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Resuscitation and Obstetrical Care to Reduce Intrapartum-Related Neonatal Deaths: A MANDATE Study

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Abstract

To evaluate the impact of neonatal resuscitation and basic obstetric care on intrapartum-related neonatal mortality in low and middle-income countries, using the mathematical model, Maternal and Neonatal Directed Assessment of Technology (MANDATE). Using MANDATE, we evaluated the impact of interventions for intrapartum-related events causing birth asphyxia (basic neonatal resuscitation, advanced neonatal care, increasing facility birth, and emergency obstetric care) when implemented in home, clinic, and hospital settings of sub-Saharan African and India for 2008. Total intrapartum-related neonatal mortality (IRNM) was acute neonatal deaths from intrapartum-related events plus late neonatal deaths from ongoing intrapartum-related injury. Introducing basic neonatal resuscitation in all settings had a large impact on decreasing IRNM. Increasing facility births and scaling up emergency obstetric care in clinics and hospitals also had a large impact on decreasing IRNM. Increasing prevalence and utilization of advanced neonatal care in hospital settings had limited impact on IRNM. The greatest improvement in IRNM was seen with widespread advanced neonatal care and basic neonatal resuscitation, scaled-up emergency obstetric care in clinics and hospitals, and increased facility deliveries, resulting in an estimated decrease in IRNM to 2.0 per 1,000 live births in India and 2.5 per 1,000 live births in sub-Saharan Africa. With more deliveries occurring in clinics and hospitals, the scale-up of obstetric care can have a greater effect than if modeled individually. Use of MANDATE enables health leaders to direct resources towards interventions that could prevent intrapartum-related deaths. A lack of widespread implementation of basic neonatal resuscitation, increased facility births, and emergency obstetric care are missed opportunities to save newborn lives.

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Abbreviations

BEmOC:

Basic emergency obstetrical care

CEmOC:

Comprehensive emergency obstetrical care

IRNM:

Intrapartum-related neonatal mortality

LiST:

Lives saved tool

MANDATE:

Maternal and Neonatal Directed Assessment of Technology

NICU:

Neonatal intensive care unit

WHO:

World Health Organization

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Acknowledgments

This work was funded by a grant from the Bill and Melinda Gates Foundation to RTI International for MANDATE (Maternal and Neonatal Directed Assessment of Technology). The Gates Foundation did not contribute to study design, interpretation, or reporting of the results.

Conflict of interest

The authors have nothing to disclose.

Author information

Authors and Affiliations

  1. Perinatal Institute, Cincinnati Children’s Hospital, MLC 7009, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA

    Beena D. Kamath-Rayne & Alan H. Jobe

  2. Global Health Center, Cincinnati Children’s Hospital, Cincinnati, OH, USA

    Beena D. Kamath-Rayne

  3. Social Statistical and Environmental Sciences, RTI International, Durham, NC, USA

    Jennifer B. Griffin, Katelin Moran, Bonnie Jones, Allan Downs, Elizabeth M. McClure & Doris Rouse

  4. Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA

    Robert L. Goldenberg

Authors
  1. Beena D. Kamath-Rayne
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  2. Jennifer B. Griffin
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  3. Katelin Moran
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  4. Bonnie Jones
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  5. Allan Downs
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  6. Elizabeth M. McClure
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  7. Robert L. Goldenberg
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  8. Doris Rouse
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  9. Alan H. Jobe
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Corresponding author

Correspondence to Beena D. Kamath-Rayne.

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For the MANDATE Team.

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Kamath-Rayne, B.D., Griffin, J.B., Moran, K. et al. Resuscitation and Obstetrical Care to Reduce Intrapartum-Related Neonatal Deaths: A MANDATE Study. Matern Child Health J 19, 1853–1863 (2015). https://doi.org/10.1007/s10995-015-1699-9

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  • DOI: https://doi.org/10.1007/s10995-015-1699-9

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