Blood safety refers to the comprehensive measures taken to ensure that blood and blood products are free from harmful pathogens and are suitable for transfusion. This involves a series of steps designed to protect both donors and recipients throughout the entire blood donation and transfusion process.
In Nigeria, blood safety is a critical component of the healthcare system, given the vital role of blood transfusions in treating conditions like trauma, surgery, maternal complications, and chronic diseases. However, ensuring blood safety is challenging due to factors like limited resources, inadequate blood supply, and the risk of transmitting blood-borne infections such as HIV, hepatitis B, hepatitis C, and syphilis.
To address these concerns, Nigeria has established guidelines and regulations for safe blood collection, testing, and transfusion. The National Blood Transfusion Service (NBTS) is responsible for coordinating blood donations, ensuring that donated blood is screened for infectious diseases, and maintaining an adequate blood supply. Efforts are also made to promote voluntary, non-remunerated blood donation and to strengthen the infrastructure for blood safety across the country.
Despite these efforts, Nigeria continues to face challenges in achieving optimal blood safety, and ongoing improvements in screening, donor recruitment, and healthcare infrastructure are necessary to protect both blood donors and recipients.
CHALLENGES FACING BLOOD SAFETY IN NIGERIA
The attainment of blood transfusion safety in Nigeria (and probably the rest of Sub-Saharan Africa) remains an uphill task due to a number of factors, ranging from :
1.Inadequate Blood Supply: Nigeria faces a significant shortage of blood donations, with a reliance on family replacement and commercial donors rather than voluntary, non-remunerated donors. This shortage leads to difficulties in meeting the transfusion needs of patients, especially during emergencies. Studies have identified factors hindering voluntary blood donation, including misconceptions and ingrained beliefs. An intense campaign using mass and social media is recommended to counter these erroneous beliefs.
2. High Prevalence of Transfusion-Transmissible Infections (TTIs): The country has a high prevalence of TTIs, including HIV, hepatitis B, and hepatitis C. For instance, studies have reported prevalence rates of 18%, 23%, and 12.3% for HIV, hepatitis B, and hepatitis C, respectively, among certain populations. This poses a significant risk to blood safety.
3. Dependence on Commercial Blood Donors: A substantial portion of blood donations comes from commercial donors, who may not be as reliable or safe as voluntary donors. This dependence increases the risk of transfusion-related infections. The Safe Blood for Africa Foundation emphasizes the importance of developing sustainable blood services in accordance with WHO guidelines to address this issue.
4. Inadequate Blood Screening and Testing: There are challenges in ensuring that all donated blood is screened for infections such as HIV, hepatitis B, hepatitis C, and syphilis. In some regions, not all donated blood is screened for these infections, compromising blood safety. The World Health Organization recommends the development of systems, such as hospital transfusion committees and hemovigilance, to monitor and improve the safety of transfusion processes.
5. Limited Infrastructure and Resources: Many blood banks and transfusion services lack the necessary infrastructure, equipment, and trained personnel to ensure the safety and adequacy of the blood supply. This includes insufficient storage facilities and inadequate testing capabilities. The National Blood Service Agency is working to address these challenges by collaborating with international partners to improve blood transfusion safety in Nigeria.
INITIATIVES FOR BLOOD SAFETY IN NIGERIA
Nigeria has implemented several initiatives to enhance blood safety and address the critical shortage of safe blood. Key efforts include:
1. National Blood Transfusion Service (NBTS): The NBTS is the primary government agency responsible for ensuring the availability of safe blood in Nigeria. It has been established to coordinate blood collection, testing, and distribution across Nigeria. It aims to ensure a safe and adequate blood supply through various programs and partnerships. The NBTS is working to increase the pool of voluntary blood donors and improve blood transfusion safety. In 2019, the NBTS launched the One-Million-Safe-Blood-Units-Initiative (OMSBUI) project, aiming to increase the nation’s blood bank from 25,000 to one million units by 2023 and three million by 2030.
2. LifeBank Initiative: Founded in 2016 by Temie Giwa-Tubosun, LifeBank is a medical distribution company that uses data and technology to discover and deliver essential medical products, including blood, to hospitals in Nigeria. As of January 2017, the company had helped deliver over 2,000 pints of blood to patients across Lagos State. LifeBank has been instrumental in addressing the blood shortage in Nigeria by facilitating the transmission of blood from labs to patients and doctors in hospitals.
