Promoting national blood systems in developing countries

Ifland, Luke

doi:10.1097/moh.0000000000000078

Cited by 9 publications

(17 citation statements)

References 22 publications

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“…A recent report in Morbidity and Mortality Weekly Report (MMWR) [ 115 ] indicates that the number of countries in Africa and sub-Saharan Africa testing at least 95 % of donations for HBV increased from 76 to 94 %. Nucleic acid testing (NAT) is not widely available in the developing world [ 116 ], and is now considered a standard of care in blood safety. In Asia, there are few audits of blood safety measures in developing countries; consequently, it is unclear to what extent is blood safety is established.…”

Section: Guidelinesmentioning

confidence: 99%

Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update

et al. 2015

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Worldwide, some 240 million people have chronic hepatitis B virus (HBV), with the highest rates of infection in Africa and Asia. Our understanding of the natural history of HBV infection and the potential for therapy of the resultant disease is continuously improving. New data have become available since the previous APASL guidelines for management of HBV infection were published in 2012. The objective of this manuscript is to update the recommendations for the optimal management of chronic HBV infection. The 2015 guidelines were developed by a panel of Asian experts chosen by the APASL. The clinical practice guidelines are based on evidence from existing publications or, if evidence was unavailable, on the experts’ personal experience and opinion after deliberations. Manuscripts and abstracts of important meetings published through January 2015 have been evaluated. This guideline covers the full spectrum of care of patients infected with hepatitis B, including new terminology, natural history, screening, vaccination, counseling, diagnosis, assessment of the stage of liver disease, the indications, timing, choice and duration of single or combination of antiviral drugs, screening for HCC, management in special situations like childhood, pregnancy, coinfections, renal impairment and pre- and post-liver transplant, and policy guidelines. However, areas of uncertainty still exist, and clinicians, patients, and public health authorities must therefore continue to make choices on the basis of the evolving evidence. The final clinical practice guidelines and recommendations are presented here, along with the relevant background information.

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Section: Guidelinesmentioning

confidence: 99%

Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update

et al. 2015

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“…3 For these reasons, country or regional-level approaches focused on the local context may have greater impact than global recommendations. 4 …”

Section: Introductionmentioning

confidence: 99%

“…Such patients may include those in need of transfusion secondary to malaria or other infections, sickle cell disease, thalassemia, obstetric hemorrhage, and trauma . For these reasons, country‐ or regional‐level approaches focused on the local context may have greater impact than global recommendations …”

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confidence: 99%

Addressing gaps in international blood availability and transfusion safety in low‐ and middle‐income countries: a NHLBI workshop

Custer

Zou²,

Glynn³

et al. 2018

Transfusion

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In April 2017, a workshop sponsored by the National Heart, Lung, and Blood Institute, Division of Blood Diseases and Resources, and the Center for Translation Research and Implementation Science was held to discuss blood availability and transfusion safety in low- and middle-income countries (LMICs). The purpose of the workshop was to identify research opportunities for implementation science (IS) to improve the availability of safe blood and blood components and transfusion practices in LMICs. IS describes the late stages of the translational research spectrum and studies optimal and sustainable strategies to deliver proven-effective interventions. Regional working groups were formed to focus on opportunities and challenges in East Africa, Central/West Africa, Middle East and North Africa, Latin America and the Caribbean, Southeast Asia, Western Pacific Asia, Eastern Europe, and Central Asia. The need for an "adequate supply of safe blood" emerged as the major overriding theme. Among the regional working groups, common cross-cutting themes were evident. The majority of research questions, priorities, and strategies fell into the categories of blood availability, blood transfusion safety, appropriate use of blood, quality systems, health economics and budgeting, and training and education in IS. The workshop also brought into focus inadequate country-level data that can be used as the basis for IS initiatives. A mixed approach of needs assessment and targeted interventions with sufficient evidence base to move toward sustainment is an appropriate next step for blood availability and transfusion safety research in LMICs.

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“…The Guidance from the World Health Organisation (WHO) and the President’s Emergency Plan for Aids Relief (PEPFAR) recommends that countries aim by 2020 for 100% blood to be donated by non-remunerated volunteers rather than family members, primarily for reasons of sustainability and safety of the service [32]. The need for an understanding of the SSA context and how this differs from the primarily European and American contexts where most of the research which underpins the guidance is carried out, was emphasised in two recent literature reviews around blood donation behaviour in SSA [33, 34].…”

Section: Discussionmentioning

confidence: 99%

‘Just because she’s young, it doesn’t mean she has to die’: exploring the contributing factors to high maternal mortality in adolescents in Eastern Freetown; a qualitative study

November

Sandall

2018

Reprod Health

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BackgroundIn Sierra Leone, 34% of pregnancies and 40% of maternal deaths are in the adolescent population. Risks are known to be higher for younger adolescents, this being borne out by a household survey in Eastern Freetown in 2015. This current qualitative study, funded by Wellbeing of Women’s international midwifery fellowship, was conducted to explore the causes of this high incidence of maternal death for younger teenagers, and to identify possible interventions to improve outcomes.Methods This qualitative study used semi-structured interviews (n = 19) and focus groups (n = 6), with a wide range of professional and lay participants, recorded with consent. Recordings were transcribed by the first author and a Krio-speaking colleague where necessary, and Nvivo software was used to assist with theming of the data around the three main research questions.ResultsThemes from discussions on vulnerability to teenage pregnancy focused on transactional sex, especially for girls living outside of their birth family. They included sex for school fees, sex with teachers for grades, sex for food and clothes, and sex to lessen the impact of the time-consuming duties of water collection and petty trading. In addition, the criminal justice system and the availability and accessibility of contraception and abortion were included within this major theme. Within the major theme of vulnerability to death once pregnant, abandonment, delayed care seeking, and being cared for by a non-parental adult were identified. Several obstetric risks were discussed by midwives, but were explicitly related to the socio-economic factors already mentioned. A cross-cutting theme throughout the data was of gendered social norms for sexual behaviour, for both boys and girls, being reinforced by significant adults such as parents and teachers.ConclusionFindings challenge the notion that adolescent girls have the necessary agency to make straightforward choices about their sexual behaviour and contraceptive use. For girls who do become pregnant, risks are believed to be related more to stigma and abandonment than to physical maturity, leading to lack of family-based support and delayed care-seeking for antenatal and delivery care. Two potential interventions identified within the research are a mentoring scheme for the most vulnerable pregnant girls and a locally managed blood donation register. A feasibility study of a pilot mentoring scheme is currently underway, run by the first author and a local partner.

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Promoting national blood systems in developing countries

Cited by 9 publications

References 22 publications

Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update

Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update

Addressing gaps in international blood availability and transfusion safety in low‐ and middle‐income countries: a NHLBI workshop

‘Just because she’s young, it doesn’t mean she has to die’: exploring the contributing factors to high maternal mortality in adolescents in Eastern Freetown; a qualitative study

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