Transfusion in sub-Saharan Africa Blood products, clinical care and community perceptions

Blood transfusion in sub-Saharan Africa (SSA) is a life-saving therapy for patients with severe anemia and acute hemorrhage. Access to transfusion is a national healthcare priority. Gaps in blood supply are related to several factors including the high prevalence of transfusion-transmissible infections (TTIs), insufficient inventory, and community participation as blood donors. This thesis documents blood utilization in SSA, explores ways to improve blood safety, highlights transfusion monitoring, and describes community perceptions regarding transfusion.
Transfusion in SSA is primarily used for pediatric malaria, sickle cell anemia, and obstetric hemorrhage. Most transfusion is either packed red cells (RBC, 58.5%) or whole blood (31.7%). Current blood safety strategies focus on TTIs, but hemovigilance programs with increased attention to proper blood utilization are also needed. Our research found that RBC storage duration did not influence the efficacy of oxygen delivery by transfusion as measured by lactate clearance and by cerebral tissue oxygenation. For SSA where blood is in short supply, our findings validate use of full expiry dates to improve inventory management. Recurrent severe anemia (RSA) is a major cause of morbidity and mortality for children after hospital discharge. Strategies to reduce RSA should address its risk factors, such as un-diagnosed sickle cell anemia and malaria. Community perceptions of transfusion are important because they influence healthcare seeking. In Uganda, community members hold blood transfusion in high regard but addressing perceived risks may further improve acceptance of transfusion services. In summary, this thesis investigates the principal routes for improving access to safe transfusion in SSA.