High Wastage Rate Research Articles

Overcoming barriers to COVID‐19 herd immunity in Afghanistan

AbstractAfghanistan faces numerous obstacles in its endeavor to achieve herd immunity against COVID‐19. Inadequate resources, vaccine hesitancy, and the new government's lack of international recognition have impeded the country and harmed vaccine procurement and distribution. Although the recent power shift has led to a more secure situation, the country's vaccination coverage remains at 44.05% as of November 26, 2023. The main hurdles to herd immunity include limited vaccine accessibility, extensive vaccine hesitancy, an inefficient cold chain system causing high vaccine wastage rates, substandard service delivery, recent restrictions on women's healthcare access, low health literacy, and a weakened economy owing to decades of conflict and international sanctions. This article assesses vaccination progress, and herd immunity barriers, and provides solutions to overcome them in Afghanistan. A comprehensive approach is required, which involves enhancing public awareness of the benefits of vaccination, debunking vaccine‐related misconceptions through the media, expanding vaccine accessibility especially in remote areas, increasing vaccination personnel, promoting the cold chain and delivery system, reversing the ban on women's education and employment, boosting the economy, and increasing the inflow of humanitarian aid by lifting international sanctions. Successfully implementing these measures can help Afghanistan overcome obstacles to herd immunity, leading the country toward a safer and healthier future.

Study on the preparation of Interleukin 8 loaded hydrogel fiber and regulation on recruitment of stem cells

The high wastage rate and low survival rate of seed cells in conventional bone tissue engineering (BTE) are always a challenge for tissue regeneration. Constructing scaffolds that could continuously recruit endogenous stem cells is considered a novel way to promote tissue repair. In this study, a GelMA fiber hydrogel membrane loaded interleukin 8 (IL8) (IL8-GelMA), was prepared via electrostatic spinning technology. Compared with Gelatin fiber, GelMA fiber possessed a smooth morphology with nanoscale diameter and better physical properties including hydrophilicity, elastic modulus, swelling rate and degradation rate. In addition, IL8-GelMA fiber membranes could lead an osteogenic differentiation of BMSCs. Moreover, the results of chemotaxis experiment demonstrated that both IL8 and IL8-GelMA fiber membranes promote the migration of BMSCs in vitro. These results suggested that IL8-GelMA fiber membranes can be used for cell-free scaffold of bone repair, which can not only recruit endogenous BMSCs, but also promote osteogenic differentiation of BMSCs.

Vaccine management practices among healthcare workers in Morogoro, Tanzania: a cross-sectional study

BackgroundEffective vaccine management is essential to maintain the quality of vaccines, minimise wastages, and prevent missed opportunities for vaccination at service delivery points.ObjectivesThis study aims to assess vaccine management practices among vaccinators at health facilities in the Morogoro region, Tanzania.MethodologyA descriptive cross-sectional study design involved health workers from 77 health facilities offering vaccination services. The study population consisted of vaccine handlers and vaccinators working in public health facilities in the Morogoro region. The vaccine management practices were assessed using data collected from ledgers and the Vaccine Information Management System (VIMS). The temperature records were downloaded from the Fridge-tag® 2 and Coldtrace5 devices.ResultsThe findings indicated that 65 (84%) health facilities had functional refrigerators and are using power from 26 (34%), 28 (36%), and 23 (30%) of grid electricity, solar, and Liquefied Petroleum Gas (LPG), respectively. Besides, 27 (35%) health facilities have an alternative energy source as a backup. In general, healthcare workers had a good knowledge of cold chain management, including the World Health Organization recommended storage temperatures for vaccines. Furthermore, vaccine stockout was found in 12 (15.6%) health facilities for at least one antigen and 4 (5.1%) health facilities for all five antigens under observation. This current study also revealed that the average calculated vaccine wastage rates for DTP, Measles–Rubella and Rotavirus vaccines were 7%, 19%, and 15%, respectively. More than half of health workers did not perform monthly temperature data reviews. In addition, poor performance led to high wastage rates, including the Rotavirus vaccines, and a change in VVM to discard points. Finally, a small number of 5 (6.5%) health facilities consecutively reported temperature exposure beyond + 8 Celsius (between 5.9 and 281 h).ConclusionsHealthcare workers’ vaccine and cold chain management knowledge were good for temperature data reading and documentation. However, the practices were poor for some health facilities. The gaps observed in this study inform health managers and policymakers toward establishing interventions to improve health workers' knowledge and practice, including mentorships, supervision, and training to guarantee that each child in all communities reaps the benefits of immunisation services.

