Determinants of intention to return to donate blood among first-time blood donors in Ghana.

OBJECTIVE: This study seeks to identify factors that are predictive of intention to return to donate blood among first-time blood donors. METHODS: A cross-sectional survey of 505 first-time blood donors, selected from blood donation sessions across three regions in Ghana. Data were obtained on their intention to donate blood in the next four months, factors that would influence this decision. Logistic regression models were used to test factors that were predictive of intention to return. RESULTS: First-time donors were young with 87·4% below 35 years of age, male (72·5%), single (73·3%), Christian (93·7%), employed (58·8%), with at least a basic education (98%). Factors that positively predicted intention to return included: motivational incentives (OR = 1·67, 95%CI: 1·01-2·78; P = 0·045); ease of access to the donation site (OR = 2·65, 95%CI: 1·48-4·73; P = 0·001); SMS and email reminders (OR = 2·84, 95%CI: 1·60-5·06; P < 0·001); and television, radio or newspaper advertisements (OR = 2·97, 95%CI: 1·66-5·31; P < 0·001). Factors that negatively predicted intention included preferential access to transfusions (i.e. 'blood credits') (OR = 0·43, 95%CI: 0·23-0·83; P = 0·012); getting to know test results (OR = 0·40, 95%CI: 0·20-0·80; P = 0·010); and not knowing and/or trusting what happens to the blood after donating (OR = 0·50, 95%CI: 0·28-0·88; P = 0·016). CONCLUSION: Motivational incentives, convenient access to donation sessions, reminders and mass media advertisements appear to positively influence intention to return to donate. Conversely not knowing what happens to the blood after donation negatively influenced intention to return. Interventions to promote repeat blood donation should consider the identified factors.

Blood donors' perceptions, motivators and deterrents in Sub-Saharan Africa - a scoping review of evidence.

Achieving an adequate blood supply in Sub-Saharan Africa (SSA) through donor mobilization and retention is crucial. Factors that motivate or deter blood donors vary according to beliefs and social norms. Understanding the factors that influence blood donation behaviour in SSA is vital to developing effective strategies to address blood donor motivation and retention. This review of 35 studies from 16 SSA countries collates available evidence concerning the perceptions, motivators and deterrents that influence blood donors in SSA. The review revealed a common understanding that blood and blood donation save lives. The main deterrent to blood donation was fear due to lack of knowledge and discouraging spiritual, religious and cultural perceptions of blood donation. The main motivators for blood donation were altruism, donating blood for family and incentives. The findings support the need for targeted, culturally sensitive education, recruitment and retention strategies to improve the blood supply in SSA.

Pediatric blood transfusion practices at a regional referral hospital in Kenya.

BACKGROUND: Severe anemia in children is a major public health problem in sub-Saharan Africa. In this study we describe clinical and operational aspects of blood transfusion in children admitted to Coast Provincial General Hospital, Kenya. STUDY DESIGN AND METHODS: This was an observational study where over a 2-year period, demographic and laboratory data were collected on all children for whom the hospital blood bank received a transfusion request. Clinical data were obtained by retrospective review of case notes over the first year. RESULTS: There were 2789 requests for blood for children (median age, 1.8 years; interquartile range [IQR], 0.6-6.6 years); 70% (1950) of the samples were crossmatched with 85% (1663/1950) issued. Ninety percent (1505/1663) were presumed transfused. Median time from laboratory receipt of request to collection of blood was 3.6 hours (IQR, 1.4-12.8 hr). Case notes of 590 children were reviewed and median pretransfusion hemoglobin level was 6.0 g/dL (IQR, 4.2-9.1 g/dL). Ninety-four percent (186) were transfused "appropriately" while 52% (120) were transfused "inappropriately." There was significant disagreement between the clinical and laboratory diagnosis of severe anemia (exact McNemar's test; p < 0.0001). Antimalarials were prescribed for 65% (259) of children who received blood transfusions but only 41% (106) of these had a positive blood film. CONCLUSION: In this setting, clinicians often order blood based on the clinical impression of "severe anemia." This has implications for laboratory workload and the blood supply itself. However, the majority of children with severe anemia were appropriately transfused. The use of antimalarials with blood transfusions irrespective of blood film results is common practice.

The microbiologic safety of umbilical cord blood transfusion for children with severe anemia in Mombasa, Kenya.

