The aims of this study were to determine the factors that influence blood donation in different demographic groups in a multi-ethnic, multicultural community, and to devise a strategy for a national campaign to increase voluntary non-remunerated blood donations. The majority (87%) of blood donations in Trinidad and Tobago are replacement donations. Seventy per cent of the country's transfusion needs are not met. In 1998, the World Health Assembly recommended that reliance on replacement donations should be phased out due to their association with an increased risk of transfusion-transmitted infections. An observer-administered questionnaire was completed by 1423 respondents in a multi-ethnic borough in central Trinidad. Respondents were classified as donors or non-donors and grouped by age, race, religion, employment status and highest level of education. The prevalence of a history of blood donation and the factors that encouraged donation or conversely discouraged donation in each demographic group were recorded. A total of 1146 (81.2%) respondents had never donated blood. Of the 277 (18.8%) who had previously donated, replacement for a family member or friend was the most common reason (86.9%). The prevalence of donation was low in all racial, religious, gender, educational and age groups. However, there were significant demographic variations. The majority (71.3%) of non-donors cited a lack of information as a major reason for non-donation and expressed a willingness to donate if access to information and donation facilities were improved. Voluntary blood donation in Trinidad and Tobago could be greatly increased by a national education campaign and increased accessibility to donation centres. This would ensure a safer and more reliable blood supply.

The majority of blood donations in Trinidad and Tobago are made as replacement by family members or friends. National Blood Transfusion Policy was drafted in 2007 to promote voluntary, repeated donation. The objective of this study is to assess the current rate and reasons for donor deferral, and the aim is to guide the proposed donor education and recruitment programme. A retrospective study of pre-donation deferral of prospective blood donors at the National Blood Transfusion Centre, Port of Spain, Trinidad and Tobago, was conducted. Records of all pre-donation deferrals over a 12-month period were studied. As many as 11,346 pre-donation screening interviews were conducted. There were 4043 (35.6%) deferrals. The most common reasons for donor deferral were exposure to high-risk sexual activity (27.6%), low haemoglobin 22.2% and hypertension 17.5%. Other reasons such as medication, chronic medical illness, tattoos, travel history, recent pregnancy, surgery or presentation outside the accepted age limit caused 33.8% of all deferrals and the majority (34.7%) of male deferrals. Low haemoglobin (44.5%) was the most common reason among females. The rate of deferral of voluntary donors was not significantly different from that for replacement donors (31.7 vs. 35.4%, P = 0.25). This study exposed a lack of public awareness as the principal reason for an unacceptably high rate of donor deferral. Donor education about selection criteria needs to be urgently addressed as an objective of the National Policy. Monitoring and evaluation of deferral rates and reasons could be used as one indicator of the effectiveness of the Policy.

The Caribbean islands form an archipelago connecting North and South America. They have all been colonised by European countries and share strong historical, social, economic and diplomatic links with North America. However, their blood transfusion services have evolved differently, using predominantly family/replacement rather than voluntary non-remunerated donors as has been the practice in England and America since 1926 and 1970, respectively. This article uses the case of Trinidad and Tobago to examine the history and current state of blood transfusion services in the Caribbean and to present early results of an initiative for improving blood safety and adequacy in the region.

Background and objectives Trinidad and Tobago is a multi-ethnic, multicultural country with an annual blood donation rate of 17 per 1000 and predominantly (87%) family/replacement (F/R) donors. A knowledge, attitudes and practice (KAP) community survey in 2003 revealed lack of information and poor access to donation centres as barriers to voluntary non-remunerated donors (VNRD). The survey was repeated in 2013 after a national intervention to increase VNRD failed. Materials and methodsThe second cross-sectional, questionnaire-based survey was administered to 816 adults in the same community. The variables assessed were sociodemographics, knowledge, attitudes and blood donation behaviour. Data analysis was performed using SPSS statistical software and Minitab 17. Chi-square was used to assign significance and logistic regression to analyse correlation between variables. Results of the two surveys were compared.Results There was no difference in the overall percentage of donors (18Á8 vs. 21Á1%, P = 0Á337), and a low donor percentage was observed in all sociodemographic groups (7Á7-31Á6% vs. 10Á2-31Á7%). The main reason for donating blood was replacement for a relative or friend (86Á0 vs. 86Á9% P = 0Á851). Willingness to repeat donation was high (90Á6% vs. 86Á4%, P = 0Á006). Motivators and demotivators to donation varied among sociodemographic groups.Conclusion There was no significant change in community KAP between surveys. Anthropological studies into blood donation are needed to plan an effective revised and targeted blood donation campaign. Legal and regulatory changes must facilitate VNRD. Literature reviewLownik et al. [6] identified the recurrent themes of misinformation, fear, willingness to donate and failure to convert positive attitudes into actual blood donation in a series of surveys about blood donation in developing countries. The combination of positive attitudes but poor donation

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