Blood Transfusion In Africa Research Articles

Neonatal Blood Transfusion in Africa; Towards Optimizing Scarce Resource

Neonatal transfusion is a common practice in Africa, where many infants are born with low birth weight and require blood transfusions. The use of paediatric packs for neonatal blood transfusions has been recommended. However, the optimal use of these packs in Africa is not clearly understood by some healthcare practitioners. This review aims to provide insights into the optimal use of paediatric packs in neonatal transfusion in Africa.The World Health Organization (WHO) recommends restrictive transfusion practices for paediatric patients, including neonates, based on expert opinion. Transfusion triggers in neonates are controversial and mainly based on expert clinical opinion, although recent randomized controlled trials of ‘liberal’ versus ‘restrictive’ red cell transfusion policies in very low birth weight preterm babies are starting to influence clinical guidelines. Many neonatal red cell transfusions are given to replace losses from frequent blood sampling. This can be reduced by avoiding non-essential tests, using low-volume sample tubes, validated near patient testing, micro-techniques in the laboratory, and non-invasive monitoring where possible.The use of CMV-seronegative blood products for transfusion in low birth weight neonates is not deemed necessary. The primary rationale is that the risk of transfusion-transmitted infections should be reduced by stringent screening of donors, restrictive transfusion practice and certain interventions like irradiation of blood units before transfusion. A recent international survey of transfusion practices for extremely premature infants showed that factors considered “very important” regarding the need to administer blood transfusions included degree of oxygen requirement and need for respiratory support. Donor exposure can also be reduced by allocating single donor units, split into paedipacks, to babies predicted to need more than one transfusion episode within the expiry date of the donation. Implementing a program to improve compliance with neonatal intensive care unit transfusion guidelines was accompanied by a reduction in transfusion rate. The implementation of guidelines to improve compliance with neonatal intensive care unit transfusion guidelines can also reduce the transfusion rate.

Improving Education and Research in Haematology and Blood Transfusion in Africa: Panacea to Improving the Health and Wellbeing of Patients in the Region

Africa bears a heavy burden of diverse diseases which includes blood diseases that overwhelm the healthcare system. A multitude of factors were believed to be responsible for this burden and it includes a lack of trained healthcare workforce, multi-disciplinary research on diseases facing the region, and a dearth of advanced diagnostic and clinical services for haematologic disorders. Measures taken to improve the situation includes increased health budgetary spending which had marginally improved. The improvement thus far achieved in haematology and blood transfusion education and research need to be determined. Three databases, namely Google Scholar, PubMed and Core, were searched for literature on haematology and blood transfusion education and research. About 2616 articles were identified, of which 7 articles were included for the review following screening and eligibility assessment by independent reviewers. The articles reviewed revealed that there was a significant improvement in haematology and blood transfusion education and research. This has translated to an improved health workforce, service delivery and research capacity and profile. However, these gains were not quantifiably presented to judge the real progress against any set standards. To fully understand the progress made and the levels that need to be reached, a comprehensive, multifaceted, and multinational study that explicitly explores the improvement measures taken and their consequential outcome is necessary.

Blood Trials: Transfusions, Injections, and Experiments in Africa, 1890-1920.

From about 1880 to 1920, a culture of medical experimentation promoted blood transfusion as a therapy for severe anemia in Europe, which was applied in German East Africa in 1892 for a case of blackwater fever, a complication of malaria afflicting mainly Europeans. This first case of blood transfusion in Africa, in which an African's blood was transfused into a German official, complicates the dominant narrative that blood transfusions in Africa came only after World War I. Medical researchers moreover experimented with blood serum therapies on human and animal subjects in Europe and Africa, injecting blood of different species, "races" and ethnicities into others to demonstrate parasite transmissibility and to discover vaccines for diseases such as malaria, sleeping sickness, and yellow fever. While research in German colonies is highlighted here, this was a transnational medical culture that crossed borders and oceans. This research is of interest as a possible early pathway for the epidemic spread of HIV and other zoonoses in Africa and the world, which biomedical researchers have identified as emerging in West-Central Africa sometime around the turn of the twentieth century.

