types of blood donors and blood safety in developing countries 2011/03_ mbanya.pdf · 1953 nigeria,...
TRANSCRIPT
Types of Blood Donors and Blood Safety in Developing
CountriesDORA MBANYA DORA MBANYA FMBS FMBS –– UYI/CHUUYI/CHU
YAOUNDE YAOUNDE -- CAMEROONCAMEROON
Developing countries - hmmmm
AFRICAAFRICA
Presentation OutlinePresentation Outline
Introduction Introduction
History & evolution of transfusion in SubHistory & evolution of transfusion in Sub--Saharan Saharan
Africa (SSA)Africa (SSA)
Types of blood donors in SSA & impactTypes of blood donors in SSA & impact
Any hope?Any hope?
ConclusionsConclusions
Introduction Introduction
Blood safety continues to represent a big challenge in
developing countries, especially of SSA
According to a review by Tayou et al (2008) it is
multifactorial:
Related issues include the absence of policies and
legislation that organize and coordinate transfusion
practice, and their implementation
Introduction Introduction
Blood donors and donor programmes are
inexistent
High prevalence Transfusion Transmissible
Infections (TTI) & inappropriate screening
Cold chain disruptions and storage problems
Distribution and rational use issues
IntroductionIntroduction
Blood donation remains Blood donation remains a key element a key element in blood in blood
safetysafety
In these settings, blood donors tend to be mainly In these settings, blood donors tend to be mainly
family or replacement donorsfamily or replacement donors
However, according to WHO (1997), these are very However, according to WHO (1997), these are very
risky donorsrisky donors. .
First Reports of Blood Transfusion (service or systematic First Reports of Blood Transfusion (service or systematic treatment) in subtreatment) in sub--Saharan Africa, 1924Saharan Africa, 1924--19551955
19241924 Belgian Congo (Zaire)
19431943 Senegal
19481948 Kenya, Uganda, Tanganyika
19501950 Angola, Cameroon, Dahomey (Benin), Ivory Coast, Guinea, Mali, Mozambique, Niger, Northern Rhodesia, Togo, Upper Volta (Burkina Faso)
19511951 Southern Rhodesia (1926 for Europeans only)
19531953 Nigeria, Gold Coast (Ghana)
19551955 Tchad, French Congo, Gabon
History
Courtesy Dr. William SchneiderCourtesy Dr. William Schneider
Who gave blood?Who gave blood?Blood banksBlood banks–– ““voluntaryvoluntary”” donorsdonors
SchoolsSchoolsSoldiersSoldiersGovGov’’t private officest private officesPrisonersPrisoners
Blood donation, Hôpital Principal Dakar, 1950s
Donation in Uganda
Mengo Hosp 1949
Schoolboys 1951
Rural Uganda 1953
History
Courtesy Dr. William SchneiderCourtesy Dr. William Schneider
Daily Nation (Kenya), 1962
Press coverage of blood transfusion near the time of independence in Kenya
Supplying oneSupplying one’’s own donors existed right s own donors existed right after independenceafter independence
History
Courtesy Dr. William SchneiderCourtesy Dr. William Schneider
WHO Intervention in blood safetyWHO Intervention in blood safety
During the 28During the 28thth WHO WHA of WHO WHA of May 1975May 1975, ,
Resolution WHA 28.72 called on member states to :Resolution WHA 28.72 called on member states to :
Promote the creation of Promote the creation of National Blood Transfusion National Blood Transfusion
ServicesServices (NBTS) based on voluntary non(NBTS) based on voluntary non--
remunerated blood donors (remunerated blood donors (VNRBDVNRBD))
Promote the Promote the promulgation of laws promulgation of laws that govern that govern
transfusion practicetransfusion practice
History of blood transfusion in subHistory of blood transfusion in sub--Saharan Saharan Africa: 1975 to presentAfrica: 1975 to present
Example of Burundi assistance from Swiss Red CrossExample of Burundi assistance from Swiss Red Cross–– Donor Recruitment and mobile unit Donor Recruitment and mobile unit
Courtesy Dr. William SchneiderCourtesy Dr. William Schneider
Types of donorsTypes of donors
3 categories of donors can be identified:3 categories of donors can be identified:
Volunteer nonVolunteer non--remunerated blood donor (VNBD): remunerated blood donor (VNBD): ““person person
gives blood of his/her own free will and receives no gives blood of his/her own free will and receives no
payment for it, either in the form of cash, or in kind which payment for it, either in the form of cash, or in kind which
could be considered a substitute for moneycould be considered a substitute for money””
Courtesy Prof. JP AllainCourtesy Prof. JP Allain
Types of donorsTypes of donors
Family/Replacement donor (F/R donor)Family/Replacement donor (F/R donor)
