RESUMEN
BACKGROUND: Operating rooms contribute to over 40% of hospital expenses, with a portion attributed to waste from single-use, sterile surgical supplies (SUSSS). This research aimed to determine the amount of cost wastage due to not using SUSSS during laparotomy procedures. METHODS: A descriptive-analytical investigation was conducted in two prominent teaching hospitals in Mashhad, Iran 2018. Seventy-seven laparotomy surgeries were scrutinized, documenting both used and unused disposable devices, with their respective costs being assessed. Data analysis was performed using SPSS version 16 software. RESULTS: The study revealed that during surgery in the operating rooms, waste of SUSSS averaged 5.9%. Betadine solution and sterile Gauze types were the top two contributors to resource wastage. Sterile Gauze types incurred the highest cost loss. The study found a significant correlation between cost wastage and surgeon experience (r = 0.296, P < 0.001) as well as surgery duration (r = 0.439, P < 0.001). CONCLUSION: Inadequate management of available and commonly used disposable supplies leads to increased hospital expenses. Enhancing the surgical team's knowledge of sterile surgical supplies usage and making thoughtful selections can play a vital role in curbing health costs by minimizing waste of SUSSS in the operating rooms.
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Laparotomía , Quirófanos , Humanos , Laparotomía/economía , Quirófanos/economía , Quirófanos/organización & administración , Irán , Hospitales de Enseñanza , Esterilización/economía , Residuos Sanitarios/economía , Residuos Sanitarios/estadística & datos numéricos , Equipos Desechables/economía , Equipos Desechables/provisión & distribución , Equipos Desechables/estadística & datos numéricosRESUMEN
BACKGROUND: Single-use materials and equipment are regularly opened by the surgical team during procedures but left unused, potentially resulting in superfluous costs and excess environmental waste. OBJECTIVE: This study aimed to estimate the excess use of surgical supplies in minimally invasive benign gynecologic surgeries. STUDY DESIGN: This is a prospective observational study conducted at a university-affiliated single tertiary medical center. Designated study personnel were assigned to observe surgical procedures performed during July to September 2022. Surgical teams were observed while performing surgeries for benign indications. The teams were not informed of the purpose of the observation to avoid potential bias. Disposable materials and equipment opened during the procedure were documented. Excess supplies were defined as those opened but left unused before being discarded. Costs per item of the excess supplies were estimated on the basis of material and equipment costs provided by the hospital. RESULTS: A total of 99 surgeries were observed, including laparoscopic (32%), robotic (39%), hysteroscopic (14%), vaginal (11%), and laparotomy procedures (3%). Excess use of surgical supplies was documented in all but one procedure. The total cost across all surgeries reached $6357. The contained tissue extraction bag was the most expensive item not used (Applied Medical, Rancho Santa Margarita, CA; $390 per unit) in 4 procedures, contributing 25.54% to the total cost. Raytec was the most common surgical waste, with a total of n=583 opened but unused (average n=5.95 per surgery). A significant difference was found in the rate of excess supplies across the surgical approaches, with robotic surgery contributing 52.19% of the total cost (P=.01). CONCLUSION: Excess use of disposable materials and equipment is common in minimally invasive benign gynecologic surgeries and contributes to superfluous costs and excess environmental waste. It is predominantly attributed to the opening of inexpensive materials that are left unused during the procedure. Increased awareness of costs and generated waste may reduce excess use of surgical supplies and should be further explored in future research.
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Procedimientos Quirúrgicos Ginecológicos , Procedimientos Quirúrgicos Robotizados , Humanos , Femenino , Procedimientos Quirúrgicos Ginecológicos/instrumentación , Procedimientos Quirúrgicos Ginecológicos/economía , Procedimientos Quirúrgicos Ginecológicos/estadística & datos numéricos , Estudios Prospectivos , Procedimientos Quirúrgicos Robotizados/economía , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos , Procedimientos Quirúrgicos Robotizados/instrumentación , Procedimientos Quirúrgicos Mínimamente Invasivos/economía , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Laparoscopía/economía , Laparoscopía/estadística & datos numéricos , Laparoscopía/instrumentación , Histeroscopía/economía , Histeroscopía/estadística & datos numéricos , Equipos Desechables/economía , Equipos Desechables/provisión & distribución , Laparotomía/economía , Adulto , Persona de Mediana EdadRESUMEN
The diagnosis of COVID-19 relies on the direct detection of SARS-CoV-2 RNA in respiratory specimens by RT-PCR. The pandemic spread of the disease caused an imbalance between demand and supply of materials and reagents needed for diagnostic purposes including swab sets. In a comparative effectiveness study, we conducted serial follow-up swabs in hospitalized laboratory-confirmed COVID-19 patients. We assessed the diagnostic performance of an in-house system developed according to recommendations by the US CDC. In a total of 96 serial swabs, we found significant differences in the accuracy of the different swab systems to generate a positive result in SARS-CoV-2 RT-PCR, ranging from around 50 to 80%. Of note, an in-house swab system was superior to most commercially available sets as reflected by significantly lower Ct values of viral genes. Thus, a simple combination of broadly available materials may enable diagnostic laboratories to bypass global limitations in the supply of swab sets.