Inventory management performance for laboratory commodities and their challenges in public health facilities of Gambella Regional State, Ethiopia: A mixed cross-sectional study

BackgroundSustaining an adequate inventory level of laboratory commodities is critical as 70% of medical decisions are made using laboratory-related information. However, millions of populations in developing countries still do not get elementary laboratory services due to the inaccessibility of laboratory commodities. Hence, this study aimed to assess inventory management performance and challenges for laboratory commodities in public health facilities of Gambella regional state, Ethiopia. MethodA health facility-based descriptive cross-sectional study was conducted using a mixed quantitative and qualitative method in seventeen public health facilities of the Gambella regional state between May and July 2021. Data were collected from documents, health professionals, and health care facilities' warehouses. Quantitative data were analyzed using Excel spreadsheets version 14 and SPSS version 23. In the qualitative part, 18 key informants were interviewed, and data were analyzed using thematic analysis techniques. ResultThe average availability of laboratory commodities on the day of the visit was 60.39% in health facilities. Over the past year, 12.94% (37,488.76 US$) of laboratory commodities were wasted due to damage and expiration, while the average stock out date was 58 days. The average accuracy, completeness, and timeliness of the report and requisition form were 49%, 71%, and 64%, respectively. The health facilities had attained only, 68.2% of the storage conditions criteria. Lack of adequate and committed staff, budget constraints, insufficient storage space, frequent shortages of commodities from the suppliers, lack of frequent supervision, and feedback from higher officials were the main challenges for inventory management of laboratory commodities. ConclusionThe inventory management for laboratory commodities was inadequate, which was disclosed by inaccurate records and reports, stock-outs, high wastage rate, lack of adequate staff, budget constraints, and unacceptable storage conditions criteria. The study result suggests strict and close monitoring is needed to improve the inventory management performance for laboratory commodities at health facilities.

Research on 3D Jewelry Design Based on Virtual Reality Technology

The existing three-dimensional jewelry design method has the problem of imperfect three-dimensional display model, which leads to a high product wastage rate. A three-dimensional jewelry design method based on virtual reality technology is designed. From the perspective of diversified production needs, the jewelry production and processing process is obtained. CNC plate making is adopted to identify the technological characteristics of plane elements. The digital three-dimensional model is taken as the design carrier, and the three-dimensional display model is constructed by virtual reality technology. Experimental Results. The average product loss rate of the three-dimensional jewelry design method in this paper and the other two three-dimensional jewelry design methods were 5.523%, 8.043%, and 8.237%, respectively, indicating that the performance of three-dimensional jewelry design method is more perfect after the combination of virtual reality technology.

Valorization and extraction optimization of Prunus seeds for food and functional food applications: A review with further perspectives

Valorization of byproducts generated during food processing has recently attracted considerable attention, especially processes with high wastage rates. In this review we present a detailed analysis of the phytochemical composition of Prunus seed oil and extracts as potential sources of unsaturated fatty acids, phenolics, and phytosterols. Besides their nutritional value these seeds, especially apricot and peach seeds, could be exploited to produce value-added products such as food enhancers, and antioxidants. Optimum extraction methods of Prunus seeds are discussed to improve yield and lessen environmental hazards associated with typical solvent extraction-based methods. This review presents the best valorization practices for one of the largest cultivated fruit seeds worldwide and its different applications in food and functional food industries.

Extract from the Macroalgae Ulva rigida Induces Table Grapes Resistance to Botrytis cinerea.

