Availability Of Blood For Transfusion Research Articles

Protocol: identifying policy, system, and environment change interventions to enhance availability of blood for transfusion in Kenya, a mixed-methods study

BackgroundSafe blood is essential for the care of patients with life-threatening anemia and hemorrhage. Low blood donation rates, inefficient testing procedures, and other supply chain disruptions in blood administration affect patients in low-resource settings across Sub-Saharan countries, including Kenya. Most efforts to improve access to transfusion have been unidimensional, usually focusing on only point along the blood system continuum, and have excluded community stakeholders from early stages of intervention development. Context-appropriate interventions to improve the availability of safe blood at the point of use in low-resource settings are of paramount importance. Thus, this protocol proposes a multifaceted approach to characterize the Kenyan blood supply chain through quantitative and qualitative analyses as well as an industrial engineering approach.MethodsThis study will use a mixed-methods approach in addition to engineering process mapping, modeling and simulation of blood availability in Kenya. It will be guided by a multidimensional three-by-three-by-three matrix: three socioeconomic settings, three components of the blood system continuum, and three levels of urgency of blood transfusion. Qualitative data collection includes one-on-one interviews and focus group discussions with stakeholders across the continuum to characterize ground-level deficits and potential policy, systems, and environment (PSE) interventions. Prospectively-collected quantitative data will be used to estimate blood collection and transfusion of blood. We will create a process map of the blood system continuum to model the response to PSE changes proposed by stakeholders. Lastly, we will identify those PSE changes that may have the greatest impact on blood transfusion availability, accounting for differences across socioeconomic settings and levels of urgency.DiscussionIdentifying and prioritizing community-driven interventions to improve blood supply in low-resource settings are of utmost importance. Varied constraints in blood collection, processing, delivery, and use make each socioeconomic setting unique. Using a multifaceted approach to understand the Kenyan blood supply and model the response to stakeholder-proposed PSE changes may lead to identification of contextually appropriate intervention targets to meet the transfusion needs of the population.

Maternal mortality is preventable in Lebanon: A case series of maternal deaths to identify lessons learned using the "Three Delays" model.

To identify the lessons learned from women who died during pregnancy or childbirth in Lebanon between 2018 and 2020. This is a case series and synthesis of maternal deaths between 2018 and 2020 that were reported by healthcare facilities to the Ministry of Public Health in Lebanon. The notes recorded from the maternal mortality review reports were analyzed using the "Three Delays" model to identify preventable causes and lessons learned. A total of 49 women died before, during, or after childbirth, with hemorrhage being the most frequent cause (n = 16). The possible factors that would have prevented maternal deathsincluded a prompt recognition of clinical severity, availability of blood for transfusion and magnesium sulfate for eclampsia, adequate transfer to tertiary care hospitals comprising specialist care, and involvement of skilled medical staff in obstetric emergencies. Many maternal deaths in Lebanon are preventable. Better risk assessment, use of an obstetric warning system, access to adequately skilled human resources and medications, and improved communication and transfer mechanisms between private and tertiary care hospitals may avoid future maternal deaths.

Knowledge, attitudes and practices on voluntary blood donation among final year undergraduates in the Faculty of Law, University of Colombo

Background: Voluntary blood donation is essential to ensure the adequate availability of blood for transfusion in healthcare institutions. There should be sufficient knowledge, positive attitudes and good practices among voluntary blood donors to keep up regular blood donations. This study aimed to assess the knowledge, attitudes and practices regarding voluntary blood donation among final year undergraduates in the Faculty of Law, University of Colombo, Sri Lanka.Methods: A descriptive cross-sectional study was conducted among 156 final year law undergraduates in the University of Colombo. A self-administered questionnaire was used to collect data. A descriptive analysis and chisquare test were used in data analysis.Results: Majority of the participants had good knowledge (64.1%) but poor attitude (82.7%) regarding blood donation. Only 16% had donated blood previously, out of which only 2% had donated blood more than once per year. The reasons stated for not donating blood included being unfit to donate (22.7%), fear of needles (20.2%), not being approached to donate (16.6%) and needing to donate for friends or relatives in the future (7.4%). There was no statistically significant association between knowledge, attitudes and practices of voluntary blood donation (p<0.05).Conclusion: In spite of having good knowledge, majority of the participants had poor attitudes towards blood donations, which most likely led to poor blood donating practices. To increase the practice of voluntary blood donation among university undergraduates, there should be awareness programmes to promote positive attitudes and eradicate misconceptions regarding blood donation.