BACKGROUND: Severe anemia requiring blood transfusion is common in hospitalized young children in sub-Saharan Africa but blood is often in short supply. Umbilical cord blood may be a useful source of blood if microbiologic safety concerns can be addressed. STUDY DESIGN AND METHODS: Cord blood, donated on the labor ward at the provincial hospital in Mombasa, was cultured soon after collection (screening culture) and after a period of storage (poststorage culture). Conventional blood transfused to children at the hospital was cultured only at the time of issue (poststorage culture). Maternal sera (cord blood) and conventional blood donations were also screened for transfusion-transmitted infection. RESULTS: At poststorage culture, the overall contamination rate of cord blood was one-third that of conventional blood (13/449 vs. 38/434; odds ratio [OR], 0.31; 95% confidence interval [CI], 0.15-0.61) and for bacteria of high pathogenic potential it was half that of conventional blood (4/449 vs. 7/434; OR, 0.55; 95% CI, 0.12-2.18). Screening cultures were positive in 50% (2/4) of cord blood packs where an organism of high pathogenic potential was isolated at poststorage culture. Cord blood donors had a lower seroreactivity than conventional donors for human immunodeficiency virus (OR, 0.63; 95% CI, 0.29-1.18), hepatitis B virus (OR, 0.32; 95% CI, 0.16-0.59), and hepatitis C virus (OR, 0.20; 95% CI, 0.24-0.76). For syphilis, initial seroreactivity in cord blood donors was 3.8% compared to 1.8% in conventional blood donors (OR, 2.10; 95% CI, 1.15-3.60) but was 0.5% after retesting. CONCLUSION: With respect to bacterial contamination and seroreactivity for transfusion-transmitted infection, the safety of cord blood in Mombasa compares favorably with conventional blood. Clinical trials of cord blood transfusion are justified.

Safety and efficacy of allogeneic umbilical cord red blood cell transfusion for children with severe anaemia in a Kenyan hospital: an open-label single-arm trial.

BACKGROUND: In sub-Saharan Africa, children are frequently admitted with severe anaemia needing an urgent blood transfusion, but blood is often unavailable. When conventional blood supplies are inadequate, allogeneic umbilical cord blood could be a feasible alternative. The aim of this study was to assess the safety and efficacy of cord blood transfusion in children with severe anaemia. METHODS: Between June 26, 2007, and May 20, 2008, 413 children needing an urgent blood transfusion were admitted to Kilifi District Hospital in Kenya. Of these, 87 children were eligible for our study--ie, younger than 12 years, no signs of critical illness, and haemoglobin 100 g/L or lower (if aged 3 months or younger) or 40 g/L or lower (if older than 3 months). Cord blood was donated at Coast Provincial General Hospital, Mombasa, and screened for transfusion-transmitted infections and bacterial contamination. Red blood cells were stored vertically at 2-6°C to enable sedimentation. After transfusion, children were monitored closely for adverse events and followed up for 28 days. The primary outcome measure was the frequency and nature of adverse reactions associated with the transfusion. Secondary outcomes were the changes in haemoglobin concentrations 24 h and 28 days after transfusion, compared with pretransfusion levels. This trial is registered on ISRCTN.com, number ISRCTN66687527. FINDINGS: Of the 87 children eligible for the study, cord blood was unavailable for 24, six caregivers declined consent, and two children were withdrawn before transfusion. Therefore, 55 children received umbilical cord red blood cells from 74 donations. Ten (18%) children had ten serious adverse events and 43 (78%) had 94 adverse events; the most frequent adverse events were anaemia (n=14), weight loss (n=12), and vomiting (n=10). An independent expert panel judged none of these adverse events to be probably or certainly caused by the cord blood transfusion (one-sided 97·5% CI 0-6·5). Haemoglobin increased by a median of 26 g/L (IQR 21-31) 24 h after transfusion and by 50 g/L (10-68) a median of 29 days (28-35) after transfusion. INTERPRETATION: These preliminary data suggest that cord blood could be an important supplementary source of blood for transfusion in children in sub-Saharan Africa. Further studies are needed to compare the safety and efficacy of cord blood with conventional adult-donated blood for transfusions. Challenges associated with cost, infrastructure, and scale up also need investigating. FUNDING: Wellcome Trust.