RESEARCH TRIANGLE PARK, N.C. — More than 98 percent of maternal and neonatal deaths occur in low-resource settings. Strategies to reduce maternal and neonatal deaths need to incorporate improving access to appropriate curative and preventive interventions, especially in home and community settings, where over half of the more than 60 million births per year occur.
Delivering innovative technologies across the continuum of care – including technologies for frontline workers to use in homes, communities, and first-level clinics – may significantly improve pregnancy outcomes. However, no quantitative process currently exists to evaluate and prioritize technology development options based on the potential to save lives in low-resource settings.
As part of an effort to improve maternal and neonatal health care in low-resource countries, RTI International has developed a web-based tool to objectively assess the impact of new medical technologies on maternal, fetal and neonatal mortality.
The assessment tool, called MANDATE (Maternal and Neonatal Directed Assessment of Technology), is being developed with funding from the Bill & Melinda Gates Foundation. It is a decision support tool to inform effective allocation of technology development resources.
According to Dr. Joy Lawn, director of Global Evidence and Policy at Saving Newborn Lives, "Innovative technologies could save millions of lives – but not all technologies have equal impact. No technology can magically transform a hut with no electricity or running water, and one community health worker into safe place for a mother in labor or for a sick baby. MANDATE offers a rational approach to prioritizing which innovations could save the most lives and work for the poorest families in the hardest to reach places."
By calculating the potential number of maternal and neonatal lives saved, the tool allows users to identify and compare the potential impact of a technology. Users may adjust variables related to a technology's availability, appropriate use and efficacy, to determine how a technology might be improved to have the greatest impact.
Once the variables are set by the user, MANDATE can determine the technology's potential impact by patient category, medical condition and health care settings in sub-Saharan Africa and South Asia, the regions with the highest burden of mortality.
The tool will be available for public use on the MANDATE website free of charge, with the launch of the first condition, neonatal respiratory distress, at the end of November 2011. Additional conditions will be made available over the next nine months.
"Some very good technologies are simply not practical for use in low-resource settings," said Doris Rouse, Ph.D., project director and vice president of global health technologies at RTI. "In some cases, innovative, low-tech solutions are more appropriate in these settings. MANDATE enables the user to assess the reduction in maternal and neonatal mortality that might result from a new or improved technology that is more appropriate or effective in specific settings."
The project aims to assist in prioritizing where and how to deliver innovative and appropriate technologies across the continuum of care in order to have the largest reductions in mortality.
RTI researchers initiated the project in 2009 and focused on the major causes and sub-causes of maternal, fetal and neonatal deaths as well as the available medical technologies for prevention, diagnosis and treatment. They then developed a quantitative assessment of the potential of a new technology, or set of technologies, to reduce maternal, fetal and neonatal mortality in a given setting.
The MANDATE tool can also be used to define the characteristics that a new technology would need to achieve the highest efficacy and coverage in various areas, and to estimate the potential benefit in lives saved of any new device under development.
RTI plans to further evolve MANDATE to provide an enhanced user interface, expanded conditions and additional insights as to the key factors for optimizing technologies in different health care settings.