Blood Donation Practice and Associated Factors among College Students in Kolfe Keraniyo Sub City, Addis Ababa, Ethiopia

Availability of blood for transfusion is limited in Ethiopia, as is voluntary blood donation. Evidence relating to practice on blood donation among Ethiopians is also scarce. Therefore, assessing the level of blood donation practice and its determinants among students has a paramount importance in designing an effective strategy for sustaining adequate and safe blood provision. Hence, this study aimed to assess blood donation practice and associated factors among college students in Kolfe Keraniyo Sub City, Addis Ababa, Ethiopia. Methods and materials: Institution based cross-sectional study was conducted among 354 college students from August 23, 2019 to October 7, 2019. The study participants were selected by multi stage sampling technique. A pre tested self-administered structured questionnaire was used to collect data. Binary logistic regression analysis was used to identify factors associated with blood donation practice. Result: Out of 349 sampled college students 34.4% of participants had donated blood so far. The result showed that study participants aged 21-23 and 24 and above years were 2.23 and 3.38 times more likely to donate blood compared to study participants aged 18-20 years (AOR=2.23 (95% CI: 1.15, 4.33)) and (AOR=3.38 (95% CI: 1.52, 7.50)) respectively. Health science student were 3.06 times more likely to donate blood than non-health science students (AOR=3.06 (95% CI: 1.65, 5.67)). College students who were knowledgeable about blood donation were 7.99 times more likely to donate blood compared to those who were not knowledgeable (AOR=7.99 (95% CI: 3.99, 16.02)). Study participants who said the Blood Bank working hour is convenient were 2.12 times more likely to donate blood compared to those who said the working hour is not convenient (AOR=2.12 (95% CI:1.07, 4.19)). Conclusion: Blood donation practice of college students was found to be low. Age, knowledge of blood donation, department and blood bank working hour convenience were significantly associated with blood donation practice. Hence, providing repeated blood donation awareness campaigns in the colleges and ongoing educational and motivational activities to encourage voluntary blood donation by the students.

The WOMAN trial: clinical and contextual factors surrounding the deaths of 483 women following post-partum haemorrhage in developing countries

BackgroundPost-partum haemorrhage (PPH) is a leading cause of maternal death worldwide. The WOMAN trial assessed the effects of tranexamic acid (TXA) on death and surgical morbidity in women with PPH. The trial recorded 483 maternal deaths. We report the circumstances of the women who died.MethodsThe WOMAN trial recruited 20,060 women with a clinical diagnosis of PPH after a vaginal birth or caesarean section. We randomly allocated women to receive TXA or placebo. When a woman died, we asked participating clinicians to report the cause of death and to provide a short narrative of the events surrounding the death. We collated and edited for clarity the narrative data.ResultsCase fatality rates were 3.0% in Africa and 1.7% in Asia. Nearly three quarters of deaths were within 3 h of delivery and 91% of these deaths were from bleeding. Women who delivered outside a participating hospital (12%) were three times more likely to die (OR = 3.12, 95%CI 2.55–3.81) than those who delivered in hospital. Blood was often unavailable due to shortages or because relatives could not afford to buy it. Clinicians highlighted late presentation, maternal anaemia and poor infrastructure as key contributory factors.ConclusionsAlthough TXA use reduces bleeding deaths by almost one third, mortality rates similar to those in high income countries will not be achieved without tackling late presentation, maternal anaemia, availability of blood for transfusion and poor infrastructure.

