Attitudes towards blood donation in Trinidad and Tobago

Blood transfusion in the Caribbean: Historical perspective in the context of Trinidad and Tobago

To compare the historical development of blood transfusion in Britain and a former British West Indian colony. International transfusion bodies recommend national coordination and exclusively voluntary non-remunerated donation as essential pre-requisites for blood safety. These ideals have been achieved in high-income countries including Great Britain, the United States of America and Canada. However, most West Indian countries have fragmented, hospital-based blood services that rely on family replacement and remunerated donors. Comparative historical analysis of blood transfusion service development in Great Britain and Trinidad and Tobago was undertaken to provide insight into their dichotomous development and inform policy decisions to bridge the gap between the two types of transfusion service. The British National Blood Transfusion service was based on voluntary non-remunerated blood donation from its inception but achieved national coordination over 50 years that included a period of regional control during which incoordination contributed to a tainted blood scandal. Failure to establish community voluntary non-remunerated donation in Trinidad and Tobago during the colonial period, before independence in 1962, allowed regionally-controlled family replacement and remunerated blood donation to become entrenched then perpetuated by path dependence. A university-led programme has recently used historically-proven methods, drawing on the experiences of the British National Blood Transfusion Service, to establish a model for developing a voluntary non-remunerated programme. The programme aims to avoid historical pitfalls during its national extension. Historical analysis provided information for introducing voluntary non-remunerated blood donation and planning a nationally-coordinated blood transfusion service.

Blood donation practices, motivators and barriers in the Caribbean: A narrative review

Adequacy and safety are the twin prerogatives of the blood transfusion service which in turn is an indispensable component of public health delivery; however, many Caribbean countries have inadequate blood supply for the current and projected demands of their health care systems. Understanding blood donor motivators and barriers is crucial to improving the rate of voluntary non-remunerated blood donation (VNRD) to meet World Health Organisation (WHO) targets. The objective of this study was to review current research on the landscape of blood donation practices and attitudes in the Caribbean. We undertook a systematic search of electronic databases through September 2023 to identify studies of blood donation practices, knowledge and attitudes, including motivators and barriers to donation in the English-speaking Caribbean. We identified eight (8) relevant studies of observational study design. VNRD remain relatively uncommon; family replacement or remunerated donations were most common. Barriers to blood donation included lack of a known recipient such as a family member who needed blood, never having been asked to donate, presumed ineligibility to donate, and fear of needles or adverse reactions. Study participants indicated willingness to donate blood if provided more information about the importance of blood donation. There is a paucity of published research regarding blood donor knowledge, motivators and barriers in the Caribbean context. Such research could indicate the necessary interventions for achieving the goals of an adequate and safe blood supply.

Five year follow -up of a university initiated national voluntary non remunerated blood donation programme in a developing country

International bodies continue to recommend blood services based on voluntary non remunerated blood donation as an essential prerequisite for blood safety and adequacy. Trinidad and Tobago is a multi-ethnic, multi-religious, high income developing country with a long history of family replacement and remunerated blood donation. Delivery of blood services is fragmented across five autonomous Regional Health Authorities and policy is established by the National Blood Transfusion Service in the Ministry of Health. A voluntary non remunerated blood donor programme initiated by The University of the West Indies at one blood donation centre collected 1.8 % of the annual donations in its first three years and was accepted for national extension in 2018. The COVID-19 pandemic delayed implementation of this plan. The programme to achieve exclusive voluntary non remunerated donation nationally was launched by the Ministry of Health on World Blood Donor Day, June 14th 2022. Knowledge, attitude and practices surveys were done to gather information for communication and interventional strategies. Voluntary non remunerated blood donation was linked to restructuring of blood transfusion services across all Regional Health Authorities. Fifteen surveys identified misconceptions, knowledge gaps and socially acceptable methods of intervention. Voluntary non remunerated donations accounted for 10.8 % of the national collection in the first full year of implementation (p < 0.05). A voluntary non remunerated blood donation programme based on research, education and action has been successfully extended nationally.

Knowledge, attitudes and risk perception surrounding blood donation and receipt in two high income Caribbean countries

OBJECTIVES

To compare knowledge, attitudes and risk perception related to blood donation and transfusion in Trinidad and Tobago and Bahamas.

BACKGROUND

Trinidad and Tobago and the Bahamas are two Caribbean countries whose national blood transfusion systems are heavily reliant (76.2% and 76%) on family replacement donors. The Pan American Health Organisation/World Health Organisation recommends blood collection from exclusively voluntary nonremunerated donors on the grounds that family replacement donor-based blood systems are unsafe and inadequate compared to those based on voluntary nonremunerated blood donors.

