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

Transfusion medicine research in Africa: Insights from investigators in the field

BACKGROUND AND OBJECTIVES

Research in low-resource settings is inherently challenging. We sought to assess the factors that have impeded or facilitated transfusion medicine (TM) research in various African settings.

MATERIALS AND METHODS

A qualitative case study was conducted of selected investigators in Africa; selection was based on productivity-spanning publication, leadership and research in TM. We designed a questionnaire to explore the factors impeding or facilitating TM research to understand the impact on the investigators' careers. Written responses were independently coded and double-checked for precision. Qualitative analysis was conducted, whereby responses were grouped thematically and clustered by relationship. The initial findings were discussed with respondents to validate and refine the interpretations. The recorded transcript was analysed and incorporated into the final analysis.

RESULTS

Six investigators participated in the study. Their responses yielded 471 coded comments: 389 from the questionnaires and 82 from the ensuing discussion. The most frequently cited factors described included knowledge and intellectual abilities (n = 104), personal effectiveness (n = 99), research and governance structure (n = 97), and engagement, influence and impact (n = 75). Four relationship clusters emerged from the facilitators (n = 42), barriers (n = 28), and common approaches (n = 26) to research, informing summary themes of adaptation, collaboration, perseverance, and resiliency.

CONCLUSION

Individual attributes were found to be central to a successful TM research career in African settings. However, given other public health priorities and constraints, interpersonal relationships, organizational structures and the broader research context were important to TM researchers. Overcoming complexities demands adaptation, collaboration, perseverance and resiliency.

Insufficient Supply, Diagnostic Services, and Lack of Trained Personnel in Primary Hospitals in North-West Ethiopia Worsened Trauma Care: A Mixed-Method Study

OBJECTIVE

Although there has been a massive expansion of hospitals in Ethiopia in the last 2 decades, most are primary-level hospitals. Assessing the capability of the hospitals in managing trauma victims is essential to strengthening the hospitals.

METHODS

We employed a mixed-method approach using quantitative descriptive design triangulated with qualitative research. We audited 10 hospitals using WHO essential trauma care checklist. We interviewed 37 health care professionals, 9 hospital managers, and 12 decision-makers using a semi-structured interview guide. We used the COREQ checklist to report the qualitative finding.

RESULTS

The physical structures of the hospitals were good in all cases. Airway, breathing and circulation management were partially available, with a score ranging from 0 - 3. The extent of injury, lack of radiology service, and scarcity of drugs and supplies were common causes for the referral of trauma victims to Gondar University hospital.

CONCLUSION AND RECOMMENDATION

Unavailability of drugs and supplies, lack of diagnostic services, inability to recruit specialist professionals, lack of training, and inconvenient working and living environment were stated as the main barriers to providing trauma care. In the study area, the gaps in trauma care in the primary hospitals can be improved by further commitment of the hospitals, the district, zonal administrators, and the regional health bureau.

Implementation of an Africa-specific donor health questionnaire for human immunodeficiency virus risk screening

BACKGROUND AND OBJECTIVES

We had previously developed an Africa-specific donor health questionnaire (ASDHQ) based on local risk factors and designed a scoring scheme. This study assessed the performance of a new donor health questionnaire by comparing the human immunodeficiency virus (HIV) status in accepted versus deferred donors by ASDHQ and comparing the rate of risk deferrals with historical data.

MATERIALS AND METHODS

Data were collected during a cross-sectional study conducted over 15 months at three referral-hospital-based blood services in Cameroon. ASDHQ was administered to blood donors aged 18-65 years in the same screening conditions as the routine questionnaire. The main outcomes of the study were ASDHQ sensitivity and specificity with regard to HIV laboratory testing as well as donor deferral rates for each of the routine screening algorithms and for ASDHQ.

RESULTS

Overall, 71/11,120 (0.6%) were confirmed as HIV positive. The mean ASDHQ score was 95.80 ± 4.4 in HIV-negative donors and 94.80 ± 4.4 in HIV-positive donors (p = 0.05). The optimal cut-off provided by the receiver operating characteristic (ROC) curve for the best performance of ASDHQ was 95.04. Using this optimal cut-off, the ASDHQ sensitivity and specificity were 57% and 53%, respectively (area under curve = 0.58 [0.51, 0.64], p = 0.028). Using ASDHQ, the HIV prevalence was 0.7% in deferred donors and 0.6% in accepted donors.

CONCLUSION

ASDHQ might be efficient only in specific conditions that maximize truthful donor responses, requiring each blood service to create an environment of trust and transparency to increase donor compliance and improve the accuracy of the questionnaire.

Assessing the global burden of hemorrhage: The global blood supply, deficits, and potential solutions

There is a critical shortage of blood available for transfusion in many low- and middle-income countries. The consequences of this scarcity are dire, resulting in uncounted morbidity and mortality from trauma, obstetric hemorrhage, and pediatric anemias, among numerous other conditions. The process of collecting blood from a donor to administering it to a patient involves many facets from donor availability to blood processing to blood delivery. Each step faces particular challenges in low- and middle-income countries. Optimizing existing strategies and introducing new approaches will be imperative to ensure a safe and sufficient blood supply worldwide.

Knowledge, attitude and seropositivity of hepatitis B virus among blood donors in the Bamenda Regional Hospital Blood Bank, Cameroon

Introduction

despite the existence of a preventive vaccine against hepatitis B viral (HBV) infection, approximately 250 million people are infected with the virus worldwide. This study aimed at evaluating the level of knowledge, attitude and seropositivity of the disease among apparently healthy, potential blood donors at the blood service of the Bamenda Regional Hospital Blood Bank.

Methods

a cross-sectional study was carried out from March to May 2019 among 250 blood donors. Following screening for hepatitis B surface antigen (HBsAg) using the one-step HBsAg test strip, information on the level of knowledge and attitude towards the infection was obtained using a self-administered questionnaire. The correlation analysis was done to assess relationships between selected factors and knowledge of hepatitis B, p-value of 0.05 was considered as statistical significance.