“We do what we can do to save a woman” health workers’ perceptions of health facility readiness for management of postpartum haemorrhage

ABSTRACT Background: In many low-resource settings, in-service training is a common strategy to improve the performance of health workers and ultimately reduce the persistent burden of maternal mortality and morbidities. An evaluation of the Helping Mothers Survive Bleeding After Birth (HMS BAB) training as a single-component intervention in Tanzania found some positive albeit limited effect on clinical management and reduction of postpartum haemorrhage (PPH). Aim: In order to better understand these findings, and particularly the contribution of contextual factors on the observed effects, we explored health workers’ perceptions of their health facilities’ readiness to provide PPH care. Methods: We conducted 7 focus group discussions (FGDs) and 12 in-depth interviews (IDIs) in purposively selected intervention districts in the HMS BAB trial. FGDs and IDIs were audio-recorded, transcribed and translated verbatim. Thematic analysis, using both inductive and deductive approaches, was applied with the help of MAXQDA software. Results: Health workers perceive that their facilities have a low readiness to provide PPH care, leading to stressful situations and suboptimal clinical management. They describe inconsistencies in essential supplies, fluctuating availability of blood for transfusion, and ineffective referral system. In addition, there are challenges in collaboration, communication and leadership support, which is perceived to prevent effective management of cases within the facility as well as in referral situations. Health workers strive to provide life-saving care to women with PPH despite the perceived challenges. In some health facilities, health workers perceive supportive clinical leadership as motivating in providing good care. Conclusion: The potential positive effects of single-component interventions such as HMS BAB training on clinical outcome may be constraint by poor health facility readiness, including communication, leadership and referral processes that need to be addressed.

Maternal death review and surveillance: The case of Central Hospital, Benin City, Nigeria.

BackgroundDespite the adoption of Maternal and Perinatal Death Surveillance and Response (MPDSR) by Nigeria’s Federal Ministry of Health to track and rectify the causes of maternal mortality, very limited documentation exists on experiences with the method and its outcomes at institutional and policy levels.ObjectiveThe objective of this study was to identify through the MPDSR process, the medical causes and contributory factors of maternal mortality, and to elucidate the policy response that took place after the dissemination of the results.MethodsThe study was conducted at the Central Hospital, Benin between October 1, 2017, and May 31, 2019. We first developed a strategic plan with the objective to reduce maternal mortality by 50% in the hospital in two years. An MPDSR committee was established and the members and all staff of the Maternity Department of the hospital were trained to use the nationally approved protocol. All consecutive cases of maternal deaths in the hospital were then reviewed using the MPDSR protocol. The results were submitted to the hospital Management and its supporting agencies for administrative action to correct the identified deficiencies.ResultsThere were 18 maternal deaths in the hospital during the period, and 4,557 deliveries giving a maternal mortality ratio (MMR) of 395/100,000 deliveries. This amounted to a seven-fold reduction in MMR in the hospital at the onset of the project. The main medical causes identified were obstetric hemorrhage (n = 10), pulmonary embolism (n = 2), ruptured uterus (n = 2), eclampsia (n = 1), anemic heart failure (n = 1) and post-partum sepsis (n = 2). Several facility-based and patient contributory factors were identified such as lack of blood in the hospital and late reporting with severe obstetric complication among others. Response to the recommendations from the committee include increased commitment of hospital managers to immediately rectify the attributable causes of deaths, the establishment of a couples health education program, mobilization and sensitization of staff to handle pregnant women with great sensitivity, promptness and care, the refurbishing of an intensive care unit, and the increased availability of blood for transfusion through the intensification of blood donation drive in the hospital.ConclusionWe conclude that the results of MPDSR, when acted upon by hospital managers and policymakers can lead to an improvement in quality of care and a consequent decline in maternal mortality ratio in referral hospitals.

Management of pregnancy sensitized with anti-Inb maternal blood donation

Abstract Maternal red blood cell (RBC) alloantibodies can cause hemolytic disease of the fetus and newborn (HDFN). Although much is described about common antibodies associated with HDFN, management of a pregnancy complicated by a maternal rare antibody presents several challenges related to assessment of fetal anemia risk, availability of blood for transfusion to the mother and/or the fetus or newborn if needed, and planning for delivery in the case of maternal hemorrhage. Here we report the laboratory medicine workup of a patient who presented for obstetrical care in the United States in the third trimester and had a rare antibody (anti-Inb). Prenatal antibody detection testing demonstrated maternal anti-Inb in a 28-year-old woman (gravida 4 para 1021). Ultrasound could not rule out fetal anemia. Monocyte monolayer assay was performed to assess for the clinical significance of the anti-Inb and revealed that the antibody may be capable of causing accelerated clearance of antigen-positive RBCs. A local and national query revealed that no appropriate units of RBCs were available for either the mother or neonate. Given this information, serial maternal autologous blood donations were performed, and a comprehensive care plan with a multidisciplinary approach for delivery, neonatal management, and preparation for hemorrhage was developed. Published data and our experience suggest that maternal blood donation appears to be a safe and effective way to manage mothers who cannot safely use the community blood supply. Involvement of obstetric, transfusion medicine, anesthesia, and neonatology providers was imperative for a favorable outcome. The antibody did not cause clinically significant anemia in this infant. Immunohematology 2018;34:7–10.

