Optimizing Haemophilia Care in Resource-Limited Countries: Current Challenges and Future Prospects.

About 75% of persons with hemophilia live in the developing world and do not have access to routine care due to many barriers. There are a lot of challenges associated with hemophilia care in resource-limited settings, ranging from financial to organisational and government commitments. This review discusses some of these challenges and future prospects, while highlighting the important role of the World Federation of Hemophilia in hemophilia patient care. A participative approach involving all stakeholders is key to optimizing care in resource-limited settings.

Factors influencing the return of inactive blood donors in a Cameroonian blood bank.

Identify factors that influence the return of donors to increase their loyalty while improving blood safety is crucial in our context. Between October 2017 and April 2018, we conducted a descriptive cross-sectional study at the Blood Bank of the Yaoundé University Teaching Hospital. The study included all former donors who had not donated blood voluntarily for over a year. Quantitative variables were described using means and standard deviations. Fisher's exact test and Chi2 test were used for association measures between qualitative variables. Statistical test results were considered significant for a P<0.05 value. We interviewed a total of 101 inactive donors. The study population was 74.3% male, donors average 30±7 years. Female gender and good staff hospitality were the factors most associated with the intention to return. The barriers to donor return were mainly lack of information on blood needs (35.60%) and time constraint for blood donation (26.73%). Pro-social motivations such as altruism (30.70%) were the main possible sources of motivation cited. To reduce blood deficiency and mortality due to lack of blood products, non-financial material compensation, good outreach and communication strategy can increase inactive donors' loyalty and consequently in improving blood safety in our context.

[Jean-Jacques Lefrère: A miscarried ambition for blood safety in francophone Africa]. / Jean-Jacques Lefrère: une ambition fauchée pour la sécurité transfusionnelle en Afrique francophone.

The announcement of the death of Professor Jean-Jacques Lefrère caused considerable emotion and surprise within the francophone Africa blood transfusion research network. The group was created in 2007 in Paris. Each member that works within this group wanted to pay their last respects through dedicated publication for a brilliant researcher and writer. The tribute describes the creation of the group, its goals, its operations, its achievements and the prospects of its activities while emphasizing the essential role that Professor Lefrère played within the group.

[The new HemoCue system Hb 301 for the haemoglobin measurement in pregnant women]. / Evaluation du nouvel appareil HemoCue Hb 301 dans le dosage de l'hémoglobine chez des femmes enceintes camerounaises.

The performance of the HemoCue apparatus in the diagnosis of anaemia in pregnancy was evaluated using the HemoCue Hb 301 and the HemoCue Hb 201+ apparatus. The HemoCue Hb 201 + was considered as the reference method in this study. Two hundred and thirty six pregnant women attending the University Teaching Hospital in Yaoundé (Cameroon) were included in the analysis. Anaemia was defined as haemoglobin < 11 g/dL in pregnant women during the first and the third trimester of pregnancy and as <10. 5 g/dL during the second trimester of pregnancy. With the reference method, anaemia was present in 17.7% of pregnant women compared to 11% using the HemoCue 301 method. The sensitivity, specificity, positive and negative predictive values for the HemoCue 301 method were respectively 61.9%, 100%, 100% and 92.3%. A strong correlation was shown with a Pearson's coefficient of 0.98. Using the Bland and Altman method for assessing agreement between two methods, the 95% (+/- 2SD) distribution of Hb levels about the mean was not much spread (0.06 - 0.52) though it was positive, with slightly higher Hb levels in the HemoCue Hb 301 method, compared to the reference method. Considering the study of the precision, coefficient of variation of the two methods were similar. It may be concluded that the HemoCue Hb 301 method compared to the HemoCue Hb 201+ method has acceptable sensitivity and is very specific in the diagnosis of anaemia in the Cameroonian pregnant woman. Although it gives slightly higher values, it is precise and exact in measuring Hb levels.

[Frequency of hypomagnesemia in a Cameroonian hospital: retrospective study of 1,088 values]. / Fréquence de l'hypomagnésémie en milieu hospitalier camerounais : étude rétrospective sur une série de 1,088 analyses.