METHODS/MATERIALS

A 23-item questionnaire was distributed online by snowball sampling in these two countries to assess knowledge, attitudes, risk perception and behaviour. SPSS version 24 was used for interpretative and descriptive data analysis, chi-square to measure significance and linear regression the strength of associations. p < 0.05 was used to define statistical significance.

RESULTS

Four hundred and fifty three (453) responses were obtained from Trinidad and Tobago and 101 from the Bahamas. Knowledge and positive attitudes were high in both countries (75.5% vs. 80.2%, p < 0.001 and 96.6% vs. 100%, p < 0.001). A substantial proportion of respondents held the perception that the local blood donation system was safe or very safe (26.4 and 61.4%, p < 0.001) that was linked to the misconception that the prevalent method of blood donation was voluntary nonremunerated (27.8 and 51.4%, p < 0.001). Concerns about receiving blood were underpinned by mistrust of transfusion-related procedures.

CONCLUSION

A social interface to transfer information between blood transfusion services and the community could encourage voluntary nonremunerated blood donation and reduce concerns about receiving transfusion.

Revision Total Hip Arthroplasty in Jehovah's Witnesses at a Public Hospital: Practical Recommendations for a Low-Resource Setting

Revision total hip arthroplasty (THA) is a major reconstructive procedure traditionally associated with significant blood loss. Jehovah’s Witnesses (JW) do not accept blood or blood product transfusions because of their religious beliefs. When confronted with a JW patient requiring a complex arthroplasty procedure, surgeons face moral and ethical questions and may be reluctant to perform surgery. A successful outcome depends on several factors including surgical and anesthetic expertise, a range of revision implants, and a multimodal blood management protocol. While these resources are readily available in a developed country, in many of the developing Caribbean islands, the healthcare system is underfunded and under-resourced.

Here, we describe our experience performing a revision THA on a JW patient in the Caribbean. Through this case report, we aim to illustrate our approach to blood management by exploring the fundamental elements that were employed in a low-resource setting. We believe that the extrapolation of these crucial principles to the broader category of primary arthroplasty in the general population can be used to reduce the rate of blood transfusion, increase access to surgery, and improve outcomes.

Promoting the propensity for blood donation through the understanding of its determinants

BACKGROUND

The paper aims to understand the main antecedents related to the blood donation propensity related to both donors and non-donors. With our research, we will analyse the two perspectives to identify similarities and differences concentrating on the Italian context. Blood is a vital resource that strongly affects every national healthcare system's efficacy and sustainability and the system's ability to achieve the goal of universal coverage.

METHODS

The purpose of this paper is to understand the main antecedents of citizens' blood donation intention and the propensity to encourage communication about blood donation among both donors and non-donors. The Theory of Planned Behaviour is adopted as a theoretical lens. An empirical investigation was performed in Italy, adopting a mixed methods research design. First, a qualitative analysis was carried out through 30 in-depth interviews. Then, a survey was used to quantitatively investigate the intention to donate among both donors (N = 173) and non-donors (N = 87). A conceptual model was developed and tested through Structural Equation Modelling, developing a multi-group approach.

RESULTS

The present study confirms the relations proposed by the Theory of Planned Behaviour, even though some differences between the two groups are shown. The construct Information and Communication is crucial for donors, non-donors, whereas for non-donor inhibitors is vital. Service quality has an impact on the propensity to recommend and communicate the value of blood donation.

CONCLUSION

This paper reveals the main differences between donor and non-donor perspectives. Fruitful insights for enhancing blood donation awareness are provided.

Examining students’ intention to perform voluntary blood donation using a theory of planned behaviour: A structural equation modelling approach

OBJECTIVE

This study aims to examine the behavioural intention of students to make voluntary blood donations. Moreover, it uses a theory of planned behaviour as its guiding principle and does so within the context of Malaysia, a developing nation.

METHODS

Data were collected via a self-administered questionnaire from a sample of 500 students at a public higher learning institution in Malaysia. Structural equation modelling approach (SEM) was performed to assess the strength of the hypothesized relationships of the proposed model simultaneously via the two-stage model-building process.

RESULTS

The SEM approach revealed that knowledge was the most influential predictor of students' intention to make a voluntary blood donation. With the knowledge that the more blood they donate, the more lives will be saved, the inclination to donate blood is intensifying among students. Moreover, all of the TPB constructs applied were also seen to significantly influence students' response to voluntary blood donation.

