Volume 121, Issue 1 p. 5-9
Special articles

The MANDATE model for evaluating interventions to reduce postpartum hemorrhage

Elizabeth M. McClure

Corresponding Author

Elizabeth M. McClure

Department of Statistics and Epidemiology, Research Triangle Institute, Durham, USA

Corresponding author at: Department of Statistics and Epidemiology, Research Triangle Institute, 3040 Cornwallis Road, Durham, NC 27709, USA. Tel.: + 1 919 316 3773; fax: + 1 919 647 4160.Search for more papers by this author
Doris J. Rouse

Doris J. Rouse

Department of Statistics and Epidemiology, Research Triangle Institute, Durham, USA

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Emily R. MacGuire

Emily R. MacGuire

Department of Statistics and Epidemiology, Research Triangle Institute, Durham, USA

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Bonnie Jones

Bonnie Jones

Department of Statistics and Epidemiology, Research Triangle Institute, Durham, USA

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Jennifer B. Griffin

Jennifer B. Griffin

Department of Statistics and Epidemiology, Research Triangle Institute, Durham, USA

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Alan H. Jobe

Alan H. Jobe

Department of Pediatrics, University of Cincinnati, Cincinnati, USA

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Beena D. Kamath-Rayne

Beena D. Kamath-Rayne

Department of Pediatrics, University of Cincinnati, Cincinnati, USA

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Craig Shaffer

Craig Shaffer

Applied Strategies, San Manteo, USA

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Robert L. Goldenberg

Robert L. Goldenberg

Department of Obstetrics, Columbia University, NY, USA

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First published: 11 January 2013
Citations: 13

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.