Knowledge, Attitude, Practice and Associated Factors of Voluntary Blood Donation among Undergraduate Students in Hargeisa University

Background: Availability of blood for transfusion is limited in Somaliland; as is the evidence relating to knowledge, attitude and practice on blood donation among youth Since youth represent both large share of the population and important group of potential donors, this study attempts to investigate what factors may be important to consider for promoting voluntary blood donation among them. Objectives: To assess the Knowledge, Attitude, Practice (KAP) of Voluntary Blood Donation and associated factor among undergraduate students in Hargeisa University. Methods: An institutional based cross-sectional study was conducted on 311 undergraduate regular students in the University of Hargeisa from March 1-12 2016. The study participants were selected using stratified random sampling. A pre-tested structured questionnaire was used to collect data. Variables with P-value<0.25 were selected as candidates for Multivariate regression and variables with P-value<0.05 were considered as statistically significantly associated. Results: The proportion of students having adequate knowledge was 46.6% and significantly associated with being a medical student [AOR: 2.591, 95% CI: 1.518, 4.422]. The proportion of students having favorable attitude was 46.9% and significantly associated with being a student at the faculty of Applied Science [AOR: 2.8, 95% CI: 1.136, 6.956], Health Science [AOR: 3.8, 95% CI: 1.205, 12.554] and Social Science [AOR: 10.00, 95% CI: 1.786, 55.976]. The proportion of students who have ever donated blood was 11.3% and significantly associated with age [AOR: 1.284, 95% CI: 1.078, 1.530] and being a male [AOR: 7.465, 95% CI: 2.104, 26.487]. Conclusion and Recommendation: More than half of the students had inadequate knowledge and unfavorable attitude towards blood donation; and majority of them had never donated blood. University Administrators in collaboration with Ministry of Health and Hargeisa Group Hospital’s Blood Bank Department must come up with plans to increase KAP of blood donation among university students.

Knowledge, Attitude and Practice on Voluntary Blood Donation and Associated Factors among Ambo University Regular Students, Ambo Town, Ethiopia

Availability of blood for transfusion is limited in Ethiopia, as is voluntary blood donation. Evidence relating to knowledge, attitudes and practices on blood donation among Ethiopians is also scarce. Because University students represent an important group of potential blood donors, we investigated what socio-cultural factors may be important to consider for promoting voluntary blood donation among them. Methods: Cross-sectional facility based quantitative study method was employed among Ambo university regular students from April 5-15, 2014. The study participants were selected by using simple random sampling technique. A pre-tested structured questionnaire was used to collected data. Both bivariate and multivariable logistic regressions were used to identify associated factors. Result: The proportion of students having good knowledge blood donation was 40.4% and significantly associated with source of information from health facility [(AOR=24.72, 95%CI: 7.18-85.09], mass media [AOR=10.28-95%CI: 2.92-36.18] and family education [AOR=13.04, 95%CI: 3.82-44.55], sex [AOR=1.7, 95%CI: 1.08-2.68], faculty of natural science [AOR =1.98, 95% CI: 1.20-3.25 and residence [AOR=2.24-95%CI: 1.43-3.53]. The positive attitude of the respondents towards blood donation were 47.4% and significantly associated with family education [AOR=2.46, 95%CI: 1.44-4.21], Academic year [AOR=2.4, 95%CI: 1.26-4.58] and good knowledge [AOR=2.16, 95%CI: 1.4-3.35]. The practiced of voluntary blood donation were 23.6% and significantly associated with family education [AOR=2.04, 95%CI: 1.19-3.48], voluntary blood donors [AOR=3.16, 95%CI: 1.03-9.66], family member received blood [AOR=2.24, 95%CI: 1.31-3.81] and good knowledge [AOR=2.96, 95%CI: 1.78-4.92]. Conclusion and recommendation: Majority, 59.6% had poor knowledge and more than half (52.3%) of the study participants had unfavorable attitude towards voluntary blood donation and 76.4% had never practiced blood donation yet. Therefore, Policy makers would be better to plan to increase KAP of voluntary blood donation among University students. These factors should be emphatically considered during Voluntary blood donation program development.