CONCLUSIONS

The nexus of attitude, subjective norm, perceived behavioural control, and knowledge about students' intention to perform voluntary blood donation are evidenced in a developing nation. The implications of the study and directions for future research are provided.

Are future doctors ready to donate blood and encourage blood donation?

BACKGROUND

Blood donation is the most common method of supplying blood. For maintaining the reliability of the blood supply through donation, the blood should be provided by voluntary, non-profit and regularly donating individuals. It is critical to be aware of the attitudes, behaviors and knowledge levels of the doctors about this issue who will inform and lead people to donate blood. The aim of this study was to determine the current knowledge levels, attitudes, and behaviors of the medical faculty students, who will be future doctors, on blood donation and to investigate whether a change occurs in the these parameters with the initiation of clinical education and training.

METHOD

This descriptive study was conducted by using a questionnaire including a total of 40 questions about blood donation. Chi-square and Mann-Whitney U tests were performed.

RESULTS

The study included 120 students in the third year of the faculty, which is the last preclinical year, and 100 students in the fifth year, which is the second year of clinical education. Of the students, 44.1% were trained for blood donation. The rates of blood donation and promoting people to donate blood were significantly higher in students who had received blood donation training compared to those who had not received such training. Willingness to donate blood and the knowledge levels regarding blood donation were significantly greater among the fifth year students.

CONCLUSION

Efforts for raising the awareness of blood donation together with its training should be increased and popularized in medical faculties.

Understanding the underlying motives and intention among Indian blood donors towards voluntary blood donation: A cross-sectional study

OBJECTIVES

The present study aims to fill the gap in the literature by conducting a comprehensive research on Indian donor's intention towards voluntary blood donation in India. The study attempts to conceptualize and validate an integrative framework incorporating voluntary function inventory (VFI) in the theory of planned behaviour (TPB) model with the purpose tomeasure the voluntary blood donation intention.

MATERIAL AND METHODS

Structural equation modeling (SEM) has been used to rigorously test the hypothesized interrelationships among the underlying motives influencing voluntary blood donation intention. A self-administered questionnaire was used to collect data from a sample of respondents selected conveniently from selct locations in India. Total 450 completed questionnaires were received out of 1000 distributed.

RESULTS

The study develops a final conceptual framework that determines the drivers of blood donor's intention towards voluntary donation. The components of theory of planned behavior (TPB) model which include 'attitude', 'subjective norms' (SN), and 'perceived behavioral control' (PBC) along with modified volunteer functions namely 'value', 'social', 'career' and 'enhancement' were found significantly explaining the donation intention in the model.

CONCLUSION

The model achieves robustness with respect to predicting Indian donor's intention towards the voluntary donation of blood. The proposed model in this study advances the theory and research on thevolunteering motives towards blood donation. The study would provide a comprehensiveunderstanding of donors' intention to the practitioners, policy makers and Non-Government Organization (NGO), helping them to frame a calibrated strategydirected towards facilitating healthy blood donation practices.

The effects of a culturally-tailored campaign to increase blood donation knowledge, attitudes and intentions among African migrants in two Australian States: Victoria and South Australia

Research suggests that African migrants are often positively predisposed towards blood donation, but are under-represented in participation. A culturally-tailored intervention targeting the African migrant community in Australia was developed and implemented, to enhance knowledge about blood donation, improve attitudes towards donating, increase intentions to donate blood, and increase the number of new African donors in Australia. Four weeks after a targeted campaign, a survey evaluation process commenced, administered face-to-face by bilingual interviewers from the African community in Melbourne and Adelaide, Australia (community survey). The questionnaires covered demographics, campaign awareness, blood donation knowledge and intentions, medical mistrust and perceived discrimination, and were analysed to evaluate changes in knowledge and intention. Sixty-two percent of survey participants (n = 454) reported being aware of the campaign. With increasing campaign awareness, there was a 0.28 increase in knowledge score (p = .005); previous blood donation was also associated with an increased blood donation knowledge score. Blood donation intention scores were not associated with campaign awareness (p = 0.272), but were associated with previous blood donation behaviour and a positive blood donation attitude score. More positive scores on the blood donation attitude measure were associated with increasing blood donation intentions, self-efficacy and campaign awareness (score increases of 0.27, 0.30 and 0.04, respectively, all p<0.05). Data were collected on the ethnicity of new blood donors in six blood collection centres before and after the intervention, and independent of the intervention evaluation survey. These data were also used to assess behavioural changes and the proportions of donors from different countries before and after the survey. There was no difference in the number of new African migrant donors, before and after the intervention. The culturally-relevant marketing campaign was associated with improved blood donation knowledge and attitudes, but there was no short-term change in blood donation intentions or the number of African donors.