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Prueba de Ácido Nucleico para COVID-19/instrumentación , COVID-19/diagnóstico , Equipos Desechables/provisión & distribución , Técnicas de Diagnóstico Molecular/instrumentación , SARS-CoV-2/aislamiento & purificación , Prueba de Ácido Nucleico para COVID-19/métodos , Técnicas de Laboratorio Clínico , Pruebas Diagnósticas de Rutina , Genes Virales , Humanos , Técnicas de Diagnóstico Molecular/métodos , Control de Calidad , ARN Viral/análisis , Reproducibilidad de los Resultados , Asignación de Recursos , Manejo de EspecímenesRESUMEN
BACKGROUND: To date, the literature surrounding healthcare sustainability has focused largely on operating rooms, energy efficiency and biohazardous waste management. Few studies have looked at the sustainability within intensive care units (ICUs). OBJECTIVE: Our study sought to capture the array of sustainability initiatives undertaken by Canadian ICUs and gain a better understanding of current practices with regard to the management of single-use equipment waste. METHODS: We conducted a nationwide e-mail survey through the Canadian Critical Care Network. RESULTS: We received responses from a total of 81 hospital sites representing all 10 Canadian provinces and approximately 28.3% of all Canadian ICUs. The vast majority of responses came from ICU managers or nursing leadership. Our study identified variable waste management practices across the country and showcased successful initiatives undertaken by Canadian ICUs toward increased environmental sustainability.
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Equipos Desechables/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Administración de Residuos/métodos , Canadá , Equipos Desechables/provisión & distribución , Hospitales , Humanos , Encuestas y CuestionariosAsunto(s)
Broncoscopios , Broncoscopía/instrumentación , COVID-19 , Infección Hospitalaria/prevención & control , Transmisión de Enfermedad Infecciosa/prevención & control , Equipos Desechables/provisión & distribución , Control de Infecciones/métodos , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/transmisión , Infección Hospitalaria/virología , Humanos , SARS-CoV-2/aislamiento & purificaciónRESUMEN
Both polyester and foam nasal swabs were collected from convalescent COVID-19 patients at a single visit and stored in viral transport media (VTM), saline or dry. Sensitivity of each swab material and media combination were estimated, three by three tables were constructed to measure polyester and foam concordance, and cycle threshold (Ct) values were compared. 126 visits had polyester and foam swabs stored in viral transport media (VTM), 51 had swabs stored in saline, and 63 had a foam swab in VTM and a polyester swab stored in a dry tube. Polyester and foam swabs had an estimated sensitivity of 87.3% and 94.5% respectively in VTM, 87.5% and 93.8% respectively in saline, and 75.0% and 90.6% respectively for dry polyester and foam VTM. Polyester and foam Ct values were correlated, but polyester showed decreased performance for cases with a viral load near the detection threshold and higher Ct values on average.
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Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico , Convalecencia , Infecciones por Coronavirus/virología , Cavidad Nasal/virología , Pandemias , Neumonía Viral/virología , Poliésteres , Poliuretanos , Manejo de Especímenes/instrumentación , Adulto , Betacoronavirus/genética , COVID-19 , Prueba de COVID-19 , Infecciones por Coronavirus/diagnóstico , Medios de Cultivo , Equipos Desechables/provisión & distribución , Femenino , Personal de Salud , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , ARN Viral/análisis , Distribución Aleatoria , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , SARS-CoV-2 , Solución Salina , Sensibilidad y Especificidad , Manejo de Especímenes/métodos , Carga ViralRESUMEN
CDC and WHO guidelines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis only recommend synthetic fiber swabs for nasopharyngeal (NP) sampling. We show that cotton-tipped plastic swabs do not inhibit PCR and have equivalent performance to rayon swabs. Cotton-tipped plastic swabs are massively produced worldwide and would prevent swab supply shortages under the current high SARS-CoV-2 testing demands, particularly in developing countries.