Results

the seropositivity of HBV was 6.4% (n = 16). Overall, 46.8% (n = 19) of the study participants had adequate knowledge while 76.3% (n = 31) had a positive attitude toward the disease. The highest seropositivity was observed in singles (7.1%; n = 13), primary school leavers (14.3%; n = 5), unskilled laborers (14.5%; n = 8) and replacement donors (9.33%; n = 7). The probability of being hepatitis B seropositive was higher in males, students (aOR: 8.8, 95% CI 0.7-96.1; p = 0.046) and those who had attained higher education (aOR: 3.2, 95% CI 0.8-12.7; p = 0.016). Independent factors responsible for higher odds of inadequate knowledge were being a male and attaining secondary education. On the contrary, students (aOR: 0.3, 95% CI 0.1-0.8; p = 0.012) and those with a history of blood donation (aOR: 0.5, 95% CI 0.2-0.9; p = 0.042) recorded lower odds of inadequate knowledge.

Conclusion

the prevalence of hepatitis B among blood donors in this blood service is in the high intermediate category. Overall, the level of knowledge on this infection among these blood donors is average. These findings suggest that health education on HBV infection should be provided to the public as a major strategy to curb the infection.

Low retention rate of voluntary blood donors: contribution of an original method based on a composite classification (results of a monocentric study in the Democratic Republic of Congo)

Introduction

in order to improve the safety of blood transfusion, the retention of voluntary donors remains a major concern in the Democratic Republic of Congo. Nevertheless, retention is still difficult to assess because of the lack of local studies. The present study establishes the donors' profile and regularity, as well as regularity-associated factors, at the Provincial Blood Transfusion Centre in Bukavu.

Methods

this descriptive and analytical cross-sectional study included the records of 387 out of 773 blood donors during the period from 2015 to 2017. Donor retention and its associated factors were measured. The composite approach used here considered the number of blood donations, their frequency, the previous regularity of donors and the inter-donation interval.

Results

we bring to light an important loss of regular voluntary donors in the centre. Only 23.8% of them were still regular donors in 2017. The majority of donors registered in the centre are young males and have no income. On the contrary, factors associated with the profile of a regular donor in 2017 were: age at least 46 years old, being a woman and working in the formal sector. The composite classification highlighted that an important proportion of former regular donors, namely 72.8% (N=161/221), had not given blood in 2017.

Conclusion

the use of a composite classification to assess the regularity of voluntary blood donors provides more accurate information that will enable the improvement of donors' awareness and retention as well as the possible reinstatement of former donors.

Factors influencing the return of inactive blood donors in a Cameroonian blood bank

Identify factors that influence the return of donors to increase their loyalty while improving blood safety is crucial in our context. Between October 2017 and April 2018, we conducted a descriptive cross-sectional study at the Blood Bank of the Yaoundé University Teaching Hospital. The study included all former donors who had not donated blood voluntarily for over a year. Quantitative variables were described using means and standard deviations. Fisher's exact test and Chi² test were used for association measures between qualitative variables. Statistical test results were considered significant for a P<0.05 value. We interviewed a total of 101 inactive donors. The study population was 74.3% male, donors average 30±7 years. Female gender and good staff hospitality were the factors most associated with the intention to return. The barriers to donor return were mainly lack of information on blood needs (35.60%) and time constraint for blood donation (26.73%). Pro-social motivations such as altruism (30.70%) were the main possible sources of motivation cited. To reduce blood deficiency and mortality due to lack of blood products, non-financial material compensation, good outreach and communication strategy can increase inactive donors' loyalty and consequently in improving blood safety in our context.

Sero-prevalence ABO and Rh blood groups and their associated Transfusion-Transmissible Infections among Blood Donors in the Central Region of Saudi Arabia

BACKGROUND

Screening of blood products is considered a mandatory protocol implemented in health care facilities in order to reduce the onset of transfusion-transmitted infections (TTIs). This study was aimed to determine the sero-prevalence of ABO and Rh blood groups and their associated TTIs among blood donors in the Central Region of Saudi Arabia.

METHODS

This was retrospective study performed on the blood donors' records from March 2017 to December 2018 at Buraidah Central Hospital Blood Bank. Study was conducted on a total of 4590 blood donors. ABO and Rh typing was performed.The blood samples were also screened serologically for hepatitis B surface antigen (HBsAg), anti-hepatitis B core total antibodies (anti-HBc total), hepatitis C virus (HCV), human immunodeficiency viruses (HIV), human T-lymphotrophic virus-1 (HTLV-1) and veneral disease research laboratory test(VDRL) for syphilis.

RESULTS

Out of 4590 blood donors, O positive blood group was found to be highest (42%), followed by A positive (23.4%), B positive (20.9%), O negative (5.45%), AB positive (3.4%), A negative (2.8%), B negative (2.1%) and AB negative (0.5%). Moreover, total number of Rh-negative donors was significantly lowered as compared with Rh-positive. Seroreactive tests were found to be positive in only 1.002% of all studied donors and mainly found in male donors. Among TTI, anti-HBc total was the highest (0.784%), followed by HBsAg, HCV, VDRL and TPHA. Whereas all tested donors were found to be negative for HIV infections.

CONCLUSIONS

The information collected for the frequency of ABO blood phenotypic groups has a vital significance in establishing a simple blood group database. This study clearly determined significantly lower rate of seropositive TTIs among the studied blood donors but still steps are needed to improve the knowledge and to prevent the seropositive occurrence of TTIs.

Improving blood transfusion services

Postpartum haemorrhage contributes to 25% of maternal deaths worldwide, rising to 40% in sub-Saharan Africa. Treatment of postpartum haemorrhage-particularly for women with anaemia -requires timely, quality blood transfusions. There are a number of barriers to the provision of transfusion services, especially in low- and middle-income settings where the need is the greatest. These include unavailability of blood, unsafe blood, poor uptake of labour and delivery care, difficulties getting blood to transfusing facilities and poor documentation of patient information. Examples of innovative and practical solutions to overcome these barriers are highlighted.

Seroprevalence of transfusion transmitted infections among blood donors in Gash Barka Zonal Blood Transfusion Center, Barentu, Eritrea, 2014 through 2017

Background

Transfusion-transmissible infections pose a major health risk in developing countries, including Eritrea. In the present study, we sought to determine the prevalence of specific transfusion transmitted infections (TTIs) and the associated risk factors among blood donors at a newly established regional blood transfusion center in Barentu, Eritrea.