An analysis of blood donation barriers experienced by North American and Caribbean university students in Grenada, West Indies

OBJECTIVES

To estimate the associations of nationality, university program, donation history and gender, with blood donation barriers experienced by non-donating students on the day of a campus blood drive. This project focused particularly on nationality and the effect of the different blood donation cultures in the students' countries of origin.

METHODS

A retrospective cohort study of 398 North American and Caribbean university students was conducted at St. George's University, Grenada, in 2010. Data were collected from non-donating students on campus while a blood drive was taking place. Log-binomial regression was used to estimate associations between the exposures of interest and donation barriers experienced by the students.

RESULTS

North American (voluntary blood donation culture) students were more likely than Caribbean (replacement blood donation culture) students to experience "Lack of Time" (relative risk (RR) = 1.57; 95% confidence interval (CI): 1.19-2.07) and "Lack of Eligibility" (RR = 1.55; 95% CI: 1.08-2.22) as barriers to donation. Conversely, Caribbean students were a third as likely to state "Lack of Incentive" (RR = 0.32; 95% CI: 0.20-0.50), "Fear of Infection" (RR = 0.35; 95% CI: 0.21-0.58), and "Fear of Needles" (RR = 0.32; 95% CI: 0.21-0.48) were barriers than North American students.

CONCLUSIONS

University students from voluntary blood donation cultures are likely to experience different barriers to donation than those from replacement cultures. Knowledge of barriers that students from contrasting blood donation systems face provides valuable information for blood drive promotion in university student populations that contain multiple nationalities.

Determination of the knowledge level, attitudes, and behaviors of islamic religious officials toward blood donation

The aim of the present study was to determine knowledge level, attitudes, and behaviors of Islamic religious officials toward blood donation. This study included 334 religious officials rendering service in the province of Kahramanmaras, located in the Mediterranean region of Turkey. A questionnaire was administered to gather sociodemographic data of the participants and their knowledge levels, attitudes, and behaviors toward blood donation. The questionnaire consisted of 11 questions that yielded a total of 11 points. The religious officials in the study included 206 imams (61.7%, males) and 128 Quran course instructors (38.3%, females). Of study participants, 134 (40.1%) reported a previous experience of blood donation and 200 (59.9%) denied previous experience of blood donation. The mean knowledge score was 7.09±2.54 points for males and 6.89±2.18 points for females. Male and female participants achieved comparable scores (p=0.476). Of the participants, 291 (87.1%) agreed and nine (2.7%) disagreed with the expression, "Blood donation is permissible in Islam;" 34 (10.2%) participants had no idea. The present study revealed considerable deficiencies in knowledge about blood donation among religious officials. In addition, the rate of blood donation and willingness to donate blood were low among religious officials. Although the level of knowledge about blood donation was similar in males and females, it was an interesting finding that the blood donation rate was significantly higher in males than in females.

Survey on knowledge, attitude and practice about blood donation among continuing medical education (CME) students in Sichuan province, China

The study was to assess the knowledge, attitude and practice of blood donation among continuing medical education students in Sichuan.This study was carried out on 841 continuing medical education students using a self-administered structured questionnaire. The statistical analysis was done by using the SPSS software.Among the 800 students, 424 were donors and 417 were non-donors The score of knowledge (mean11.71±2.22 VS 8.46±3.27) and attitude (mean 9.19±2.42 VS 7.08±2.02) in donors were statistically significant higher than the non-donors. The moral responsibility of altruism was the major reason for donating blood and worrying of the sanitation and getting infectious disease during donation was the major reason for not donating blood. Being male, aged more than 40, worked in grassroots hospital were predictors of being a blood donor.Blood services should take more efforts to improve donation experience and reinforce the positive KAP of CME students through blood donation training could help more grassroots people to know the blood donation and abandon the prejudice of blood donation.

