Safe blood supply in sub-Saharan Africa: challenges and opportunities

Dei‐Adomakoh, Yvonne; Asamoah‐Akuoko, Lucy; Appiah, Bernard; Yawson, Alfred E.; Olayemi, Edeghonghon

doi:10.1016/s2352-3026(21)00209-x

Cited by 13 publications

(9 citation statements)

References 32 publications

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“…We observed an HIV prevalence among donors consistent with population-based prevalence estimates among men aged 15 to -34 years over the study period (1.3%-6.5%) 7,5,22 . While a lower prevalence than among the general population, this represents a substantial level of previously undiagnosed infections among people who can then be linked to con rmatory testing and treatment.…”

Section: Discussionsupporting

confidence: 85%

“…Syphilis prevalence among the general population is not reported in national population health surveys, 6,23 but those we observed are consistent with prevalences seen in other blood donation studies from other countries in the SSA region 18, [24][25][26][27] . The HIV incidence we observed is higher than those seen in recent population-based surveys (0.37% in 2015-2016 and 0.21% in 202-2021), but was close to those observed among men aged 25-49 (0.40% − 0.49%) 7,22 . Notably we observed a higher incidence among men than women, which is the converse of the relationship seen in population-based surveys 7 .…”

Section: Discussionsupporting

confidence: 73%

See 1 more Smart Citation

Use of Routinely Collected Blood Donation Data for Expanded Hiv and Syphilis Surveillance in Blantyre District, Malawi

Singogo¹,

Hartney

Bourdin

et al. 2023

Preprint

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Background Although WHO recommends that all blood donations be screened for transfusion transmissible infections, these data are currently not incorporated into national surveillance. We set out to use routinely collected data from blood donors in Blantyre district, Malawi to explore HIV and syphilis prevalence and identify seroconversions among repeat donors. Methods We conducted a retrospective cohort analysis of blood donation data collected by the Malawi Blood Transfusion Service (MBTS) from October, 2015 to May, 2021. All blood donations were routinely screened for HIV and syphilis. We characterized donor demographics as well as screening outcomes, including identifying seroconversions among repeat donors who previously tested negative on their last donation. Log binomial regression was used to model the impact of individual level covariates on HIV and syphilis prevalence and risk of seroconversion. Results A total of 23,280 donations from 5,051 donors were recorded, with a median frequency of donations of 3 (IQR:2–6). At the time of their first donation, most donors were male (4,294; 85%) and students (3262; 64.6%). Of those screened for HIV and syphilis at first donation, 1.0%, (52/5,051) and 1.6% (80/5,051) tested positive, respectively. Among repeat donors who previously tested negative, 52 HIV seroconversions and 126 syphilis seroconversions were identified, indicating an incidence rate per 1,000 person-years of 5.9 (95% CI: 4.7, 7.4) and 13.3 (95% CI:11.4, 15.4) respectively. Prevalence of HIV (Prevalence ratio (PR) = 0.31: 95% CI: 0.15, 0.65) and syphilis (PR = 0.54: 95% CI:0.30, 0.94) were lower and risk of syphilis seroconversion (Risk ratio = 0.47: 95% CI:0.31, 0.70) was higher among students compared to other donors. Conclusions While blood donors are generally considered a low-risk population for HIV and syphilis, we were able to identify that there remain relatively high rates of undiagnosed HIV and syphilis infections among donors. The routinely collected data from national blood donation services may be used to better understand the epidemiology of HIV and syphilis in specific locations, with the potential to enhance existing population-level disease surveillance systems. In addition, these findings may be used to identify priority prevention areas and populations in Blantyre district that can inform targeted interventions for improved disease prevention, testing and treatment.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 73%

Use of Routinely Collected Blood Donation Data for Expanded Hiv and Syphilis Surveillance in Blantyre District, Malawi

Singogo¹,

Hartney

Bourdin

et al. 2023

Preprint

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“…They incorrectly retain patients (overnight) at the primary healthcare level where diagnostic and therapeutic facilities are insufficient to manage bloodstream infections [5,38,39]. Intravenous therapy furthermore carries an important risk of fatal healthcare-associated infections [56,57,59,60], as observed in this study. The fact that more than half of the children received intramuscular antipyretics further illustrate the widespread problem of unnecessary and unsafe injection practices in sub-Saharan Africa [61][62][63].…”

Section: Delayed Appropriate Treatment Due To Prehospital Antibiotics...mentioning

confidence: 85%

Health itinerary-related survival of children under-five with severe malaria or bloodstream infection, DR Congo

