Blood Transfusion In sub-Saharan Africa Research Articles

The BLOODSAFE program: Building the future of access to safe blood in Sub-Saharan Africa.

The supply of blood in many low- and middle-income nations in Sub-Saharan Africa (SSA) does not meet the patient care needs. Lack and delay of blood transfusion cause harm to patients and slow the rate of progress in other parts of the health system. Recognizing the power of implementation science, the BLOODSAFE Program was initiated which supports three SSA research study teams and one data coordinating center (DCC) with the goal to improve access to safe blood transfusion in SSA. The study team in Ghana is focusing on studying and decreasing iron deficiency in blood donors and evaluating social engagement of blood donors through different approaches. The study team in Kenya is building a "vein to vein" workflow model to elucidate and devise strategies to overcome barriers to blood donation and improve infrastructural components of blood product production and use. The Malawi team is studying the infectious disease ramifications of blood donation as well as blood donor retention strategies aimed at blood donors who commence their donation career in secondary schools. Together the project teams and the DCC work as a consortium to support each other through a shared study protocol that will study donor motivations, outcomes, and adverse events across all three countries. The BLOODSAFE Program has the potential to lead to generalizable improvement approaches for increasing access to safe blood in SSA as well as mentoring and building the research capacity and careers of many investigators.

Blood transfusion in sub-Saharan Africa: understanding the missing gap and responding to present and future challenges.

Blood transfusion in sub-Saharan Africa (SSA) is at a crossroad. Significant recent developments may help meet local needs in safe blood products and fulfil a global health target, as highlighted by the World Health Organization (WHO) Millennium and Sustainable Development Goals, in improving supply and safety, and ensuring the gradual implementation of selective haemotherapy. When WHO recommended the evaluation of convalescent blood or plasma to treat Ebola-infected patients during the recent epidemics, substantial gaps in local blood collection, testing and technology infrastructure and safety, as compared to best accepted quality standards, became evident. This evidence should now serve as an 'electro-shock'/awakening call used to highlight the needs for local governments to support National Blood Transfusion Services and establish robust national regulatory authorities that are mandated to bear regulatory responsibilities of blood establishments. A nationally co-ordinated blood programme is the best tool to gather reliable epidemiological data, address local needs in blood and blood products and serve public health. A literature review using WHO website and PubMed was conducted in this article to outline the current clinical use of blood products and plasma derivatives in SSA. This text also intends to highlight the gaps to be filled in the coming years with respect to quality, safety, supply and efficacy of blood and plasma products, in line with WHO guidelines for transfusion.

The costs of producing a unit of blood in Zimbabwe.

There is lack of published data on the costs of blood and blood transfusion in sub-Saharan Africa. This study aimed to assess the unit costs of producing blood in Zimbabwe using an activity-based costing (ABC) method. A management accounting approach, based on the ABC method, was used to develop a cost model for blood. The production of blood was broken down into recruitment, collection, testing, processing, and storage plus distribution. Data for the year 2013 were collected retrospectively from budgets, financial and expenditure reports, databases, and interviews with transfusion personnel and managers. All direct and indirect costs, in 2013 US$, were allocated, accordingly, to the activities of blood acquisition. The total cost of producing safe blood in Zimbabwe for the year 2013 was US$8.6 million. Variable costs accounted for 51.2% of the total cost of production. The unit production costs for red blood cells (RBCs) were US$15.94 for recruitment, US$34.62 for collection, US$17.88 for testing, US$11.49 for processing, and US$3.06 for storage plus distribution. The overall cost of production of one unit of whole blood was US$118.42 and RBCs was US$130.94 constituting 12.4 and 13.7% of the country's annual GDP per capita. The high unit cost of producing blood relative to the annual GDP per capita demonstrates that acquiring safe blood is a burden on the health care sector in Zimbabwe. Introducing additional safety measures, such as nucleic acid amplification testing and pathogen reduction technology, although desirable, will further increase this burden.

The History of Blood Transfusion in Sub-Saharan Africa by William H. Schneider (review)

The History of Blood Transfusion in Sub-Saharan Africa by William H. Schneider (review)

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. …

The history of blood transfusion in sub-Saharan Africa

The history of blood transfusion in sub-Saharan Africa

Abstract Presentations from the AABB Annual Meeting, Philadelphia, PA, October 25-28, 2014.