The History of Blood Transfusion in Sub-Saharan Africa, by William H. Schneider

The History of Blood Transfusion in Sub-Saharan Africa, by William H. Schneider. Athens, Ohio University Press, 2013. ix, 239 pp. $32.95 US (paper). William Schneider's new book is first extensive historical study of blood transfusion in Africa. It breaks ground in history of medicine and public health by detailing how health professionals introduced and practiced blood transfusion in Sub-Saharan Africa (excluding South Africa). Schneider explored archives of colonial-era governments, European Red Cross societies, independent African governments, and various physicians and health officers for evidence of blood transfusion practices in last hundred years. The lasting value of Schneider's research may very well lie in its meticulous efforts to illustrate how blood transfusion rose to level of effective medicine in SubSaharan Africa, but text itself begins with a different emphasis. This book is cast, first and foremost, as a veteran historian's attempt to help scientists and public health experts determine role of blood transfusion in origins of AIDS epidemic (p. 4). The principle question facing scholars interested in origin of AIDS has been, how did a simian immunodeficiency virus (SIV) that existed among primates of Central and West Africa for thousands of years suddenly jump species and become a viral epidemic in humans only within last thirty-five years? There is widespread agreement that constitutive conditions for AIDS epidemic were both complex and recent. Intravenous injections and blood transfusion practices have therefore always been at top of epidemiologist's list of likely co-factors in early spread of HIV among humans. Colleagues of Schneider at Indiana University approached him to address their own theories about origins of HIV-AIDS epidemic. They wanted to know from a historian (previously versed in history of blood transfusions) what role, if any, did practice play in origins of HIVAIDS epidemic. No history of blood transfusion in Africa existed. Schneider's response was therefore to produce a rigorous account of the major changes in introduction and expansion of blood transfusion [in Sub-Saharan Africa] from first reports of practice, during colonial rule in 1920s, to independence of AIDS, at end of twentieth century (p. 4). Schneider's history does deliver some novel findings on introduction and practice of blood transfusion in Sub-Saharan Africa, but it is far from clear that this book gives scientists and public health experts what they want or need. The book provides a detailed but still circumstantial case for saying that blood transfusion was practiced widely-enough in twentieth-century Africa for it to have been a highly likely vector of HIV transmission in decades preceding 1982, year when AIDS was first linked to blood transfusion. …

Financing blood transfusion services in sub-Saharan Africa: a role for user fees?

The provision of a secure and safe blood supply has taken on new importance in sub-Saharan Africa with the onset of the AIDS epidemic. Blood transfusion services capable of providing safe blood are not cheap, however, and there has been some debate on the desirability and sustainability of different financing mechanisms for blood transfusion services. This paper examines patterns of financing blood transfusion in three countries--Côte d'Ivoire, Zimbabwe and Mozambique. It goes on to consider the conceptual options for financing safe blood, and to examine in detail the possible role of user fees for blood transfusion in Africa, developing a simple model of their likely burden to patients based on data from Côte d'Ivoire. The model indicates that, at best, there can only be a limited role for user fees in the financing of safe blood transfusion services, due mainly to the relatively high cost of producing a unit of safe blood. Charging individuals for the blood they receive is likely to be administratively complex and costly, could realistically recover only a fraction of the production costs involved, and is further complicated by the fact that the main recipients of blood transfusion in sub-Saharan Africa are children and pregnant women. If cost-recovery for safe blood is to be attempted, the most viable option appears to be that of charging a collective fee, levied upon all inpatients, not just on those who receive blood. Such a mechanism is not without problems, not least in its failure to offer incentives for more appropriate blood use, and it is still likely to recover only a portion of the costs of producing safe blood. Whether or not cost-recovery is instituted, there will remain an important role for public funding of blood transfusion services, and, by implication, an important role for foreign donor support.

HIV-2 infection with a long asymptomatic period

We give details of a patient infected with HIV-2 which had what we believe to be the longest asymptomatic period so far reported. The infection was probably acquired though a blood transfusion in Africa 27 years ago. At present the patient remains asymptomatic and her cellular defence mechanisms, evaluated by CD+4 lymphocyte counts and hypersensitivity skin tests, are not severely compromised. HIV-2 has come distinct epidemiological, clinical and biological features which are different from the related HIV-1 and deserve investigation in order for its natural history to be better understood.