title: Interventions to reduce neonatal mortality: a mathematical model to evaluate impact of interventions in sub-Saharan Africa.
abstract: OBJECTIVE
  To determine which interventions would have the greatest impact on reducing neonatal mortality in sub-Saharan Africa in 2012.
  
  
  METHODS
  We used MANDATE, a mathematical model, to evaluate scenarios for the impact of available interventions on neonatal deaths from primary causes, including: (i) for birth asphyxia - obstetric care preventing intrapartum asphyxia, newborn resuscitation and treatment of asphyxiated infants; (ii) for preterm birth - corticosteroids, oxygen, continuous positive air pressure and surfactant; and, (iii) for serious newborn infection - clean delivery, chlorhexidine cord care and antibiotics.
  
  
  RESULTS
  Reductions in infection-related mortality have occurred. Between 80 and 90% of deaths currently occurring from infections and asphyxia can be averted from available interventions, as can 58% of mortality from preterm birth. More than 200 000 neonatal deaths can each be averted from asphyxia, preterm birth and infections. Using available interventions, more than 80% of the neonatal deaths occurring today could be prevented in sub-Saharan Africa.
  
  
  CONCLUSIONS
  Reducing neonatal deaths from asphyxia require improvements in infrastructure and obstetric care to manage maternal conditions such as obstructed labour and preeclampsia. Reducing deaths from preterm birth would also necessitate improved infrastructure and training for preterm infant care. Reducing infection-related mortality requires less infrastructure and lower-level providers.
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Griffin
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.affiliation: Cincinnati Children's Hospital, Cincinnati, OH, USA.
authors.forename: Beena D
authors.initials: BD
authors.lastname: Kamath-Rayne
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Bonnie M
authors.initials: BM
authors.lastname: Hepler
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Doris J
authors.initials: DJ
authors.lastname: Rouse
authors.affiliation: Cincinnati Children's Hospital, Cincinnati, OH, USA.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Jobe
authors.affiliation: Columbia University, New York, NY, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D001238:Asphyxia Neonatorum / Q000401:mortality*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007239:Infections / Q000401:mortality*; D008962:Models, Theoretical; D018743:Perinatal Care; D047928:Premature Birth
keywords: Birth asphyxia; Neonatal infections; Neonatal mortality; Preterm birth; Sub-Saharan Africa