Background/Case Studies: Blood utilization and blood transfusion costs are generally perceived to be increasing at a time when healthcare budgets continue being constricted. There is a paucity of published data on the production costs of blood and the costs of blood transfusion in sub-Saharan Africa. Blood transfusion costs from developed countries are likely not transferable to the sub-Sahara African region, due to differences in models for collecting blood, the level of processing into components, and implementation of sophisticated blood safety measures. This study aimed to assess the unit costs of production of blood at the national blood service by using standardized methodology. Study Design/Methods: A management accounting approach, based on the Activity- Based Costing (ABC) methodology, was chosen to develop the cost model from the provider's perspective. The production of blood was broken down into recruitment, collection, processing and storage, and distribution. Data covering the calendar year of 2013 were collected retrospectively from the budgets, financial and expenditure reports, databases, and interviews with transfusion personnel and managers. All direct and indirect costs (capital and recurrent), in 2013 US$, were allocated accordingly to the components of blood acquisition. Results/Findings: Of the 70,834 donation visits (including repeat visits) that were screened in 2013, 67,440 visits (95.2%) were accepted for donation and, of these, the number of useful units of whole blood collected was 67,422 (99.9%). The total number of units of safe blood prepared was 70,636, and the total number of units distributed was 62,624 (88.7%). The total cost of producing blood for the year 2013 stood at US$8.3 million. Recurrent costs accounted for 94.2% of the total cost of production. The major cost drivers for the recurrent costs were personnel (38.5%) and laboratory supplies (31.9%). The unit production costs for recruitment, collection, processing, storage, and distribution were US$22.44, US$30.90, USD$73.00, and USD$5.75, respectively. The overall unit production cost for 2013 was US$132.10, 18.5% of the country's GDP per capita. Conclusion: These findings show that acquiring safe blood in an underdeveloped country is an expensive undertaking compared to that in the United States (0.4% of GDP). To account for all of the blood transfusion costs, this study has to be expanded to include all of the vein-to-vein incurred costs of transfusion.

The History of Blood Transfusion in Sub-Saharan Africa

The History of Blood Transfusion in Sub-Saharan Africa

History of Blood Transfusion in Sub-Saharan Africa

The adequacy and safety of blood transfusion in sub-Saharan Africa is the subject of much concern, yet there have been very few studies of its history. An overview of that record finds that transfusions were first reported in Africa (sub-Saharan and excluding South Africa) in the early 1920s, and organized transfusion practices were established before the Second World War. Blood transfusion grew rapidly after 1945, along with the construction of new hospitals and expanded health services in Africa. Significant differences existed between colonial powers in the organization of transfusion services, but these converged after independence as their use continued to grow and decentralized and hospital-based practices were adopted. It was only after the oil crisis in the mid-1970s that health spending declined and the collection, testing, and transfusion of blood began to level off. Thus, when the AIDS crisis hit transfusion services, they were already struggling to meet the needs of patients. At this time, foreign assistance as well as the World Health Organization and the League of Red Cross Societies helped respond to both the immediate problem of testing blood, and for some countries, support existed for the broader reorganization of transfusion. Overall, the history shows that transfusion was adopted widely and quickly, limited mainly by the availability of knowledgeable doctors and hospital facilities. There was less resistance than expected by Africans to receive transfusions, and the record shows a remarkable flexibility in obtaining blood. The dangers of disease transmission were recognized from an early date but were balanced against the potential lifesaving benefits of transfusion.

A malaria control program’s effect on paediatric transfusion

Paediatric malaria is one of the leading causes for blood transfusion in sub-Saharan Africa. Malaria not only causes severe, sometimes life-threatening anaemia, but it leads to the exposure to a blood supply that may result in viral disease transmission. This study determined the frequency of paediatric malaria and transfusion for malaria before and after implementation of a Malaria Control Program in one of Ghana's districts. Paediatric patients' malaria test results and blood transfusions were reviewed during two time periods: before Malaria Control Program implementation (2003) and after (2009). Results were analysed using descriptive and bivariate statistics. The number of paediatric malaria cases confirmed by laboratory testing declined by 40·7% after implementation of the program. The number of paediatric patients transfused decreased by 12·8% (P<0·005). Of those patients tested for malaria, the frequency of transfusion was lower in 2009 (11·3%) compared to 2003 (24·1%, P<0·005). Gender and age were not associated with altered rates of transfusion. Average haemoglobin was higher in 2009 (10·4±2·0 g/dl) compared to 2003 (8·7±2·1 g/dl, P<0·005). During both periods of study, malaria positive patients who were 0-5 years were more likely to be transfused (47·6% in 2003, 75% in 2009) compared to children 5-9 years (17·3% in 2003, 18·8% in 2009). The implementation of malaria control led to fewer paediatric patients with laboratory-confirmed malaria and fewer requiring blood transfusion. Such programs may reduce morbidity and mortality directly, while limiting exposure to blood transfusion.