Fungal pathogens are a central cause of the high wastage rates of harvested fruit and vegetables. Seaweeds from the genus Ulva are fast-growing edible green macroalgae whose species can be found on the shore of every continent, and therefore present a resource that can be utilized on a global scale. In this study, we found that the application of ulvan extract, a sulfated polysaccharide extracted from Ulva rigida (1000 mg/L), elicited table grapes defense and reduced the incidence and decay area of Botrytis cinerea by 43% and 41%, respectively. In addition, compared to the control group at two days post-treatment, ulvan extract elicited a variety of defense-related biomarkers such as a 43% increase in the activity of reactive oxygen species, 4-fold increase in the activity of catalase, 2-fold increase in the activity of superoxide dismutase and 1.4-fold increase in the activity of chitinase. No increase was observed in phenylalanine ammonia-lyase activity, and the treatment did not affect fruit quality parameters such as the pH levels, sugar levels, and titratable acidity of grapes. These results illustrate the potential of ulvan extract to naturally induce the plant defense response and to reduce postharvest decay.

Inventory Management Practices and Supply Chain Performance of Antiretroviral Medicines in Public Hospitals in Nyamira County, Kenya

BackgroundUnreliable supply systems have plagued the provision of an uninterrupted supply of life- saving medicines in many developing countries, with antiretroviral (ARV) medicines having the worst repercussions.ObjectiveTo identify the inventory management practices used, evaluate the supply chain performance, and determine the challenges affecting inventory management of ARV medicines in public hospitals.MethodsThe study used a descriptive cross-sectional design, gathering snapshot data on inventory management practices happening in all the 8 public hospitals across Nyamira County. Data collection was done using structured questionnaires, key informant interviews, checklists and data from the national health information system.ResultsThe response rate was 97.3% for the questionnaires and 100% for the key informant interviews. The prevailing inventory management practices were: use of scheduled inventory control model (80.95%), forecasting demand using previous consumption data (100%), keeping accurate and updated stock records for each commodity (92.31%), having essential logistical data in reports (100%), including safety stock (61.54%) when ordering and keeping ARV medicines in dedicated stores (75%). With the exception of order lead time (17.98 days), the other supply chain performance metrics namely stock out rate (52.12%), stock wastage rate (43.2%), and reporting rates (70.84%) were found to be deficient. The challenges mostly affecting inventory management included inadequate staff and training, lack of proper storage, and unreliable supply of medicines.ConclusionInventory management practices were according to the recommended best approaches despite various challenges. The supply chain performance metrics evaluated, with the exception of order lead time, were all found to be unsatisfactory owing to the high stock out rates, below par reporting rates and high stock wastage rate due to expiries discovered. Adoption of an electronic inventory system, use of data for decision making, dedicated storage of ARV medicines, and inclusion of buffer stock, are some strategies to improve inventory management.Rwanda J Med Health Sci 2021;4(2): 257-268

Incidence of foetal wastage in goats in Umuahia, Abia state Nigeria

This study investigated the indiscriminate slaughter of pregnant goats and the incidence of foetal wastage at Ahiaeke goat slaughter slab in Umuahia, Abia State for a period of 7 months (March – September 2018). A total of 518 goats were slaughtered during the period of study comprising 311 (60.03 %) males and 207 (39.96 %) females. The study revealed that majority (76%) of the goats slaughtered within the study period were not inspected ante mortem while only 24% of the total goats were inspected prior to slaughter. In the course of the investigation, it was observed that out of the 207 does slaughtered, 130 (62.80%) does were pregnant while 77 (37.19%) were not. A total of 182 foetuses (109 males and 73 females) were recovered from the 130 pregnant does slaughtered. The highest number of slaughtered pregnant does was recorded during the traditional festive season, in August, resulting in high percentage (21.41%) of foetal wastage during the study. Averagely, a monthly slaughter of 30 (14.31 %) gravid does was obtained. The slightly high rate of foetal wastage recorded in this study may be due to the very low coverage of ante-mortem inspection. Given the findings from this study, it can be inferred that poor ante-mortem inspection, ignorance on the part of farmers, butchers, and policy makers on proper management of pregnant animals in markets/slaughter slabs may have contributed to the foetal wastage and the slaughter of pregnant does.

Educational Wastage in Colleges of Education in Nigeria: Situational Report

The research examined the situation of educational wastage in Colleges of Education. This study adopted descriptive research design of survey type. The population for this study comprised all the 70 Colleges of Education in existence between 2013/2014 and 20117/2018 in Nigeria. These Colleges of Education were owned by both the federal and state governments in Nigeria. There were 26 federal and 50 states owned Colleges of Education located in all the six geo-political zones of the country. The sample for this study comprised of twelve (12) Colleges of Education. The respondents were all the 191 heads of departments drawn from these twelve (12) Colleges of Education in three geo-political Zones. The sample technique involved multi-stage, stratified random and purposive samplings. The instrument used was a self-developed inventory titled ‘Inventory on wastages in Colleges of Education in Nigeria’ (IWCOEN). The instrument was subjected to screening by experts in Educational Management and Test and Measurement. Data collected were analysed using descriptive statistics such as cohort and percentages. The findings of the study revealed 3.01% stagnation rate in year one and 2.37% in year two, the dropout rate was 2.08% in year one while year two had 1.54%. It was concluded that there was high wastage rate in The Colleges of Education in Nigeria. Based on the conclusion, it was therefore recommended that management of Colleges of Education should provide enabling environment for the students to learn and that the policy of five maximum years for students should be reduced to allow those that could no graduate within the approve years to privilege of spending more years.

Negative impact of high doses of follicle-stimulating hormone during superovulation on the ovulatory follicle function in small ovarian reserve dairy heifers†.

When women with small ovarian reserves are subjected to assisted reproductive technologies, high doses of gonadotropins are linked to high oocyte and embryo wastage and low live birth rates. We hypothesized that excessive follicle-stimulating hormone (FSH) doses during superovulation are detrimental to ovulatory follicle function in individuals with a small ovarian reserve. To test this hypothesis, heifers with small ovarian reserves were injected twice daily for 4 days, beginning on Day 1 of the estrous cycle with 35, 70, 140, or 210IU doses of Folltropin-V (FSH). Each heifer (n=8) was superovulated using a Williams Latin Square Design. During each superovulation regimen, three prostaglandin F2α injections were given at 12-h interval, starting at the seventh FSH injection to regress the newly formed corpus luteum (CL). Human chorionic gonadotropin was injected 12h after the last (8th) FSH injection to induce ovulation. Daily ultrasonography and blood sampling were used to determine the number and size of follicles and corpora lutea, uterine thickness, and circulating concentrations of estradiol, progesterone, and anti-Müllerian hormone (AMH). The highest doses of FSH did not increase AMH, progesterone, number of ovulatory-size follicles, uterine thickness, or number of CL. However, estradiol production and ovulation rate were lower for heifers given high FSH doses compared to lower doses, indicating detrimental effects on ovulatory follicle function.

A bottom‐up cost analysis of silicon–perovskite tandem photovoltaics

AbstractStacking two photovoltaic (PV) cells to form a tandem structure can improve the efficiency of PV modules, and if achieved at sufficiently low cost, could dominate the PV market in the future. Rapid progress in silicon–perovskite tandem (SPT) cell efficiency has been made, so cost modelling is becoming important in analysing the commercial attractiveness of this approach. While previous cost modelling assumed idealised production processes, this work focuses first on six demonstrated SPT sequences using both homojunction and heterojunction bottom silicon cells, analysed in detail using a bottom‐up cost and uncertainty model and then compared with other reported SPT high‐efficiency cells. This identifies cost barriers in the perovskite cell, including high‐cost hole transport material (HTM) and electron transport layer (ETL) materials such as (2,2′,7,7′‐tetrakis[N,N‐di(4‐methoxyphenyl)amino]‐9,9′‐spirobifluorene [SPIRO] and [6,6]‐phenyl‐C61‐butyric acid methyl ester [PCBM]), and the use of spin coating which has a high wastage rate. Once these cost issues are solved, the silicon cell cost becomes important, and the use of lower cost homojunction cells with p‐type wafers can further reduce costs. A hypothetical medium term low‐cost sequence that combines the lowest cost parts of the analysed sequences and an improved perovskite deposition process has a projected likely cost of $1.50/cell, which if combined with 25% efficiency would give a favourable levelised cost of electricity (LCOE) compared with industry standard c‐Si cells. This analysis guides research directions to address cost issues in parallel with higher efficiencies in this technology area.

Rearing in female-only groups and dietary mineral supplementation improves sow welfare in the early parities and lifetime performance.

