RT Journal Article SR Electronic T1 Evaluating WHO-Recommended Interventions for Preterm Birth: A Mathematical Model of the Potential Reduction of Preterm Mortality in Sub-Saharan Africa JF Global Health: Science and Practice JO GLOB HEALTH SCI PRACT FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs SP 215 OP 227 DO 10.9745/GHSP-D-18-00402 VO 7 IS 2 A1 Jennifer B. Griffin A1 Alan H. Jobe A1 Doris Rouse A1 Elizabeth M. McClure A1 Robert L. Goldenberg A1 Beena D. Kamath-Rayne YR 2019 UL http://www.ghspjournal.org/content/7/2/215.abstract AB Using the Maternal and Neonatal Directed Assessment of Technology (MANDATE) model, we estimate that WHO-recommended interventions could have saved nearly 300,000 lives in 2015. Combined interventions had the greatest impact. MANDATE can allow health officials to prioritize implementation strategies.Background:Preterm birth, a leading cause of neonatal mortality, has the highest burden in low-income countries. In 2015, the World Health Organization (WHO) published recommendations for interventions to improve preterm outcomes. Our analysis uses the Maternal and Neonatal Directed Assessment of Technology (MANDATE) model to evaluate the potential effects that WHO-recommended interventions could have had on preterm mortality in sub-Saharan Africa in 2015.Methods:We modeled preterm birth subconditions causing mortality (respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, birth asphyxia, and low birth weight). For each subcondition, models were populated with estimates of WHO-recommended intervention prevalence, case fatality, coverage, and efficacy. Various scenarios modeled improved coverage of single and combined interventions compared with baseline.Results:In 2015, approximately 500,000 neonatal deaths due to preterm birth occurred in sub-Saharan Africa. Single interventions with the greatest impact on preterm mortality included oxygen/continuous positive airway pressure (44,000 lives saved), cord care (38,500 lives saved), and breastfeeding (30,200 lives saved). Combined with improved diagnosis/transfer to a hospital, the impact of interventions showed greater reductions in mortality (oxygen/continuous positive airway pressure, 134,100 lives saved; antibiotics, 28,600 lives saved). Combined interventions had the greatest impact. Together, hospital delivery with comprehensive care for respiratory distress syndrome saved 190,600 lives, and comprehensive thermal care, breastfeeding, and prevention/treatment for sepsis saved 94,400 lives.Conclusion:In 2015, WHO-recommended interventions could have saved the lives of nearly 300,000 infants born preterm in sub-Saharan Africa. Combined interventions are necessary to maximize impact. Mathematical models such as MANDATE can estimate effects on health outcomes to allow health officials to prioritize implementation strategies.