Exploring maternal perspectives on human milk banks in Pakistan and identifying barriers and enablers for establishment

Background: Low-and middle-income countries including Pakistan still have low breastfeeding rates and infant feeding remains a concern. Human milk banks (HMBs) play a crucial role in neonatal and infant health by providing safe, pasteurized donor human milk to infants who do not have access to their mother\u27s own milk, particularly preterm and low-birth-weight infants. The perception regarding the concept and use of HMBs has yet to be explored in several contexts, especially in the low-and middle-income countries including Pakistan.Aim: To explore the perceptions of mothers regarding human milk banks in Pakistan, focusing on the barriers and enablers to their establishment, and the strategies to overcome these challenges.Methodology: This study will employ a qualitative descriptive exploratory approach. A purposive sampling technique will be used to select 10 to 14 mothers for participation, with the final number determined by data saturation. In-depth interviews will be conducted using a semi-structured interview guide, which will be validated by experts to ensure its relevance and comprehensiveness. The collected data will be analyzed following Creswell\u27s thematic analysis guide, ensuring a comprehensive identification of barriers and enablers to the establishment of human milk banks in Pakistan.Significance/Implications: Understanding these factors is crucial for midwives, as they play a key role in advocating for and educating about human milk banking. The findings can inform policy development and the implementation of support systems, ultimately enhancing maternal and infant health outcomes. By addressing the identified barriers and leveraging enablers, midwives can contribute to the successful integration of human milk banks into the healthcare system, promoting optimal breastfeeding practices

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries