BackgroundLean is a set of operating philosophies and methods that help create a maximum value for patients by reducing waste and waits. It emphasizes the consideration of the customer’s needs, employee involvement and continuous improvement. Research on the application and implementation of lean principles in health care has been limited.MethodsThis is a protocol for a systematic review, following the Cochrane Effective Practice and Organisation of Care (EPOC) methodology. The review aims to document, catalogue and synthesize the existing literature on the effects of lean implementation in health care settings especially the potential effects on professional practice and health care outcomes. We have developed a Medline keyword search strategy, and this focused strategy will be translated into other databases. All search strategies will be provided in the review. The method proposed by the Cochrane EPOC group regarding randomized study designs, non-randomised controlled trials controlled before and after studies and interrupted time series will be followed. In addition, we will also include cohort, case–control studies, and relevant non-comparative publications such as case reports. We will categorize and analyse the review findings according to the study design employed, the study quality (low- versus high-quality studies) and the reported types of implementation in the primary studies. We will present the results of studies in a tabular form.DiscussionOverall, the systematic review aims to identify, assess and synthesize the evidence to underpin the implementation of lean activities in health care settings as defined in this protocol. As a result, the review will provide an evidence base for the effectiveness of lean and implementation methodologies reported in health care.Systematic review registrationPROSPERO CRD42014008853

Introduction: Meconium staining amniotic fluid is associated with lots of adverseoutcome and has long been considered to be a bad predictor of fetal outcome.Objective: This prospective observational study was undertaken to find out immediatefetal outcome in meconium stained liquor.Materials and Methods: This study was conducted in Obstetrics and Gynecologydepartment of Dhaka National Medical Collage Hospital from July to December 2008.The pregnant women with yellow, brown and thinly stained amniotic fluid in labour withgestational age 37 completed weeks were enrolled in the study. Their babies weretaken as case and followed upto 7 days after delivery in National Medical CollageHospital and in Dhaka Shishu Hospital after admission when required. Babies bornwithout meconium stained liquor were taken as a control.Results: Total 80 cases were enrolled in the study as case and 80 cases wereenrolled as control. Mean gestational age was 39.3±1.5 weeks in cases and 38.5±1.3weeks in control. There was 13.8% pregnancy induced hypertension in case groupand 3.8% in control group. Pre-eclampsia were present 10% in case group and 1.1%in control group (p<0.05). Caesarean deliveries were high (75%) in cases and it wasmuch higher with thick meconium (75%) as compared to the thin meconium (25%,p<0.001). Apgar scores in first minute and fifth minute were also low in cases. Birthasphyxia was more in cases (20%). Meconium Aspiration syndrome (25%) andConvulsion (3.8%) were developed only in cases. Admission in neonatal ward wasmore (22.5%) in cases (p<0.05) as compared to control. Neonatal mortality was high(3.8%) in cases than control (1.3%).Conclusion: Meconium stained amniotic fluid were associated with higher rate ofcaesarian delivery, increased need for neonatal resuscitation, increased rate of birthasphyxia with hypoxic ischemic encephalopathy, meconium aspiration syndrome,hospital admission and mortality.Key words: Meconium stained liquor; foetal outcome.DOI: 10.3329/bjch.v33i2.5675Bangladesh Journal of Child Health 2009; Vol.33(2): 41-45

Background: Despite proven cost effective intervention, there has been little change in neonatal mortality. In Bangladesh neonatal mortality accounts for two third of infants death. About 90% deliveries take place in home and majority of neonatal death are taking place within 7 days of birth. Information about reasons for delivering at home and newborn care practices will be useful to undertake simple intervention measures by policy makers.Aims and objective: To see the knowledge, perception and behaviour of mothers towards their normal and sick newborn.Methods: A cross sectional study was carried out in Dhaka Shishu Hospital from June to November, 2007. A semistructured, pretested questionnaire was used to interview mothers attending inpatient (IPD) and outpatient department (OPD) of hospital.Results: A total 198 mothers were interviewed. Home deliveries were 35.5% and Institutional were 64.5%. Among the Institutional deliveries 35% (44 out of 127) were planned and tried first at home, but when failed mothers were taken to hospital. Majority (86%) of home deliveries were conducted by Dai/relatives. Umbilical cord was cut with new/boiled blade in 85% of home deliveries and household knife was used in 4% cases. Birth place were not at all heated in all home deliveries. In 32 % of home deliveries babies were given bath within 1 hour of birth and it was 15% in case of hospital deliveries. Forty-eight percent babies of home deliveries were wrapped within 10 minutes. Prelacteal feed was given in 51% of home deliveries in comparison to 23% of institutional deliveries. The rate of initiation of breast feeding within one hour of birth was 52% in home and 35% in institutional deliveries. In all cases breast milk was given within 48 hours. Main reasons cited for delivering at home were preference (43%) and fear about hospital (39%). In case of educated (graduate) mothers 72% deliveries took place at hospital. Less feeding (56%), vomiting (42%), less movement (32%), fever (29%) and cough (27%) could be recognized by mothers as signs of sickness.Conclusion: Home deliveries and poor newborn care practices are commonly found in this study. Traditional birth attendants should be adequately trained as they are conducting majority of home deliveries. Female education is very important to reduce home delivery as it is seen that deliveries of educated mothers are taking place in hospital. High risk traditional newborn care practices like delayed wrapping, early bathing, use of oil in umbilical stump and prelacteal feeding need to be addressed. This study also found that knowledge to identify sickness in newborn is still poor.DOI: http://dx.doi.org/10.3329/bjch.v35i3.10497  Bangladesh J Child Health 2011; Vol 35 (3): 90-96

Reducing maternal and neonatal mortality remains a big challenge for a developing country like Bangladesh. Mothers' knowledge in neonatal care plays an important role in bringing down the mortality as well as morbidity. This study was conducted in Dhaka Shishu Hospital during the period of December 2007 to February 2008 and was based on primary data collected on socioeconomic status, knowledge and practice of mothers of neonates attending the hospital. A total of 400 mothers were interviewed. More than fifty percent mothers had an appropriate knowledge on feeding neonates, hand washing before handling neonates, care of eye, care of umbilicus and they were practicing as well. Where as less than fifty percent mothers had appropriate knowledge on keeping neonates warm, cutting hair, bathing, vaccination, oil massage and their practice rate also commensurate well with their knowledge level. Majority of the mothers were in the age group of 21-25 years, having completed primary education or passed SSC exam. They were house wives living in an urban area, with a monthly family income of 3000-7000 taka. Statistically significant association was found between socio demographic variables and knowledge and practices on neonatal care of the mothers.Ibrahim Med. Coll.

This study was conducted in Dhaka Shishu Hospital from December 2007 to February 2008 and was based on primary data on knowledge and practice of 400 mothers of neonates attending the hospital. More than 50% of the mothers had appropriate knowledge on feeding, hand washing, care of eye and umbilicus and they were practicing as well. Less than 50% of the mothers had an appropriate knowledge on raising neonates, shaving hair, bathing, vaccination, oil massaging and their practice rates also did commensurate with their knowledge level. It may be concluded that half of the interviewed mothers had an inadequate knowledge and adopted inappropriate practices in the care of their neonates. Strong steps should be taken to improve the level of knowledge and change attitudes for providing healthy practices of mothers in the care of their children. Ibrahim Med. Coll. J. 2009; 3(2): 59-62 DOI: 10.3329/imcj.v3i2.4218