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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. Electronic supplementary material The online version of this article (doi:10.1007/s10995-015-1699-9) contains supplementary material, which is available to authorized users., Author(s): Beena D. Kamath-Rayne[sup.1] [sup.2] , Jennifer B. Griffin[sup.3] , Katelin Moran[sup.3] , Bonnie Jones[sup.3] , Allan Downs[sup.3] , Elizabeth M. McClure[sup.3] , Robert L. Goldenberg[sup.4] , Doris Rouse[sup.3] , [...]

Objective The aim of the study is to evaluate clinical interventions to significantly reduce maternal mortality from prolonged labor, obstructed labor, and prolonged obstructed labor (PL/OL/POL) in sub-Saharan Africa (SSA). Methods A mathematical model--Maternal and Neonatal Directed Assessment of Technology ("MANDATE")--was created for SSA with estimated prevalence for PL/OL/POL and case fatality rates from hemorrhage, infection, and uterine rupture. Based on a literature review and expert opinion, the model was populated with estimated likelihoods of the current healthcare system ability to diagnose, transfer, and treat women with these conditions. Impact on maternal mortality of improved diagnosis, transfer, and delivery to relieve PL/OL/POL was assessed. Results Without current technologies, the model estimated 8,464 maternal deaths annually in SSA from these conditions. Imputing current diagnosis, transfer, and treatment of PL/OL/POL, an estimated 7,033 maternal deaths occur annually from these complications. With improved PL/OL/POL diagnosis and improved transfer, 1,700 and 740 lives could be saved, respectively. Improved diagnosis, transfer, and treatment for PL/OL/POL reduce the mortality rate to 864 maternal deaths annually, saving 6,169 lives. If improved transfusion and antibiotic use were added, only 507 women per year would die from PL/OL/POL in SSA. Conclusion In SSA, increasing diagnostics, transfer to higher care, and operative delivery could substantially reduce maternal mortality from PL/OL/POL. Synopsis A computerized model of obstructed labor in SSA was created to explore the interventions necessary to reduce maternal mortality from this condition. [ABSTRACT FROM AUTHOR]

Introduction: Postpartum haemorrhage (PPH) claims more than 100,000 maternal lives annually worldwide, most of them in low-resource settings. To address morbidity and mortality from PPH, the global health community is exploring novel drug formulations, such as inhalable medicine, to improve treatment availability and use, especially in community settings with limited access to skilled birth attendants. A major limitation in the ability to prevent or treat PPH in resource-limited settings is that the most effective medications for prevention and treatment are injectables, which require administration by skilled birth attendants., Methodology: We conducted formative research, including online surveys and in-person interviews, with a range of providers across a variety of health-care settings in Guatemala, Indonesia, Kenya, and Nigeria, to better understand the standard of care for mothers and newborns in low-resource settings, including care practices related to PPH., Results: It is estimated that up to 40% of PPH deaths could be averted if an inhalable prevention and treatment were available. However, survey and interview respondents noted a desire for more intravenous and oral medicinal formulations over inhalable formulations., Discussion/conclusion: Lack of knowledge and use of inhalable medicines among these health workers illuminates key challenges to introducing novel formulations in low-resource settings., Competing Interests: Competing Interests: None declared., (© The East African Health Research Commission 2018.)