Emergency blood transfusion practices among anaemic children presenting to an urban emergency department of a tertiary hospital in Tanzania

Shari, Catherine R.; Sawe, Hendry R.; Murray, Brittany; Mwafongo, Victor; Mfinanga, Juma A.; Runyon, Michael S.

doi:10.1186/s12878-017-0091-y

Cited by 17 publications

(27 citation statements)

References 21 publications

(41 reference statements)

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“…In the study hospitals, a diagnosis of ‘severe anemia’ was the indication for blood transfusion in almost all (95%) children that were transfused. Conversely, children not diagnosed with SA were unlikely to be transfused, similar to a Tanzanian study where patients not identified by physicians in the emergency room to have severe anemia were not transfused [ 14 ]. Thus correct diagnosis of severe anemia is a critical step in the appropriate use of blood transfusion in resource limited settings.…”

Section: Discussionmentioning

confidence: 72%

“…In addition, giving blood inappropriately not only exposes children to unnecessary risks associated with blood transfusion like transfusion reactions etc. [ 18 ] but also deprives patients who are truly anemic opportunity to get life-saving blood transfusion [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, adherence to the guidelines is variable [ 11 ]. Blood transfusions are often given without laboratory confirmation of Hb level [ 12 ] or documented indications [ 13 ], and patients with indications for transfusions are not given blood [ 14 ]. Most of the studies that examined clinical use of blood amongst children have done so in children with a known pre-transfusion Hb level [ 4 , 6 , 15 ] usually under controlled research settings [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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High rate of inappropriate blood transfusions in the management of children with severe anemia in Ugandan hospitals

Opoka

Ssemata

Oyang

et al. 2018

BMC Health Serv Res

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BackgroundSevere anaemia (SA) is a common reason for hospitalisation of children in sub-Saharan Africa but the extent to which blood transfusion is used appropriately in the management of severe anemia has hitherto remained unknown. We report on the use of blood transfusion in the management of anemic children in two hospitals in Uganda.MethodsInpatient records of children 0–5 years of age admitted to Lira and Jinja regional referral hospitals in Uganda were reviewed for children admitted on selected days between June 2016 and May 2017. Data was extracted on the results, if any, of pre-transfusion hemoglobin (Hb) level, whether or not a blood transfusion was given and inpatient outcome for all children with a diagnosis of ‘severe anemia’. Qualitative data was also collected from health workers to explain the reasons for the clinical practices at the two hospitals.ResultsOverall, 574/2275 (25.2%) of the children admitted in the two hospitals were assigned a diagnosis of SA. However 551 (95.9%) of children assigned a diagnosis of SA received a blood transfusion, accounting for 551/560 (98.4%) of the blood transfusions in the pediatric wards. Of the blood transfusions in SA children, only 245 (44.5%) was given appropriately per criteria (Pre-transfusion Hb ≤ 6 g/dL), while 306 (55.5%) was given inappropriately; (pre-transfusion Hb not done, n = 216, or when a transfusion is not indicated [Hb > 6.0 g/dl], n = 90). SA children transfused appropriately per Hb criteria had lower inpatient mortality compared to those transfused inappropriately, (7 (2.9%) vs. 22 (7.2%), [OR 0.4, 95% CI 0.16, 0.90]). Major issues identified by health workers as affecting use of blood transfusion included late presentation of SA children to hospital and unreliable availability of equipment for measurement of Hb.ConclusionMore than half the blood transfusions given in the management of anemic children admitted to Lira and Jinja hospitals was given inappropriately either without pre-transfusion Hb testing or when not indicated. Verification of Hb level by laboratory testing and training of health workers to adhere to transfusion guidelines could result in a substantial decrease in inappropriate blood transfusion in Ugandan hospitals.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High rate of inappropriate blood transfusions in the management of children with severe anemia in Ugandan hospitals

Opoka

Ssemata

Oyang

et al. 2018

BMC Health Serv Res

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“…Finally, despite the high proportion of patients with severe anemia, less than half of the patients received transfusion. A previous study carried out at MNH, revealed difficulties in obtaining blood for transfusion, including a general unavailability of blood, scarcity of un-cross matched blood at the blood bank along with delays in obtaining blood [26]. It is worth noting that ED management of UGIB is guided by the presence of departmental protocol for various conditions including UGIB.…”

Section: Discussionmentioning

confidence: 99%

Profile and Outcome of Patients with Upper Gastrointestinal Bleeding Presenting to Urban Emergency Departments of Tertiary Hospitals in Tanzania

