Blood utilisation in a developing society: what is the best index of efficiency?

OBJECTIVES: To assess blood usage for elective surgery in a developing country as a first step towards developing a maximum surgical blood-ordering schedule (MSBOS). BACKGROUND: Cross-match:transfusion (C/T) ratio, transfusion index (Ti ) and transfusion ratio (T%) are standard indices of efficient blood usage for elective surgical procedures. The MSBOS assigns surgical procedures to Group and Cross Match (GXM) and Group and Save (G&S) categories. Non-use probability (NUP) is the percentage of blood that is requested but not used. Trinidad and Tobago (TTO) has a transfusion service that predominantly uses family replacement (F/R) donors. MATERIALS/METHODS: C/T ratio, Ti , T% and NUP were retrospectively calculated for 304 elective surgical procedures performed at a tertiary medical institution in TTO between 1st January and 15th May 2013. RESULTS: For 17 types of surgical procedure, C/T ratio was <2·5 for 10, T% ≥ 30 for 10 and Ti ≥ 0·5 for 12, suggesting efficiency, significant blood use and a requirement for GXM for most operations. However, the majority of these procedures qualify for G&S when performed under conditions that guarantee ready access to blood in an emergency. A substantial proportion of issued blood was returned unused to the blood bank, giving an NUP of 39·7%. CONCLUSION: NUP was the most sensitive measure of efficiency. C/T ratio, T% and Ti must be interpreted in the context of the blood donation system. An internationally accepted value of NUP that equates to efficient blood use should be adopted.

Dengue in Trinidad: a survey of knowledge, attitudes, practices and beliefs in two communities in Trinidad, West Indies

This study was conducted to test the Health Belief Model as it relates to dengue fever in two urban communities, namely Curepe and Woodbrook, Trinidad using a knowledge, attitude, practices and beliefs questionnaire and entomological investigations. The knowledge of dengue symptomatology, its prevention and control suggested a high level of awareness about dengue and its aetiological agents among residents of both commuities, but the connection between the vector Aedes aegypti (L.) and dengue fever transmission was poorly understood. The major determinants for cues to action were demographics, prevention of water treatment and garbage collection and disposal. Data from the present study gave clear indications of the need for health education programs, defining what garbage is and the further studies using the transtheoretical model of change (Prochaska Model). With these tools a holistic approach to vector control using community participation, health education and conventional vector control strategies may be adopted for the prevention and control of dengue and its vector. Ae. aegypti, on a sustained basis in Trinidad and, possibly, the Caribbean region.(AU)