Prevalence of Allo and Auto Antibodies in Adults with SCD

AbstractAbstract 4379 Introduction:Allo- and auto- antibody formation is one of the major and serious complications of RBC transfusion in patients with sickle cell disease. This problem appears to be more common than in other diseases requiring chronic transfusion that leads to acute and delayed hemolytic transfusion reactions, serious morbidity and occasional life threatening problems. Although there have been reports describing prevalence of immunization in SCD patients, data specific for adult population with SCD is lacking. We report the prevalence of allo- and auto-immunization in adult SCD patients. Methods:Patients aged 18 and above with diagnoses of SCD, confirmed by standard hemoglobin electrophoresis, who had at least one type and cross match done from 1995 through 2011 were considered eligible. To facilitate patient management all data on antibody identification, screening and transfusions were routinely recorded in the electronic database of the Georgia Comprehensive Sickle Cell Program at Grady Health System. We gathered red cell antigen phenotype, dates and results of antibody screens, antibody specificity, and demographics which include but not limited to age in years and gender of all transfused patients. Results:A total of 424 patients 230 females and 194 males were identified with SCD who have been tested for antibodies during this period. The average age of the patients is 34 (range 18–84). A total of 138/32.5% of patients had antibodies. The most common antibodies were E (14%), C (10%) and K (8%). This may be an under estimations because antibodies disappear over time without repeated exposure. A total of 82 (19.3%) of patients developed autoantibodies. Detailed results described in Table 1. Conclusion:Allo and auto antibody formation remains significant limiting factor in finding compatible blood resulting in delays in availability of blood for transfusion that can compromise patient care in SCD. With better supportive care and hydroxyurea, adult population is growing resulting in increased need for blood transfusion and risk of antibody formation. Our practice is to do limited phenotypic matching in all patients and extended phenotype matching once antibodies are produced. Despite this practice allo- and autoimmunization continues to be a significant problem. Studies need to be done to understand pathophysiology of antibody formation in SCD and prospective randomized trials are required to define best preventive clinical practices.Table 1AntibodyNumber of patientsPercentage %C4110c3<1D164E5914e7<2K348k00Jka5<2Jkb246Fya276.35Fyb2<1S317.3Auto Antibodies8219.3M123Bga4<1A14<1Jsa102.35Lea92.11Leb2<1HTLA6<2Goa5<2Kpa1<1f1<1C+E+215C+K+123E+K+174C+E+K+7<2 Disclosures:No relevant conflicts of interest to declare.

Blood donation: survey results.

A survey of 1735 blood centers (131) and hospitals (1604) in the US showed that blood collection rate per thousand US population of donor age between 18 and 65 years decreased from 85.6 (total number of collections, 13.890) in 2004 compared to 88.0 (total number of collections, 14.259) in 2001 (2.7 % decrease). As blood utilization increases with the advent of more complex therapeutic interventions, blood collection centers are finding it difficult to maintain an adequate blood inventory because the availability of blood for transfusion is dependent on volunteer donors [1]. In the US approximately 40% of the adult population is eligible to donate blood, but just 5% about 5% do so [2]. moreover, only 3.5% of the age-eligible population donates blood in Australia. Donation anxiety due to a previous blood donation experience might be a major predictor of a donor’s future intention not to donate blood. Providing easy access to donation sites, overcoming time demands (such as scheduling appoinments for donation hours) and feeling confident for the procedure, more flexible donation hours, and increasing the number of sites where donation take place have positively influenced blood donation intentions [3]. The present study aimed to determine blood donors’ perceptions of the blood donation experience, behavioural and affective attitudes toward donation, and demographic characteristics that may influence their intention to donate blood in the future.