Rajan

Sawe

Iyullu

et al. 2019

Preprint

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Background Upper Gastrointestinal Bleeding (UGIB) is a common Emergency Department (ED) presentation with high morbidity and mortality. There is a paucity of data on the profile and outcome of patients who present with UGIB to EDs, especially within limited resource settings where emergency medicine is a new specialty. We aim to describe the patient profile, clinical severity and outcomes of the patients who present with UGIB to the ED of tertiary referral hospitals in Tanzania.Methodology This was a prospective cohort study of consecutive adult (≥18 years) patients presenting to the EDs of Muhimbili National Hospital (ED-MNH) and MUHAS Academic Medical Centre (ED-MAMC), in Tanzania with non-traumatic upper gastrointestinal bleeding (UGIB) from July 2018 to December 2018. Patient demographic data, clinical presentation, and ED and hospital management provided were recorded. We used the clinical Rockall score to assess disease severity. The primary outcome was 7- day mortality and regression analysis was performed to identify predictors of mortality.Results During the study period, 123 patients presented to one of the two EDs with an UGIB. The median age was 42 years (Interquartile range (IQR) 32-64 years), and 87 (70.7%) were male. Hematemesis with melena was the most frequently encountered ED complaint 39 (31.7%). Within 7 days, 23 (18.7%) patients died and one-third 8 (34.8%) of these died within 24 hours. There were no ED deaths. Upper GI endoscopy, was performed on 46 (37.4%) patients, of whom only 8 (17.4%) received endoscopy within 24 hours (early UGI endoscopy). All patients who received early UGI endoscopy had a low or moderate clinical Rockall score i.e. <3 and 3-4. No patient with scores of >4 received early UGI endoscopy. Age >40 years was a significant independent predictor of mortality (OR=7.00 (95% CI 1.7-29.2). Having a high clinical Rockall score of ≥4 was a significant independent predictor of mortality (OR=6.4 (95% CI 1.8-22.8)Conclusion In this urban ED in Sub-Saharan Africa, UGIB carried a high mortality rate. Age > 40 years and clinical Rockall score ≥4 were independent predictors of higher mortality. Future studies should focus on evaluating how to improve access to UGI endoscopy.

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“…In this extensive process they found that mortality from different clinical conditions ( ex: mortality in trauma patients within 24 h of emergency unit (EU) presentation, or transfusion rate among eligible trauma patients presenting to EU) can easily be studied and indicate the quality of care delivery in the EU. In Tanzania, Shari CR et al studied emergency blood transfusion practices among anaemic children presenting to an urban emergency department of a tertiary hospital in which he enrolled under five children who met the world health organization criteria for emergency transfusion [ 25 ]. Forty-nine percent of children with anaemia had indications for blood transfusion, but only 23% were transfused in the EU, and those not transfused had nearly a 3-fold higher mortality.…”

Section: The Components Of a High Quality Emergency Care Systemmentioning

confidence: 99%

Emergency care systems in Africa: A focus on quality

Kannan

Tenner

Sawe

et al. 2020

African Journal of Emergency Medicine

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Emergency care systems (ECS) are undergoing a period of rapid development on the African continent. What were formerly large intake zones are now being shaped into dedicated emergency units. Emergency care providers are being trained via certificate and even residency programs. However, significant challenges still exist. Resource limitations, staffing, and other system inputs are often the easiest issues to identify, but they only account for part of the problem. There are other prominent barriers to the delivery of high quality emergency care including lack of governmental leadership, poor system and facility organization, lack of provider training, and community misunderstanding of ECS functions. Released in May 2019, World Health Assembly (WHA) 72 resolution 12.9 “Emergency care systems for universal health coverage: ensuring timely care for the acutely ill and injured” has squarely placed ECS strengthening as a priority item to member state governments. Moving forward, it will be important to ensure that these systems are set up for success, as high-quality emergency care systems have the potential to avert half of all deaths in low- and middle-income countries (LMIC). With momentum building from the recent WHA amendment and the health systems community more focused than ever on the consideration of quality in health systems design, it is of the utmost importance that ECS planners dovetail these interests such that these nascent systems are designed while 1) applying a systems thinking lens and 2) maintaining a focus on quality. This article helps to accomplish this by breaking down ECS into five major categories for evaluation as defined by the WHO Emergency Care Systems Assessment tool, providing an understanding of the functions of each, and identifying which indicators might be used to gauge performance. We also reinforce the notion that these indicators must dive deeper than system inputs and health outcomes, they must be patient centered in order to truly be reflective of success.

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Emergency blood transfusion practices among anaemic children presenting to an urban emergency department of a tertiary hospital in Tanzania

Cited by 17 publications

References 21 publications

High rate of inappropriate blood transfusions in the management of children with severe anemia in Ugandan hospitals

High rate of inappropriate blood transfusions in the management of children with severe anemia in Ugandan hospitals

Profile and Outcome of Patients with Upper Gastrointestinal Bleeding Presenting to Urban Emergency Departments of Tertiary Hospitals in Tanzania

Emergency care systems in Africa: A focus on quality

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