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Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico/instrumentación , Infecciones por Coronavirus/diagnóstico , Equipo para Diagnóstico/provisión & distribución , Equipos Desechables/provisión & distribución , Neumonía Viral/diagnóstico , Reacción en Cadena en Tiempo Real de la Polimerasa/instrumentación , Betacoronavirus/genética , COVID-19 , Prueba de COVID-19 , Celulosa/provisión & distribución , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/virología , Fibra de Algodón/provisión & distribución , Humanos , Nasofaringe , Pandemias , Plásticos/provisión & distribución , Neumonía Viral/virología , ARN Viral/análisis , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , SARS-CoV-2 , Manejo de Especímenes/instrumentación , Manejo de Especímenes/métodosRESUMEN
The recent SARS-CoV-2 outbreak has placed immense pressure on supply chains, including shortages in nasopharyngeal (NP) swabs. Here, we report our experience of using 3D-printing to rapidly develop and deploy custom-made NP swabs to address supply shortages at our healthcare institution.
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Técnicas de Laboratorio Clínico/instrumentación , Equipo para Diagnóstico/provisión & distribución , Nasofaringe/patología , Impresión Tridimensional , Biopsia/instrumentación , Prueba de COVID-19 , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Equipo para Diagnóstico/normas , Equipos Desechables/normas , Equipos Desechables/provisión & distribución , Humanos , Nasofaringe/virología , Mucosa Respiratoria/patología , Mucosa Respiratoria/virologíaRESUMEN
The supply chain management of medical consumables in hospitals is an important guarantee for the improvement of clinical diagnosis and treatment. It requires continuous re-engineering and optimization on procurement and supplier management, costs and efficiency of daily operation. Based on the practical case of Shanghai Yueyang Integrated Traditional Chinese Medicine and Western Medicine Hospital, the study discusses the practical path and key points as well as improvement results in hospital medical consumables supply chain re-engineering via SPD model. Also, the research can provide references on medical consumables supply chain management to large and medium-size hospitals.
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Equipos Desechables/provisión & distribución , Hospitales , China , Costos y Análisis de CostoRESUMEN
Objective: While myriads of studies have suggested that a survey of wound pH environment could indicate wound healing activities, it is not clear whether wound alkalinity can be used as a prognostic indicator of nonhealing wounds. Currently available systems cannot reliably assess the pH environment across wounds, which is the objective of this study. Approach: A disposable device, DETEC® pH, was developed and characterized on its ability to map wound alkalinity by pressing a freshly recovered wound dressing against its test surface. By comparing the wound's alkalinity and size reduction rates (â¼7 days) following pH measurement, we assessed the capability of wound alkalinity to prognosticate subsequent short-term wound size reduction rates. Results: The device had high accuracy and specificity in determining the alkalinity of simulated wound fluids soaked onto wound dressing. The type of wound dressing type had an insignificant effect on its detection sensitivity. Upon testing discarded wound dressings from human patients, the device quickly determined alkaline and acidic wounds. Finally, statistical analyses of wound size reduction rates in wounds with various alkalinities confirmed that wound alkalinity has a strong influence on, at least, short-term wound healing activity. Innovation: Without directly contacting the patient, this device provides a quick assessment of wound alkalinity to prognosticate immediate and short-term wound healing activities. Conclusion: DETEC® pH may serve as a prognosis device for wound care specialists during routine wound assessment to predict wound healing progress. This information can assist the decision-making process in a clinical setting and augur well for chronic wound treatment. DETEC® pH can also be used as an aid for home health care nurses or health care providers to screen nonhealing wounds outside clinics.
