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Raykar NP, Raguveer V, Abdella YE, Ali-Awadh A, Arora H, Asamoah-Akuoko L, Barnes LS, Cap AP, Chowdhury A, Cooper Z, Delaney M, DelSignore M, Inam S, Ismavel VA, Jensen K, Kumar N, Lokoel G, Mammen JJ, Nathani P, Nisingizwe MP, Puyana JC, Riviello R, Roy N, Salim A, Tayou-Tagny C, Virk S, Wangamati CW. Innovative blood transfusion strategies to address global blood deserts: a consensus statement from the Blood Delivery via Emerging Strategies for Emergency Remote Transfusion (Blood DESERT) Coalition. Lancet Glob Health 2024; 12:e522-e529. [PMID: 38365422 PMCID: PMC10882207 DOI: 10.1016/s2214-109x(23)00564-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/10/2023] [Accepted: 11/28/2023] [Indexed: 02/18/2024]
Abstract
In rural settings worldwide, many people live in effective blood deserts without access to any blood transfusion. The traditional system of blood banking is logistically complex and expensive for many resource-restricted settings and demands innovative and multidisciplinary solutions. 17 international experts in medicine, industry, and policy participated in an exploratory process with a 2-day hybrid seminar centred on three promising innovative strategies for blood transfusions in blood deserts: civilian walking blood banks, intraoperative autotransfusion, and drone-based blood delivery. Participant working groups conducted literature reviews and interviews to develop three white papers focused on the current state and knowledge gaps of each innovation. Seminar discussion focused on defining blood deserts and developing innovation-specific implementation agendas with key research and policy priorities for future work. Moving forward, advocates should prioritise the identification of blood deserts and address the context-specific challenges for these innovations to alleviate the ongoing crisis in blood deserts.
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Affiliation(s)
- Nakul P Raykar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Vanitha Raguveer
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | | | - Asma Ali-Awadh
- Sub-county Langata and Kibera, Nairobi Metropolitan Health Services, Nairobi, Kenya; Sisu Global Health, Baltimore, MD, USA
| | - Harshit Arora
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Lucy Asamoah-Akuoko
- Department of Research, Planning, Monitoring, and Evaluation, National Blood Service, Accra, Ghana
| | | | - Andrew P Cap
- US Army Institute of Surgical Research, Houston, TX, USA
| | - Aulina Chowdhury
- Department of Anesthesia, Boston Children's Hospital, Boston, MA, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Meghan Delaney
- Department of Pathology and Laboratory Medicine, Children's National Hospital, Washington, DC, USA
| | | | - Sidra Inam
- Allied Hospital Faisalabad, Faisalabad, Pakistan
| | | | - Kennedy Jensen
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Nikathan Kumar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, University of California San Francisco, East Bay, Oakland, CA, USA
| | - Gilchrist Lokoel
- Department of Medical Services, Turkana County Government, Lodwar, Kenya
| | - Joy John Mammen
- Department of Transfusion Medicine, Christian Medical College, Vellore, India
| | - Priyansh Nathani
- Dr RN Cooper Municipal Medical College and General Hospital: Hinduhridaysamrat Balasaheb Thackeray Medical College and Rustom Narsi Cooper Municipal General Hospital, Mumbai, India; WHO Collaboration Center for Research in Surgical Care Delivery in Low and Middle Income Countries, Mumbai, India
| | - Marie Paul Nisingizwe
- Department of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Juan Carlos Puyana
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert Riviello
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Nobhojit Roy
- Operative Care, Clinical Services and Systems, WHO, Geneva, Switzerland
| | - Ali Salim
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Claude Tayou-Tagny
- Department of Haematology and Transfusion Medicine, University of Yaoundé, Yaoundé, Cameroon
| | - Sargun Virk
- WHO Collaboration Center for Research in Surgical Care Delivery in Low and Middle Income Countries, Mumbai, India