Knowledge, Attitude, and Practice of Adult Population towards Blood Donation in Gondar Town, Northwest Ethiopia: A Community Based Cross-Sectional Study

Background. Though World Health Organization recommends 100% voluntary blood donation, the percentage of blood collected from voluntary blood donors and the average annual blood collection rate are extremely low in Ethiopia. The role of adults is crucial to meet the demand of safe blood. Thus, this study aimed to assess knowledge, attitude, and practice of adult population towards blood donation in Gondar town, Northwest Ethiopia. Method. A community based cross-sectional study was conducted among 768 adults. Multistage sampling technique together with simple random and systematic random sampling technique was employed. Bivariate and multivariate logistic regression analysis and bivariate correlation analysis were done. Result. About 436 (56.8%), 630 (82%), and 141 (18.4%) study participants had adequate knowledge, good attitude, and experience of blood donation, respectively. Secondary and higher educational statuses were significantly associated with adequate knowledge towards blood donation. Participants who were protestant by religion were more likely to have good attitude towards blood donation. Age, self-perceived health status, and religion were significantly associated with blood donation practice. Conclusion. Knowledge and attitude towards blood donation are high. However, the level of practice is low. District and national blood banks and transfusion agency should design strategies that promote and motivate the communities to donate blood.

Study of knowledge and attitude among college-going students toward voluntary blood donation from north India

Introduction

The study was conducted to assess the knowledge and attitude of college-going students toward voluntary blood donation and to bring out and compare the reasons for donating or not donating blood.

Materials and methods

This cross-sectional study was conducted on 1,000 college-going students after taking their consent for participation using a prevalidated, self-administered, structured questionnaire after its content and construct validation.

Results

The difference in the means of the level of knowledge among the donor (mean: 14.71±2.48) and nondonor students (mean: 11.55±2.82) was statistically significant. There was significant impact of previous blood donation on the level of knowledge in donor students. The attitude toward blood donation was more positive among blood donor as compared to nondonor students, and the difference in their means was statistically significant. About one in two (45.8%) college-going students fear that either they are not fit enough to donate blood (26.8%) or that they will become weak (19%) after blood donation. Almost one in four (27.4%) have fear of needle pain; therefore, they do not come forward for blood donation.

Interpretation and conclusion

The most significant reason hindering blood donation comes out to be related to health of the individual donor. The findings of this study conclude that the national targets of voluntary blood donation could be better met with specific blood donor information, education, motivation, and recruitment strategies focusing on the myths and misconceptions prevalent in the donor demographic area of that particular region, specifically targeting high-school children in countries developing a volunteer donor base.

Knowledge, Attitudes, and Motivations towards Blood Donation among King Abdulaziz Medical City Population

Background. Blood donation is remarkably safe medical procedure. However, attitudes, beliefs, and level of knowledge may affect it. Objectives. To measure the level of knowledge regarding blood donation, find out positive and negative attitudes, identify the obstacles, and suggest some motivational factors. Methodology. A cross-sectional study was conducted at King Abdulaziz Medical City (KAMC). Participants were selected by convenient nonrandom sampling technique. A self-created questionnaire was used for data collection. Results. The study included 349 individuals. About 45.8% of the participants claimed that they have a history of blood donation. Reported causes for not donating blood were blood donation not crossing their mind (52.4%), no time for donation (45%), and difficulty in accessing blood donation center (41.3%). Reported motivating factors for donating blood were one day off (81.4%), mobile blood donation caravans in public areas (79.1%), token gifts (31.5%), and finally paying money (18.9%). Conclusion. People in the age group 31-50 years, males, higher education and military were more likely to donate blood as well as People who showed higher knowledge level and positive attitude towards blood donation. More educational programs to increase the awareness in specific targeted populations and also to focus on some motivational factors are recommended.

The symbolic roots of blood donation

BACKGROUND

Throughout history, blood has been embedded with powerful and paradoxical connotations. In the last decades, a more rational conception based on scientific knowledge has emerged, portraying blood as a "disenchanted" and utilitarian object, hence more apt for donation between strangers. This study aims to examine blood's representations in Quebec, Canada.

STUDY DESIGN AND METHODS

Data were collected in four separate studies carried out between 2009 and 2011 in Quebec. A total of 234 1 to 1½ hour-long semi-structured qualitative interviews were conducted with: 184 donors (including lapsed donors) and 50 nondonors; 106 women and 128 men from a variety of age groups eligible to donate; 76 minority informants from Asian, Middle-Eastern, Latin American, African, and Caribbean origins; and 158 informants from the majority society.

RESULTS

Many respondents donated blood because it was a "useful" substance. Others associated blood donation with a gift of vitality, strength, and energy. Some stressed the irreplaceable nature of blood, its rarity, and preciousness. It can also be associated with worrisome representations and seen as "bad" or carry infections: as a fluid, it has the ability to cross troublesome body boundaries.