The risk of transfusion‐transmitted infections in sub‐Saharan Africa

Blood transfusions carry the risk of transmitting infections. This risk has been studied in detail in high-income countries but not in sub-Saharan Africa. This study estimates the risks of acquiring human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV) from a single unit of blood in sub-Saharan Africa. A mathematical model was constructed to quantify transfusion risks across 45 sub-Saharan African countries using three components: the risk of a contaminated unit entering the blood supply, the risk that the unit will be given to a susceptible patient, and the risk that receipt of the unit will lead to infection in the recipient. Variables included prevalence of infection in donors, extent of blood testing, test sensitivity, and susceptibility of recipients. Data from the World Health Organization (WHO) African Region and a systematic review of the literature were used to parameterize the model. Uncertainty in the risk estimates was quantified using probabilistic sensitivity analysis. The median overall risks of becoming infected with HIV, HBV, and HCV from a blood transfusion in sub-Saharan Africa were 1, 4.3, and 2.5 infections per 1000 units, respectively. If annual transfusion requirements projected by the WHO were met, transfusions alone would be responsible for 28,595 HBV infections, 16,625 HCV infections, and 6650 HIV infections every year. Sensitivity analysis suggests that the true risks may be even higher. This study is the first to systematically quantify the risks of transfusion-transmitted infections across sub-Saharan Africa. Although the results are limited by the quality and quantity of available data, these may be the most reliable estimates at this time.

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 and blood transfusion in sub-Saharan Africa

Blood transfusion services were poorly developed until the mid 1980s in most of sub-Saharan Africa, and were unable to provide adequate supplies of blood with acceptable safety. The pandemic of HIV was recognized seroepidemiologically from 1985 onwards. Blood transfusion was contributing from 10 to 15% to transmission in Africa. Groups at highest risk are children with malaria and anaemia, women with pregnancy-related haemorrhage or anaemia, victims of trauma and subjects with sickle-cell disease. Haemophiliacs are not a major risk group in comparison. Blood transfusion services have undoubtedly benefitted from the international, national and regional responses to the AIDS epidemic. Organizational structures have been established. There have been concerted moves to recruit voluntary unremunerated blood donors, selected from population groups with low seroprevalence. Serological screening for HIV, hepatitis viruses and syphilis has been introduced or strengthened. Standards for blood group serology, blood storage and handling have been improved. Guidelines for the appropriate use of blood have been formulated and adopted. There have been many training and retraining programmes. Much remains to be completed, however, using national and international resources, before the blood supply reaches acceptable standards of safety and is adequate in remote as well as in central areas of Africa.

HIV and blood transfusion in sub-Saharan Africa

Blood transfusion services were poorly developed until the mid 1980s in most of sub-Saharan Africa, and were unable to provide adequate supplies of blood with acceptable safety. The pandemic of HIV was recognized seroepidemiologically from 1985 onwards. Blood transfusion was contributing from 10 to 15% to transmission in Africa. Groups at highest risk are children with malaria and anaemia, women with pregnancy-related haemorrhage or anaemia, victims of trauma and subjects with sickle-cell disease. Haemophiliacs are not a major risk group in comparison. Blood transfusion services have undoubtedly benefitted from the international, national and regional responses to the AIDS epidemic. Organizational structures have been established. There have been concerted moves to recruit voluntary unremunerated blood donors, selected from population groups with low seroprevalence. Serological screening for HIV, hepatitis viruses and syphilis has been introduced or strengthened. Standards for blood group serology, blood storage and handling have been improved. Guidelines for the appropriate use of blood have been formulated and adopted. There have been many training and retraining programmes. Much remains to be completed, however, using national and international resources, before the blood supply reaches acceptable standards of safety and is adequate in remote as well as in central areas of Africa.