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Vuhahula EAM, Yahaya J, Morgan ED, Othieno E, Mollel E, Mremi A. Frequency and distribution of ABO and Rh blood group systems among blood donors at the Northern Zone Blood Transfusion Center in Kilimanjaro, Tanzania: a retrospective cross-sectional study. BMJ Open 2023; 13:e068984. [PMID: 36787973 PMCID: PMC9930552 DOI: 10.1136/bmjopen-2022-068984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVES ABO and Rh blood group systems are the major factors affecting the blood transfusion safety. The frequency and distribution of these blood group systems vary worldwide. We aimed to determine the frequency and distribution of ABO and Rh blood group systems among first-time blood donors at the Northern Zone Blood Transfusion Center in Kilimanjaro, Tanzania. DESIGN Cross-sectional descriptive population-based study. SETTING Data on ABO and Rh blood group systems were obtained and analysed from the Northern Zone Blood Transfusion Center among first-time blood donors. PARTICIPANTS There were 65 535 first-time blood donors aged 15-55 years who donated at the Northern Zone Blood Transfusion Center from January 2017 to December 2019. OUTCOME MEASURES The percentage of ABO and Rh blood group systems among different categories of blood donors was calculated. RESULTS Retrospective data from Blood Establishment Computer System of 65 535 first-time blood donors were analysed in the present study. The mean age of the blood donors was 30.6±11.2 years (range: 15-55 years). The vast majority of the blood donors 84.2% (n=55 210) were men. Also, the majority 69.6% (n=45 595) were aged ≥35 years. Blood group O was the most common blood group which was found in over half 52.4% (n=34 333) of the blood donors and majority 95.3% (n=62 461) of the donors were Rh positive. Moreover, the majority 78.3% (n=51 336) were voluntary donors and the remaining 21.7% (n=14 199) were replacement donors. CONCLUSION Majority of the donors had blood group O and also the vast majority of the donors were Rh positive. Considering the large size of our study population, this has provided a more comprehensive information regarding the frequency and patterns of ABO and Rh blood group systems in Tanzania. The observed association of blood group A with one of the regions from which donors were coming from, is intriguing and further studies may confirm possible related genetic evolution.
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Affiliation(s)
- Edda A M Vuhahula
- Pathology, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania, United Republic of
| | - James Yahaya
- Department of Pathology, Soroti University, Soroti, Uganda
| | | | | | - Edson Mollel
- Department of Haematology, Northern Zone Blood Transfusion Center (NZBTC), Moshi, Tanzania, United Republic of
| | - Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania, United Republic of
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Mammen JJ, Asirvatham ES, Lakshmanan J, Sarman CJ, Pandey A, Ranjan V, Charles B, Mani T, Khaparde SD, Upadhyaya S, Rajan S. The clinical demand and supply of blood in India: A National level estimation study. PLoS One 2022; 17:e0265951. [PMID: 35385543 PMCID: PMC8986005 DOI: 10.1371/journal.pone.0265951] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/10/2022] [Indexed: 11/26/2022] Open
Abstract
Background Estimating the clinical demand for blood and components arising in a health facility is crucial to ensure timely availability of blood. This study aims to estimate disease-specific clinical demand, supply and utilization of whole blood and components in India. Methods We conducted a national level cross-sectional study in five randomly selected states from five regions of the country. We included 251 public and private facilities representing primary, secondary and tertiary care facilities. We collected annual disease-specific demand, supply and utilization of blood and components using a structured tool. We estimated the national demand by extrapolating the study data (demand and beds) to the total number of estimated beds in the country. Findings According to the study, the total clinical demand of 251 health facilities with 51,562 beds was 474,627 whole blood units. Based on this, the clinical demand for India was estimated at 14·6 million whole blood units (95 CI: 14·59–14·62), an equivalent of 36·3 donations per 1,000 eligible populations, which will address whole blood and component requirement. The medicine specialty accounted for 6·0 million units (41·2%), followed by surgery 4·1 million (27·9%), obstetrics and gynecology 3·3 million (22·4%) and pediatrics 1·2 million (8·5%) units. The supply was 93% which is equivalent to 33·8 donations against the demand. Conclusion The study indicated a demand and supply gap of 2.5 donations per 1,000 eligible persons which is around one million units. The gap emphasises the need for sustained and concerted efforts from all stakeholders and for increasing the awareness about repeat voluntary non-remunerated blood donation (VNRBD); optimizing the availability of blood components through efficient blood component separation units; promoting modern principles of patient blood management and strengthening capacities of human resources in the blood transfusion system in India.