Methods

The seroprevalence of markers for specific TTIs by sex, age, educational status, residence, occupation, and donor type was evaluated for donors who donated blood between July 2014 and April 2017. The relationship between TTIs and the stated factors was evaluated using the Pearson Chi-square test/Fishers exact test. Adjusted and unadjusted binary logistic regression models were employed to estimate the odds ratio (OR) and 95% confidence interval (CI) for the occurrence of TTIs. A two-sided p-value < 0.05 was considered statistically significant.

Result

A total of 1939 donors were included in this study. Majority of the donors were males (88.2%), urban residents (68.8%), greater than 25 years of age (67%), and family replacement blood donors (FRBD) (59.7%). Two hundred and fifty (12.9%) donors were infected by at least one TTI. The cumulative seroprevalence of Human immunodeficiency virus, Hepatitis B virus, Hepatitis C virus and syphilis were 16 (0.8%), 97 (5%), 13 (0.7%) and 140 (7.2%), respectively. Out of the total 266 infected donors, the prevalence of co-infection was 16 (0.8%). In the adjusted model, the OR and 95% CI for the seropositivity for any TTI associated with age, no formal education, elementary school educational level, and junior school educational level were 1.02 (95% CI: 1.01–1.04), 4.4 (95% CI: 2.58–7.49), 2.67 (95% CI: 1.49–4.80), and 2.00 (95% CI: 1.14–3.52), respectively. In addition, blood from FRBD had an increased likelihood of contamination with at least one TTI, with an OR (95% CI) of 1.56 (1.10–2.21).

Conclusion

The prevalence of transfusion-transmissible infections is relatively high. In particular, specific groups in the population appear to be disproportionally affected. Therefore, targeted sensitization campaigns should be implemented in the future.

Blood transfusion safety in sub-Saharan Africa: A literature review of changes and challenges in the 21st century

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.

Trends of blood-borne infectious diseases in a rural blood donation center of southeast Gabon (Koula-Moutou)

Introduction

Blood-borne pathogens such as human immunodeficiency virus (HIV), hepatitis B and C (HBV and HCV) viruses and Treponema pallidum remain a major public health problem in sub-Saharan Africa. The purpose of this study was to assess the frequency and clinical implications of HIV, HBV, HCV and Treponema pallidum markers in blood donors in a rural area of Southeast Gabon (Koula-Moutou) from 2012 to 2017.

Methods

Hepatitis B surface antigen (HBsAg), anti-HIV, anti-HCV and anti-Treponema pallidum antibodies were screened using rapid diagnostic tests (RDTs).

Results

Of a total of 5,706 blood donors, 1,054 (18.5%) were seropositive for at least one infectious marker and 59 (5.6%) had serologic evidence of multiple infections. The overall seroprevalence of HIV, HBsAg, HCV, and syphilis was 3.1%; 5.9%; 6.2% and 3.3%, respectively. HIV, syphilis and HCV distributions were associated with neither the sex nor the age of the donors. Only HBsAg seroprevalence was significantly higher in donors of the age group 26-35 years old compared to donors of the age group 36-45 years (OR = 1.43 (95% CI: 1.01-2.04), P = 0.045). There was a significant increase in the frequencies of HIV and syphilis and a regression of HBsAg and HCV among blood donors.

Conclusion

This study presents the epidemiology of the main pathogens detected in blood donors in a rural area in Gabon. We found that the overall distribution of transfusion transmitted infectious diseases were lower than those observed in the general population but could be underestimated due to the use of RDTs in the screening process of the blood donations.

Updated characteristics of blood services, donors and blood products in 11 French-speaking African countries

BACKGROUND AND OBJECTIVES

The Francophone Africa Transfusion Research Network conducted the first large and comprehensive surveys on the status of blood safety in francophone African countries in 2009 and 2012. Since then, there has been substantial investment in blood safety but little is known about progress made in the region.

MATERIALS AND METHODS

This multicentre cross-sectional study describes characteristics of blood services, donors and blood products and compares results with previous data. A web-based questionnaire collected data of 2016 from 38 blood facilities in 11 French-speaking countries. Data were analysed according to type of blood services and compared to similar studies conducted in 2009 and 2012.

RESULTS

The study included data on 572 933 donations from 366 844 donors. Compared to 2012, there was an increase in the median proportion of voluntary nonremunerated blood donation (+22%) (P = 0·004), and a reduction from 2·1 to 0·9 (P = 0·01), from 10·3 to 6·7 (P = 0·00), from 3·2 to 1·3 (P = 0·006) and from 1 to 0·4 (P = 0·03) in median seroprevalences of HIV, HBV, HCV and syphilis, respectively. The median proportion of blood orders fulfilled decreased (-18·2%) (P = 0·001). The number of technical staff per 1000 donations ranged from 1 to 54 with hospital-based blood transfusion services having 12-fold more staff than National and Regional services.

CONCLUSION

Several indicators have improved in Francophone Africa Blood services during the last 5 years and national and regional services likely have better indicators than hospital-based services. These findings may support the need for ongoing blood safety initiatives.

Prevalence of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus among blood donors of Mekelle blood bank, Northern Ethiopia: A three-year retrospective study

Blood transfusion services are a vital and integral part of modern healthcare services. However, the risk of transfusion transmittable infections (TTI) has been a major handicap. Therefore, this study was aimed at determining the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) among blood donors. A retrospective study was conducted to collect data about the blood donors who consecutively donated blood from October 2011 to 2014. A three-year retrospective study was conducted in Mekelle Blood Bank. A data abstraction format was used to collect the sociodemographic and clinical data, and the prevalence of HBV, HCV, and HIV was determined. Data were analyzed using STATA version 10 analytical software. P value less than 0.05 was considered significant in all the analyses. A total of 10 728 blood donors, median (interquartile range) of age 30 (23-45) years and 3750 (34.9%) males were enrolled in this study. Of the participants 407(3.79%), 143(1.33%), and 111(1.03%) blood donors were positive for HBV, HCV, and HIV, respectively. HBV-HIV coinfections were found 10 (1.93%) blood donors, followed by HBV-HCV and HIV-HCV. A significant association between sex and marital status with HBV and HIV infection was found. However, significant association of HCV was observed among sex ( X ²  = 33.18, P < 0.001) and occupational ( X ²  = 84.33, P < 0.001). A significant percentage of HBV, HCV, and HIV among blood donors was observed. To select a donor and collect safe blood risk factors exposing blood donor should be studied, and community-based prevalence studies on TTI are also required.

