Availability and safety of blood transfusion during humanitarian emergencies.

BACKGROUND: Availability and safety of blood transfusion is a major concern in countries affected by humanitarian emergencies. These emergencies increase demand for blood transfusion and make its delivery challenging and complex. Nevertheless, there is a lack of information on emergency preparedness and response capacity of blood transfusion services and on the challenges in meeting patients' needs. AIMS: To assess availability and safety of blood transfusion during humanitarian emergencies. METHODS: We searched PubMed and Index Medicus for the World Health Organization Eastern Mediterranean Region for data on availability and safety of blood transfusion during humanitarian emergencies. We also gathered information through a survey and during a regional consultation in Tunisia. RESULTS: We found 24 publications on disaster from 5 countries in the Region and 16 publications on disaster preparedness and blood transfusion in casualties and severe trauma outside the Region. However, none dealt with availability and safety of blood transfusion during humanitarian emergencies. Armed conflicts and terrorism, flooding and earthquakes are the most frequent emergencies with 10-85% of the injured requiring blood transfusion. There are gaps in emergency preparedness and response, including human resources, transport and cold chain, supply of consumables and maintenance of equipment, power supply, and finances. CONCLUSIONS: There is a need to integrate blood transfusion services in the overall national emergency preparedness and response, and provide assistance to affected countries to address identified gaps. Recommendations for individual countries need to be tailor made, along the lines of the regional strategic framework for blood safety and availability.

A country-wide comparison of cost recovery and financing systems of blood and blood products.

BACKGROUND: As blood is a scarce and expensive resource, irrational blood usage places huge burden on health expenditures. In response to this challenge, governments and health care providers are developing different strategies to optimize blood utilization. Among these strategies is trying to raise the public awareness on the actual costs of the blood production and changing the cost recovery systems of blood and blood components. AIMS: This study aims to compare cost recovery and financing systems of blood and blood products in different countries. METHODS: This research was an email-based survey of 30 countries from four HDI categories. All related literature was reviewed. RESULTS: Out of 28 countries, 19 have blood and blood products that are provided totally free of charge to the patients. In nine countries blood and blood products are totally or partially chargeable to the patients. CONCLUSIONS: In countries with low and lower-middle income economies, total or partial costs of blood and blood products are recovered directly from the patients. While countries in which blood and blood products are 'free of charge' for patients are mostly categorized in upper-middle- or high-income economies with well-developed healthcare and insurance systems. There is no clear relation between blood usage and the type of cost recovery system. However, having an efficient cost recovery system will help blood establishments to sustain their service delivery.

Seeking health care from a general hospital in Uganda following a fracture or a dislocation.

INTRODUCTION: Selecting a treatment approach and a facility to get treated from, poses a challenge in musculoskeletal injuries in Africa. The study aimed at determining demographic and injury characteristics of patients with musculoskeletal injuries and how these impact the time and reason for presenting to a general hospital in Uganda. METHODS: An observational study was carried out at Entebbe general hospital on patients presenting with musculoskeletal injuries between 1 November 2014 and 28 February 2015. The patient demographics, injury characteristics, duration of injury to presentation for treatment and reason for seeking treatment from this hospital were noted. RESULTS: A total of 101 patients were recruited. Of these, 95 had fractures while six had dislocations. Patients took an average of 96 h before presenting for care, females taking significantly longer than males (191.2 and 58.6 h respectively, p = 0.005). The fractured segment of bone significantly influenced the patients' choice for care at this hospital (p = 0.02). DISCUSSION: Entebbe General Hospital serves a young and unemployed population for musculoskeletal injuries. These patients present late for care, especially females. Patients base their choice for care from this hospital on the character of the injury.

