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

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

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

Exploring the Role of Community Involvement in Reducing the Burden of Schistosomiasis and Other Neglected Tropical Diseases in Malawi: Where are We in the Fight Against Neglected Tropical Diseases?

Adriano Focus Lubanga,1,2 Akim Nelson Bwanali,1,3 Leonard Eston Munthali,2 Mzati Mphepo,3 Gertrude Diana Chumbi,2 Melina Kangoma,2 Yankho Matola,2 Byenala Kaonga,2 Chitemwa Sithando Moyo2 1Education and Research, Clinical Research Education and Management Services Ltd (CREAMS), Lilongwe, Malawi; 2Department of Clinical Services, Kamuzu Central Hospital, Lilongwe, Malawi; 3Department of Clinical Services, Queen Elizabeth Central Hospital, Blantyre, MalawiCorrespondence: Adriano Focus Lubanga, Education and Research, Clinical Research Education and Management Services Ltd (CREAMS), Anderson House, Area 43, P.O Box 31045, Lilongwe, Malawi, Tel +265992744497, Email [email protected]; [email protected]: Schistosomiasis has been endemic in Malawi since 1947. Despite the longevity of endemicity of the disease, it still maintains a high burden in Malawi. This could be attributed to insufficient coverage of preventive and therapeutic mass drug administration (MDA) which mainly targets school-aged children, leaving out adults who also bear a high burden of the disease. Additionally, despite well documented impact of community involvement in boosting up the effectiveness of health programmes, there is minimal community involvement in schistosomiasis control and prevention programmes. Therefore, this perspective seeks to discuss the historical background of schistosomiasis in Malawi, gaps in community engagement and participation and suggest ways of enhancing the role of the community in prevention and control programmes. Amongst other challenges, the control programmes are centralised, leading to minimal input at the district and community level as well as low awareness of schistosomiasis control and prevention methods at the community level. It is of utmost significance therefore to provide comprehensive schistosomiasis health education to the communities and devise a thorough outline of the specific roles and responsibilities of all stakeholders including community members in the fight against schistosomiasis and other neglected tropical diseases.Keywords: schistosomiasis, community prevention, water, sanitation, hygiene, neglected tropical disease

Traditional uses and local perspectives on baobab (Adansonia digitata) population structure by selected ethnic groups in northern Namibia

The aim of this study was to document local traditional uses on Adansonia digitata (baobab) among the Herero, Ovambo, San and Masubiya ethnic groups in northern Namibia. Data was collected by oral interviews using a semi-structured questionnaire. A total of 64 respondents were interviewed. Indigenous knowledge on baobab is transferred from older generations to younger generations through word of mouth. The information that was captured includes local traditional use and benefits of baobab, use value, and perceptions on baobab population dynamics. Findings from the current study revealed that baobab uses go beyond provision of food, medicine and spiritual needs in Namibia. It is also used as feed for chicken. The bark was also recorded to be useful as fodder during drought. The fruit is the most used part of the baobab, but the use value of bark was generally high among all ethnic groups. The study revealed that the Ovambo people use more baobab products than the Herero, San and Masubiya communities. Destructive uses of seeds were identified as a factor contributing to the lack of regeneration of baobab. It is recommended that destructive uses of baobab, especially use of seeds, need to be regulated to sustainable levels for conservation of baobab in Namibia. Furthermore, the benefits from the baobab tree need to be promoted in order to fully utilize its potential in improving livelihoods of rural communities in Namibia.http://www.elsevier.com/locate/sajb2018-11-01hj2018Plant Production and Soil Scienc