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Maternal and Neonatal Directed Assessment of Technology (MANDATE)

An evidence-based framework to inform effective technology development to reduce maternal and neonatal mortality rates in developing countries

Maternal and neonatal mortality rates remain alarmingly high across the globe. More than 350,000 women die in pregnancy or childbirth each year, while more than 3.6 million infants die within four weeks of being born and another 3.2 million are stillborn.

These deaths occur largely in low-resource settings with limited access to health care facilities and hospitals. Maternal and infant mortality rates remain alarmingly high across sub-Saharan Africa and India.

There are many interventions and efforts to address these mortality rates, including prevention, diagnosis and treatment technologies, provider training, and the location of health care centers, but a system was needed to prioritize, evaluate, and optimize these interventions.

Creating a Framework to Assess Interventions

In 2011 our researchers, with funding from the Bill & Melinda Gates Foundation, developed an online framework that approximates and compares the effectiveness of a variety of neonatal and maternal technologies to save lives in low-resource settings.

The resulting framework, called MANDATE, allows researchers, health care providers, ministries of health, and others to assess how various interventions address maternal and neonatal health issues in specific settings or locations. For example, the framework can estimate how many lives will be saved in sub-Saharan Africa if antibiotics are available to treat maternal infections, such as syphilis or malaria, and the impact of transferring a mother to a clinic or hospital for delivery or postpartum treatment. 

The mathematical framework, which is based on an extensive literature review, is highly customizable, allowing researchers to narrow the focus as needed and adjust parameters based on how close a community is to a health care clinic or hospital, or whether the location has the necessary resources and capacity to administer and implement the intervention adequately.

Improving Outcomes for New Mothers and Infants and for Other Health Concerns

MANDATE has had a profound impact on understanding options and outcomes for maternal and neonatal care in India and sub-Saharan Africa.

For example, MANDATE was used by a pharmaceutical company to assess the potential impact of different formulations of oxytocin, a drug used to prevent and treat post-partum hemorrhaging, the leading cause of maternal mortality. MANDATE results showed that approximately 40 percent of maternal deaths from post-partum hemorrhaging could be prevented with universal use of inhalable oxytocin. MANDATE also determined that widespread neonatal resuscitation can save as many as 170,000 infants in sub-Saharan Africa and India.

Beyond maternal and child health, MANDATE has further potential for adaptation to other health care concerns. With the support of UNITAID and the Global Alliance for TB Drug Development, the system is being adapted by RTI to inform the development of more effective technologies for pediatric tuberculosis in several countries in sub-Saharan Africa and Asia.