Towards a safe and sufficient blood supply in Sub‐Saharan Africa

Abstract

Most countries in Sub‐Saharan Africa (SSA) are either low‐income or low‐middle income countries, that is countries whose gross national income per capita is $995 (USD) or less or $996–3895, respectively. Added to this, they have very few health care professionals specifically trained in transfusion medicine and are the countries whose populations have a high prevalence of transfusion‐transmissible agents (especially HIV, hepatitis B and malaria) and whose patients (women haemorrhaging at birth, men in motor vehicle or motorcycle accidents, children with malaria or sickle cell anaemia) are often in urgent need of blood transfusion. This combination of few resources, both financial and human, combined with many potential donors at risk of transmitting infection and patients with urgent transfusion requirements renders the provision of a safe and adequate blood supply in SSA extremely challenging. In this review, we will discuss the current literature addressing how these challenges are being met and present one example of a SSA national blood transfusion service, the Uganda Blood Transfusion Service.

Risk factors for blood transfusion in traumatic and postpartum hemorrhage patients: Analysis of the CRASH-2 and WOMAN trials

“…However, in low-income countries there is a limited supply of safe blood for transfusion [14]. Due to transfusion transmitted infections, low donation rates, sub-optimal management of blood stocks and inadequate distribution of blood, many low-and middle-income countries are unable to meet transfusion demand [15,16]. To better understand how both hemodynamic and non-hemodynamic risk factors influence transfusion likelihood, we assessed the risk factors associated with likelihood of transfusion in two large, previouslypublished multinational trials.…”

Assessing the global burden of hemorrhage: The global blood supply, deficits, and potential solutions

“…Avoiding both paid and replacement donors, many blood collection organizations rely on school-aged children to form the majority of the donor pool. 29 In addition to ethical challenges, this leads to dramatic blood shortages when school is out of session.…”

“…Hospital-based, regional, and national transfusion committees can adopt this work and establish evidence-based guidelines adapting the best of international standards to local needs. 29 …”

“…Studies that previously argued that replacement donors carry a higher rate of TTI compared with VNRDs have been reevaluated and shown to have significant methodologic flaws, including confounding between first-time and repeat donors. 29 , 87 – 89 First-time donors do have a higher rate of TTI than recurrent donors, and the studies that showed a higher rate of TTI in replacement donors never controlled for the higher rate of first-time donors in the replacement pool. One ground-up alternative incorporates elements of both.…”

Obstetric anaemia in Africa in the time of COVID‐19: a call to action

“…It is predicted that we should be prepared for a 'sustained war' against COVID-19, where it is suggested that the globe may be fighting this virus and its consequences for up to 18 months [3]. . Most countries in Africa have struggled to maintain an adequate and safe blood supply and subsequently many patients have been under-transfused prior to the pandemic [4]. The strained healthcare sector in Africa may well be overwhelmed due to the consequences of the pandemic.…”