INTRODUCTION: La sélection d'une approche de traitement et d'un établissement où l'on peut se faire soigner pose un problème en matière de lésions musculosquelettiques en Afrique. L'étude visait à déterminer les caractéristiques démographiques et des blessures des patients atteints de lésions musculosquelettiques et leur incidence sur le délai et le motif de la consultation dans un hôpital général en Ouganda. MÉTHODES: Une étude d'observation a été effectuée à l'hôpital général d'Entebbe sur des patients présentant des lésions musculosquelettiques entre le 1er novembre 2014 et le 28 février 2015. Les données démographiques des patients, les caractéristiques des blessures, le délai entre la blessure et la consultation en vue de se faire traiter, et le motif de la recherche de traitement auprès cet hôpital ont été enregistrés. RÉSULTATS: Au total, 101 patients ont été étudiés. Parmi ceux-ci, 95 souffraient de fractures alors que 6 souffraient de luxations. Les patients ont mis en moyenne 96 heures à consulter pour se faire soigner, les femmes prenant bien plus de temps que les hommes (191,2 et 58,6 heures respectivement, p = 0,005). Le segment fracturé de l'os a influencé de façon significative le choix des patients de se faire soigner dans cet hôpital (p = 0,02). DISCUSSION: L'hôpital général d'Entebbe a pour patients une population jeune et sans emploi en ce qui concerne les lésions musculosquelettiques. Ceux-ci se présentent de façon tardive pour obtenir des soins, en particulier les femmes. Les patients fondent leur choix de prise en charge par cet hôpital en fonction de la nature de la blessure.

Family donors are critical and legitimate in developing countries.

INTRODUCTION: For many years, family blood donors have been considered less safe than volunteer non-remunerated blood donors and actively discouraged by international organisations and affluent countries support agencies for developing countries. In addition to safety, pressure and coercion was considered unethical. However these assumptions were not supported by evidence. AIMS OF THE STUDY: To assemble recently collected evidence to reopen the assessment whether or not the ban of family blood donors is justified. METHODS: Review of old and recent literature through Pubmed and references from identified articles. RESULTS AND DISCUSSION: Viral marker data comparing confirmed seroprevalence in 1(st) time volunteer non-remunerated donors (VNRD) and family/replacement donors (FRD) corrected for gender and age, show no significant difference between the two groups. Evidence has been provided that for both VNRD and FAD benevolence is more appropriate than altruism. The two groups merge for psychological attitude to donation for which knowing someone needing transfusion is a powerful incentive to give blood. Excluding a life or death situation found in areas where severe blood shortage justifies replacement donation, pressures are exerted on both VNRD and FRD. There is no evidence of coercion of FRD. FRDs therefore meet all criteria for VNRD and are willing to become VNRD and to repeat donation. Ostracising FRD is illegitimate and damaging to the blood supply in resource poor areas. In some countries no difference is made between the two groups of donors representing similar populations asked to give blood in different circumstances. CONCLUSIONS: FRDs remain a critical source of volunteer, non-remunerated, blood meeting all classical criteria of VNRD that should be considered legitimate and indispensable at this point in time instead of discouraged.

The impact of external donor support through the U.S. President's Emergency Plan for AIDS Relief on the cost of red cell concentrate in Namibia, 2004-2011.

BACKGROUND: External assistance can rapidly strengthen health programmes in developing countries, but such funding can also create sustainability challenges. From 2004-2011, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) provided more than $ 8 million to the Blood Transfusion Service of Namibia (NAMBTS) for supplies, equipment, and staff salaries. This analysis describes the impact that support had on actual production costs and the unit prices charged for red cell concentrate (RCC) units issued to public sector hospitals. MATERIAL AND METHODS: A costing system developed by NAMBTS to set public sector RCC unit prices was used to describe production costs and unit prices during the period of PEPFAR scale-up (2004-2009) and the 2 years in which PEPFAR support began to decline (2010-2011). Hypothetical production costs were estimated to illustrate differences had PEPFAR support not been available. RESULTS: Between 2004-2006, NAMBTS sold 22,575 RCC units to public sector facilities. During this time, RCC unit prices exceeded per unit cost-recovery targets by between 40.3% (US$ 16.75 or N$ 109.86) and 168.3% (US$ 48.72 or N$ 333.28) per year. However, revenue surpluses dwindled between 2007 and 2011, the final year of the study period, when NAMBTS sold 20,382 RCC units to public facilities but lost US$23.31 (N$ 170.43) on each unit. DISCUSSION: PEPFAR support allowed NAMBTS to leverage domestic cost-recovery revenue to rapidly increase blood collections and the distribution of RCC. However, external support kept production costs lower than they would have been without PEPFAR. If PEPFAR funds had not been available, RCC prices would have needed to increase by 20% per year to have met annual cost-recovery targets and funded the same level of investments as were made with PEPFAR support. Tracking the subsidising influence of external support can help blood services make strategic investments and plan for unit price increases as external funds are withdrawn.