CONCLUSION

This overview of contemporary representations of blood in relation to blood donation in Quebec illustrates that though this substance might be disenchanted for many, it still maintains its mysteriousness for others, which underpins the importance of its social, cultural, and religious representations that can potentially lead to useful avenues in improving donor recruitment and retention.

Blood donation practices, motivations and beliefs in Montreal's Black communities: the modern gift under a new light

OBJECTIVES

Through the conceptual lens of the archaic and modern gift, this study aims to examine perceived limitations and facilitators to increasing blood donations within Black communities in Montreal, Canada. The overall objective is to support blood agencies, such as Héma-Québec, in understanding the challenges and opportunities they face in promoting blood donation among Black communities in pluralistic societies.

DESIGN

Thirty-three semi-structured qualitative interviews were conducted with donors and leaders of ethnocultural groups in Montreal: of these, 6 were Héma-Québec employees; 3 were Caribbean blood drive organizers; 14 were leaders of African, Caribbean or Black multiethnic churches and community groups; and finally, 10 were donors, including 2 African, 4 French-speaking Haitian and 4 English-speaking Caribbean.

RESULTS

The existence of multiple Black communities in Montreal reflects the various facilitators and obstacles facing Héma-Québec. Caribbean and African communities have their own experiences with regard to blood donation as well as different relationships with the broader Quebec society, both of which have great impact on how they perceive the cause. Questions of trust, of giving to the family and to the community, as well as perceived social exclusion appear to be fundamental issues for our informants. The current participation of groups interested in bettering the lives of those affected by sickle cell anaemia combined with the fact that leaders felt more comfortable donating to someone close to the community suggests that the promotion of blood donation through this angle would be well received.

CONCLUSION

Trust issues, perceived discrimination and social exclusion have structural and historical roots that can only be partly overcome with long-term efforts to increase awareness, develop collaborative partnerships and increase institutional efforts to adapt to the challenges of blood donation from Black citizens.

Knowledge, attitudes and practices surveys of blood donation in developing countries

BACKGROUND AND OBJECTIVES

  Knowledge, attitude and practice (KAP) surveys have been used in many countries to understand factors that influence blood donation and as the basis for communication and donor mobilization strategies.

MATERIALS AND METHODS

  A search was conducted of publically available databases, and studies with the following characteristics were selected: (1) the study was a knowledge, attitude and practice or KAP plus behaviour survey; (2) the subject of the survey was blood donation; (3) the survey was performed between 1995 and 2011; and (4) the survey was performed in countries classified as emerging and developing by the International Monetary Fund.

RESULTS

  Eighteen KAP studies conducted in seventeen developing countries were identified. There was considerable difference in the structure, population surveyed and conduct of the KAP studies. The common following themes emerged: misinformation about blood donation, fear of blood donation, willingness to donate for family and friends, concern about selling blood and a failure to transfer positive attitudes into actual blood donation.

CONCLUSION

  Despite considerable differences in the culture and demographics of developing countries, several common themes emerged from different KAP surveys.

Barriers to blood donation in African communities in Australia: the role of home and host country culture and experience

BACKGROUND

An influx of African migrants and refugees can strain a host country's blood services, because often migrants have unique blood needs that cannot be sourced from local donors. To increase blood donation by the new migrants, host country blood services need to understand how blood and blood donations are viewed by immigrant communities, because recruitment models that are not culturally adapted may have limited success.

STUDY DESIGN AND METHODS

Nine focus groups representing a cross-section of Australian-based African communities were conducted in multiple languages, facilitated by bilingual workers. The qualitative protocol was guided by the literature on blood donation by African migrants and communities in Africa. Thematic analysis identified the relevance of issues previously included in the literature and whether other issues facilitated or prohibited blood donation.

RESULTS

Home country cultural issues were not generally raised as barriers to donation, and respondents were positively disposed toward donation. Home country experiences shaped respondents' views in Australia. Participants focused on assisting "individuals in need," rather than giving to a blood service that many viewed with suspicion because of issues in their home country. There was a lack of knowledge about the donation process in Australia. More importantly, respondents perceived that their blood would not be wanted, based on a perception of host country mistrust and discrimination.

CONCLUSION

Developing an intervention that encourages migrants to donate blood needs to be culturally focused. It appears that addressing perceptions based on home country experiences is essential. Overcoming a general perception of discrimination is beyond any blood service, but there can be an attempt to ensure that blood donation is seen as an inclusive process-blood from everyone, for everyone.

