Traumatic brain injury (TBI) is a major contributor to long-term neurodisability in children worldwide, with a disproportionately higher impact in low-income countries such as Uganda. The challenges in these settings are multifaceted, including a high incidence of road traffic accidents, insufficient trauma diagnosis and care infrastructure, and limited access to post-TBI rehabilitation services. These issues are further exacerbated by a scarcity of empirical data linking objective diagnostic and prognostic measures, such as minimally invasive biomarkers, to TBI outcomes. Since 2019, Kei Kawata has been actively collaborating with Dr. Dibya Datta at the Indiana University School of Medicine on pediatric TBI diagnosis and prognosis in Uganda. Dr. Datta, originally trained in infectious diseases and neuropharmacology, has focused primarily on cerebral malaria in Uganda. However, in her efforts to expand into TBI research, she initiated this collaboration. Through the exchange of expertise—my background in TBI and her extensive experience in conducting research in resource-limited settings—Kawata has gained valuable insights into the logistical and operational challenges of conducting clinical research in such environments (Datta, Bangirana et al. 2021 JAMA Netw Open, Datta, Gopinadhan et al. 2023 Brain Commun).

 

Since 2022, Kei Kawata have served as a Co-Investigator on Dr. Datta’s R21 project (R21NS129234: Blood Biomarkers and Risk Factors of Acute Brain Injury Associated with Neurodisability in Ugandan Children [BRAIN-Child]). Our study has leveraged Abbott’s portable point-of-care biomarker assessment, revealing the strong diagnostic potential of glial fibrillary acidic protein (GFAP) as a marker of astrocyte activation (Figure 4). Notably, GFAP demonstrated 97% accuracy in distinguishing Ugandan children with TBI from community controls, with a sensitivity of 95% and a specificity of 88%. Furthermore, elevated GFAP levels at admission showed moderate predictive value (~73%) in identifying pediatric TBI patients who exhibited neurological deficits at discharge and at the two-week follow-up. A manuscript detailing these findings is currently under review in JAMA Pediatrics (Datta, Muhindo….& Kawata, JAMA Pediatrics). Fueled by success of our R21 project, Dr. Datta and I worked collaboratively as MPI to develop an R01 (R01NS145245), which has recently received a score of 31st percentile. Currently in the talks of finding a way to resubmit this R01. This effort involved Kawata traveling to Kampala, Uganda to assess capability to build a brain trauma center.