Epidemiological Aspects of Hepatitis B and C Markers in Blood Donors in Kazakhstan; 2000-2011.

BACKGROUND: Transfusion-transmissible infections such as hepatitis B and hepatitis C are among the greatest threats to blood safety for transfusion recipients and pose a serious public health problem. The aim of this study was to assess the epidemiological aspects of hepatitis B and C in Kazakhstani donor's blood over the period 2000-2011. METHODS: The data were obtained from the annual reports of the Republican Blood Center. The retrospective study was conducted from 2000 to 2011. RESULTS: Over the study period in the republic a growth of volumes of procured blood from 312.4 to 398.0 units was noted, in total equaled to 4,277.8 units. The proportion of blood wasted increased from 8.3% to 8.7%. In the dynamics the proportion of viral hepatitis among all causes of blood wasted decreased from 29% to 15.5% (HBV) and from 33.5% to 9.9% (HCV). The proportion of HBV and HCV in whole blood decreased considerably, in plasma and red cell concentrate the rates changed slightly. The average annual prevalence of HBV and HCV were 2.1% and 1.8%, respectively. CONCLUSION: Despite the reduction of viral hepatitis rates among blood donors in Kazakhstan the prevalence still remains high. The HBV prevalence is higher compared to HCV, which needs further investigations in the general population to address the issue.

Trends of Blood and Plasma Donations in Kazakhstan: 12-Years Retrospective Analysis.

BACKGROUND: Each country faces a continuing challenge to collect enough blood to meet the national needs. According to WHO, there should be at least 20 blood donations per 1,000 population for developing countries, in Kazakhstan this indicator was only 16.8 in 2011. Thus, we conducted an epidemiological assessment and drew a map of the regional distribution of blood and plasma donations in Kazakhstan during the years 2000-2011. METHODS: The retrospective study was conducted from 2000 to 2011. Data on blood and its components donations were acquired from the Ministry of Health (annual statistical reporting form N° 39). RESULTS: During 2000-2011, number of blood donors decreased to 17.4% and blood donations to 6.3%. The proportion of non-remunerated blood donations and donors decreased from 97.6% to 77.9% and 97.9% to 87.7%, respectively. The paid donations had the opposite trend. Number of plasma donors increased in 2.1 times, plasma donations in 2.4 times, nevertheless the proportion of non-remunerated plasma donations decreased from 60.1% to 29.8%. The average number of blood donations per 1,000 population decreased from 19.8 (2000) to 16.8 (2011), plasma donations increased from 1.4 to 3.1. Regionally, annual average rates of blood and plasma donations per 1,000 population over 12 years varied greatly. CONCLUSION: This is the first study conducted in Kazakhstan to provide detailed information, including the regional characteristics of blood and plasma donations over an extended period of time, which can be used in blood transfusion services work.

Filling a gap in transfusion medicine education and research.

After the outbreak of the HIV/AIDS epidemic, attention was focused on the restructuring and reorganization of nationally supported safe and sustainable blood supply systems. Networking and human capacity building in transfusion medicine were developed through World Health Organization initiatives. Educational materials were created for the core elements of the blood transfusion chain. However, the management aspects of transfusion medicine as well as applied health science research in transfusion medicine were not addressed. In 2000, the World Health Organization initiated the creation of the Academic Institute for International Development of Transfusion Medicine (IDTM). This would focus on the development of a postgraduate master's course in management of transfusion medicine (MMTM) and the development of research programs for transfusion medicine-related health sciences. The Academic Institute IDTM was created at the University of Groningen Faculty of Medical Sciences, The Netherlands. The MMTM course was thus established, and since September 2007 fourteen fellows from economically restricted countries have entered the course.