Prevalence and risk factors of HTLV-1/2 and other blood borne infectious diseases among blood donors in Yaounde Central Hospital, Cameroon

Introduction

Transfusion-transmissible infectious microorganisms including bacteria and viruses are among the greatest threats to blood safety for the recipient. The prevalence and risk factors of HTLV-1/2 and other blood borne infectious diseases were determined among blood donors in Yaounde Central Hospital, Cameroon.

Methods

Design: cross sectional study. Setting: The blood bank unit of Yaounde Central Hospital, Cameroon. Subjects: a consecutive sample of 265 apparently healthy adult blood donors. Investigations: Search for the presence of hepatitis B surface antigen (AgHBs) and antibodies to human T-lymphotropic virus type 1 (anti-HTLV-1/2), human immunodeficiency virus (anti-HIV), hepatitis C virus (anti-HCV) and syphilis and to determine the epidemiological correlates, if any, in the occurrence of HTLV infection.

Results

77 (29.05%) of the blood donors had serological evidence of infection with at least one pathogen and 4 (5.2%) had dual infections with HTLV-1/2. The overall prevalence of HTLV-1/2, HIV, HCV, HBV and syphilis were 5.7%, 5.3%, 2.6%, 11.7%, 3.8% respectively. Surgical history (Chi²=4.785; P=0.029), scarification (Chi²=6.359; P = 0.012), piercing (Chi² = 16.353; P = 0.000) and intravenous drug use (Chi² = 15.660; P = 0.000) were identified as risk factors for HTLV-1/2 infection.

Conclusion

A relative high prevalence of viral infections and syphilis was recorded among the study participants especially for HTLV-1/2 for which none blood donation is routine screened in our set up. Therefore, a routine screen of blood prior to transfusion should include anti-HTLV-1/2 tests.

Seroprevalence of hepatitis B virus infection in Cameroon: a systematic review and meta-analysis

OBJECTIVE

Better knowledge of hepatitis B virus (HBV) infection prevalence at the national level can help to implement pertinent strategies to address HBV related burden. The aim was to estimate the seroprevalence of HBV infection in Cameroon.

DESIGN

Systematic review and meta-analysis.

PARTICIPANTS

People residing in Cameroon.

DATA SOURCES

Electronic databases including PubMed/MEDLINE, African Journals Online (AJOL), ScienceDirect, WHO-Afro Library, WHO-IRIS, African Index Medicus, National Institute of Statistics and National AIDS Control Committee, Cameroon; regardless of language and from 1 January 2000 to 30 September 2016. This was completed with a manual search of references of relevant papers. Risk of bias in methodology of studies was measured using the Newcastle-Ottawa Scale.

RESULTS

Out of 511 retrieved papers, 44 studies with a total of 105 603 individuals were finally included. The overall pooled seroprevalence was 11.2% (95% CI 9.7% to 12.8%) with high heterogeneity between studies (I²=97.9%). Egger's test showed no publication bias (p=0.167). A sensitivity analysis excluding individuals at high risk of HBV infection and after adjustment using trim and fill method showed a pooled seroprevalence of 10.6% (95% CI 8.6% to 12.6%) among 100 501 individuals (general population, blood donors and pregnant women). Sources of heterogeneity included geographical regions across country and setting (rural 13.3% vs urban 9.0%), and implementation of HBV universal immunisation (born after 9.2% vs born before 0.7%). Sex, site, timing of data collection, HBV screening tools and methodological quality of studies were not sources of heterogeneity.

LIMITATION

Only a third of the studies had low risk of bias in their methodology.

CONCLUSION

The seroprevalence of HBV infection in Cameroon is high. Effective strategies to interrupt the transmission of HBV are urgently required. Specific attention is needed for rural settings, certain regions and people born before the implementation of the HBV universal immunisation programme in Cameroon in 2005.

REGISTRATION

PROSPERO, CRD42016042654.

Risk factors for human immunodeficiency virus among blood donors in Cameroon: evidence for the design of an Africa-specific donor history questionnaire

BACKGROUND

In sub-Saharan Africa improving the deferral of at-risk blood donors would be a cost-effective approach to reducing transfusion-transmitted human immunodeficiency virus (HIV) infections. We performed a pilot case-control study to identify the risk factors for HIV infection and to develop an adapted donor history questionnaire (DHQ) for sub-Saharan Africa.

STUDY DESIGN AND METHODS

We recruited 137 HIV-positive donors (cases) and 256 HIV-negative donors (controls) and gathered risk factor data using audio computer-assisted self-interview. Variables with univariate associations were entered into a logistic regression model to assess independent associations. A scoring scheme to distinguish between HIV-positive and HIV-negative donors was developed using receiver operating characteristics curves.

RESULTS

We identified 16 risk factors including sex with sex worker, past history or treatment for sexually transmitted infections, and having a partner who used injected or noninjected illegal drugs. Two novel risks were related to local behavior: polygamy (odds ratio [OR], 22.7; 95% confidence interval [CI], 5.9-86.7) and medical or grooming treatment on the street (OR, 1.8; 95% CI, 1.0-3.0). Using the 16 selected items the mean scores (>100) were 82.6 ± 6.7 (range, 53.2-95.1) and 85.1 ± 5.2 for HIV-negative donors versus 77.9 ± 6.8 for HIV-positive ones (p = 0.000). Donors who scored between 80 and 90 were more likely to be HIV negative than those who scored less (OR, 31.4; 95% CI, 3.1-313.9).

CONCLUSION

We identified both typical and novel HIV risk factors among Cameroonian blood donors. An adapted DHQ and score that discriminate HIV-negative donors may be an inexpensive means of reducing transfusion-transmitted HIV through predonation screening.

