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

Runoff water harvesting for dry spell mitigation for cowpea in the savannah belt of Nigeria

Cowpea yields obtained by smallholder farmers in the savannah belt of Nigeria are often less than the maximum obtainable yields because water deficit during critical growth stages is a common occurrence. Runoff harvesting to supplement direct rainfall may prove beneficial in improving current smallholder farming systems in this region. We study the effects of macro- and micro-catchments runoff harvesting, with or without in situ soil conservation, on cowpea yield in the savannah belt of Nigeria. The macro-catchments runoff harvesting (RH) experiment consisted of four treatments: conventional tillage and RH (CRH), zero tillage with RH (ZRH), reduced tillage with RH (RRH) and the direct rain fed (DR) treatment which served as the control in a randomized block design with four replicates. The micro-catchment experiment consisted of four treatments: runoff harvesting (RH), semi-circular bunds (SC), semi-circular bunds with runoff harvesting (SRH) and also direct rainfed (DR) in a randomized block design with four replicates. Results suggest that runoff harvesting can be used with existing conservation techniques. Applying harvested runoff water through supplemental irrigation provides the twin benefits of alleviating the prevailing slack periods and improving the yields of smallholder farming systems.Supplemental irrigation Water deficit Macro- and Micro-catchments Semi-circular bunds Smallholder farming systems Conventional tillage