BackgroundTwo out of three neonatal deaths occur in just 10 countries and Pakistan stands third among them. Maternal mortality is also high with most deaths occurring during labor, birth, and first few hours after birth. Enhanced access and utilization of skilled delivery and emergency obstetric care is the demonstrated strategy in reducing maternal and neonatal mortality. This trial aims to compare reduction in neonate mortality and utilization of available safe birthing and Emergency Obstetric and Neonatal Care services among pregnant mothers receiving ‘structured birth planning’, and/or ‘transport facilitation’ compared to routine care.MethodsA pragmatic cluster randomized trial, with qualitative and economic studies, will be conducted in Jhang, Chiniot and Khanewal districts of Punjab, Pakistan, from February 2011 to May 2013. At least 29,295 pregnancies will be registered in the three arms, seven clusters per arm; 1) structured birth planning and travel facilitation, 2) structured birth planning, and 3) control arm. Trial will be conducted through the Lady Health Worker program. Main outcomes are difference in neonatal mortality and service utilization; maternal mortality being the secondary outcome. Cluster level analysis will be done according to intention-to-treat.DiscussionA nationwide network of about 100,000 lady health workers is already involved in antenatal and postnatal care of pregnant women. They also act as “gatekeepers” for the child birthing services. This gate keeping role mainly includes counseling and referral for skill birth attendance and travel arrangements for emergency obstetric care (if required). The review of current arrangements and practices show that the care delivery process needs enhancement to include adequate information provision as well as informed “decision” making and planned “action” by the pregnant women. The proposed three-year research is to develop, through national technical working group process, and then test a set of arrangements for achieving the enhanced utilization of safe birthing services.Trial registrationCurrent Controlled Trials ISRCTN86264432

Streptococcus viridans is one of the microorganisms found in root canals. The infection caused by S. viridans can cause an inflammatory response that will cause damage to the root canal. Infections in the root canal can be treated with root canal treatment. In the disinfection stage, a sterilization material is needed, one of which is Cresophene. However, certain people have an allergy to cresophene. Therefore, it is necessary to develop new drug options. Development of natural ingredients for alternative root canal sterilization drugs for patients who are hypersensitive to cresophene and have antibacterial effects with minimal side effects, one of which is essential oil extract of Curcuma xanthorrhiza Roxb. Essential oil extract of C. xanthorrhiza Roxb contains xanthorrhizol, camphene and curcumin which are antibacterial compounds. This study aims to determine the antibacterial activity of temulawak essential oil extracts on the growth of S. viridans. Temulawak is extracted using the steam and air distillation method. Inhibition test was carried out using the disc diffusion method. The concentration of essential oil extract of C. xanthorrhiza Roxb used were 25%, 50%, 75%, and 100%. The research data were statictically analyzed using SPSS with the Kruskal Wallis test. The average inhibition zone diameters at concentration of 25%, 50%, 75% and 100% is 0 mm, 8,22 mm, 12,16 mm, and 16,1 mm. Data anaylisis using Kruskal Wallis showed a significance value of 0,00 (p<0,05), which means that it has a significant difference. Essential oil extract of C. xanthorrhiza Roxb has antibacterial activity against S. viridans.