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The MANDATE model for evaluating interventions to reduce postpartum hemorrhage
Author(s) -
McClure Elizabeth M.,
Rouse Doris J.,
MacGuire Emily R.,
Jones Bonnie,
Griffin Jennifer B.,
Jobe Alan H.,
KamathRayne Beena D.,
Shaffer Craig,
Goldenberg Robert L.
Publication year - 2013
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2012.10.030
Subject(s) - medicine , psychological intervention , case fatality rate , mandate , intervention (counseling) , intensive care medicine , environmental health , pediatrics , emergency medicine , medical emergency , nursing , population , political science , law
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.