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Affiliation(s)
- Joy John Mammen
- Christian Medical College, Vellore, Tamil Nadu, India
- * E-mail:
| | | | - Jeyaseelan Lakshmanan
- Professor of Biostatistics, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, DHCC, Dubai, United Arab Emirates
| | | | - Arvind Pandey
- National Institute of Medical Statistics, Ministry of Health and Family Welfare, New Delhi, India
| | - Varsha Ranjan
- Christian Medical Association of India (CMAI), New Delhi, India
| | - Bimal Charles
- Christian Medical Association of India (CMAI), New Delhi, India
| | | | - Sunil D Khaparde
- Ministry of Health and Family Welfare, Mumbai, Maharashtra, India
| | - Sunita Upadhyaya
- Division of Global HIV and TB, Center for Centers for Disease Control and Prevention (CDC), New Delhi, India
| | - Shobini Rajan
- National AIDS Control Organization (NACO), Janpath, New Delhi, India
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Candotti D, Tagny-Tayou C, Laperche S. Challenges in transfusion-transmitted infection screening in Sub-Saharan Africa. Transfus Clin Biol 2021; 28:163-170. [PMID: 33515730 DOI: 10.1016/j.tracli.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In Sub-Saharan Africa, high clinical demand for transfusion faces endemic bloodborne infections and limited resources. Blood screening for transfusion-transmitted bloodborne pathogens is the cornerstone of blood safety. Although there have been substantial improvements over the years, challenges in transfusion-transmitted infection screening that have been identified repeatedly long ago still need to be addressed. Affordability and sustainability of state-of-the-art quality assessed serological and molecular assays, and associated confirmation strategies remain of real concern. In addition, limited resources and infrastructures hamper the development of adequate facilities, quality management, and staff qualification, and exacerbate shortage of reagents and equipment maintenance. It is also important to maintain effort in constituting pools of repeat voluntary non-remunerated donors. Alternative strategies for blood screening that take into account local circumstances might be desirable but they should rely on appropriate field evaluation and careful economic assessment rather than dogma established from high-resource settings.
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Affiliation(s)
- D Candotti
- Département d'Études des Agents Transmissibles par le Sang, Institut National de la Transfusion Sanguine, Centre National de Référence Risques Infectieux Transfusionnels, 75015 Paris, France.
| | - C Tagny-Tayou
- Department of Hematology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, BP: 1364, Yaoundé, Cameroon
| | - S Laperche
- Département d'Études des Agents Transmissibles par le Sang, Institut National de la Transfusion Sanguine, Centre National de Référence Risques Infectieux Transfusionnels, 75015 Paris, France
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Mili FD, Teng Y, Shiraishi RW, Yu J, Bock N, Drammeh B, Watts DH, Benech I. New HIV infections from blood transfusions averted in 28 countries supported by PEPFAR blood safety programs, 2004-2015. Transfusion 2021; 61:851-861. [PMID: 33506960 DOI: 10.1111/trf.16256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND To quantify the impact of the US President's Emergency Plan for AIDS Relief (PEPFAR) on the risk of HIV transmission through infected blood donations in countries supported by PEPFAR blood safety programs. METHODS Data reported to the World Health Organization Global Database on Blood Safety were analyzed from 28 countries in sub-Saharan Africa (SSA), Asia, and the Caribbean during 2004-2015. We used the Goals model of Spectrum Spectrum System Software, version 5.53, to perform the modeling, assuming laboratory quality for HIV testing had 91.9% sensitivity and 97.7% specificity irrespective of testing method based on results of two external quality assurance and proficiency testing studies of transfusion screening for HIV in SSA blood centers. We calculated the number of new HIV infections from the number of transfusions and the prevalence of HIV infection acquired from blood transfusions with infected blood donations. We determined the impact of laboratory testing programs by estimating the number of new HIV infections averted since PEPFAR implementation. RESULTS Assuming that HIV testing would not be performed in any of these countries without PEPFAR funding, the number of new HIV infections acquired from blood transfusions averted by laboratory testing increased over time in all 28 countries. The total number of HIV infections averted was estimated at 229 278 out of 20 428 373 blood transfusions during 2004-2015. CONCLUSION Our mathematical modeling suggests a positive impact achieved over 12 years of PEPFAR support for blood safety. Standardized HIV testing of donated blood has reduced the risk of HIV transmission through blood transfusions in SSA, Asia, and the Caribbean.
