MANDATE: Maternal and Neonatal Directed Assessment of Technology

An evidence-based framework to reduce maternal and neonatal mortality rates in developing countries

Bill & Melinda Gates Foundation

Globally, more than 350,000 women die in pregnancy or childbirth each year, while more than 3.6 million infants die within four weeks of birth and another 3.2 million are stillborn. Although there are many interventions to address these mortality rates, a system was needed to prioritize, evaluate, and optimize these interventions.

Our researchers developed an online framework, MANDATE, which has had a profound impact on understanding options and outcomes for maternal and neonatal care in India and sub-Saharan Africa. MANDATE allows researchers, health care providers, ministries of health, and others to assess how effectively various interventions address maternal and neonatal health issues in specific locations.

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.

The mathematical framework 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.

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.