3. World Health Organization (WHO) Support: The WHO has been working with Nigerian health authorities to improve blood safety and availability. This includes providing guidelines for blood screening and promoting voluntary, non-remunerated blood donation. The WHO emphasizes the importance of developing systems to monitor and improve the safety of transfusion processes.
4. Public Awareness Campaigns: Various organizations and media outlets have been involved in campaigns to raise awareness about the importance of voluntary blood donation and the risks associated with transfusion-transmissible infections. These campaigns aim to educate the public and encourage more people to donate blood voluntarily. For example, the Safe Blood for Africa Foundation is dedicated to the development and strengthening of sustainable blood services in Africa, including Nigeria.
5. Haima Health Initiative (HHI): HHI advocates for voluntary blood donations and operates Haima Mobile services in hospitals across Nigeria. Supported by the Queen’s Commonwealth Trust, HHI has organized blood drives and delivered blood using cold chain delivery bikes to patients and hospitals.
6. Trauma Care International Foundation (TCIF): TCIF is a non-governmental organization that works to improve disaster and emergency medical response, including blood donation efforts. In 2018, it set a Guinness World Record by registering 3,310 people for blood donation in an 8-hour period.
7. Non-Pneumatic Anti-Shock Garment (NASG): In collaboration with international partners, Nigeria has implemented the use of NASG to manage obstetric hemorrhage, a leading cause of maternal mortality. Studies have shown that NASG significantly reduces blood loss and improves maternal outcomes.
8. Safe Blood for Africa Foundation: This foundation conducts situational assessments, strategic planning, and quality management systems to enhance blood safety in Nigeria. It focuses on blood collection, donor mobilization, and training to improve the blood supply chain.
These initiatives collectively aim to improve blood safety in Nigeria by increasing the availability of safe blood, promoting voluntary blood donation, and enhancing emergency medical.
RECOMMENDATIONS TO ENSURE BLOOD SAFETY IN NIGERIA
Ensuring blood safety in Nigeria is crucial to prevent the transmission of infectious diseases through blood transfusions. To enhance the safety and availability of blood products, consider the following recommendations:
1. Increase Voluntary Blood Donation: Implement intensive mass mobilization campaigns to encourage voluntary, non-remunerated blood donation. Utilize mass and social media to counter misconceptions and promote the benefits of voluntary donation. Studies suggest that increasing the pool of voluntary blood donors is key to bridging the blood supply gap and improving blood transfusion safety
2. Enhance Blood Screening and Testing: Strengthen donor blood screening protocols and ensure that all donated blood is tested for infections such as HIV, hepatitis B, hepatitis C, and syphilis. Implement nucleic acid testing (NAT) to improve the detection of infections. The WHO recommends the development of systems, such as hospital transfusion committees and hemovigilance, to monitor and improve the safety of transfusion processes.
3. Develop Alternative Transfusion Methods: Encourage the use of autologous blood transfusion and erythropoietin to reduce dependence on homologous blood transfusions and minimize the risks associated with transfusion-transmissible infections. Studies suggest that encouraging more universal use of autologous blood transfusion, intraoperative cell salvage, and erythropoietin is imperative to reduce the huge demand on homologous blood.
4. Improve Infrastructure and Training: Invest in the development of blood bank infrastructure, including storage facilities and testing laboratories. Provide training for healthcare professionals to ensure the safe handling and transfusion of blood products. The National Blood Service Agency is collaborating with international partners to improve blood transfusion safety in Nigeria.
5. Strengthen Policy and Regulation: Enforce policies that promote voluntary blood donation and regulate the collection and distribution of blood to ensure safety and adequacy. Collaborate with international organizations to align with global best practices.
In conclusion, ensuring blood safety in Nigeria requires addressing challenges such as inadequate supply, high prevalence of transfusion-transmissible infections, and limited infrastructure. Initiatives like NBTS, LifeBank, and WHO support are underway. Recommendations include increasing voluntary donation, enhancing screening, developing alternative methods, improving infrastructure, and strengthening policy. A sustained commitment from government, healthcare professionals, and the public is crucial to improving blood safety in Nigeria and ensuring that patients have timely access to safe blood transfusions.