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Diseño de Equipo/instrumentación , Concentración de Iones de Hidrógeno/efectos de los fármacos , Propiedades de Superficie/efectos de los fármacos , Cicatrización de Heridas/efectos de los fármacos , Adulto , Vendajes/normas , Enfermedad Crónica , Toma de Decisiones Clínicas , Equipos Desechables/provisión & distribución , Diseño de Equipo/estadística & datos numéricos , Femenino , Personal de Salud , Humanos , Masculino , Tamizaje Masivo/instrumentación , Pronóstico , Sensibilidad y Especificidad , Factores de Tiempo , Cicatrización de Heridas/fisiologíaRESUMEN
The supply chain management of medical consumables in hospitals is an important guarantee for the improvement of clinical diagnosis and treatment. It requires continuous re-engineering and optimization on procurement and supplier management, costs and efficiency of daily operation. Based on the practical case of Shanghai Yueyang Integrated Traditional Chinese Medicine and Western Medicine Hospital, the study discusses the practical path and key points as well as improvement results in hospital medical consumables supply chain re-engineering via SPD model. Also, the research can provide references on medical consumables supply chain management to large and medium-size hospitals.
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China , Costos y Análisis de Costo , Equipos Desechables/provisión & distribución , HospitalesRESUMEN
BACKGROUND: Knowledge, self-care and access to diabetes-related resources is critical to diabetes management. However, there is paucity of data on source of education, source of care, and access to diabetes-related resources in the developing world, including Ethiopia. OBJECTIVE: To examine source of education, source of care, access to diabetes-related resources, and correlates of diabetes knowledge in a random sample of adults with diabetes in Ethiopia. METHODS: A sample of 337 subjects was selected using systematic random sampling. Validated questionnaires were used to obtain data on source of education, source of care, access to diabetes-related resources, and diabetes knowledge. Multiple logistic and linear models were used to assess independent correlates of owning a glucometer and good diabetes knowledge. RESULTS: Response rate was 91.1%. Correlates of access to glucometer were being ≥55 years of age (OR = 2.6 95% CI 1.0 to 6.73), having high school (OR = 3.5; 95% CI: 1.17 to 10.41) and college education (OR = 5.2; 95% CI: 1.67 to 16.27), higher income (OR = 3.3; 95% CI: 1.19 to 9.19), and receiving DM care in private hospital/clinics (OR = 9.4; 95% CI: 2.24 to 39.31). Independent correlates of poor diabetes knowledge were being age 40-54, being single, lack of education, lower monthly income (0-499 birr or $0 - $18.11), getting DM care from public hospitals, treatment with oral medications, and not owning a glucometer. CONCLUSIONS: This study provides new insights on source of education, source of care, access to diabetes-related resources (e.g. glucometers, test strips), and correlates of diabetes knowledge in developing countries like Ethiopia that are experiencing an increasing prevalence of diabetes.
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Países en Desarrollo , Diabetes Mellitus/sangre , Equipos Desechables/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Automonitorización de la Glucosa Sanguínea/instrumentación , Diabetes Mellitus/terapia , Equipos Desechables/provisión & distribución , Escolaridad , Etiopía , Femenino , Hospitales Privados/estadística & datos numéricos , Hospitales Públicos/estadística & datos numéricos , Humanos , Renta , Masculino , Estado Civil , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: The effectiveness of operating room headgear in preventing airborne contamination has been called into question. We hypothesized that bouffant style hats would be as effective in preventing bacterial and particulate contamination in the operating room compared with disposable or cloth skull caps, and bouffant style hats would have similar permeability, particle penetration, and porosity compared with skull caps. STUDY DESIGN: Disposable bouffant and skull cap hats and newly laundered cloth skull caps were tested. A mock surgical procedure was used in a dynamic operating room environment. Airborne particulate and microbial contaminants were sampled. Hat fabric was tested for permeability, particle transmission, and pore sizes. RESULTS: No significant differences were observed between disposable bouffant and disposable skull caps with regard to particle or actively sampled microbial contamination. However, when compared with disposable skull caps, disposable bouffant hats did have significantly higher microbial shed at the sterile field, as measured by passive settle plate analysis (p < 0.05). When compared with cloth skull caps, disposable bouffants yielded higher levels of 0.5 µm and 1.0 µm particles and significantly higher microbial shed detected with passive analysis. Fabric assessment determined that disposable bouffant hats had larger average and maximum pore sizes compared with cloth skull caps, and were significantly more permeable than either disposable or cloth skull caps. CONCLUSIONS: Disposable bouffant hats had greater permeability, penetration, and greater microbial shed, as assessed by passive microbial analysis compared with disposable skull caps. When compared with cloth skull caps, disposable bouffants yielded greater permeability, greater particulate contamination, and greater passive microbial shed. Disposable style bouffant hats should not be considered superior to skull caps in preventing airborne contamination in the operating room.