Characteristics, behaviors and association between Human African Trypanosomiasis and HIV seropositivity among volunteer blood donors in a semi-rural area: A survey from Kikwit, the Democratic Republic of Congo

Blood safety is a major element in the strategy to control the HIV epidemic. The aim of this study was to determine the prevalence and the associated factors of a positive HIV test among blood donors and its association between Human African Trypanosomiasis in Kikwit, the Democratic Republic of Congo. A cross-sectional study was conducted between November 2012 and May 2013. An anonymous questionnaire was designed to extract relevant data. The average mean age of participants was 30 years. The majority were man (67.8%). The overall prevalence of HIV, syphilis, hepatitis B, hepatitis C and human African trypanosomiasis was respectively 3.2%, 1.9%, 1.6%, 1.3% and 1.3%. Alcohol intake, casual unprotected sex, not using condoms during casual sex, sex after alcohol intake and seroprevalence of human African trypanosomiasis were significantly associated with a positive HIV test result ( p<0.05). In this study, sexual risk behaviors were the major risk factors associated with positive HIV tests in blood donors living in Kikwit. It is important to raise awareness about HIV and voluntary blood donation in response to some observations noted in this study such as the low educational level of the blood donors, the low level of knowledge of HIV prevention methods.

Hepatitis B, HIV, and Syphilis Seroprevalence in Pregnant Women and Blood Donors in Cameroon

Objectives. We estimated seroprevalence and correlates of selected infections in pregnant women and blood donors in a resource-limited setting. Methods. We performed a cross-sectional analysis of laboratory seroprevalence data from pregnant women and voluntary blood donors from facilities in Cameroon in 2014. Rapid tests were performed to detect hepatitis B surface antigen, syphilis treponemal antibodies, and HIV-1/2 antibodies. Blood donations were also tested for hepatitis C and malaria. Results. The seroprevalence rates and ranges among 7069 pregnant women were hepatitis B 4.4% (1.1–9.6%), HIV 6% (3.0–10.2%), and syphilis 1.7% (1.3–3.8%) with significant variability among the sites. Correlates of infection in pregnancy in adjusted regression models included urban residence for hepatitis B (aOR 2.9, CI 1.6–5.4) and HIV (aOR 3.5, CI 1.9–6.7). Blood donor seroprevalence rates and ranges were hepatitis B 6.8% (5.0–8.8%), HIV 2.2% (1.4–2.8%), syphilis 4% (3.3–4.5%), malaria 1.9%, and hepatitis C 1.7% (0.5–2.5%). Conclusions. Hepatitis B, HIV, and syphilis infections are common among pregnant women and blood donors in Cameroon with higher rates in urban areas. Future interventions to reduce vertical transmission should include universal screening for these infections early in pregnancy and provision of effective prevention tools including the birth dose of univalent hepatitis B vaccine.

The infectious risks in blood transfusion as of today - A no black and white situation

Transfusion has been tainted with the risk of contracting an infection - often severe - and fears about this risk are still prevailing, in sharp contrast with the actual risk in Western countries. Those actual risks are rather immunological, technical (overload) or metabolic. Meanwhile, in developing countries and particularly in Africa, transfusion transmitted infections (TTIs) are still frequent, because of both the scarcity of volunteer blood donors and resources and the high incidence and prevalence of infections. Global safety of blood components has been declared as a goal to be attained everywhere by the World Heath Organization (WHO). However, this challenge is difficult to meet because of several intricate factors, of which the emergence of infectious agents, low income and breaches in sanitation and hygiene. This review aims at encompassing the situation of TTIs in different settings and means that can be deployed to improve the situation where this can possibly be.

Reducing risks of Transfusion-transmitted infections in a resource-limited hospital-based blood bank: the case of the Yaoundé University Teaching Hospital, Cameroon

BACKGROUND AND OBJECTIVES

Although interest in assessing risk of TTIs, very few trends in blood safety epidemiological data from resource-limited blood services are reported in the literature. This analysis aims at reporting trends in seroprevalences of TTIs in blood donations in the Yaoundé University Teaching Hospital (UTH) from 2011 to 2015 and to describe reasons for these changes.

MATERIALS AND METHODS

All donations of 2015 were tested for HIV 1&2 antibodies and the P24 antigen, HBsAg, HCV antibody and the Treponema pallidum antibody. Screening for HIV uses a national algorithm based on the systematic use of two assays of different principles: a rapid determination testing assay and an EIA HIV 1 & 2 Ab-Ag. The tests used for HBsAg and HCVAb screening were all based on EIA techniques. Treponema pallidum antibody screening was based on Treponema Pallidum hemagglutination assay (TPHA) and rapid immunochromatographic test (RIT). Screening techniques and results from 2015 were compared to retrospective data from 2011, 2012, 2013 and 2014.

RESULTS

In 2015, 13·4% (n = 214) of 1,596 blood donations were seropositive for at least one screened TTIs. The most frequent serological marker was HBsAg with 123 (7·7%) blood units contaminated. Nineteen (1·2%) and 18 (1·1%) blood units was positive for HIV and syphilis, respectively. There was a significant decrease in the total number of blood donations (P < 10^-4) and HIV, HBsAg and syphilis seroprevalences and an increase in the proportion of voluntary non-remunerated blood donor (P < 0·05). HCVAb seroprevalence was 3·8% in 2015 and has not decreased significantly over the years (P = 0·09).

CONCLUSION

Significant progress is noted in reduction in seroprevalences of HIV, HBV, HCV and syphilis since the beginning of a regular registration of data in 1990.

Malaria and blood transfusion: major issues of blood safety in malaria-endemic countries and strategies for mitigating the risk of Plasmodium parasites

Malaria inflicts humankind over centuries, and it remains as a major threat to both clinical medicine and public health worldwide. Though hemotherapy is a life-sustaining modality, it continues to be a possible source of disease transmission. Hence, hemovigilance is a matter of grave concern in the malaria-prone third-world countries. In order to pursue an effective research on hemovigilance, a comprehensive search has been conducted by using the premier academic-scientific databases, WHO documents, and English-language search engines. One hundred two appropriate articles were chosen for data extraction, with a particular reference to emerging pathogens transmitted through blood transfusion, specifically malaria. Blood donation screening is done through microscopic examination and immunological assays to improve the safety of blood products by detection major blood-borne pathogens, viz., HIV, HBV, HCV, syphilis, and malarial parasites. Transfusion therapy significantly dwindles the preventable morbidity and mortality attributed to various illnesses and diseases, particularly AIDS, tuberculosis, and malaria. Examination of thick and thin blood smears are performed to detect positivity and to identify the Plasmodium species, respectively. However, all of these existing diagnostic tools have their own limitations in terms of sensitivity, specificity, cost-effectiveness, and lack of resources and skilled personnel. Globally, despite the mandate need of screening blood and its components according to the blood-establishment protocols, it is seldom practiced in the low-income/poverty-stricken settings. In addition, each and every single phase of transfusion chain carries sizable inherent risks from donors to recipients. Interestingly, opportunities also lie ahead to enhance the safety of blood-supply chain and patients. It can be achieved through sustainable blood-management strategies like (1) appropriate usage of precise diagnostic tools/techniques, (2) promoting hemovigilance system, and (3) adopting novel processes of inactivation technology. Furthermore, selection of the zero-risk donors could pave the way to build a transmissible malaria-free world in the near future.