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Affiliation(s)
- Fatima D Mili
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yu Teng
- Avenir Health, Glastonbury, Connecticut, USA
| | - Ray W Shiraishi
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Junping Yu
- World Health Organization, Geneva, Switzerland
| | - Naomi Bock
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bakary Drammeh
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - D Heather Watts
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, Washington, District of Columbia, USA
| | - Irene Benech
- Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Mtenga J, Orf K, Zheng J, Chamba C, Chuwa H, Luoga F, Malangahe SW, Iversen PO, Makani J. Haematopoietic stem cell transplantation in Tanzania. Br J Haematol 2020; 192:17-21. [PMID: 32976624 DOI: 10.1111/bjh.17106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/20/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Janeth Mtenga
- Department of Haematology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kate Orf
- Department of Haematology, University College London Hospital, London, UK
| | - Jiexin Zheng
- Department of Haematology, University College London Hospital, London, UK
| | - Clara Chamba
- Department of Haematology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Harrison Chuwa
- Department of Haematology, Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Frederick Luoga
- Department of Haematology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Programme, Department of Haematology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Per Ole Iversen
- Department of Haematology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Haematology, University of Oslo, Oslo, Norway.,Department of Nutrition, University of Oslo, Oslo, Norway
| | - Julie Makani
- Department of Haematology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Sickle Cell Programme, Department of Haematology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Alwy Al-Beity F, Pembe AB, Kwezi HA, Massawe SN, Hanson C, Baker U. "We do what we can do to save a woman" health workers' perceptions of health facility readiness for management of postpartum haemorrhage. Glob Health Action 2020; 13:1707403. [PMID: 31928163 PMCID: PMC7006654 DOI: 10.1080/16549716.2019.1707403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: In many low-resource settings, in-service training is a common strategy to improve the performance of health workers and ultimately reduce the persistent burden of maternal mortality and morbidities. An evaluation of the Helping Mothers Survive Bleeding After Birth (HMS BAB) training as a single-component intervention in Tanzania found some positive albeit limited effect on clinical management and reduction of postpartum haemorrhage (PPH). Aim: In order to better understand these findings, and particularly the contribution of contextual factors on the observed effects, we explored health workers’ perceptions of their health facilities’ readiness to provide PPH care. Methods: We conducted 7 focus group discussions (FGDs) and 12 in-depth interviews (IDIs) in purposively selected intervention districts in the HMS BAB trial. FGDs and IDIs were audio-recorded, transcribed and translated verbatim. Thematic analysis, using both inductive and deductive approaches, was applied with the help of MAXQDA software. Results: Health workers perceive that their facilities have a low readiness to provide PPH care, leading to stressful situations and suboptimal clinical management. They describe inconsistencies in essential supplies, fluctuating availability of blood for transfusion, and ineffective referral system. In addition, there are challenges in collaboration, communication and leadership support, which is perceived to prevent effective management of cases within the facility as well as in referral situations. Health workers strive to provide life-saving care to women with PPH despite the perceived challenges. In some health facilities, health workers perceive supportive clinical leadership as motivating in providing good care. Conclusion: The potential positive effects of single-component interventions such as HMS BAB training on clinical outcome may be constraint by poor health facility readiness, including communication, leadership and referral processes that need to be addressed.
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Affiliation(s)
- Fadhlun Alwy Al-Beity
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrea B Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Hilda A Kwezi
- Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Siriel N Massawe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Claudia Hanson
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Ulrika Baker
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden.,Department of Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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Ali SA, Tesfaghiorghis YK, Tesema MT, Achila OO. Met and unmet blood demand, recipients profiles and associated trends in Eritrea. Transfus Med 2020; 30:247-254. [PMID: 32391599 DOI: 10.1111/tme.12682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To estimate Eritrean national blood demand and demand satisfaction and to assess the associated trend of blood and blood products usage. BACKGROUND Estimating blood demand to determine collection goals is a challenge in many low-income countries, including Eritrea. METHODOLOGY This study was a 5-year survey of a representative sample of hospitals and was conducted in the National Blood Transfusion Center of Eritrea. Four referral hospitals in Asmara were selected. Blood bank registers and blood request papers were reviewed retrospectively from 2013 to 2017 to determine the number of components requested and the number and units issued. Data were calculated for annual trends in the difference between request and issue of blood products and the annual national estimate. RESULTS The largest met-demand percentages were seen for International Organization for Cardiac Centre Asmara (IOCCA) (88.63%) followed by surgeries (79.49%), active bleeding (73.76%) and anaemia (67.82%), which were mostly requested for adult patients (>40 years). The mean value of requested products and issued products per patient were 2.50 (±0.972) and 1.81 (±0.839), respectively. The calculated correlation coefficient for the difference between demand and demand satisfaction was strong (R2 = 0.967), implying an increasing linear difference. It was estimated that nearly 72% of blood component demand was met over the 5 years. CONCLUSION Even though there was an increase in blood collection over years, the Eritrean National Blood Transfusion Services (NBTS) still falls short in satisfying the full demand.
