A safe and adequate supply of blood for transfusion is an essential component of any health system. For many countries, however, blood is either not available in the required quantities or is not safe enough for transfusion. The demand for blood is always increasing in the world due to the highly sophisticated health systems as well as longer post-transfusion life expectancy. The demand profile in Africa and indeed the developing world is different, but these nations are no less dependent on safe supplies.
Blood safety, however, remains a challenge to many countries in sub-Saharan Africa due to unstable economies, civil strife, natural and manmade disasters, and failure to translate government commitment to practical interventions that would lead to further improvement. Moreover, the African Region does not only have 10% of the world’s disease burden (World Health Report) but also the highest rates of infectious diseases transmissible through blood transfusion, high HIV prevalence (about 60% of the world’s total prevalence and 60% of the total transmissions in 2006). It has a prevalence of more than 8% of the hepatitis B surface antigen (HBsAg) which is a marker of infective carrier state10 and a prevalence of HCV as high as 2.5% to 10% in some areas.
Blood safety can broadly be defined as adequate and timely provision of safe blood and blood products to all in need of transfusion as part of their treatment. The product must be of the right efficacy and adequate quantity to correct the homeostatic defect in the normal physiology of the blood for the patient; the blood must be free of infections transmissible by blood transfusion.
Blood transfusion is a life-saving intervention that has an essential role in patient management within health care systems. All Member States of the World Health Organization (WHO) endorsed World Health Assembly resolutions WHA28.72 (1) in 1975 and WHA58.13 (2) in 2005. These commit them to the provision of adequate supplies of safe blood and blood products that are accessible to all patients who require transfusion either to save their lives or promote their continuing or improving health. It is the responsibility of governments to assure a safe and sufficient supply of blood and blood products for all patients requiring transfusion.
WHO recommends an integrated strategy for the provision of safe blood and blood products and safe, efficacious blood transfusion. Crucial among such strategy is Collection of blood from voluntary non-remunerated blood donors at low risk of infections that can be transmitted through blood and blood products, the phasing out of family/replacement donation and the elimination of paid donation.
Blood Donors and Blood Screening
Screening of donated blood for TTIs represents one element of strategies for blood safety and availability. However, the first line of defense in providing a safe blood supply and minimizing the risk of transfusion-transmitted infection is to collect blood from well-selected, voluntary non-remunerated blood donors from low-risk populations, particularly those who donate regularly. The prevalence of TTIs in voluntary non-remunerated blood donors is generally much lower than among family/replacement and paid donors.
The two crucial issues related to blood transfusion in the developing world, particularly Africa, are blood shortages and unsafe blood, which all too frequently lead to serious health consequences such as death from postpartum hemorrhage or the transmission of life-threatening infections such as HIV and hepatitis. These deaths and serious side effects are preventable through actions to improve blood safety and availability.
Unsafe blood transfusions have contributed to the enormous burden of HIV infections in sub-
Saharan Africa and still continue to add to this burden. The risk of HIV infection through unsafe blood and blood products is exceptionally high (95–100%) compared to other common routes of HIV exposure: for example, 11–32% for mother-to-child transmission and 0.1%–10% for sexual contact. Sub-Saharan Africa has a particularly high level of transfusion-associated HIV compared with other regions due to a higher risk of infected blood being transfused. These results from a combination of factors: high rates of transfusion in some groups of patients (particularly women and children), a higher incidence and prevalence of HIV infection, dependence on unsafe blood donors and inadequate testing of blood for HIV in some countries. Women and children account for a disproportionate number of HIV infections through unsafe blood because they are the main groups of patients receiving blood transfusion.
This is as a result of the following interconnectedness of availability of safe blood to addressing of the various burgeoning health challenges facing the African state.
Severe anemia occurs more frequently in Africa than in most other parts of the world. This results from the high number of patients with pregnancy-related complications, malaria, worm infestations, malnutrition and sickle cell disease. Blood transfusion is frequently central to the management of life-threatening anemia, but blood shortages are experienced throughout Africa. These have a particular impact on women and children. Africa has the highest maternal mortality in the world; most of which are attributable to haemorrhage. Globally, more than half a million women die each year as a result of complications of pregnancy and childbirth2. Of the 20 countries with the highest maternal death rates, 19 are in sub-Saharan Africa where the risk of maternal death is 1 in 16, compared with 1 in 2800 in rich countries. The most common cause of maternal death is severe bleeding, which can kill even a healthy woman within two hours, if unattended; in Africa, severe bleeding during delivery or after childbirth contributes to up to 44% of maternal deaths3. Many of these deaths could be prevented through access to safe blood.