Factors for viral infection in blood donors of South Kivu in the Democratic Republic of Congo

INTRODUCTION

Assessing the knowledge, attitudes, practices and behaviors among blood donors in South Kivu and identify risk factors for viral markers.

METHODS

A descriptive and analytical cross-sectional study involved 595 blood donors in the city of Bukavu (Head city of the province of South Kivu) in the eastern Democratic Republic of Congo.

RESULTS

Our sample consisted of 70.3% men with a median age of 23 and 77% of young people fewer than 30 years. The score of knowledge and attitude of blood donor's volunteer on blood safety were assessed at 23.5% and 79.1%. A statistically significant difference was observed between the loyal and new blood donors volunteer (25.1% vs 64.6% p < 0.001); between blood donors volunteer of low and high education level (p = 0.04). Motivation to donate blood in 95.9% of cases respect ethical rules of donation. The prevalence of viral markers in blood donors is as follows: 4.8% hepatitis B, 3.9% hepatitis C, 1.6% HIV. For HIV, the low level of education and replacement blood donors are most at risk, the antigen of hepatitis B is observed in blood donors over 30 years, blood donors living couple.

CONCLUSION

General knowledge on blood safety is very low in the first link in the chain transfusion (blood donors). A good education of this population conducted by the transfusion service reinforced building (training and support) is needed.

The use of rapid diagnostic tests for transfusion infectious screening in Africa: a literature review

Infectious risk associated with blood transfusion remains a major public health challenge in Africa, where prevalence rates of the major transfusion-transmissible infections (ie, hepatitis B, hepatitis C, human immunodeficiency virus, and syphilis) are among the highest in the world. Resource-limited blood services often operate with minimal predonation screening safeguards, prompting exclusive reliance on laboratory testing to mitigate infectious risk. Transfusion screening with rapid diagnostic tests (RDTs) has been adopted in areas that lack the capacity to support the routine use of more sophisticated technologies. However, uncertainty surrounding the performance of some RDTs in the field has spurred debate regarding their application to blood donation screening. Our review of the literature identified 17 studies that evaluated RDTs for the infectious screening of blood donors in Africa. The review highlights the variable performance of available RDTs and the importance of their use in a quality-assured manner. Deficiencies in performance observed with some RDTs underscore the need to validate test kits prior to use under field conditions with locally acquired samples. Suboptimal sensitivities of some available tests, specifically hepatitis B virus rapid assays, question their suitability in single-test algorithms, particularly in high-prevalence regions. Although RDTs have limitations, many of which can be addressed through improved training and quality systems, they are frequently the only viable option for infectious screening in resource-poor African countries. Therefore, additional studies and specific guidelines regarding the use of RDTs in the context of blood safety are needed.

Screening for hepatitis C virus infection in a high prevalence country by an antigen/antibody combination assay versus a rapid test

In low-income-countries, screening for hepatitis C virus (HCV) infection is often based on rapid tests (RT). Their lower sensitivity compared to enzyme immunoassay (EIA) suggests that newer HCV Antigen/Antibody (Ag/Ab) combination assays might have a role in such countries. To test this idea, 1998 blood donors were tested at the University Teaching Hospital blood bank in Yaoundé, Cameroon simultaneously with a RT (HCV rapid test, Human Diagnostics, Berlin, Germany) according to standard practice (S1) and with an Ag/Ab assay (Monolisa HCV Ag/Ab Ultra, Biorad, France) (S2). All discordant, borderline and reactive samples were submitted to confirmatory testing by immunoblot and/or HCV-RNA. Of the 86 (4.3%) samples positive with one or both strategies, 29 were confirmed negative, 37 positive and 20 were false positive or resolved infection. There was a significant difference in test sensitivity (p=0.01) between S1 (70.3%) and S2 (91.9%) but not in test specificity (99.4% and 98.6%, respectively). The benefit of the Ag/Ab assay in the detection of recent HCV seronegative infections could not be evaluated since no Antigen-only donations were identified. However, better Ag/Ab test sensitivity compared to RT supports the implementation of these newer immunoassays for HCV screening in the African blood bank setting.

[The francophone Africa blood transfusion research network: a five-year report]

There has been little blood safety research in sub-Saharan Africa, often consisting of local efforts whose findings had limited impact The "Francophone Africa Transfusion Research Network" was created in May 2007 with the objective of developing common evidence-based blood safety policies that may be adapted to each country's situation. The Group's activities to date have focused mainly on obtaining epidemiological and laboratory data on blood transfusion and on suggesting blood safety strategies, particularly in the field of TTIs. To carry out such research activities, the group works closely with the National Blood Transfusion Services (NBTS), the Regional Blood Transfusion Services (RBTS), the hospital blood banks (HBB) and collection stations. For the first 5years, four research priorities were identified: (i) descriptive studies of the characteristics of francophone African blood donors and blood centers; (ii) estimation of the residual risk of transfusion-transmitted major viral infections; (iii) an analysis of blood donor deferral strategies; and (iv) a description of TTI screening strategies and an external quality assurance system (EQAS) project. During this period, seven projects have been implemented at the national level and published and five multicenter studies were conducted and published. The present review reports the main observations and recommendations from those studies that could improve blood safety statute in Africa.