To describe the values of serum magnesium and to determine the frequency of low levels of serum magnesium in a Cameroonian hospital, a retrospective study of 1088 results of serum magnesium was carried out in the University Teaching Hospital of Yaoundé (Cameroon). Among the 1088 values, 1025 were normal (94, 20 %). The prevalence of low level of serum magnesium was 4,13%. The mean of the serum magnesium was 0, 81 +/- 0,10 mmol/L. The median was 0,81 mmol/L. Among the 63 abnormal values, 10 (15,87 %) was related to a possible renal insufficiency. Three high levels of calcemia were associated to high level of serum magnesium. A total of 1069 values of the serum magnesium was required at the same time as the calcemia (98,25%). A gaussian distribution of the values of serum magnesium was observed. In conclusion, the imbalance of serum magnesium is far from frequent in Cameroonian hospital and exceptionally related to an imbalance of the calcemia.

[Concentrated red blood cells transfusion in Yaoundé, Cameroon: what quality?]. / Transfusion de concentrés de globules rouges à Yaoundé, Cameroun: quelle qualité ?

As part of a quality assurance process in the transfusion service of a hospital blood bank of Yaoundé, Cameroon, a selection of units of red cell concentrates (RCC) were evaluated for volume, haemoglobin, and haematocrit levels as well as blood cell content. Blood samples were all collected into standard double blood bags containing an anticoagulant, citrate-phosphate-dextrose and adenine. During a three-month period, 35 bags intended for the preparation of the RCC were analysed. After relevant screening for transfusion transmissible infections ,and ABO and rhesus (RH1) blood grouping, the bags were centrifuged to obtain RCC. The resultant red cell bags were weighed and the volumes estimated. Full blood counts were performed on samples of the RCC using an electronic particle counter (DIANA 5, HYCEL Diagnostics, Reims, France). The results obtained showed that, based on ISO 9001: 2000 norms, there were 57, 66 and 80% of RCC respectively with volumes, hemoglobin levels as well as hematocrit that were in conformity with the norms. When the data was analysed based on the Algerian norms, 83, 66 and 95% respectively conformed. The significance of these findings and the need for establishing local norms for quality assurance in our community are discussed.

[Blood safety: malaria and blood donation in Africa]. / Sécurité transfusionnelle: paludisme et don de sang en Afrique.

Malaria is a principal cause of mortality in Africa and represents a major blood-borne disease. The studies made on the continent show that transfusion-associated malaria is highly prevalent in blood donors groups and that some risk factors and clinical manifestations are frequently observed. The disease is mostly asymptomatic and the signs are mild, which reduces significantly an efficient selection of the blood donors during the predonation interview and a secure supply of blood products. Furthermore, the lack of appropriate screening assays of the malaria in blood banks on the continent limit the diagnosis of the disease and hamper the blood safety. However, the prevention of transfusion-associated malaria is a frequently asked question. The destruction of the parasite in the blood bag and the recipient anti-malarial prophylaxis are the described possibilities, added to local programs against the vectors of the disease.

[Evaluation of two methods for haemoglobin measurement in Cameroonian blood donors]. / Evaluation de deux techniques de dosage de l'hémoglobine chez des donneurs de sang camerounais.

In order to identify a rapid feasible and adaptable method of haemoglobin measurement for use in a blood bank, two methods were evaluated against the automated method in 204 blood donors in Yaoundé, Cameroon. Anaemia was defined as Haemoglobin<12 g/dl. Using the World Health Organisation (WHO) haemoglobin colour scale (HCS), the Hemocue method (HemoCue AB, Angelhom, Suède) and the Celly Electronic counter (Hycel Diagnostics, Reims, France), anaemia was found in 27.5, 29.4 and 31.9% of donors respectively (P<0.05). The sensitivity and specificity of the HCS was 75.38 and 94.96% respectively compared to 86.15 and 97.13% respectively in the HemoCue method. Correlation studies between each method compared to automated method showed r=0.70 for the WHO. colour scale method and 0.91 for the Hemocue method. Using the Bland and Altman statistical method, the haemoglobin distribution around the mean was wider in the WHO scale (-2.74;+2.96) than in the Hemocue method (-2.06; +1.38). We conclude that while the two methods can be used to detect anaemia in the blood bank, that the Hemocue method is more sensitive and more specific.