Human immunodeficiency virus and AIDS and other important predictors of maternal mortality in Mulago Hospital Complex Kampala Uganda

BackgroundWomen with severe maternal morbidity are at high risk of dying. Quality and prompt management and sometimes luck have been suggested to reduce on the risk of dying. The objective of the study was to identify the direct and indirect causes of severe maternal morbidity, predictors of progression from severe maternal morbidity to maternal mortality in Mulago hospital, Kampala, Uganda.MethodsThis was a longitudinal follow up study at the Mulago hospital's Department of Obstetrics and Gynaecology. Participants were 499 with severe maternal morbidity admitted in Mulago hospital between 15th November 2001 and 30th November 2002 were identified, recruited and followed up until discharge or death. Potential prognostic factors were HIV status and CD4 cell counts, socio demographic characteristics, medical and gynaecological history, past and present obstetric history and intra- partum and postnatal care.ResultsSevere pre eclampsia/eclampsia, obstructed labour and ruptured uterus, severe post partum haemorrhage, severe abruptio and placenta praevia, puerperal sepsis, post abortal sepsis and severe anaemia were the causes for the hospitalization of 499 mothers. The mortality incidence rate was 8% (n = 39), maternal mortality ratio of 7815/100,000 live births and the ratio of severe maternal morbidity to mortality was 12.8:1.The independent predictors of maternal mortality were HIV/AIDS (OR 5.1 95% CI 2-12.8), non attendance of antenatal care (OR 4.0, 95% CI 1.3-9.2), non use of oxytocics (OR 4.0, 95% CI 1.7-9.7), lack of essential drugs (OR 3.6, 95% CI 1.1-11.3) and non availability of blood for transfusion (OR 53.7, 95% CI (15.7-183.9) and delivery of amale baby (OR 4.0, 95% CI 1.6-10.1).ConclusionThe predictors of progression from severe maternal morbidity to mortalitywere: residing far from hospital, low socio economic status, non attendance of antenatal care, poor intrapartum care, and HIV/AIDS.There is need to improve on the referral system, economic empowerment of women and to offer comprehensive emergency obstetric care so as to reduce the maternal morbidity and mortality in our community.

English

&nbsp; All 2000 healthy students of Moshood Abiola Polytechnic, Abeokuta, Nigeria (intakes of 2006/2007 academic session) comprising of 1058 females and 942 males were screened for ABO and Rhesus &lsquo;D&rsquo; blood type. The analysis of the results shows O+&nbsp;(49.75%), A+&nbsp;(20.30%), B+&nbsp;(19.60%), AB+&nbsp;(3.70%), O-&nbsp;(3.95%), A-&nbsp;(1.10%), B-&nbsp;(1.35%) and AB-&nbsp;(0.25%). These values compares well with what has been reported in other countries. The high percentage of blood group O (53.70%) in the new intakes population provides an advantage in terms of availability of blood for transfusion especially in emergencies. &nbsp; Key words:&nbsp;ABO and Rhesus &lsquo;D&rsquo; blood type, healthy students, distribution patterns.

Prevalence Of Hepatitis B And C Virus Amongst Blood Donors And Abnormal Alt Activities In Blood Donors In Nigeria

The present study was designed to investigate incidences of both Hepatitis B and C Virus and serum activity of alanine aminotransaminase (ALT) amongst professional blood donors. For this study, 100 professional blood donors participated. Using blood samples collected from each donor, screening for HBV and HCV were performed by qualitative detection of serum anti-HBV and anti-HCV while the serum activity of ALT was also determined in 56 of the participants. 7% of the participating blood donors were sero-positive for Hepatitis B surface antigen (HbsAg), 3% for HCV and 2% had co-morbidity for both HBV and HCV. In addition, amongst the participants that had ALT activity > 24.0 iu/l, 5(27.7%) were HBV sero-positive out of which 2(11.1%) had co-morbidity for HBV and HCV infections. The prevalent rates of HBV and HCV amongst professional blood donors call for concern. Transfusion of blood or blood products in this area is still largely a source of transmission of these viruses. The possible use of raised ALT activities in areas where HCV screening is not available to disqualify donors from donating blood still lacks the ability to rule out 1% of donors with HCV. The present study thus concludes that HBV and HCV co-morbidity is a real problem amongst blood donors in Nigeria and may limit availability of Blood for transfusion. Implications of these bindings are discussed. Keywords: hepatitis B and C, ALT, Blood, donors. Journal of Biomedical Investigation Vol. 4 (2) 2006 pp. 32-36