The challenges of meeting the blood transfusion requirements in Sub-Saharan Africa: the need for the development of alternatives to allogenic blood

As a resource, allogenic blood has never been more in demand than it is today. Escalating elective surgery, shortages arising from a fall in supply, a lack of national blood transfusion services, policies, appropriate infrastructure, trained personnel, and financial resources to support the running of a voluntary nonremunerated donor transfusion service, and old and emerging threats of transfusion-transmitted infection, have all conspired to ensure that allogenic blood remains very much a vital but limited asset to healthcare delivery particularly in Sub-Saharan Africa. This is further aggravated by the predominance of family replacement and commercially remunerated blood donors, rather than regular benevolent, nonremunerated donors who give blood out of altruism. The demand for blood transfusion is high in Sub-Saharan Africa because of the high prevalence of anemia especially due to malaria and pregnancy-related complications. All stakeholders in blood transfusion have a significant challenge to apply the best available evidenced-based medical practices to the world-class management of this precious product in a bid to using blood more appropriately. Physicians in Sub-Saharan Africa must always keep in mind that the first and foremost strategy to avoid transfusion of allogenic blood is their thorough understanding of the pathophysiologic mechanisms involved in anemia and coagulopathy, and their thoughtful adherence to the evidenced-based good practices used in the developed world in a bid to potentially reduce the likelihood of allogenic blood transfusion in many patient groups. There is an urgent need to develop innovative ways to recruit and retain voluntary low-risk blood donors. Concerns about adverse effects of allogenic blood transfusion should prompt a review of transfusion practices and justify the need to search for transfusion alternatives to decrease or avoid the use of allogenic blood. These strategies should include the correction of anemia using pharmacological measures (use of antifibrinolytics to prevent bleeding and the use of erythropoietin and oral and intravenous iron to treat anemia) use of nonpharmacologic measures (preoperative autologous blood transfusion, perioperative red blood cell salvage and normothermia to reduce blood loss in surgical patients). All these strategies will help optimize the use of the limited blood stocks.

Sociodemographic and attitudinal factors to blood donation in the urban population of Dakar, Senegal

BACKGROUND

The objectives of this analysis were 1) to compare the sociodemographic characteristics of donors and nondonors, 2) to describe the channels through which Dakar's population is made aware of blood donation, and 3) to analyze the motivations and barriers to blood donation expressed by donors and nondonors.

STUDY DESIGN AND METHOD

A survey of 600 individuals age 20 and older representative of Dakar's population was conducted in 2009 to analyze awareness of blood donation, donor characteristics, and barriers and motivations to blood donation.

RESULTS

A total of 94.7% of the respondents had already heard of giving blood and 25.8% had already donated. Men and individuals age 40 and over are overrepresented among donors (chi-square [1ddl]= 19.54, p<0.001; chi-square [3ddl]=14.24, p<0.01). Those with higher education were also more likely to be donors (chi-square [4ddl]=38.91, p<0.001). Main motivations to blood donation are altruism (43%) and awareness of a blood shortage (20.33%). Never having been contacted to give blood is the number one obstacle to blood donation (37.31%).

CONCLUSIONS

In Dakar, the vast majority of people are familiar with the practice of giving blood. The sociodemographic characteristics of blood donors, and the main motivations and barriers to blood donation are the same in Dakar as in other countries, but this study also demonstrates the importance to inform Dakarites that blood donation does not amount to a blood test, that donating is not harmful for one's health, and that the blood donated is quickly regenerated.

Prevalência de doação de sangue e fatores associados, Pelotas, RS

OBJETIVO: Estimar a prevalência de doação de sangue e fatores associados. MÉTODOS: Estudo transversal com amostra representativa de 2.986 indivíduos com 20 anos ou mais realizado em Pelotas, RS, em 2007. Foram considerados três desfechos: doação de sangue alguma vez na vida, doação no último ano e doação fidelizada (pelo menos duas doações no último ano). Cada desfecho foi analisado de acordo com variáveis demográficas, socioeconômicas, de saúde, exposição a campanhas de promoção da doação de sangue e ter parente ou amigo doador. A análise bruta e multivariável foi feita utilizando-se regressão de Poisson, com ajuste para o efeito do desenho amostral. RESULTADOS: As prevalências encontradas de doação de sangue alguma vez na vida, no último ano e de doação fidelizada, foram, respectivamente, 32%, 7,7% e 3,6%. Tais prevalências foram maiores para indivíduos do sexo masculino e aumentou conforme o nível econômico e a autopercepção da saúde. A prevalência de doação na vida foi maior para o grupo etário de 50 a 65 anos; no último ano, foi maior entre os mais jovens (20 a 29 anos); e a doação fidelizada foi maior para o grupo de 30 a 49 anos. Cor da pele, situação conjugal, religião, ter parente ou amigo doador e conhecimento sobre campanhas não apresentaram associação com nenhum dos desfechos analisados. CONCLUSÕES: A prevalência de doação de sangue foi maior para os homens e para aqueles com melhor auto-percepção de saúde e nível econômico. As campanhas de incentivo à doação deveriam diversificar o perfil dos doadores, de modo a atingir os grupos de pessoas menos propensas a doar sangue

