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Blood Transfusion Services in Nigeria

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Each year, an estimated 287,000 women die worldwide from complications related to pregnancy and childbirth[i]. More than half of these maternal deaths (56%) occur in sub-Saharan Africa[i] and haemorrhage (severe bleeding) as the leading cause[ii].

Efforts have been made to reduce maternal deaths from haemorrhage through skilled birth attendance and ensuring the availability of Emergency Obstetric Care (EmOC)[iii]. Despite the fact that Caesarean Sections (CSs) and blood transfusions are key components of Comprehensive Emergency Obstetric Care (CEmOC)[iv], improving the effectiveness of Blood Transfusion Services (BTS) has not received enough attention[v].  

It is estimated that 26% of maternal deaths in sub-Saharan Africa are directly related to a lack of blood[iii].

A major reason why so many women die from haemorrhage is because once bleeding starts death can occur in around two hours, compared with 10 hours for eclampsia and 72 hours for obstructed labour[vi]. Therefore, among other strategies to prevent maternal deaths from haemorrhage, it is crucial to make available rapid access to adequate, safe, and affordable blood for transfusion[iii].

To ensure the provision of safe and effective BTS, the World Health Organization (WHO) recommends[iii] [vii]:

  • The establishment of a nationally-coordinated Blood Transfusion Service;
  • The collection of blood only from voluntary non-remunerated  blood donors from low-risk populations;
  • Testing of all donated blood, including screening for  transfusion-transmissible infections, blood grouping and  compatibility testing;
  • Reduction in unnecessary transfusions through the effective clinical use of blood.

What we know of the situation in Nigeria:

Blood supply

Total population in the country

158 423 000 (2010)[viii]

Whole blood units collected

Just over 36,200 units collected in 2010 by the National Blood Transfusion Service (NBTS)[ix]

Blood needed

An estimated 1,500,000 (2005)[x]

Whole blood donations (units)/1,000 population

(provides information on the general availability of blood in the country)

 0.2 units/1,000 population by NBTS in 20109

(WHO recommends 10 per 1000 population to meet clinical demand in resource-limited settings[xi])

Donor population  

% of whole blood units collected in Nigeria from voluntary non-remunerated donors

 

5% (2006) (WHO recommends 100%)[xii]

% of whole blood units collected by Nigeria Blood Transfusion Services  only from voluntary non-remunerated donors

86.5% (2010)[ix]

Family replacement donors

Latest data found suggests[x]:

Public health facilities: 75% (2004-2005)

Private health facilities: 25% (2004-2005)

Paid (commercial) donors

Latest data found suggests[x]:

Public health facilities: 25% (2004-2005)

Private health facilities: 75% (2004-2005)

Organisation of the Blood Transfusion Services

Established national policy

Yes[xiii]

Enacted legislative framework

Yes[xiii]

Full implementation of policy

No[x]

Blood system

Centralised: if blood collection, testing, and distribution are co-ordinated centrally)[iii].

Decentralised: if blood collection, testing, and distribution are co-ordinated at the hospital-level)[iii].

Centralised, decentralised, and informal[x]

Blood Safety and Screening[x]

Blood tested for HIV

Yes (if following policy guidelines)

Blood tested for Hepatitis B Virus

Yes (if following policy guidelines)

Blood tested for Hepatitis C Virus

Yes (if following policy guidelines)

Blood tested for malaria

No (the national policy does not say to do so)

Blood tested for syphilis

Yes (if following policy guidelines) 

What we need more information on:

Reliable, up-to-date, and publically accessible information on:

  • Blood supply;
  • Blood used, especially for mothers and newborns;
  • Blood need. This will highlight whether the amount used is meeting blood need;
  • The donor population. It will be useful to know the break-down and calculation of voluntary non-remunerated donors, paid donors, and family-replacement donors including compulsory spousal donations.
  • Perceptions/attitudes to blood donation;
  • Blood safety and screening; and
  • The organisation of the Blood Transfusion Services.

References:


[i] WHO, UNICEF, UNFPA and The World Bank. 2012.  Trends in Maternal Mortality: 1990 to 2010: WHO, UNICEF, UNFPA and The World Bank Estimates.  Geneva: WHO. Available at: http://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Trends_in_maternal_mortality_A4-1.pdf

[ii] Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet 2006;367:1066–74. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16581405 Free subscription is required to read the full article.

[iii] Bates I, Chapotera G, McKew S, van den Broek N. Maternal mortality in sub-Saharan Africa: the contribution of ineffective blood transfusion services. BJOG 2008;115:1331–1339. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2008.01866.x/pdf No subscription or payment required.

[iv] WHO, UNFPA, UNICEF and AMDD. 2009. A handbook on monitoring emergency obstetric care. Geneva: WHO. Available at: http://whqlibdoc.who.int/publications/2009/9789241547734_eng.pdf

[v] Ronsmans C, Graham WJ. Lancet maternal survival series steering group. Maternal mortality: who, when, where, and why. Lancet 2006; 368:1189–200. As cited in Bates I, et al. Maternal mortality in sub-Saharan Africa: the contribution of ineffective blood transfusion services. BJOG 2008;115:1331–1339. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2008.01866.x/pdf

[vi] Walraven G, Telfer M, Rowley J, Ronsmans C. Maternal mortality in rural Gambia: levels, causes and contributing factors. Bull World HealthOrgan 2000; 78:603–13. As cited in Bates, I et al Maternal mortality in sub-Saharan Africa: the contribution of ineffective blood transfusion services. BJOG 2008;115:1331–1339. http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2008.01866.x/pdf

[vii] World Health Organization. 2002 (re-printed in 2009). Aide-memoire: Blood Safety for National Blood Programmes. Geneva: WHO. Available at: http://www.searo.who.int/entity/bloodsafety/Blood_Safety_Eng.pdf

[viii] UNDP. 2010. 2010 revision of the United Nations Population Division census estimates.

[ix] CDC. Progress Toward Strengthening National Blood Transfusion Services - 14 Countries, 2008-2010. MMWR Weekly, 2011: 60(46);1578-1582. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6046a2.htm (accessed 13.06.13)

[x] National Blood Transfusion Service [Nigeria]. 2006. Nigeria National Blood Policy: Revised November 2005. Abuja: National Blood Transfusion Service, Federal Ministry of Health.

[xi] World Health Organization. 2009. Blood safety and availability: facts and figures from the 2007 Blood Safety Survey. Geneva: WHO. As cited in CDC. Progress Toward Strengthening National Blood Transfusion Services - 14 Countries, 2008-2010. MMWR Weekly, 2011: 60(46);1578-1582.. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6046a2.htm (accessed 13.06.13)

[xii] Tapko JB, Mainuka P, Diarra-Nama A J. 2009. Status of blood safety in the WHO African Region, Report of the 2006  Survey. Brazzaville, Congo: WHO, Regional Office for Africa.

[xiii]CDC. Progress Toward Strengthening Blood Transfusion Services - 14 Countries, 2003-2007. MMWR Weekly. 2008;57(47):1273-7. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5747a2.htm#top (accessed 13.06.13)

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