““Individuals who are generally relatives or friends of patients Individuals who are generally relatives or friends of patients
who require blood transfusionwho require blood transfusion””
Paid donors:Paid donors:
““Persons who receive monetary payment from the family of a Persons who receive monetary payment from the family of a
patient to substitute for unavailable patient to substitute for unavailable ‘‘replacementreplacement’’ donors donors
within the family circlewithin the family circle”” Courtesy Prof. JP AllainCourtesy Prof. JP Allain
Characteristics of Blood Characteristics of Blood donations in SSAdonations in SSA
Variation in transfusion servicesVariation in transfusion services::
–– HospitalHospital--based systemsbased systems
–– Centralized BTS Centralized BTS
–– Hybrid of both systems; is predominant Hybrid of both systems; is predominant (Bates et al, (Bates et al,
2007), where a few centralized functions (transfusion 2007), where a few centralized functions (transfusion
guidelines; collection from voluntary donors) are guidelines; collection from voluntary donors) are
incoorporated into the hospitalincoorporated into the hospital--based blood banking based blood banking
Characteristics of Blood donors in SSACharacteristics of Blood donors in SSA
Mainly Family/Replacement in 70 Mainly Family/Replacement in 70 –– 100% cases100% cases
R/FR/F donors are donors are readily available readily available and and cheapercheaper to obtain than to obtain than
VNRBD (Hensher& Jefferys, 2000; VNRBD (Hensher& Jefferys, 2000; Allain et al.,Allain et al.,2004; Lara 2004; Lara
et al., 2007).et al., 2007).
Mainly firstMainly first--time time donors donors
About About >75% aged <30 yrs >75% aged <30 yrs (Rajab, Nigeria; Nebie, (Rajab, Nigeria; Nebie,
Burkina;Tayou et al (Multicentric study)Burkina;Tayou et al (Multicentric study)
Type and age distribution of blood donors in Type and age distribution of blood donors in Kumasi, GhanaKumasi, Ghana
0
10
20
30
40
50
60
70
<20 20-24 25-29 30-34 35-39 40 -44 45-49 >50
Age groups
% o
f tot
al
Replacement donorsVolunteer donors
0
10
20
30
40
50
60
70
<20 20-24 25-29 30-34 35-39 40 -44 45-49 >50Age groups
% o
f tot
al
Replacement donors
Volunteer donors
0
10
20
30
40
50
60
70
<20 20-24 25-29 30-34 35-39 40 -44 45-49 >50
Age groups
% o
f tot
al
Replacement donorsVolunteer donors
0
10
20
30
40
50
60
70
<20 20-24 25-29 30-34 35-39 40 -44 45-49 >50Age groups
% o
f tot
al
Replacement donors
Volunteer donors
Allain JP, ISBT Science Series,2010, 5: Allain JP, ISBT Science Series,2010, 5: 169169--175175
Characteristics of Blood donors in SSACharacteristics of Blood donors in SSA
Contrast with Europe: Contrast with Europe:
ExEx. Lefrere & Rouger, 2006 reported:. Lefrere & Rouger, 2006 reported:
–– <50% aged under 35 years <50% aged under 35 years in some European countriesin some European countries
Male predominance Male predominance in most African reports ranging in most African reports ranging
6060--90% 90% (Agbovi et al, Togo; Nebie et al, Burkina F; (Agbovi et al, Togo; Nebie et al, Burkina F;
Allain et al, Ghana; Tayou et al (Multicentric study)Allain et al, Ghana; Tayou et al (Multicentric study)
Characteristics of Blood donors in SSACharacteristics of Blood donors in SSA
High TTI prevalence High TTI prevalence (HBV,HIV, HCV, Syphilis, (HBV,HIV, HCV, Syphilis,
Malaria, FilariaMalaria, Filaria……))
According to WHO at least 5% TTI transmitted According to WHO at least 5% TTI transmitted
through blood transfusion in Africathrough blood transfusion in Africa
TTI in 1TTI in 1stst time donors Cameroon compared to some time donors Cameroon compared to some African countries (Mbanya et African countries (Mbanya et al, Transfusion Medicine
2003; 13(5): 267 – 73)Type of infection Number cases detected
(n=252)
Percentage
(Cameroon, 2003)
Other African Prevalences
among donors (%)
Reference
HBV 27 10.7 11 (Tanzania)
20.3 (Mauritania)
Matee et al, 1999
Lo et al, 1999
Syphilis 23 9.1 12.7 (Tanzania)
13.5 (Ghana)
14.4 (Cameroon)
Matee et al, 1999
Ampofo et al, 2002
Mbanya et al, 2002
HIV 20 7.9 3.0 (Kenya)
8.7 (Tanzania)
Mwangi, 1999
Matee et al, 1999
HCV 12 4.8 8.0 (Tanzania)
HTLV-1 4 1.6 0.0: (Tanzania)
0.7 (Ghana)
7.1 (Cameroon)
Matee et al. 1999
Ampofo et al, 2002
Mbanya et al, 2002
Total 66 26.2 - -
Serological findings among blood donors Serological findings among blood donors ((FTD = First time donors; RD= Regular donors; FD=Family donors; BFTD = First time donors; RD= Regular donors; FD=Family donors; BD=Benevolent donorsD=Benevolent donors))
No.