Children are also particularly vulnerable to shortages of blood in Africa because of their high requirement for transfusion arising from severe life-threatening anemia caused by malaria or malnutrition. Falciparum malaria causes more than 1 million deaths each year worldwide4. It also contributes indirectly to many additional deaths, mainly in young children, through synergy with other infections and illnesses. Around 60% of the cases of clinical malaria and over 80% of malarial deaths occur in sub-Saharan Africa where 9 out of 10 malarial deaths occur in children under five years of age. Mortality due to severe malarial anaemia is considerable in the Region. Studies report that up to 50% of transfusions given to children are related to malaria induced anemia.
Call to Action
The good news is that the transmission of HIV through unsafe blood transfusion is preventable- and is, in fact, the only approach to HIV prevention that is almost 100% effective. Blood safety is therefore one of the most cost-effective strategies for reducing the burden of HIV infection in Africa.
Serious blood shortages contributes to an increased risk of HIV and hepatitis because an inadequate stock of blood forces a reliance on unsafe family or paid donors and increased pressure to issue blood without testing as mentioned above. It is important that sub-Saharan countries achieve 100 per cent voluntary unpaid blood donation, which is the cornerstone of a safe blood supply, if we are to achieve zero tolerance new HIV infection.
The strategy advocated by WHO to achieve effective, cost-efficient and safe national blood supply systems has three main components, which are:
• Voluntary unpaid blood donation: the first line of defense is the donation of blood only by regular, voluntary unpaid blood donors from low-risk populations, who are the safest possible blood donors, and a careful assessment of their suitability to donate blood.
• Universal testing of donated blood: the second line of defense is the screening of all donated blood in accordance with quality requirements for, at minimum, HIV, hepatitis B, hepatitis C and syphilis.
Reducing unnecessary transfusions: the third line of defense is the appropriate use of transfusion only when medically indicated for patient survival and wellbeing, minimizing the loss of blood during surgery, and the use of suitable alternative treatment.
The impact of blood safety measures is demonstrated by the virtual elimination of transfusion transmitted infections in the United States (estimated risk of HIV infection of 1 in 1,800,000 per blood unit). Importantly, improved blood donor selection techniques contributed to a dramatic reduction in the risk of transmission of infection, even before specific laboratory screening tests were available.
The aforementioned facts among others, show the reason we need to campaign for Voluntary Non Remunerated Blood Donation (VNRBD) from low risk population of voluntary donors as recommended by the apex world health organization, WHO.
Blood Drive Initiative (BDI) an organization with the desire to provide safe and sustainable blood supply to meet the rising need for blood and blood products in the country have noticed that “the average, educated, healthy and well- to-do’’ citizen of this country whose life style is compatible with the criteria for a healthy donor do not donate blood unless compelled by circumstances this shouldn’t be the attitude of citizenry to blood donation but should be altruistic.
Towards this BDI , a youth-based organization in the front gear of canvassing for 100% voluntary non remunerative blood donation in Nigeria uses this opportunity of World AIDS Day 2011 to advocate for all and sundry to join the force towards attainment of 100% Voluntary Non Remunerated Blood Donation (VNRBD).
Join BDI and other organizations in this humanitarian efforts to ensure that Nigeria achieve 100% voluntary non remunerated regular blood donation by giving what science has not been able to create nor can money buy.
Considering the high effectiveness of HIV prevention through safe blood, there should be zero tolerance of any transmission of HIV and other infections within the health care system, particularly by ensuring availability of safe blood, which starts with attainment of 100% Voluntary Non Remunerated Blood Donation (VNRBD).
Adeluwoye Adekunle Oluwatosin
Executive Director, Operations
Blood Drive Initiative (BDI)
(T): +234(0)8035434655, +234(0)7040787897
BLOOD DRIVE INITIATIVE (BDI), founded in June 2005 in the University College Hospital Ibadan, is a youth-led non-governmental organization with a desire to provide safe and sustainable blood supply to meet the rising need for blood and blood products amidst of daunting challenges facing availability of ‘Safe Blood’ in Nigeria. A fast growing network of youth advocates and volunteer blood donors, BDI’s main shove is to be the change in the Blood Transfusion Service sector of the healthcare system by bridging the chasm that exists between need and opportunity via encouraging the right kind of people to adopt a lifestyle of voluntary blood donation.
Life is better lived, when shared in love. Give blood. Share life!
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