Tack

Vita²,

Nketo³

et al. 2023

PLoS Negl Trop Dis

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Background Prompt appropriate treatment reduces mortality of severe febrile illness in sub-Saharan Africa. We studied the health itinerary of children under-five admitted to the hospital with severe febrile illness in a setting endemic for Plasmodium falciparum (Pf) malaria and invasive non-typhoidal Salmonella infections, identified delaying factors and assessed their associations with in-hospital death. Methodology Health itinerary data of this cohort study were collected during 6 months by interviewing caretakers of children (>28 days − <5 years) admitted with suspected bloodstream infection to Kisantu district hospital, DR Congo. The cohort was followed until discharge to assess in-hospital death. Principal findings From 784 enrolled children, 36.1% were admitted >3 days after fever onset. This long health itinerary was more frequent in children with bacterial bloodstream infection (52.9% (63/119)) than in children with severe Pf malaria (31.0% (97/313)). Long health itinerary was associated with in-hospital death (OR = 2.1, p = 0.007) and two thirds of deaths occurred during the first 3 days of admission. Case fatality was higher in bloodstream infection (22.8% (26/114)) compared to severe Pf malaria (2.6%, 8/309). Bloodstream infections were mainly (74.8% (89/119)) caused by non-typhoidal Salmonella. Bloodstream infections occurred in 20/43 children who died in-hospital before possible enrolment and non-typhoidal Salmonella caused 16 out of these 20 bloodstream infections. Delaying factors associated with in-hospital death were consulting traditional, private and/or multiple providers, rural residence, prehospital intravenous therapy, and prehospital overnight stays. Use of antibiotics reserved for hospital use, intravenous therapy and prehospital overnight stays were most frequent in the private sector. Conclusions Long health itineraries delayed appropriate treatment of bloodstream infections in children under-five and were associated with increased in-hospital mortality. Non-typhoidal Salmonella were the main cause of bloodstream infection and had high case fatality. Trial registration NCT04289688

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“…Similarly, many sub-Saharan African (SSA) countries are constrained by limited financial resources to enable them build capacity, infrastructure, and systems for the provision of blood transfusion services. Available data have shown that the situation can be mitigated by recruitment and retention of regular blood donors, a thorough screening of donated blood for the presence of transfusion-transmissible infections, compatibility testing, and hemovigilance [17]. Countries within the SSA block allocate meager financial resources to this sector and depend mainly on external donor support for blood transfusion services [18].…”

Section: Discussionmentioning

confidence: 99%

Challenges facing blood transfusion services at a regional blood transfusion center in Western Kenya

et al. 2022

Int J Blood Transfus Immunohematol

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Aims: The demand for blood and blood products in sub-Saharan Africa is occasioned by tropical infectious diseases and obstetric complications that cause anemia. We therefore need a well-organized blood transfusion service with sufficient resources to process blood and blood products, especially in the Western Kenya, where co-infections of tropical diseases are rampant. This study was aimed at determining the blood deficiency and challenges experienced by Eldoret Regional Blood Transfusion Center (ERBTC). Methods: A cross-sectional descriptive design was used to conduct the study. All the ERBTC staffs, donor records, and blood requisition and dispatch registers were studied. Self-administered questionnaires and data collection abstraction forms were used to collect data. The extracted data from ERBTC registers included those on demand and supply mismatches and blood discards. The obtained data were entered into Microsoft Excel and analyzed using descriptive statistics. Results: A total of 16 staffs, 230 donor records, and 9612 units of requested blood were reviewed. The ERBTC reported many challenges ranging from understaffing, limited funding, insufficient equipment, and irregular reagents and other laboratory supplies. During the study period, the blood bank only managed to supply 4740 units of blood against a demand of 9612 units, thus occasioning a 50.7% deficit. A discard rate of 7.8% after the screening was also reported due to insufficient volumes after collection and transfusion transmissible infections. However, there were no wastages during the study period. Conclusion: The main challenges experienced by ERBTC were understaffing, insufficient funding, limited equipment, frequent reagent outages, and discards of unsuitable blood, resulting in very high deficits. We recommend hiring staff, increased funding, acquiring modern equipment and reagents, and recruiting known regular blood donors to alleviate frequent shortage.

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Safe blood supply in sub-Saharan Africa: challenges and opportunities

Cited by 13 publications

References 32 publications

Use of Routinely Collected Blood Donation Data for Expanded Hiv and Syphilis Surveillance in Blantyre District, Malawi

Use of Routinely Collected Blood Donation Data for Expanded Hiv and Syphilis Surveillance in Blantyre District, Malawi

Health itinerary-related survival of children under-five with severe malaria or bloodstream infection, DR Congo

Challenges facing blood transfusion services at a regional blood transfusion center in Western Kenya

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