: A Spatial and Environmental Analysis. PLoS ONE 9(1): e87244. doi:10.1371/journal.pone.0087244. PMCID: PMC3907522

b. Sumner SA, Pallangyo AJ, Reddy EA, Maro V, Pence BW, Lynch C, Turner, EL, Egger, JR, Thielman, NM. Effect of free distribution of safety equipment on usage among motorcycle-taxi drivers in Tanzania- A cluster randomised controlled trial. Injury 2014 Nov; 45(11): 1681-6. PMID: 24861418

c. N. Periyasamy, CA Lynch, SD Dharmaratne, DB Nugegoda, T Ostbye. Under reporting of road traffic injuries in the district of Kandy, Sri Lanka. BMJ Open 2013; 3(11): e003640 doi:10.1136/bmjopen-2013-003640. PMCID: PMC3822300

d. Staton C, De Silva V, Krebs E, Andrade L, Rulisa S, Mallawaarachchi B, Jin K, Vissoci J, Ostbye T. High Road Utilizers Surveys Compared to Police Data for Road Traffic Crash Hotspot Localization in Rwanda and Sri Lanka. 2015 BMC Public Health, 16:53, DOI: 10.1186/s12889-015-2609-1 

e. Staton CA, Vissoci JRN, Gong E, et al. (2016) Road Traffic Prevention Initiatives; a systematic review and meta-summary of effectiveness in low and middle income countries, PLoS One, http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0144971

Ongoing Collaborations

  • Kilimanjaro Christian Medical Center, Moshi, Tanzania
  • Faculdad Uniga, Maringa, Brazil
  • Federal University of Minas Gerais, Belo Horizonte, Brazil
  • State University of Maringá, Maringá,Brazil
  • Hospital Norte Paranaense, Arapongas, Brazil

Advanced Training

  • Hubert Yeargan International Medicine and Global Health Fellowship
  • Medical Student Research Year

Collaborate with Us

If you are interested in collaborating with us, please contact:

Catherine A. Staton