Nike Bello

Nigeria was an important country in the women's trial and still is whenever postpartum hemorrhage is being spoken about because Nigeria is one of the few countries where women are most likely to die.

The results of the women's trial were big.

They impacted all of us.

I dare say a lot of the clinicians in Nigeria are much more aware of tranexamic acid's role in treating postpartum hemorrhage than they were before.

Part of the drawback, the problem is that

About two-thirds of births in Nigeria do not take place in hospitals.

They take place at home or in more informal settings with a mom or a mom-in-law or a local untrained birth attendant.

The I Am Woman trial, or I Am Woman, we seem to call it that interchangeably, amongst other things, aims to assess whether giving the drug intramuscularly would work as well

as giving it intravenously, which is the traditional route for administration.

If it can be given intramuscularly, it's much easier to train a birth attendant.

Now, we're not really thinking we're going to train the birth attendants, informal birth attendants like moms and mom-in-laws and the oldest woman in the village who has seen the most amount of deliveries.

But we're thinking more like primary health care centers.

not teaching hospitals where many more people deliver.

Now in a primary health care center, the only birth attendant might be a community extension worker.

He's not quite a midwife, has not gone to midwifery school, but has undergone some formal training enough to provide basic care.

Now, they might not be able to give an intravenous injection, but they can be trained to give an IM injection.

So that's kind of the thought of the reach of the IM woman trial, that if we can show that this can be given intramuscularly, then we can rule it out well beyond where doctors and nurses supervise deliveries.

Another thing, the IM woman trial is part of a wider research called TRANSFORM.

Part of Transform's reach is to implement things in the community.

So there's a community collaborator, so to speak, who already has a reach in the community and who is taking this message there.