[Seroprevalence of infectious markers among blood donors in Niamey (Niger)]

BACKGROUND

The study aimed to determine the seroprevalence of transfusion-transmitted infectious (TTI) markers for human immunodeficiency virus (HIV), hepatitis B and C viruses (HBV, HCV) and syphilis among blood donors in Niamey (Niger). The association between seroprevalence of ITT markers and sociodemographic characteristics of blood donors was investigated.

METHODS

A cross-sectional study was conducted in 2010 among 3213 blood donors. Data were collected from a pre-donation questionnaire and from laboratory tests results.

RESULTS

The male/female ratio was 4/1. Up to 18.1% of donations had at least one positive marker, in which 2.7% presented a positive test for two or more agents. A seroprevalence of 1.62% (95%CI: 1.21-2.12) was associated with HIV, 15.4% (13.9-16.7) with HBV, 1.18% (0.84-1.62) with HCV, and 0.47% (0.26-0.77) for blood samples reacted with RPR test for syphilis. The HIV seroprevalence was two-fold higher in family than in volunteer donors (OR=2.15, 95%CI: 1.24-3.73). It was also higher in Rhesus D negative donors (OR=2.40, 95%CI: 1.11-5.17). The hepatitis B surface antigen seroprevalence was significantly higher in males than females (OR=1.85, 95%CI: 1.39-2.45) and in first time than in regular donors (P<0.0001). The HCV seroprevalence was significantly higher in male donors (OR=4.41, 95%CI: 1.06-18.4) and in donors from rural areas (OR=4.09, 95%CI: 1.42-11.8). Syphilis marker was significantly associated with the marital status (higher seroprevalence in divorced donors, P=0.0085).

CONCLUSION

Prevalence of TTI markers is high and national strategies for safe blood transfusion have to be strengthened. It is essential to recruit and maintain more volunteer donors, while females should be encouraged to donate blood.

Blood donor haemovigilance in Yaoundé, Cameroon

BACKGROUND

Blood availability is an issue of concern in countries of sub-Saharan Africa where both the demand and discard rates of blood are high. Although some degree of attention is paid when transfusion reactions occur in recipients, no information is available on donor reactions in this setting.

OBJECTIVES

This study was carried out in order to obtain some data on adverse reactions (ARs) to blood donations. It would make it possible to monitor and improve the safety of the donation procedure, which constitutes a strategy towards increasing donor supply by encouraging first-time donors to return in the absence of any negative outcomes of donation.

METHODS

A hospital blood bank-based descriptive and prospective study was carried out to document ARs among 1034 blood donors from September 2010 to January 2011. A pre-structured data collection tool was used to record the signs and symptoms observed.

RESULTS

The ARs occurred at a rate of 2.8%. The most frequent reaction was hypotension which constituted 26.62% of all ARs. Haematomas represented 18.42% while weakness and dizziness were each noted in 13.16% of donors. There was no severe vasovagal reaction. Associated factors to vasovagal reactions were first-time donor status (P = 0.004), female sex (P = 0.01) and low body weight (P = 0.02).

CONCLUSION

Our results suggest that blood donation is a relatively safe procedure in our context. The frequency is higher than studies from developed countries. The association of AR with first-time blood donation needs to be verified in a larger study. However, it could suggest another benefit of regular blood donation.

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.

Prevalence and trends of hepatitis C virus among blood donors in Antananarivo, from 2003 to 2009

PURPOSE OF THE STUDY

Due to anemia and maternal, childhood and infancy diseases, blood transfusion is one of the most important medical cares given in sub-Saharan Africa, including Madagascar. World Health Organization encourages worldwide countries to maximize transfusion security. Until now, there was no data within a large population of blood donors. Therefore, the aim of this study was to assess the prevalence and time trends of hepatitis C virus (HCV) among all first-time blood donors coming into the National Centre of Transfusion Supply in Antananarivo.

MATERIAL AND METHODS

This retrospective study was conducted at the National Centre of Transfusion Supply in Antananarivo from 2003 to May 2009. We looked up to all recorded results of systematic screening of blood donor candidates and we took data about all first-time blood donors, including age and gender. Forty-seven thousand five hundred and ten of 47,636 first-time blood donors were retained, the others were excluded due to lack of some data.

RESULTS

The mean age of our donors was 33.3 years (35.8 for male, and 32.6 for female; P<<0.05). Eighty percent were male (38,225/47,510). HCV prevalence was 0.65% during the period of study and HCV positive donor candidates were older than HCV negative (mean age: 39.1 vs. 33.2; P<<0.05). It was in fact stable from 2003 to 2007, and then decreased. HCV prevalence was higher in women than in men (0.9 vs. 0.6; P<0.05), and it increased by age (P<0.05).

CONCLUSION

Our study found a low prevalence of HCV among blood donors compared to many countries in Africa.

[Implementation of hemovigilance in Sub-Saharan Africa]

PURPOSE OF THE STUDY

Hemovigilance being an essential part of blood transfusion safety, many countries have set legislation for its organization and its establishment. In Sub-Saharan Africa, where transfusion practice is facing many challenges, hemovigilance does not always appear as a priority. Nevertheless, in 2000, Burkina Faso decided to reorganize its blood transfusion system according to the World Health Organisation recommendations and other international standards. A national blood transfusion center and regional blood transfusion centers were created. From 2005 to 2009, a hemovigilance pilot project was conducted by the regional blood transfusion center of Bobo-Dioulasso.

METHODS

The implementation of this hemovigilance project included the following steps: training of medical and paramedical personnel of the health facilities provided with blood and blood products by the regional blood transfusion center, distribution of post transfusion and hemovigilance forms, and the creation of a hemovigilance and transfusion committee.

RESULTS

During the period 2005-2009, 34,729 blood products were distributed for 23,478 patients. The return rate of the post-transfusion and hemovigilance forms (number of files completed partially or completely and returned to the regional blood transfusion center compared to the number of units distributed) raised from 83.1 to 94.8%, the rate of traceability (rate of forms returned to the regional blood transfusion center and totally completed) raised from 71.6 to 91.6%, and the concordance between the patient for which the blood was delivered and the patient transfused moved from 92.9 to 98.0%. The notification rate of transfusion incidents raised from 1.1 to 16.1 per 1000 units transfused during that period.

