New global guidance supports community and lay health workers in postpartum hemorrhage prevention.

New global guidance has emerged to support countries as they consider introducing or scaling-up misoprostol for postpartum hemorrhage (PPH). The World Health Organization (WHO) and the International Federation of Gynecology and Obstetrics (FIGO) recognize the critical role that community and lay health workers play in preventing PPH and increasing access to misoprostol where skilled birth attendants are not available. As case examples from Nigeria and Nepal illustrate, community engagement and empowerment are critical strategies in successful misoprostol for PPH programs, and must increasingly be viewed as part of efforts to improve maternal health and achieve Millennium Development Goal 5.

Acceptability of vaginal film, soft-gel capsule, and tablet as potential microbicide delivery methods among African women.

BACKGROUND: Vaginal microbicides are in development for the prevention of HIV transmission to women via sexual intercourse. Acceptability of the microbicide delivery method in the targeted population is important to product adherence and, therefore, product effectiveness. It is anticipated that multiple delivery methods will be required to satisfy personal preferences among future microbicide users. METHODS: A total of 526 sexually active women aged 18-30 years participated in a consumer product preference study in Burkina Faso, Tanzania, and Zambia. Screened women who had given consent were instructed to use each of the three products (placebo formulations of a vaginal tablet, film, and soft-gel capsule) once daily for 7 consecutive days for a total of 21 days. Women were interviewed about their impressions of the product at the completion of each 7-day trial period. RESULTS: Over 80% of women reported they liked using each dosage form, and over 85% said they would definitely use it. The film and soft-gel capsule were chosen significantly more often than the tablet as the preferred dosage form (39% and 37% vs. 25%, respectively) mainly because of faster dissolving time and easier insertion. Women in Burkina Faso and Tanzania preferred the soft-gel capsule (42%-46%), whereas Zambian women preferred the film (51%). Age, socioeconomic status, and marital status did not significantly affect product preference. CONCLUSIONS: All three dosage forms were acceptable to the women surveyed. Preferred dosage forms varied by country. These data suggest that the availability of microbicides in multiple dosage forms may increase acceptability, adherence, and, therefore, effectiveness.