The lifetime performance of commercial sows relies on longevity, which is dependent on good health and reproductive performance. However, there is a high rate of wastage of sows in the early parities, which is influenced by the way they are managed and housed during rearing. This study investigated the carry-over effect of gilt rearing strategy on the measures of welfare and performance. Eighty sows were reared using a two by two factorial design: rearing group composition [GC; female-only (FEM) or mixed-sex (MIX) from weaning] with or without supplementary minerals (CON = control diet; SUPP = control + Cu, Zn, and Mn) from 5 wk into the finisher stage. Once served, gilts were managed in a dynamic group gestation pen and fed a standard gestating sow diet. Locomotory ability was scored (0 to 5) and salivary cortisol measured five times during the first gestation, and human approach tests were carried out on day 108. Hooves were scored for injuries and legs for bursas at day 70 of the first gestation, at first weaning, and at the second farrowing. Sow behavior in the hoof scoring crate (movement, vocalization, and handling ease) was also recorded. The number of piglets born alive and dead during the first five parities was recorded as was the performance of the first litter to finish. Data were analyzed using general or generalized linear mixed models, as appropriate, using SAS (v 9.4). There was no effect (P > 0.05) of rearing treatment on locomotory ability, bursa score, the total number of piglets born, or on offspring growth. However, there was an interaction between GC and supplementary minerals (P < 0.05) on salivary cortisol levels with MIX × SUPP sows having the highest levels. Total hoof scores and heel erosion scores were higher in sows reared in MIX groups (P < 0.01), and CON sows tended to have higher horizontal crack scores (P = 0.06). Sows from MIX kicked more at weaning than FEM (P < 0.05) and tended to be more fearful in the forced human approach test (P = 0.1) where they are scored on their reaction to being approached. They also had more stillborn piglets across all five parities than FEM (P < 0.05). Overall, rearing replacement sows in FEM groups and dietary mineral supplementation had minimal but beneficial effects on their subsequent welfare and performance.

Effective vaccine management through social behavior change communication: Exploring solutions using a participatory action research approach in the Solomon Islands

Addressing vaccine management bottlenecks, including high vaccine wastage rates, has traditionally been addressed through health worker training and other didactic methods of technical assistance or support as required. It has been shown, though, that the high level of technical skills, expertise, and responsibility required in vaccine handling and management cannot be achieved by mere didactic learning. While gains have been made in vaccine management and handling with these approaches, there remain challenges of high vaccine wastage rates and poor vaccine management practices across the board. Interestingly, approaching vaccine management through social behavior change has not been documented. Through Participatory Action Research (PAR), which is increasingly being used in health sciences, we explore an attempt at strengthening vaccine management and thus reducing high vaccine wastage rates by working together with health workers to identify plausible, realistic solutions to vaccine management through social behavior change. Select health workers directly involved with the immunization program in the four major provinces of the Solomon Islands were identified purposively to use action media and come up with concepts and materials for social behavior change communication that will have an impact on effective vaccine management and reducing wastages. This is the first documented use of such methodology in addressing vaccine management issues.

Inventory management performance for laboratory commodities in public hospitals of Jimma zone, Southwest Ethiopia

BackgroundMaintaining an efficient and effective inventory management system ensures a reliable supply of laboratory commodities. The aim of this study was, therefore, to assess the performance of inventory management for laboratory commodities in public hospitals in the Jimma zone.MethodsA facility-based cross-sectional descriptive study, accompanied by a qualitative method, was conducted in seven public hospitals between April 30 and May 29, 2019. We collected data through document reviews (225 bin-cards), physical observation, self-administered questionnaires, and in-depth interviews. The quantitative data were analyzed using Excel spreadsheets and SPSS version 24. Fifteen key informants of different backgrounds took part in the qualitative study. The data were then analyzed using thematic analysis techniques.ResultsAll the public hospitals in the zone were included in the study, making a response rate of 100%. Of the total estimated bin-cards, 225 (69.9%) of them held along with the items, and only 30.4% of them filled accurately. In four of the hospitals, pharmacists determined how much to order. Five of the hospitals used average monthly consumption data to calculate purchase quantity. Over the past 6 months, four of the hospitals had placed at least one or two emergency orders. The wastage rate of the commodities in the hospitals was 27.2% and resulted in a loss of about 10,248.5 US dollars. The hospitals had met 70.6% of the criteria for proper storage conditions. Budget constraints, absence of prompt administrative support, lack of staff commitment, and frequent shortages of commodities on the part of suppliers were major bottlenecks of inventory management.ConclusionsThe hospitals had weak inventory management practices, showed by inaccurate records, stock-outs (frequent emergency orders), a high wastage rate compared to national baseline statistics, and the storage conditions below the standard.