CONCLUSION

The implementation of a hemovigilance system is possible in the Sub-Sahara African countries. This constitutes a major element in the improvement of different steps of transfusion safety. The implementation of a hemovigilance system requires negotiations between transfusion centers and the hospital personnel, and should be facilitated by the official regulation on blood transfusion practices.

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

BACKGROUND

The goal of selecting a healthy blood donor is to safeguard donors and reduce the risks of infections and immunologic complications for recipients.

STUDY DESIGN AND METHODS

To evaluate the blood donor selection process, a survey was conducted in 28 blood transfusion centers located in 15 francophone African countries. Data collected included availability of blood products, risk factors for infection identified among blood donor candidates, the processing of the information collected before blood collection, the review process for the medical history of blood donor candidates, and deferral criteria for donor candidates.

RESULTS

During the year 2009, participating transfusion centers identified 366,924 blood donor candidates. A mean of 13% (range, 0%-36%) of the donor candidates were excluded based solely on their medical status. The main risk factors for blood-borne infections were having multiple sex partners, sexual intercourse with occasional partners, and religious scarification. Most transfusion centers collected this information verbally instead of having a written questionnaire. The topics least addressed were the possible complications relating to the donation, religious scarifications, and history of sickle cell anemia and hemorrhage. Only three centers recorded the temperature of the blood donors. The deferral criteria least reported were sickle cell anemia, piercing, scarification, and tattoo.

CONCLUSIONS

The medical selection process was not performed systemically and thoroughly enough, given the regional epidemiologic risks. It is essential to identify the risk factors specific to francophone African countries and modify the current medical history questionnaires to develop a more effective and relevant selection process.

Blood transfusion safety in Africa: a literature review of infectious disease and organizational challenges

Blood safety remains an important public health concern in Africa where lack of availability or provision of unsafe blood adversely impacts morbidity and mortality in the region. In recognition of this shortfall, the World Health Organization (WHO) established a goal of regional blood safety by 2012 through improved "organization and management, blood donor recruitment and collection, testing of donor blood as well as appropriate clinical use of blood" (Tagny et al: Transfusion. 2008;48:1256-1261; Tapko et al: Status of Blood Safety in the WHO African Region: Report of the 2006 Survey http://www.afro.who.int/en/divisions-a-programmes/dsd/health-technologies-a-laboratories.html. Brazzaville, Republic of Congo: WHO Regional Office for Africa; 2006). Although there has been substantial progress toward meeting these objectives, there are continued obstacles to both development and sustainability. In a setting where transfusion oversight is still being improved, transfusion-transmitted infections are of real concern. The high prevalence of some transfusion-transmissible agents such as hepatitis B virus and HIV in the general population means that some infected blood units escape detection by even well-performed laboratory testing, resulting in potential downstream transmission to patients. The spectrum of transfusion-transmitted infection include conventional as well as exotic pathogens, many of which are endemic to the region, thereby imparting ongoing challenges to recruitment and testing strategies.

Prevalence of hepatitis B and hepatitis C coinfections in an adult HIV centre population in Gaborone, Botswana

The objective of this study was to assess the prevalence of hepatitis B and hepatitis C coinfections in human immunodeficiency virus (HIV) -infected adults at an HIV center in Gaborone, Botswana. A retrospective review was performed of charts of currently active HIV-infected adult patients in the Family Model Clinic (FMC) of the Botswana-Baylor Children's Clinical Center of Excellence (BCOE) in Gaborone, Botswana, for the results of serum hepatitis B surface antigen (HBsAg) and antihepatitis C IgG tests performed between January 1, 2005 and December 15, 2009. Of 308 active FMC patients, 266 underwent HBsAg serology testing within the period of study. The HBsAg coinfection prevalence was 5.3% (14/266); 2 of 252 patients had at least one positive antihepatitis C IgG serology, a 0.8% prevalence. Hepatitis B coinfection is relatively common in HIV-infected adults at our center in Botswana, whereas hepatitis C coinfection is rare. In this setting, where the diagnosis of hepatitis B coinfection with HIV has implications for choice of first-line antiretroviral therapy and prevention of perinatal hepatitis B transmission, broader sampling to establish the true population prevalence of hepatitis B coinfection and the desirability of adding screening to HIV management should be considered. These findings provide little justification for adding hepatitis C coinfection screening to the management of HIV infection in Botswana.

Uncovering high rates of unsafe injection equipment reuse in rural Cameroon: validation of a survey instrument that probes for specific misconceptions

BACKGROUND

Unsafe reuse of injection equipment in hospitals is an on-going threat to patient safety in many parts of Africa. The extent of this problem is difficult to measure. Standard WHO injection safety assessment protocols used in the 2003 national injection safety assessment in Cameroon are problematic because health workers often behave differently under the observation of visitors. The main objective of this study is to assess the extent of unsafe injection equipment reuse and potential for blood-borne virus transmission in Cameroon. This can be done by probing for misconceptions about injection safety that explain reuse without sterilization. These misconceptions concern useless precautions against cross-contamination, i.e. "indirect reuse" of injection equipment. To investigate whether a shortage of supply explains unsafe reuse, we compared our survey data against records of purchases.

METHODS

All health workers at public hospitals in two health districts in the Northwest Province of Cameroon were interviewed about their own injection practices. Injection equipment supply purchase records documented for January to December 2009 were compared with self-reported rates of syringe reuse. The number of HIV, HBV and HCV infections that result from unsafe medical injections in these health districts is estimated from the frequency of unsafe reuse, the number of injections performed, the probability that reused injection equipment had just been used on an infected patient, the size of the susceptible population, and the transmission efficiency of each virus in an injection.

RESULTS

Injection equipment reuse occurs commonly in the Northwest Province of Cameroon, practiced by 44% of health workers at public hospitals. Self-reported rates of syringe reuse only partly explained by records on injection equipment supplied to these hospitals, showing a shortage of syringes where syringes are reused. Injection safety interventions could prevent an estimated 14-336 HIV infections, 248-661 HBV infections and 7-114 HCV infections each year in these health districts.

CONCLUSIONS

Injection safety assessments that probe for indirect reuse may be more effective than observational assessments. The autodisable syringe may be an appropriate solution to injection safety problems in some hospitals in Cameroon. Advocacy for injection safety interventions should be a public health priority.

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.