The review cites sub-Saharan African examples of innovative strategies to collect and efficiently utilize donated blood. It also highlights the need for more data on the cost-effectiveness of hybrid strategies and research into their replicability in other countries. Hensher, M. BTS expenditures were estimated at 0. Different scenarios are posed for collecting user fees, including three institutional funding options fully central budget—funded, fully hospital-funded, or mixed and five patient payment options.
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They summarize five key lessons learned from the costing exercise for program planners and donors to consider. Ayyoubi, M. The country has a nationalized blood banking system comprising the Central Blood Bank of Kabul as well as 18 other branches in Kabul and throughout the country.
However, over two decades of armed conflict have severely disrupted the system.
Blood Safety and Availability | AIDSFree
Staff lack training in blood banking and transfusion medicine and face shortages of basic equipment and supplies, even water and electricity. The study makes recommendations to build on the existing basic infrastructure and dedicated staff by improving facilities and equipment, promoting voluntary blood donation, enhancing blood collection and processing procedures, and boosting training and education.
Tayou Tagny, C. While most countries in the region have a transfusion policy, less than half consistently apply it, and the World Health Organization WHO -recommended strategy of promoting voluntary, non-remunerated blood donation has failed the thrive in many countries. The lack of testing, preparation of blood components, and inappropriate clinical use of blood all contribute to blood safety remaining a serious issue for sub-Saharan Africa.
The development of pathogen inactivation represents a paradigm shift for blood safety, the author of this editorial argues.
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Although current practice effectively screens for a number of diseases, it does not prevent all transfusion-transmitted infections TTIs , nor does it entirely prevent transfusion-related sepsis. Pathogen inactivation addresses these issues and eliminates the need for irradiation of blood components, thus removing the risk of graft-versus-host disease.
Pathogen inactivation should be more widely adopted, with the additional costs weighed against improvements in blood safety, the author writes. However, current interest in this technology does not address noninfectious blood transfusion hazards and focuses on use in developed countries. Heyns, A. Journal of the American Medical Association , Vol. In response, in the National Blood Service closed blood donation sites in high-prevalence areas, implemented an oral questionnaire about HIV risk behaviors for donors, and began triaging donated products based on risk profiling, issuing the safest products first.
As a result, HIV prevalence in blood donations fell from a peak of 0. First-time donors were significantly more likely to have HIV than repeat donors.
After the new screening protocol was implemented, the proportion of first-time donors decreased significantly between and and and Furthermore, the prevalence of HIV among these donors decreased significantly, from 1. Collection policies will continue to be adjusted over time to ensure the continued safety of the South African blood supply.
Owusu-Ofori, S. Temple, J. Sakodie, F. The equipment-dependent western model of safe blood procurement is inefficient and unaffordable in small-scale settings in Africa. This paper proposes predonation screening for hepatitis B, hepatitis C, and HIV by rapid testing, followed by nucleic acid testing NAT on batches of donated samples, as an affordable means of improving blood safety.
As well as being cheaper than traditional screening of donated blood, this method also enables infected donors to be referred for further care, in itself a public health benefit. A study in Ghana found that in high endemic areas, such testing is effective and may reduce the cost of ensuring safe blood supply. This paper highlights the disparity between developed countries that can rely on high-performance technology to guarantee safe supplies of donated blood and resource-poor countries facing many obstacles to safe blood provision.
Namely those obstacles include limited budget; the high prevalence of HIV, hepatitis B, and hepatitis C; and factors adversely affecting retention of voluntary donors. Developing countries should use rapid tests before blood donation rather than striving for a technology-heavy solution. However, developing countries have special requirements of such tests in terms of reagent formulation and test design to compensate for the lack of sensitivity of dipstick tests compared to enzyme immunoassay screening.
Busch, M. This paper describes a novel model to estimate the proportion and number of people infected with HIV through blood transfusion in the San Francisco Bay area before the introduction of HIV antibody screening in The model relied on data on identified HIV-positive blood donations, the prevalence of HIV among homosexual and bisexual men in San Francisco from to , donation rates to a blood center over the same period, and the outcome from the tracing of recipients of seropositive transfusions.
The authors found the risk of infection was higher than previously estimated, and they underline the importance of donor education and self-exclusion to protect blood supply. In non-technical language, it explains why blood donations are needed and why people become blood donors.
It answers questions commonly asked by potential blood donors, including information on the process of blood donation and on the meaning of donor deferral. There is a step-by-step guide to the blood donation process from predonation screening to postdonation care. For U. The web-based courses on basic cell therapy, transfusion-related acute lung injury, and the Code of Good Manufacturing Practice in the Transfusion Service are fee-based with individual and institutional rates.
The other materials are all available free of charge. There are manuals on donor services training and blood administration as well as resources on a variety of topics of relevance to blood bank professionals. These design guidelines can be used to help countries develop blood services facilities. They can be used not just in the design of purpose-built facilities, but also in the renovation of existing buildings and to assess layout to improve work patterns.
The guidelines are in two parts, covering function and design.
Progress Toward Strengthening National Blood Transfusion Services — 14 Countries, 2011–2014
The functional brief covers the role and function of a blood center, issues that should be considered in its design, the operation and function of units, and how much space is required based on various average workloads. The design brief describes physical performance and engineering services requirements of the building itself. Related Materials. Discussion Although increases in the percentage of voluntary, nonremunerated blood donors and in the number of blood units collected per 1, population since have been reported, whole blood collections largely remain insufficient to meet demand.
References World Health Organization. Blood safety and availability. Geneva, Switzerland: World Health Organization; Progress toward strengthening blood transfusion services—14 countries, — PubMed external icon CDC. Progress toward strengthening national blood transfusion services—14 countries, — PubMed external icon World Health Organization. Voluntary non-remunerated blood donation.
Maternal mortality in sub-Saharan Africa: the contribution of ineffective blood transfusion services. BJOG ;—9. Blood transfusion safety in Africa: a literature review of infectious disease and organizational challenges. Transfus Med Rev ;— Vox Sang ;— A comparison of the original and revised model projections using data from a setting in west Africa. AIDS ;— Reduced risk of transfusion-transmitted HIV in Kenya through centrally co-ordinated blood centres, stringent donor selection and effective p24 antigen-HIV antibody screening.
Vox Sang ;—9. CrossRef external icon PubMed external icon.
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