Positive
% No. FTD
Positive(%)
No. RD
positive (%)
No. FD
(%)
No. BD
(%)
HBsAg 21 10.3 18 (85.7) 3 (14.3) 20 (95.2) 1 (4.8)
HIV 6 2.9 5 (83.3) 1 (16.7) 6 (100) 0 (0.0)
HCV 8 3.9 7 (87.5) 1 (12.5) 7 (87.5) 1 (12.5)
Mbanya et al, Transfusion Medicine, Mbanya et al, Transfusion Medicine, 2005, 15, 3952005, 15, 395––399399
Viral markers in the donors in Nigeria (Ahmed et al, 2007)
))Marker VNRBD (%) F/R donors (%) Paid donors (%)
HIV 4.1 4.6 8.1*
HBsAg 13.5 14.1 20.5*
HCV 1.4 1.8 2.8*
* Statistically significantly higher difference for all markers in paid donors
Comparison of viral infection markers Comparison of viral infection markers between SSA firstbetween SSA first--time VNRBD & time VNRBD &
Replacement donorsReplacement donorsCountry Viral marker 1st-time VNRD
(%)
1st time F/R
donors (%)
P value
Ghana Anti-HIV 69/6640 (1.0) 50/4360 (1.1) 0.87
(Allain et al, 2010) HBsAg 919/6640 (13.8) 649/4360 (14.9) 0.13
Guinea Anti-HIV 26/1784 (1.5) 42/8956 (0.5) <0.001
(Loua &Nze Nkoure,
2010)HBsAg 259/1784 (14.5) 1142/8956(12.8) 0.047
Cameroon Anti-HIV 11/272 (4.0) 114/3053 (3.7) 0.9
(Mbanya et al, 2010) HBsAg 49/272 (18.00) 233/3053 (7.6) <0.001
Courtesy Prof. JP AllainCourtesy Prof. JP Allain
ImpactImpact
Impact on blood supplyImpact on blood supply
Analysis of blood donation patterns ( WHO, 2004): Analysis of blood donation patterns ( WHO, 2004):
A A significant difference in blood donations between low, medium ansignificant difference in blood donations between low, medium and d
high HDI countries:high HDI countries:
–– 61% of the global blood supply 61% of the global blood supply was donated in was donated in
developed (high HDI) countries. developed (high HDI) countries.
–– 39% 39% was was donated in developing donated in developing (low and medium HDI)(low and medium HDI)
Thus, there is acute shortage Thus, there is acute shortage of blood in this regionof blood in this region
Donation per 1000 population in the African Donation per 1000 population in the African RegionRegion
Courtesy BLS/AFROCourtesy BLS/AFRO
Total units collected 1999Total units collected 1999--20082008
Courtesy BLS/AFROCourtesy BLS/AFRO
AFRO Strategy for Blood Safety AFRO Strategy for Blood Safety Resolution AFR/RC51/R2Resolution AFR/RC51/R2 (Aug 2001)(Aug 2001)
Main objectivesMain objectives–– TTo assist the countries to o assist the countries to
set up an effective set up an effective system system of of recruitmentrecruitment of lowof low--risk risk blood donorsblood donors;;
–– To To improve the safetyimprove the safety of of blood and blood productsblood and blood products
–– To promote the To promote the appropriate useappropriate use of blood of blood and blood products by and blood products by clinicians;clinicians;
Targets for 2012Targets for 2012–– Situation analysis done by Situation analysis done by
all countriesall countries–– National Policy National Policy
implemented in at least implemented in at least 75% of countries75% of countries
–– At least 80% of blood At least 80% of blood collected from VNRBDcollected from VNRBD
–– 100% of blood screened 100% of blood screened for for all major TTIsall major TTIs
Courtesy BLS/AFROCourtesy BLS/AFRO
Percentage of VNRBD in countries of the Percentage of VNRBD in countries of the African Region 2006African Region 2006
Courtesy BLS/AFROCourtesy BLS/AFRO
Voluntary donation on AFRO Voluntary donation on AFRO targetstargets
21
5
20
0 5 10 15 20 25
Number of Countries
<50%
50 to 79
80 to 100
Perc
enta
ge o
f Tot
al
dona
tions
AFRO TARGET - 80% voluntary donation by 2012Courtesy BLS/AFROCourtesy BLS/AFRO
Any hope?Any hope?
