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A new collaboration between 91����’s Injury Analytics Lab and Southern Africa Nazarene University in Eswatini will improve tools to document injuries in underrepresented populations locally and globally, while also strengthening research capacity in Eswatini.

If a bruise can’t be seen, it can’t be documented. If injuries can’t be documented, they can’t be treated or taken seriously in clinical or legal settings. Injuries that go undetected may be undertreated, misunderstood, or overlooked entirely, with real consequences for patients and survivors.

This challenge is at the center of a new international collaboration between 91����’s (IAL) and Southern Africa Nazarene University (SANU) in Eswatini. Through the Imaging of Naturally Occurring Skin Findings in Eswatini (INSIGHT-ES) project, researchers from both institutions are working to improve injury documentation while expanding research capacity in Eswatini. For years, the IAL has been focused on improving how injuries are detected, documented, and understood across diverse populations, and now the research is expanding globally.

Seeing Bruises

Bruises form beneath the surface of the skin. On individuals with darker skin tones, that can make bruising and similar injuries more difficult to see, and those injuries may also fade more quickly.

Researchers at IAL have made in using alternative light sources to enhance the visibility of bruises across a range of skin tones. By combining computer imaging, artificial intelligence, and clinical data, the team is developing approaches that strengthen injury detection in both clinical and forensic environments.

“What we’re building is not just an AI-based tool, but a way to make injury documentation more consistent and accessible across settings, explains IAL Co-Director and Professor of Health Informatics who leads development of IAL’s injury platform and software systems. “By combining existing health information with advanced imaging, we can build intelligent systems that collaborate with people to improve both the quality of the injury assessments and how they can be used to support care.”

IAL Co-Director and Professor of Engineering , adds, “The goal is a tool that is small, portable, and low-cost, making it easier to document injuries, particularly in remote or resource-constrained settings like those common in Eswatini or more rural areas of the U.S.” Lattanzi leads development of the lab’s computer vision systems and user-centered design.

Advancing the Science While Building Research Capacity

Through the partnership with SANU, IAL's work is expanding globally to develop a richer dataset while building research capacity in a country where it is critically needed. “We’re excited to partner with SANU,” said IAL Co-Director and Associate Professor of Nursing “They will bring to the project much-needed expertise in operating within Eswatini as well as important data related to accidental and violence-related injuries on darker skin tones.”

SANU’s proximity to Raleigh Fitkin Memorial Hospital provides a unique opportunity for data collection. Patients waiting to be seen may choose to participate in the study. That data will help improve future injury documentation on a range of different individuals and contribute to more equitable patient outcomes.

Those advances are especially important in Eswatini, where nearly half of women in (48.2%) have experienced physical or sexual violence during their lifetime () and 41% of reported perpetrators are intimate partners of the survivor (). By comparison, the estimates that about one in three women globally have experienced physical and/or sexual violence during their lifetime. Improving the ability to identify and document injuries across a wider range of skin tones could strengthen both patient care and forensic documentation for survivors.

“This work comes at a critical time for Eswatini, which has the highest HIV prevalence in the world, with an estimated 25 percent of its adult population living with HIV,” said Kevin Mallinson, a former faculty member in the College of Public Health who is consulting on the project and has worked in the country for decades. “More than 90 percent of HIV care in the country is delivered by nurses, which makes it especially important to strengthen both clinical practice and research capacity within the nursing workforce.”

Building sustainable research capacity is a central goal of the partnership. IAL researchers are providing workshops, mentoring SANU faculty in grant writing and research development, and working alongside them as collaborators, with SANU investigators serving as co-investigators on the project. The team is also helping develop SANU's health informatics program, creating opportunities to strengthen research and innovation long after the current project is complete.

Bongani Sibandze, PhD Nursing ’18, serves as the dean of SANU’s Faculty of Health Sciences and is one of only a small number of PhD-prepared nurses in Eswatini. He will lead the collaboration, which he sees as closely aligned with SANU's strategic goals.

Sibonile Dlamini, a department head and lecturer at SANU, will oversee the project's daily operations. Both Sibandze and Dlamini describe the collaboration as a potential turning point for research in Eswatini—one that could elevate the country's standing in global academic circles and benefit the nation well beyond the two institutions involved.

Overcoming the logistical and infrastructural challenges of conducting this research in Eswatini will itself generate insights applicable on a global scale. Ultimately, this project could serve as a model for interdisciplinary, international research—bringing together nursing, engineering, artificial intelligence, and public health to address inequities in care.

About the Injury Analytics Lab

Launched in 2026, 91����’s IAL brings together researchers from clinical science, engineering, artificial intelligence and health informatics to advance ongoing research focused on injury detection, assessment, and documentation. The lab serves as a hub for interdisciplinary projects that build on years of research to improve patient care, investigations, and legal proceedings.

IAL is directed by an interdisciplinary team including (School of Nursing, College of Public Health [CPH]), who leads the lab’s clinical research; (Department of Health Administration, Policy, and Informatics, CPH), who leads development of the injury platform and software systems; and (Volgenau School of Engineering, College of Engineering and Computing), who leads development of the computer vision systems.