June 13, 2017

SAFE BLOOD: Nigeria fails to meet WHO requirements

SAFE BLOOD: Nigeria fails to meet WHO requirements

Voluntary blood donation in action.

•Requires 1.5m pints per annum; has only 5% voluntary donors, 60% commercial donors, 30% family replacment

By Chioma Obinna

BLOOD is a scarce commodity in Nigeria. It has been so for several years and the situation does not appear set to change.

Voluntary blood donation in action.

Blood is hardly available in the hospitals when it is needed. The reason for this is not far fetched. Nigerians are not in the habit of donating blood.

When Juliet Ebuzie, 26, became pregnant for the first time, she never expected to be a blood transfusion patient.

Her pregnancy was uneventful until one night she was rushed to the Accident & Emergency department of the Lagos State University Teaching Hospital, LASUTH. Luckily, she was brought to the hospital on time. Upon medical examination, she was pregnant with triplets. Further examination also disclosed that she had elevated blood pressure. Doctors handling her case immediately recommended Caesarean Section, CS.

In the process, she lost a lot of blood and needed emergency blood transfusion. But there were some complications soon after delivery, and Juliet ended up being transfused with a total of about 23 pints of blood. But the story had a happy ending because Juliet is alive today with her babies.

The story of 32-year-old Bola Adebayo, though similar has a different ending.

Shortage of blood banks

Bola who was pregnant fell into labour prematurely. She was in a commercial bus when the cramps began and was taken to a nearby private hospital.  Few hours later, she was delivered of her baby, but began to bleed heavily.  But there was no blood bank around and other hospitals around had no matching blood group. Eventually Bola bled to death – a condition described as  Post-Partum Haemorrhage.

Emeka’s case was not much different after a ghastly motor accident on their way to a traditional marriage.

Emeka and four of his friends  sustained severe injuries and required urgent blood transfusion but could not be saved because no blood was immediately available.  Millions  die needlessly for lack of voluntary blood donors and blood banks.  Today, it is commonplace to find hospitals without robust blood banks and generla attitude of the public over voluntary blood donation is not helpful either.

Inadequate voluntary donors: As important as blood is, Nigeria is still hit by shortage of voluntary blood donors.

The World Health Organisation, WHO,  insists that 1 percent blood donation by 1 percent of the population can meet a nation’s most basic requirements for blood.

The WHO also says 57 countries are currently collecting 100 per cent of their blood supply from voluntary, unpaid blood donors with 112.5 million blood donations collected globally; and half of these are in high-income countries.

Focus on this year’s World Blood Donor day  is on blood donation in emergencies with the slogan:  “What can you do?  With the secondary message: “Give blood. Give now. Give often.”  But the question is what effect does this slogan have on Nigerians?

The WHO notes that if a minimum of 1 percent of a country’s population donates 1 percent  blood, the country can meet it’s basic requirement in blood. But Nigeria is not able to meet this minimum requirement. This is largely because 60 percent of all blood donations are from commercial donors and 30 percent from family replacement.

In some states of the Federation, spouses of pregnant women are mandated to donate blood before they are registered in the various hospitals – s policy that has continued to scare many pregnant women away from public hospital delivery.

In a study, on “Blood Donation in Nigeria: Standard of the Donated Blood”,  published in the Journal of Laboratory Physicians, findings revealed that despite WHO target of 100 percent voluntary unpaid blood donation by 2020, Nigeria is still highly reliant on family replacement and paid donors. Only about 5 percent of donations in Nigeria are from voluntary donors.

But it is known that  a high percentage of maternal deaths is due to haemorrhage.

Maternal mortality:  Reports show that 34 percent of pregnant women die in labour as a result of complications of bleeding and lack of blood for transfusion in Nigeria. Blood and blood components  are required every day to save thousands of lives in our hospitals. At the moment, with Nigeria’s level of health care delivery, it is estimated that about 1.5 million units of blood are required generally per annum. A national baseline data survey on blood transfusion indicated that, in the public sector, donor population was made up of 25 percent commercial donors and 75 percent of replacement donors while voluntary unpaid donors were negligible.

Health watchers are worried that with less than 10 percent of Nigerians donating blood voluntarily, the country is facing severe shortage of safe blood and blood products.

In the views of the Country Director, E4A Mamaye, Dr. Tunde Segun, mandatory blood donation is not ideal in saving life.

According to the Minister of State for Health, Dr. Osagie Ehanire, in an address on World Blood donor Day in Abuja, Nigeria requires innovative strategies for sufficient and safe blood supply.

Ehanire observed that access to safe blood transfusion requires innovative strategies to ensure safe and sufficient blood supply, to achieve 100 percent voluntary blood donation and to ensure 100 percent quality-assured testing of donated blood.

“There is also a need to optimize blood usage for patient health, develop quality systems in the transfusion chain, strengthen the workforce, keep pace with new developments and build effective partnerships for safe blood.”

Growing demand: He acknowledged that while the demand for blood is growing in the developed world with longevity and increasingly sophisticated clinical procedures, national blood supplies are not sufficient to meet existing requirements in developing countries.

“Evidence-based strategies for blood safety and availability have been successfully implemented in most developed countries and some transitional and developing nations”, he added.

The Minister said an adequate and reliable supply of safe blood can be assured by a stable pool of regular, voluntary, unpaid donors, who are also the safest group of donors, since the prevalence of blood borne infections is generally lowest among them.

Ehanire noted that it is important to create and expand a strong base of voluntary blood donors by healthy committed youths and adults, who consistently give blood to ensure adequate supplies of safe blood throughout the year.

Strong base required

Experts advocating a robust  blood bank system say it will drastically reduce the deaths.

In the views of a professor of Obstetrics and Gynaecology, Dr. Oluwarotimi Ireti Akinola establishing a blood banking system is key to reducing maternal deaths caused by haemorrhage.

“WHO has maintained that providing safe and adequate supplies of blood and blood products should be an integral part of every country’s efforts to improve maternal health. Studies have shown that safe blood transfusion is one of the key life-saving interventions that should be available in all facilities that provide emergency obstetric care,” he stated.

He stressed that provision of adequate blood facilities as well as increasing number of blood donors in the country would reduce the number of women dying during child births.

In the views of a member of the Lagos State Blood Transfusion Committee, LSBTC, Mr. Solomon Eka, at a voluntary blood donation drive, as long as Nigerian opinion leaders are opposed to blood donation, the country will remain far from attaining the required blood units for survival of patients.

“Presently there are opinion leaders that do not support blood donation. If these opinion leaders are meant to have a change of attitude, and also demonstrate by donating blood, their followers will follow suit.”

Eka explained that regular blood donation also helps refresh an individual’s blood.

“It is not everybody that can donate, you must attain certain criteria before you donate, which include; you must be 50 kg and above, blood pressure must be normal, PVC must at an acceptable level to avoid any unforeseen crisis. Only healthy people aged 18 -65 are likely to donate blood,” he added.