Small Session Size and Big Vial Size: Operational Research Assessing Open Vial Vaccine Wastage at the Service Delivery Points in the Mandalay Region of Myanmar During 2018.

The World Health Organization (WHO) recommends immunization programmes to monitor vaccine wastage at storage and service delivery points. As there were no vaccine wastage assessments in Myanmar, we aimed to assess the vaccine wastage rates in the Mandalay region. We conducted a cross-sectional descriptive study with the inclusion of all immunization sessions conducted through the twenty randomly selected subcentres in the year 2018. The wastage rates were calculated by aggregating vaccine utilization data from selected subcentres. The vaccine wastage rates for Bacillus Calmette–Guérin (BCG) (54.9%), inactivated polio vaccine (28.3%), and measles-rubella (27.4%) were higher than the WHO indicative rates. The high vaccine wastage rates were seen in lyophilized vaccines (36.9%), vaccines requiring only a single dose per child for complete immunization (39.1%), and those with a large vial size of 20 doses (38.8%). The median session size for BCG (6), measles-rubella (4) and inactivated polio vaccine (2) were lower than their vaccine vial size of 20, 10, and 5 doses, respectively. The wastage was high due to smaller session size and larger vial size, necessitating the disposal of unused doses. Better micro-planning to increase the session size and procuring vaccines with smaller vial sizes needs to be tested as a strategy to reduce vaccine wastage.

Determination of Blood components Utilization Pattern in Zahedan City, Southeast of Iran

BackgroundPredicting future blood requirements and optimizing current transfusion practices require information on blood product utilization.ObjectivesThe aims of this study was to determine the utilization patterns of blood components in Zahedan, the capital city of Sistan and Balouchestan province in southeastern Iran.MethodsThis descriptive study was conducted from March to August 2015. Blood bank data were collected from seven hospitals. Moreover, the archived blood request forms were studied for the demographic data of blood receivers.ResultsOverall, 13,312 blood request forms (30,418 requested blood units) were studied. The mean age of the recipients was 24.3 ± 20 year and 38.9% of them were of the O blood group, followed by B (28.8%). Packed cell (PC) units were the most commonly used products (36.7%), followed by leuko-reduced red cells (25.4%), fresh frozen plasma (FFP) (16.8%), platelets (15.2%), cryoprecipitate (3.2%), and washed red cells (2.5%). The major users of blood components were the thalassemia wards (38.7%). Among the blood components, the highest wastage was related to PC with 32.3%, followed by FFP with 22.5%. The highest rate of wastage was recorded in the surgery (1,081 units) and emergency (784 units) wards for PC products and CCUs (376 units) and ICUs (167 units) for FFP products.ConclusionsA high rate of blood wastage was observed in the use of PC and FFP units. Increased awareness of physicians and medical students leads to proper blood consumption in the future. The Hospital Blood Transfusion Committee should review blood transfusion guidelines to optimize blood consumption.

The Fetal Outcome and Fetal Wastage Pattern among Different Types of Obstetric Fistula at the National Obstetric Fistula Centre, Abakaliki, Nigeria