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Affiliation(s)
- Sham Adem Ali
- Department of Clinical Laboratory Sciences, National Blood Transfusion Services of Eritrea, Asmara, Eritrea
| | | | - Meron Tesfamariam Tesema
- Department of Clinical Laboratory Sciences, National Blood Transfusion Services of Eritrea, Asmara, Eritrea
| | - Oliver Okoth Achila
- Department of Clinical Laboratory Sciences, Asmara College of Health Sciences (ACHS), Asmara, Eritrea
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9
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Leak SA, Mmbaga LG, Mkwizu EW, Mapendo PJ, Henke O. Hematological malignancies in East Africa-Which cancers to expect and how to provide services. PLoS One 2020; 15:e0232848. [PMID: 32374771 PMCID: PMC7202623 DOI: 10.1371/journal.pone.0232848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/22/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) has an increasing non-communicable disease burden. Tanzania has an incidence of more than 35,000 cancer cases per year with an 80% mortality rate. Hematological malignancies account for 10% of these cases. The numbers will double within the next 10 years due to demographic changes, better diagnostic capabilities and life style changes. Kilimanjaro Christian Medical Centre established a Cancer Care Centre (CCC) in December 2016 for a catchment area of 15 million people in Northern Tanzania. This article aims to display the hematological diagnosis and characteristics of the patients as well as to describe the advancements of hematologic services in a low resource setting. METHODS A cross-sectional analysis of all hematological malignancies at CCC from December 2016 to May 2019 was performed and a narrative report provides information about diagnostic means, treatment and the use of synergies. RESULTS A total of 209 cases have been documented, the most common malignancies were NHL and MM with 44% and 20%. 36% of NHL cases, 16% of MM cases and 63% of CML cases were seen in patients under the age of 45. When subcategorized, CLL/SLL cases had a median age was 56.5, 51 years for those with other entities of NHL. Sexes were almost equally balanced in all NHL groups while clear male predominance was found in HL and CML. DISCUSSION Malignancies occur at a younger age and higher stages than in Western countries. It can be assumed that infections play a key role herein. Closing the gap of hematologic services in SSA can be achieved by adapting and reshaping existing infrastructure and partnering with international organizations.
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Affiliation(s)
- Steven Alan Leak
- Cancer Care Centre, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Lilian Gasper Mmbaga
- Cancer Care Centre, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Elifuraha Wilson Mkwizu
- Cancer Care Centre, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Priscus John Mapendo
- Cancer Care Centre, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Oliver Henke
- Cancer Care Centre, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
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10
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Dhabangi A, Dzik WH, Idro R, John CC, Butler EK, Spijker R, Hensbroek MB. Blood use in sub‐Saharan Africa: a systematic review of current data. Transfusion 2019; 59:2446-2454. [DOI: 10.1111/trf.15280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/20/2019] [Accepted: 03/03/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Aggrey Dhabangi
- Child Health and Development CentreMakerere University, College of Health Sciences Kampala Uganda
| | - Walter H. Dzik
- Department of Pathology (Transfusion)Harvard University / Massachusetts General Hospital Boston Massachusetts
| | - Richard Idro
- Department of Pediatrics and Child HealthMakerere University, College of Health Sciences Kampala Uganda
| | - Chandy C. John
- Ryan White Centre for Pediatric Infectious Disease and Global HealthIndiana University School of Medicine Indianapolis Indiana
| | - Elissa K. Butler
- SUNY Upstate Medical University Syracuse New York
- Harborview Injury Prevention and Research CenterUniversity of Washington Seattle Washington
| | - Rene Spijker
- Department of Global Child HealthEmma Children's Hospital, Academic Medical Centre, University of Amsterdam the Netherlands
| | - Michael B. Hensbroek
- Department of Global Child HealthEmma Children's Hospital, Academic Medical Centre, University of Amsterdam the Netherlands
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11