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Equipos Desechables/provisión & distribución , Ambiente Controlado , Quirófanos/normas , Textiles/normas , HumanosRESUMEN
STUDY OBJECTIVE: To reduce operative costs involved in the purchase, packing, and transport of unnecessary supplies by improving the accuracy of surgeon preference cards. STUDY DESIGN: Quality improvement study (Canadian Task Force classification II-3). SETTING: Gynecologic surgery suite of an academic medical center. PARTICIPANTS: Twenty-one specialized and generalist gynecologic surgeons. INTERVENTIONS: The preference cards of up to the 5 most frequently performed procedures per surgeon were selected. A total of 81 cards were distributed to 21 surgeons for review. Changes to the cards were communicated to the operating room charge nurse and finalized. MEASUREMENTS AND MAIN RESULTS: Fourteen surgeons returned a total of 48 reviewed cards, 39 of which had changes. A total of 109 disposable supplies were removed from these cards, at a total cost savings of $767.67. The cost per card was reduced by $16 on average for disposables alone. Three reusable instrument trays were also eliminated from the cards, resulting in savings of approximately $925 in processing costs over a 3-month period. Twenty-two items were requested by surgeons to be available on request but were not routinely placed in the room at the start of each case, at a total cost of $6,293.54. The rate of return of unused instruments to storage decreased after our intervention, from 10.1 to 9.6 instruments per case. CONCLUSIONS: Surgeon preference cards serve as the basis for economic decision making regarding the purchase, storing, packing, and transport of operative instruments and supplies. A one-time surgeon review of cards resulted in a decrease in the number of disposable and reusable instruments that must be stocked, transported, counted in the operating room, or returned, potentially translating into cost savings. Surgeon involvement in preference card management may reduce waste and provide ongoing cost savings.
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Comportamiento del Consumidor , Equipos Desechables/economía , Rol del Médico , Mejoramiento de la Calidad , Cirujanos , Instrumentos Quirúrgicos/economía , Adulto , Comportamiento del Consumidor/economía , Comportamiento del Consumidor/estadística & datos numéricos , Ahorro de Costo , Equipos Desechables/estadística & datos numéricos , Equipos Desechables/provisión & distribución , Femenino , Humanos , Masculino , Sistemas de Entrada de Órdenes Médicas/economía , Sistemas de Entrada de Órdenes Médicas/estadística & datos numéricos , Persona de Mediana Edad , Quirófanos/economía , Mejoramiento de la Calidad/economía , Asignación de Recursos/economía , Asignación de Recursos/estadística & datos numéricos , Estudios Retrospectivos , Cirujanos/economía , Cirujanos/normas , Cirujanos/estadística & datos numéricos , Instrumentos Quirúrgicos/estadística & datos numéricos , Instrumentos Quirúrgicos/provisión & distribución , Recursos HumanosRESUMEN
PURPOSE: The aim was to compare the power of spectacles donated to a recycled spectacle program to the custom-made spectacle refractive prescriptions dispensed in a developing country. METHODS: Two hundred consecutive prescriptions were audited in an optical dispensary in Timor-Leste, a developing nation. These refractions were compared against measurements of 2,075 wearable donated spectacles. We determined how many of the 200 prescriptions could be matched to a donated spectacle measurement, how many donated spectacles could be tried for each prescription and how long it would take to find the matched spectacles. RESULTS: There were 1,854 donated spectacles identified as being suitable for comparison with the 200 refractive prescriptions. Twenty-nine out of 200 prescriptions (14.5 per cent) were matched to at least one pair of donated spectacles. CONCLUSION: Recycling all spectacles is not cost-effective in a developing country that has the ability to make custom-made spectacles and dispense ready-made spectacles.
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Países en Desarrollo , Equipos Desechables/provisión & distribución , Anteojos/provisión & distribución , Errores de Refracción/terapia , Femenino , Humanos , Masculino , Morbilidad , Errores de Refracción/epidemiología , Estudios Retrospectivos , Timor Oriental/epidemiología , Australia OccidentalRESUMEN
This paper introduces the background, the content, the information management system of material supply chain integration management and the consumables management process. The system helps to expand the selection of hospital supplies varieties, to reduce consumables management costs, to improve the efficiency of supplies, to ensure supplies safety, reliability and traceability.