Nearly four decades Nearly four decades after the 28after the 28thth WHO WHA of May 1975, WHO WHA of May 1975,
Resolution WHA 28.72 called on member states to promote Resolution WHA 28.72 called on member states to promote
the creation of national BTS based on VNRBD, and the the creation of national BTS based on VNRBD, and the
promulgation of laws that govern transfusion practice:promulgation of laws that govern transfusion practice:
BLOOD DONATION, SUPPLY & SAFETY on the whole, in BLOOD DONATION, SUPPLY & SAFETY on the whole, in
SSA is still very challengingSSA is still very challenging..
Any hope? Any hope?
It is 2011:It is 2011:
7070--80% donations continue to be F/R 80% donations continue to be F/R
Most are firstMost are first--time donorstime donors
Hence donor retention remains a major issue.Hence donor retention remains a major issue.
Hope? : Yes, Hope? : Yes, May 2005May 2005 WHA Resolution 57.13:WHA Resolution 57.13:
–– Established the WBDD to be celebrated on 14Established the WBDD to be celebrated on 14thth of June of June
Celebration of the WBDDCelebration of the WBDD
Courtesy BLS/AFRO
World Blood Donor Day 2010: World Blood Donor Day 2010: CameroonCameroon
Club 25Club 25
Initiated in Zimbabwe (1989)Initiated in Zimbabwe (1989)
–– Pledge by youths to donate at least 25 times Pledge by youths to donate at least 25 times
Spread to many other countries of Africa & the Spread to many other countries of Africa & the
developing worlddeveloping world
Significant role in blood supply where it worksSignificant role in blood supply where it works
ConclusionsConclusions
Blood transfusion Blood transfusion safety in sub-Saharan Africa (SSA) is still
plagued amongst other issues by:
– High prevalence of infectious agents,
– Donor selection issues and chronic blood shortage
– Compounded by the lack of resources etc. etc.
This implies that international norms in transfusion safety
are not implemented/implementable in most of SSA
ConclusionsConclusions
Hence the dilemma remains:Hence the dilemma remains:
What would work best What would work best for these resourcefor these resource--limited limited
developing countries?:developing countries?:
– Supply???
– Safety???
Blood safetyBlood supply
25-50% of deathsdue to
lack of blood
High prevalence of transfusion-transmitted
infections in Africa
Conclusions
Courtesy Dr. Imelda BatesCourtesy Dr. Imelda Bates
What would strike the balance between blood supply and safety?
ConclusionsConclusions
So, what would work?So, what would work?A centralized system (A centralized system (100% VNRBD100% VNRBD) )
OR OR
A local system (A local system (tolerance of F/R donorstolerance of F/R donors))
Cost/unit of bloodCost/unit of bloodCentralised and local systemsCentralised and local systems
LocalCentralised (excl. capital costs)
$16
Donor recruitment
Blood distribution
Quality processes
$60
Medina Lara et al J. Clin. Pathol., 2007; 60:1117-1120
Patients bear donor costs
No distribution costs
Quality?
Conclusions
ConclusionsConclusions
SolutionSolution: Strategies to increase repeat donations: Strategies to increase repeat donations
Both types of 1stBoth types of 1st--time donors (VNRBD & F/R) are equally time donors (VNRBD & F/R) are equally
acceptableacceptable
Improved blood safety relies on repeat donations Improved blood safety relies on repeat donations
Hence that should be a target in our settingsHence that should be a target in our settings
““Winning isn't everything, but wanting to win isWinning isn't everything, but wanting to win is””
Following a train wreck in October 1957
AcknowledgementAcknowledgement
For kindly authorizing me to use their slides, I wish to For kindly authorizing me to use their slides, I wish to thank:thank:
Prof. JP AllainProf. JP AllainDr. W. SchneiderDr. W. SchneiderDr. I. BatesDr. I. BatesDr. JB TapkoDr. JB Tapko