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Weimer A, Tagny CT, Tapko JB, Gouws C, Tobian AAR, Ness PM, Bloch EM. Blood transfusion safety in sub-Saharan Africa: A literature review of changes and challenges in the 21st century. Transfusion 2018; 59:412-427. [PMID: 30615810 DOI: 10.1111/trf.14949] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Access to a safe, adequate blood supply has proven challenging in sub-Saharan Africa, where systemic deficiencies spanning policy, collections, testing, and posttransfusion surveillance have long been recognized. Progress in transfusion safety in the early 2000s was in large part due to intervention by the World Health Organization and other foreign governmental bodies, coupled with an influx of external funding. STUDY DESIGN AND METHODS A review of the literature was conducted to identify articles pertaining to blood safety in sub-Saharan Africa from January 2009 to March 2018. The search was directed toward addressing the major elements of the blood safety chain, in the countries comprising the World Health Organization African region. Of 1380 articles, 531 met inclusion criteria and 136 articles were reviewed. RESULTS External support has been associated with increased recruitment of voluntary donors and expanded testing for the major transfusion-transmitted infections (TTIs). However, the rates of TTIs among donors remain high. Regional education and training initiatives have been implemented, and a tiered accreditation process has been adopted. However, a general decline in funding for transfusion safety (2009 onwards) has strained the ability to maintain or improve transfusion-related services. Critical areas of need include data collection and dissemination, epidemiological surveillance for TTIs, donor recruitment, quality assurance and oversight (notably laboratory testing), and hemovigilance. CONCLUSION Diminishing external support has been challenging for regional transfusion services. Critical areas of deficiency in regional blood transfusion safety remain. Nonetheless, substantive gains in education, training, and accreditation suggest durable gains in regional capacity.
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Affiliation(s)
- A Weimer
- Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, Baltimore, MD
| | - C T Tagny
- Hematology and Blood Transfusion service, University Teaching Hospital, Yaoundé, Cameroon
| | - J B Tapko
- African Society of Blood Transfusion, Yaoundé, Cameroon
| | - C Gouws
- Blood Transfusion Service of Namibia, Windhoek, Namibia
| | - A A R Tobian
- Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, Baltimore, MD
| | - P M Ness
- Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, Baltimore, MD
| | - E M Bloch
- Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, Baltimore, MD
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12
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Mauka WI, Mtuy TB, Mahande MJ, Msuya SE, Mboya IB, Juma A, Philemon RN. Risk factors for inappropriate blood requisition among hospitals in Tanzania. PLoS One 2018; 13:e0196453. [PMID: 29771998 PMCID: PMC5957429 DOI: 10.1371/journal.pone.0196453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 04/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Blood is a critical aspect of treatment in life saving situations, increasing demand. Blood requisition practices greatly effect sufficient supply in blood banks. This study aimed to determine the risk factors for inappropriate blood requisition in Tanzania. METHODS This was a cross sectional study using secondary data of 14,460 patients' blood requests from 42 transfusion hospitals. Primary data were obtained by using cluster-sampling design. Data were analysed using a two-level mixed-effects Poisson regression to determine fixed-effects of individual-level factors and hospital level factors associated with inappropriate blood requests. P-value <0.05 (2-tails) was considered statistically significant. RESULTS Inappropriate requisition was 28.8%. Factors significantly associated with inappropriate requisition were; reporting pulse rate and capillary refill decrease the risk (RR 0.74; 95% CI 0.64, 0.84) and (RR 0.73; 95% CI 0.63, 0.85) respectively and the following increased the risk; having surgery during hospital stay (RR 1.22; 95% CI 1.06, 1.4); being in general surgical ward (RR 3.3; 95% CI 2.7, 4.2), paediatric ward (RR 1.8; 95% CI 1.2, 2.7), obstetric ward (RR 2.5; 95% CI 2.0, 3.1), gynaecological ward (RR 2.1; 95% CI 1.5, 2.9), orthopaedics ward (RR 3.8; 95% CI 2.2, 6.7). Age of the patient, pallor and confirmation of pre-transfusion haemoglobin level were also significantly associated with inappropriate requisition. Majority of appropriate requisitions within the wards were marked in internal medicine (91.7%) and gynaecological wards (77.8%). CONCLUSIONS The proportion of inappropriate blood requests was high. Blood requisition was determined by clinical and laboratory findings and the ward patients were admitted to. Adherence to transfusion guidelines is recommended to assure the best use of limited blood supply.
