Transfusion safety in francophone African countries: an analysis of strategies for the medical selection of blood donors.

BACKGROUND: The goal of selecting a healthy blood donor is to safeguard donors and reduce the risks of infections and immunologic complications for recipients. STUDY DESIGN AND METHODS: To evaluate the blood donor selection process, a survey was conducted in 28 blood transfusion centers located in 15 francophone African countries. Data collected included availability of blood products, risk factors for infection identified among blood donor candidates, the processing of the information collected before blood collection, the review process for the medical history of blood donor candidates, and deferral criteria for donor candidates. RESULTS: During the year 2009, participating transfusion centers identified 366,924 blood donor candidates. A mean of 13% (range, 0%-36%) of the donor candidates were excluded based solely on their medical status. The main risk factors for blood-borne infections were having multiple sex partners, sexual intercourse with occasional partners, and religious scarification. Most transfusion centers collected this information verbally instead of having a written questionnaire. The topics least addressed were the possible complications relating to the donation, religious scarifications, and history of sickle cell anemia and hemorrhage. Only three centers recorded the temperature of the blood donors. The deferral criteria least reported were sickle cell anemia, piercing, scarification, and tattoo. CONCLUSIONS: The medical selection process was not performed systemically and thoroughly enough, given the regional epidemiologic risks. It is essential to identify the risk factors specific to francophone African countries and modify the current medical history questionnaires to develop a more effective and relevant selection process.

[The transfusion center, the blood donor and the given blood in francophone African countries]. / Le centre de transfusion, le donneur de sang et le sang donné dans les pays d'Afrique francophone.

In subsaharan Africa, knowledge of the organization and methods of transfusion centers, as well as blood donor characteristics, is essential in choosing strategies to improve transfusion practices and the security of blood products on this Continent. The present study was based on a analysis led in partnership with the transfusion of seven francophone African countries (Burkina-Faso, Cameroon, Congo, Ivory Cost, Mali, Niger, and Rwanda). The results showed that withstanding significant progress has been realized in the organization and safety, but much remains to be undertaken over the years to come in order to improve the organization of the centers, the providing of blood products and the infectious and immunohematologic safety. This evolution, for the moment, is limited by the financial resources, insufficient training of personnel and cultural obstacles, but will necessarily pass through the pursuit of conjugated efforts of the scientific, international and local communities.

Transfusion safety on the African continent: an international quality control of virus testing in blood banks.

BACKGROUND: Following World Health Organization recommendations that a quality control (QC) system be implemented in African blood centers, a pilot study of the performance of human immunodeficiency virus antibody (anti-HIV), hepatitis B surface antigen (HBsAg), and hepatitis C virus antibody (anti-HCV) testing by several Sub-Saharan African blood centers was initiated. STUDY DESIGN AND METHODS: A reference laboratory sent a panel of 25 samples to six African blood center laboratories. The panel included eight negative samples; four anti-HIV-1­, one anti-HIV-2­, four anti-HCV­, and five HBsAg-positive samples; and three samples consisting of mixtures of two sera to mimic coinfections. Sensitivity, specificity, and overall quality (correct positive or negative status) scores were calculated. RESULTS: From the 21 sets of results obtained (seven for each virus), eight were from rapid tests (two for HIV, three for HBV, and three for HCV) and 13 were from enzyme immunoassays (EIAs; all HIV EIAs were antigen/antibody combination assays). Overall assay sensitivity was 98% for HIV, 75% for HBV, and 88% for HCV; agreement between blood centers using the same assay was good. Sensitivity of rapid tests was notably poorer than EIAs, with overall sensitivity quality scores of 64.5% for rapid tests (20% for HBsAg rapid tests) compared to 100% for EIAs. The overall specificity quality scores were 98.3 and 94.5% for EIAs and rapid tests, respectively. CONCLUSIONS: This pilot QC study organized for blood centers of Sub-Saharan Africa showed the feasibility of the approach despite some logistic constraints. Although interlaboratory variability was small, the poor performance of rapid tests, especially for HBsAg, raises policy questions about their use as the only screening assay.

Characteristics of blood donors and donated blood in sub-Saharan Francophone Africa.

BACKGROUND: The importance of blood safety in public health was recognized long ago, and data are essential to plan strategies to improve the status. This study aims to obtain data on blood donor and blood donation characteristics that would complement blood safety data from national and international organizations. MATERIALS AND METHODS: A questionnaire was sent to seven Francophone countries (Burkina Faso, Cameroon, Congo, Ivory Coast, Mali, Niger, and Rwanda) and was structured to obtain objective data on blood donors and donated blood and in administrative and technical organization. RESULTS: The results reflect a poor level of organization of blood transfusion centers in large regions of the African continent, insufficient supply of blood products, high prevalence of transfusion-transmitted infections, limited financial resources, a lack of well-trained personnel, and cultural obstacles. Six countries had less than 50% of their personnel trained in transfusion medicine. Only one country had the entire standard operating procedure written. Female donors represented less than 30% of the donors and the range of percentage of hepatitis B found in donors was 2.76% to 18.96%. CONCLUSION: The inclusion of these regions in future blood safety surveys and in the development of national blood transfusion programs is essential and will undoubtedly require the assistance of international organizations.