BACKGROUND: Obstetric Fistula is a major public health problem in developing world. It is associated with a high fetal wastage rate. The objective of this study was to evaluate different types of obstetric fistula and their fetal wastage rate. METHOD: A retrospective population study was done at the National Obstetric Fistula Centre, Abakaliki between 1st January-31st December, 2016. The calculated minimum sample size was 3, however, the total number of 203 patients were studied. The case notes of all the women who had obstetric fistula repairs over the period were analyzed. RESULTS: The mean age from this study was 38 ± 12.1 years. The fetal wastage rate from this study was 82.76% while the live birth was 17.24%. Seventy percent of the stillbirth were delivered via SVD, while 11% of stillbirth were delivered through EmCS. Twelve different types of fistula were identified in this study using anatomical classifications. Large extensive fistula, urethral loss and multiple fistula had the highest fetal wastage of 100% respectively. This was followed by mid-vaginal fistula (95.7%), Juxtaurethral fistula 94.4%, Juxtacervical fistula 88.5%, Intracervical fistula 85.71%, Ureteric fistula 85.71%, Vesicouterine 84.21%, Vault fistula 62.5%. Rectovaginal fistula had the least fetal wastage of 15.79% and the highest live birth of 84.2%. CONCLUSION: The findings showed a high fetal wastage rate amongst women with obstetric fistula. There was high fetal wastage across different types of obstetric fistula. Rectovaginal fistula had the best outcome in terms of live births.

Extent of medicines wastage and its contributing factors in public health facilities of south west Shoa Zone, Oromia Regional State, Ethiopia: a cross-sectional survey

Medicine wastage is a longtime problem of public health facilities in Ethiopia. However, evidence on the extent and type of wastage as well as its contributing factors are limited. Therefore, the aim of this study was to determine the extent of medicine wastage and identify its contributing factors in public health facilities of South West Shoa Zone, Oromia Regional State, Ethiopia. A cross-sectional survey was conducted in 10 public health facilities (1 hospital and 9 health centres). The value (i.e. the buying price), types and sources of wasted medicines were collected from records of medicines wastage, disposal report, commercial invoices and bin cards. And, the results are summarized using descriptive statistics. In terms of monetary value, the three years (2012/13-2014/15) wastage was estimated to be 500,522.10 (7.5%) Ethiopian Birr (ETB). Of the 144 items (by generic name) wasted, oral rehydration salt 245 osml/l powder (6.3%), metronidazole 250 mg capsule (4.1%), and tetracycline 250 mg capsules (3.2%) were the top three items by value. Anti-infectives (39.1%), medicines used for correcting water, electrolyte and acid-base balance (12.9%) and gastro intestinal acting medicines (10.6%) were also the top three therapeutic classes of medicines with high wastage rate. The main contributing factors identified for medicine wastage are: supplier’s delivery of near expiry date medicines, lack of a system to exchange nearly expired medicines from one facility to another, absence of electronic stock management tools and shortage of pharmacy professionals in the health facilities. In conclusion, the extent of medicine wastage in public health facilities decreased over the three consecutive years. However, the extent of the problem was still very high compared to the national target. A platform that facilitates communication among key supply chain actors should be devised to make informed decision including redistribution of overstocked and near expired products to less stocked and high consumption areas.Keywords: medicines wastage, wastage rate, expired medicines, contributing factors, Ethiopia

Cost-reduction strategy for isoproterenol use in radiofrequency catheter ablation procedures.

A cost-reduction strategy for isoproterenol use in radiofrequency catheter ablation procedures was evaluated. A medication-use evaluation at a 454-bed tertiary medical center revealed that the cardiac catheterization laboratory was the highest user of isoproterenol. Isoproterenol was removed from all AcuDose-Rx machines Omnicell, Mountain View, CA, and compounding was performed by pharmacy personnel. It was initially provided to the cardiac catheterization laboratory as an 8-µg/mL concentration in 20-mL 0.9% sodium chloride injection syringes with a 24-hour beyond-use date. This resulted in an initial cost savings but with an unacceptably high rate of wastage. Isoproterenol was then compounded as a 4-µg/mL concentration in 30 mL 5% dextrose in water syringes with a 9-day beyond-use date after a thorough literature search supported longer stability with this admixture. After 12 months of our current process, isoproterenol use during radio frequency catheter ablations (RFCAs) in the cardiac catheterization laboratory was reduced by 85%, decreasing the number of ampules used from 11.15 to 1.66 per week. A pharmacy-initiated process to mitigate an extraordinary increase in isoproterenol acquisition cost resulted in a reduction in usage in a tertiary care community hospital. Isoproterenol usage was reduced 85% after two different interventions were implemented, which is estimated to save $1,839 per procedure.