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Affiliation(s)
- Wilhellmuss I. Mauka
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- * E-mail:
| | - Tara B. Mtuy
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Michael J. Mahande
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sia E. Msuya
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Innocent B. Mboya
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Abdul Juma
- National Blood Transfusion Services, Dar es Salaam, Tanzania
| | - Rune N. Philemon
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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13
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Hepatitis B Virus Infection in Tanzania: Current Status and Challenges. J Trop Med 2018; 2018:4239646. [PMID: 29666656 PMCID: PMC5831599 DOI: 10.1155/2018/4239646] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/18/2017] [Accepted: 01/03/2018] [Indexed: 12/13/2022] Open
Abstract
Hepatitis B is one of the most common infectious diseases in the world with high prevalence in most of sub-Saharan Africa countries. The complexity in its diagnosis and treatment poses a significant management challenge in the resource-limited settings including Tanzania, where most of the tests and drugs are either unavailable or unaffordable. This mini review aims at demonstrating the current status of the disease in the country and discussing the concomitant challenges in diagnosis, treatment, and prevention.
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14
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Apata IW, Drammeh B, De AK, Bjork A, Pathak S, Lyimo M, Juma A, Kutaga R, Mahmoud M, Nkya E, Kuehnert M, Marfin A. Diagnoses and ordering practices driving blood demand for treatment of anemia in Tanzania. Transfusion 2018; 58:379-389. [PMID: 29350415 DOI: 10.1111/trf.14461] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Resource-limited countries in Africa experience blood shortages. Understanding clinical drivers of blood demand can inform strategies to increase blood availability. STUDY DESIGN AND METHODS From a national representative sample of 42 hospitals in Tanzania, patient records and requests for whole blood (WB) and red blood cells (RBCs) to treat anemia were analyzed using data collected prospectively from June through September 2013. Abstracted data included cause of anemia, number of requested units, clinical signs, and pretransfusion hemoglobin (Hb) levels. Weighted projections of nationwide drivers of blood demand for the year, 2013, were calculated. Mean posttransfusion Hb levels were estimated, and blood requests were assessed for clinical appropriateness. RESULTS Malaria was the leading driver of blood demand for anemia among children, accounting for 67% (55,949 units; standard deviation [SD], 1911 units) of projected units requested for children in 2013. Maternal hemorrhage was the leading driver of blood demand for anemia among adults, accounting for 21% (31,321 units; SD, 963 units) of projected units requested. Seventeen percent (26,133 units; SD, 1013 units) of projected requested units were deemed inappropriate. Adults with severe anemia had a mean Hb level of 3.7 g/dL and a mean of 1.6 WB or RBC units per request, resulting in an estimated mean posttransfusion Hb level of 5.3 g/dL. CONCLUSIONS Strategies to prevent and treat underlying causes of anemia and decrease inappropriate blood requests will likely increase blood availability. Restrictive blood ordering practices seen in adults with severe anemia suggests undertreatment of anemia and may result in an underestimation of the national blood demand.
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Affiliation(s)
- Ibironke W Apata
- Epidemic Intelligence Service.,Division of Global HIV/AIDS and Tuberculosis (DGHT), Centers for Disease Control and Prevention
| | - Bakary Drammeh
- Division of Global HIV/AIDS and Tuberculosis (DGHT), Centers for Disease Control and Prevention
| | - Anindya K De
- Division of Global HIV/AIDS and Tuberculosis (DGHT), Centers for Disease Control and Prevention
| | - Adam Bjork
- Division of Global HIV/AIDS and Tuberculosis (DGHT), Centers for Disease Control and Prevention
| | | | | | | | | | | | | | - Matthew Kuehnert
- Division of Global HIV/AIDS and Tuberculosis (DGHT), Centers for Disease Control and Prevention
| | - Anthony Marfin
- Division of Global HIV/AIDS and Tuberculosis (DGHT), Centers for Disease Control and Prevention
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