Demographic profile of blood donors at three major Brazilian blood centers: results from the International REDS-II study, 2007 to 2008

BACKGROUND

The profile of blood donors changed dramatically in Brazil over the past 20 years, from remunerated to nonremunerated and then from replacement to community donors. Donor demographic data from three major blood centers establish current donation profiles in Brazil, serving as baseline for future analyses and tracking longitudinal changes in donor characteristics.

STUDY DESIGN AND METHODS

Data were extracted from the blood center, compiled in a data warehouse, and analyzed. Population data were obtained from the Brazilian census.

RESULTS

During 2007 to 2008, there were 615,379 blood donations from 410,423 donors. A total of 426,142 (69.2%) were from repeat (Rpt) donors and 189,237 (30.8%) were from first-time (FT) donors. Twenty percent of FT donors returned to donate in the period. FT donors were more likely to be younger, and Rpt donors were more likely to be community donors. All were predominantly male. Replacement donors still represent 50% of FT and 30% of Rpt donors. The mean percentage of the potentially general population who were donors was approximately 1.2% for the three centers (0.7, 1.5, and 3.1%). Adjusting for the catchment's area, the first two were 2.1 and 1.6%.

CONCLUSIONS

Donors in the three Brazilian centers tended to be younger with a higher proportion of males than in the general population. Donation rates were lower than desirable. There were substantial differences in sex, age, and community/replacement status by center. Studies on the safety, donation frequencies, and motivations of donors are in progress to orient efforts to enhance the availability of blood.

Evaluation of blood donor deferral causes in the Trinidad and Tobago National Blood Transfusion Service

The majority of blood donations in Trinidad and Tobago are made as replacement by family members or friends. National Blood Transfusion Policy was drafted in 2007 to promote voluntary, repeated donation. The objective of this study is to assess the current rate and reasons for donor deferral, and the aim is to guide the proposed donor education and recruitment programme. A retrospective study of pre-donation deferral of prospective blood donors at the National Blood Transfusion Centre, Port of Spain, Trinidad and Tobago, was conducted. Records of all pre-donation deferrals over a 12-month period were studied. As many as 11,346 pre-donation screening interviews were conducted. There were 4043 (35.6%) deferrals. The most common reasons for donor deferral were exposure to high-risk sexual activity (27.6%), low haemoglobin 22.2% and hypertension 17.5%. Other reasons such as medication, chronic medical illness, tattoos, travel history, recent pregnancy, surgery or presentation outside the accepted age limit caused 33.8% of all deferrals and the majority (34.7%) of male deferrals. Low haemoglobin (44.5%) was the most common reason among females. The rate of deferral of voluntary donors was not significantly different from that for replacement donors (31.7 vs. 35.4%, P = 0.25). This study exposed a lack of public awareness as the principal reason for an unacceptably high rate of donor deferral. Donor education about selection criteria needs to be urgently addressed as an objective of the National Policy. Monitoring and evaluation of deferral rates and reasons could be used as one indicator of the effectiveness of the Policy.

Knowledge, attitudes and motivations among blood donors in São Paulo, Brazil

Recruiting safe, volunteer blood donors requires understanding motivations for donating and knowledge and attitudes about HIV. We surveyed 1,600 persons presenting for blood donation at a large blood bank in São Paulo, Brazil using a self-administered, structured questionnaire, and classified motivations into three domains as well as categorizing persons by HIV test-seeking behavior. Motivations, in descending order, and their significant associations were: "altruism": female gender, volunteer donor and repeat donor status; "direct appeal": female gender, repeat donor status and age 21-50 years; "self-interest": male gender, age under 20 years, first-time donor status and lower education. HIV test-seekers were more likely to give incorrect answers regarding HIV risk behavior and blood donation and the ability of antibody testing to detect recent HIV infections. Altruism is the main motivator for blood donation in Brazil; other motivators were associated with specific demographic subgroups. HIV test-seeking might be reduced by educational interventions.