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Equipos Desechables/provisión & distribución , Sistemas de Información Administrativa , Administración de Materiales de Hospital/organización & administraciónRESUMEN
BACKGROUND: The American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nursing Association have developed consensus guidelines for pediatric emergency department policies, procedures, supplies, and equipment. Kentucky received funding from the Health Resources and Services Administration through the Emergency Medical Services for Children program to pilot test the guidelines with the state's hospitals. In addition to providing baseline data regarding institutional alignment with the guidelines, the survey supported development of grant funding to procure missing items. METHODS: Survey administration was undertaken by staff and members of the Kentucky Board of Emergency Medical Services Emergency Medical Services for Children work group and faculty and staff of the University of Kentucky College of Public Health and the University of Louisville School of Medicine. Responses were solicited primarily online with repeated reminders and offers of assistance. RESULTS: Seventy respondents completed the survey section on supplies and equipment either online or by fax. Results identified items unavailable at 20% or more of responding facilities, primarily the smallest sizes of equipment. The survey section addressing policy and procedure received only 16 responses. CONCLUSIONS: Kentucky facilities were reasonably well equipped by national standards, but rural facilities and small hospitals did not stock the smallest equipment sizes because of low reported volume of pediatric emergency department cases. Thus, a centralized procurement process that gives them access to an adequate range of pediatric supplies and equipment would support capacity building for the care of children across the entire state. Grant proposals were received from 28 facilities in the first 3 months of funding availability.
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Servicios de Salud del Niño/normas , Servicio de Urgencia en Hospital/normas , Adhesión a Directriz , Guías de Práctica Clínica como Asunto , Niño , Servicios de Salud del Niño/economía , Servicios de Salud del Niño/estadística & datos numéricos , Equipos Desechables/economía , Equipos Desechables/normas , Equipos Desechables/provisión & distribución , Equipo Médico Durable/economía , Equipo Médico Durable/normas , Equipo Médico Durable/provisión & distribución , Servicio de Urgencia en Hospital/economía , Servicio de Urgencia en Hospital/estadística & datos numéricos , Diseño de Equipo , Equipos y Suministros de Hospitales/economía , Equipos y Suministros de Hospitales/normas , Equipos y Suministros de Hospitales/provisión & distribución , Financiación Gubernamental , Encuestas de Atención de la Salud , Necesidades y Demandas de Servicios de Salud , Hospitales Rurales/economía , Hospitales Rurales/normas , Hospitales Rurales/estadística & datos numéricos , Hospitales Urbanos/economía , Hospitales Urbanos/normas , Hospitales Urbanos/estadística & datos numéricos , Humanos , Kentucky , Proyectos PilotoRESUMEN
BACKGROUND: Every year an estimated three million neonates die globally and two hundred thousand of these deaths occur in Pakistan. Majority of these neonates die in rural areas of underdeveloped countries from preventable causes (infections, complications related to low birth weight and prematurity). Similarly about three hundred thousand mother died in 2010 and Pakistan is among ten countries where sixty percent burden of these deaths is concentrated. Maternal and neonatal mortality remain to be unacceptably high in Pakistan especially in rural areas where more than half of births occur. METHOD/DESIGN: This community based cluster randomized controlled trial will evaluate the impact of an Emergency Obstetric and Newborn Care (EmONC) package in the intervention arm compared to standard of care in control arm. Perinatal and neonatal mortality are primary outcome measure for this trial. The trial will be implemented in 20 clusters (Union councils) of District Rahimyar Khan, Pakistan. The EmONC package consists of provision of maternal and neonatal health pack (clean delivery kit, emollient, chlorhexidine) for safe motherhood and newborn wellbeing and training of community level and facility based health care providers with emphasis on referral of complicated cases to nearest public health facilities and community mobilization. DISCUSSION: Even though there is substantial evidence in support of effectiveness of various health interventions for improving maternal, neonatal and child health. Reduction in perinatal and neonatal mortality remains a big challenge in resource constrained and diverse countries like Pakistan and achieving MDG 4 and 5 appears to be a distant reality. A comprehensive package of community based low cost interventions along the continuum of care tailored according to the socio cultural environment coupled with existing health force capacity building may result in improving the maternal and neonatal outcomes. The findings of this proposed community based trial will provide sufficient evidence on feasibility, acceptability and effectiveness to the policy makers for replicating and scaling up the interventions within the health system.