The MANDATE model for evaluating interventions to reduce postpartum hemorrhage

Abstract

Objective: To create a comprehensive model of the comparative impact of various interventions on maternal, fetal, and neonatal (MFN) mortality.

Methods: The major conditions and sub-conditions contributing to MFN mortality in low-resource areas were identified, and the prevalence and case fatality rates documented. Available interventions were mapped to these conditions, and intervention coverage and efficacy were identified. Finally, a computer model developed by the Maternal and Neonatal Directed Assessment of Technology (MANDATE) initiative estimated the potential of current and new interventions to reduce mortality.

Results: For PPH, the sub-causes, prevalence, and MFN case fatality rates were calculated. Available interventions were mapped to these sub-causes. Most available interventions did not prevent or treat the overall condition of PPH, but rather sub-conditions associated with hemorrhage and thus prevented only a fraction of the associated deaths.

Conclusion: The majority of current interventions address sub-conditions that cause death, rather than the overall condition; thus, the potential number of lives saved is likely to be overestimated. Additionally, the location at which mother and infant receive care affects intervention effectiveness and, therefore, the potential to save lives. A comprehensive view of MFN conditions is needed to understand the impact of any potential intervention.

Figure 1

MANDATE framework. Abbreviations: IUGR, intrauterine growth restriction; IVS, interventricular hemorrhage; MANDATE, Maternal and Neonatal Directed Assessment of Technology. NEC, necrotizing enterocolitis; RD/RDS, respiratory distress/respiratory distress syndrome.

Figure 2

Map of obstetric hemorrhage and sub-conditions, and representative technologies that may reduce mortality.