Availability and safety of blood for transfusion in three districts in Malawi

Objective: Since its establishment in 2003, the Malawi Blood Transfusion Service (MBTS) has co-existed with an earlier decentralised hospital-based system for collecting, testing and distributing blood. The aim of this study was to assess the availability of blood for transfusion in Malawi and explore the challenges facing the current dual system of blood supply.Methods: A survey of all hospitals (8 hospitals) in three districts in Central Malawi.Results: MBTS provides two-thirds (66.7%) of the blood used by hospitals, and the hospital-based system provides the other one-third. MBTS centrally tests blood for HIV (ELISA), hepatitis B virus (HBsAg), hepatitis C virus (anti-HCV), syphilis and malaria parasite, and uses standard operating procedures (SOPs) to prevent errors. The hospital-based system does not routinely test for hepatitis C virus and malaria but routinely tests for HIV (rapid tests), hepatitis B virus (HBsAg), and syphilis. The major challenges faced by this dual system include poor communication, inadequate knowledge of the availability and clinical use of blood, difficulties recruiting and retaining donors, difficulties distributing blood, high prevalence of HIV and costs of running the two systems.Conclusions: The nationally coordinated centralised system provides high quality blood which is insufficient to meet demand and the hospital-based system supplements the deficit in blood supply by providing blood which is not routinely screened for all transfusion-transmitted infections. Both the centralised and decentralised systems of blood transfusion will continue to co-exist until the transition period is over. It is important that the hospital-based system be operated according to the same quality standards as the centralised system and that some form of regulatory control be put in place.

Availability of blood for transfusion in maternity units in Malawi

Objective: To assess the availability of blood for transfusion in Malawi and explore the challenges facing the current dual system of blood supply. Methods: A survey of 8 hospitals in three districts in Malawi. Results: Malawi Blood Transfusion Service (MBTS) provides two-third (66.7%) of the blood used by hospitals, and the decentralised hospital-based system provides the rest of the one-third. Hospitals test blood for HIV, hepatitis B virus, and syphilis, but unlike the MBTS do not routinely test for malaria and hepatitis C. The major challenges facing this dual system include poor communication, inadequate knowledge of the availability and clinical use of blood, difficulties recruiting and retaining donors, difficulties distributing blood, high prevalence of HIV and costs of running the two systems. Conclusions: Neither a centralised model nor a hospital-based model is optimal for Malawi and countries with similar socioeconomic profiles. Source of funding: The Health Foundation, UK

Reduction of maternal mortality: The need for voluntary blood donors

To explore the relationship between maternal mortality and availability of blood for transfusion at the country level in Latin American and Caribbean countries. The association of blood availability with maternal mortality, expressed either as national maternal mortality ratio or proportion of maternal deaths due to hemorrhage, in selected Latin American and Caribbean countries was analyzed by non-parametric methods. An inverse correlation was found between blood availability and both maternal mortality ratio (p<0.002) and proportion of deaths due to hemorrhage (p<0.05). Limited availability of blood for transfusion in countries with high maternal mortality ratios may hinder comprehensive care of mothers. The results presented here underscore the need for the formation of voluntary blood donors in the pursuit of improved maternal health.

Socio-Cultural Barriers to Voluntary Blood Donation for Obstetric Use in a Rural Nigerian Village

Availability of blood for transfusion is of utmost importance in the fight against maternal morbidity and mortality. This study was conducted to identify the socio-demographic characteristics and reasons of persons declining voluntary blood donation. Patients' relatives declining blood donation in rural Ebonyi State were randomly recruited and interviewed using standardised questionnaire after obtaining informed consent from each of them. Responses were ranked according to frequency of positive respondents. Illiteracy was prevalent among the population: over 76% had no formal education. 'Not being strong enough' and 'not having enough blood' were the two major reasons for declining blood donation, while loss of manhood/libido and exposure of blood to witchcraft were the other reasons given. Respondents' level of awareness of HIV/AIDS was appreciable. Socio-cultural barriers to voluntary blood donation exist in predominantly illiterate rural communities of the country. Most of the reasons given were based on misconception, misinformation and ignorance about the effect and safety of blood donation.

Human herpesvirus‐8: what (not) to do?

Human herpesvirus‐8: what (not) to do?