Trends in blood donations, blood donors' knowledge, practices and expectations during the COVID-19 pandemic in Cameroon.

INTRODUCTION: The COVID-19 pandemic, caused by a novel coronavirus, has already affected over 99 062 people in 53 African countries and killed 3082. The pandemic threatens blood supply but we do not yet know its impact on blood donations or on the perceptions and expectations of donors. METHODS: We conducted a cross-sectional study in four hospital-based blood services in Cameroon, using a survey design and focusing on the subjective and cultural aspects of donors. Using a semi-structured questionnaire, we collected the participants' responses as to their understanding of COVID-19 and of current protection measures, and their expectations. Data on trends of blood donations were collected retrospectively for the period from 1st January to 30th April 2019 and the same period in 2020. RESULTS: Of 494 donors included, 432 (87·4%) were enrolled from fixed blood collection sites and 62 (12·6%) were contacted by phone. A total of 464 (93·9%) participants believed that the COVID-19 is a lung disease, but some declared it to be imaginary (7·7%), a foreign disease (8·3%) or a blood-borne disease (3·2%). The participants reported that the distribution of face masks and hydroalcoholic solutions (92·5%), social distancing and hygiene (6·3%) are the most important measures that need to be in place for safe donation. The number of blood donations dropped by 21·5% between 2019 and 2020. CONCLUSION: Most of the donors know COVID-19, its transmission routes and manifestations. In the absence of barrier measures, they perceive blood donation as a threat to their health. Distribution of masks and hydroalcoholic solution might motivate more donors and improve the blood supply.

Traceability of Blood Transfusions and Reporting of Adverse Reactions in Developing Countries: A Six-Year Postpilot Phase Experience in Burkina Faso.

Traceability is an essential tool for haemovigilance and transfusion safety. In Burkina Faso, the implementation of haemovigilance has been achieved as part of a pilot project from 2005 to 2009. Our study aims to evaluate the traceability of blood transfusions and reporting of adverse reactions over the 6-year postpilot phase. A cross-sectional study including all blood units ordered between 2010 and 2015 has been conducted in public and private health care facilities supplied with blood products by the transfusion center of Bobo-Dioulasso. The complete traceability was possible for 83.5% of blood units delivered. Adverse reactions were reported in 107 cases representing 2.1/1,000 blood units per annum. Transfusions of wrong blood to wrong patient were reported in 13 cases. Our study shows that the haemovigilance system in Burkina Faso must be improved. Healthcare workers have to be sensitized on how traceability and haemovigilance could impact the quality of care provided to patients.

Estimate of the residual risk of transfusion-transmitted human immunodeficiency virus infection in sub-Saharan Africa: a multinational collaborative study.

BACKGROUND: Sub-Saharan Africa remains the epicenter of the human immunodeficiency virus (HIV) pandemic. However, there is a lack of multicenter data on the risk of transfusion-transmitted HIV from blood centers in sub-Saharan Africa. STUDY DESIGN AND METHODS: The incidence of HIV infections in the blood donations collected in the main blood banks of five countries (Burkina Faso, Congo, Ivory Coast, Mali, and Senegal) was determined to estimate the current transfusion risk of HIV infection using the incidence rate/window period model. RESULTS: The risk of transfusion-transmitted HIV infections associated with the window period varied from 1 in 90,200 donations (Senegal) to 1 in 25,600 (Congo). Considering the five participating blood centers as a whole, the incidence rate of HIV-positive donors per 100,000 person-years was 56.6 (95% confidence interval [CI], 47.1-67.9); the residual risk (RR) was 34.1 (95% CI, 7.8-70.7) per 1 million donations, which represents 1 in 29,000 donations (95% CI, 1/128,000-1/14,000). CONCLUSION: RR estimates varied according to the country. This is potentially due to a lower incidence of HIV infection in the general population or to a more efficient selection of blood donors in the countries with the lowest risk. The estimates of the transfusion risk of HIV infection in each country are important, both to assess the impact of current preventative strategies and to contribute data to policy decisions to reinforce transfusion safety.

Recruitment of blood donors in Burkina Faso: how to avoid donations from family members?

Burkina Faso is a continental West African country of approximately 16 M people whose transfusion needs were covered by 66,210 blood units collected mostly in 4 regional transfusion centers part of a national network but also from hospital-based smaller blood centers. The first group of blood centers relies almost exclusively on volunteer, non-remunerated, blood donors and only approximately 32.7% of them are repeating donation. In contrast, hospital-based blood centers rely nearly exclusively on family/replacement donors. The general strategy of the national blood transfusion network was to base the system exclusively on volunteer donors, which was nearly accomplished overall and completely at Bobo-Dioulasso, the largest center. However, despite considerable increase in blood collection, the overall blood supply remains low (4.7 units/1000 inhabitants) and worsens during the secondary school recesses since young student blood constitutes the most part of volunteer donors. To overcome such shortages, mobile blood collection sessions are organized in alternate sites such as military barracks or places of worship but with limited success. Another critical issue is that despite considerable efforts and help from community advocates, only 32.7% of volunteers repeat donation limiting the considerably safety advantage of a pool of regular donors.

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.

Blood safety in Sub-Saharan Africa: a multi-factorial problem.

Although the World Health Organization (WHO) has set targets for safe blood by 2012, Sub-Saharan Africa remains confronted with multi-factorial issues that compromise blood safety in most countries of the region. Some of these include the development and implementation of national policies for transfusion, the recruitment of voluntary and unpaid donors, proper screening of collected blood as well as a strategy for its rational use in a setting already plagued by a high prevalence of blood-borne agents, poverty, and sometimes organizational deficits. Furthermore, the organization of hemovigilance, as well as quality systems that could monitor transfusion practices is lacking in these settings. There is no funding and global improvement of blood safety has to be cheap to be feasible. Specific solutions for the African continent need to be developed and implemented. This paper examines the current status and difficulties of blood safety in Africa and reviews available data on transfusion medicine in the region.

[Aetiologic factors and clinical features associated with thrombocytopenia in Cameroonese adults: the importance of Plasmodium falciparum malaria]. / Les étiologies et présentations cliniques des thrombopénies chez les adultes camerounais: place du paludisme à Plasmodium falciparum.

In order to determine the main aetiologies associated with thrombocytopenia in a hospital setting of Cameroon, 180 adults with platelet counts <100x10(9)/L were examined and screened for a full blood count, thick and thin blood films, basic coagulation tests (activated partial thromboplastine time, a one-stage Quick's prothrombin time and a bleeding time), an HIV screening test as well as a bone marrow aspirate using standard methods. Other tests were selectively done as dictated by the suspected diagnosis. The major clinical findings among 180 cases included fever >37.5 C (53.9%), splenomegaly (45.6%) and haemorrhage (30.6%). The main laboratory findings were anaemia (defined as haemoglobin (Hb) <11g/dL) in 80.6% of cases and a positive thick blood film (all confirmed to be P. falciparum) in 30.6% of cases. Out of the 18 different aetiologies associated with a low platelet count in the group studied, malaria appears as the unique cause in 22.2% of cases. Petechial bleeding, bruising and epistaxis were the major forms of bleeding involved (69.1%, 27.3%, and 23.6% respectively). However, only 3 cases diagnosed with malaria showed any form of bleeding (mean malaria parasite densities >15,000/muL of blood in each case). No other haemostatic abnormalities were observed. It may be cost-effective for patients with low platelet counts in malarial regions to be systematically screened for malaria parasites.