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Recruitment of blood donors in Burkina Faso: how to avoid donations from family members?
Biologicals 38 (2010) 39–42
Contents lists available at ScienceDirect
Biologicals journal homepage: www.elsevier.com/locate/biologicals
Recruitment of blood donors in Burkina Faso: how to avoid donations from family members? Honorine Dahourou a, *, Jean-Baptiste Tapko b, Kisito Kienou c, Koumpingnin Nebie c, Mahamoudou Sanou c a b c
Regional Blood Transfusion Center (RBTC), Bobo Dioulasso, Burkina Faso World Health Organisation, Regional Office for Africa, Brazzaville, Congo National Blood Transfusion Center (NBTC), Ouagadougou, Burkina Faso
a r t i c l e i n f o
a b s t r a c t
Article history: Received 23 October 2009 Accepted 23 October 2009
Burkina Faso is a continental West African country of approximately 16 M people whose transfusion needs were covered by 66,210 blood units collected mostly in 4 regional transfusion centers part of a national network but also from hospital-based smaller blood centers. The first group of blood centers relies almost exclusively on volunteer, non-remunerated, blood donors and only approximately 32.7% of them are repeating donation. In contrast, hospital-based blood centers rely nearly exclusively on family/ replacement donors. The general strategy of the national blood transfusion network was to base the system exclusively on volunteer donors, which was nearly accomplished overall and completely at BoboDioulasso, the largest center. However, despite considerable increase in blood collection, the overall blood supply remains low (4.7 units/1000 inhabitants) and worsens during the secondary school recesses since young student blood constitutes the most part of volunteer donors. To overcome such shortages, mobile blood collection sessions are organized in alternate sites such as military barracks or places of worship but with limited success. Another critical issue is that despite considerable efforts and help from community advocates, only 32.7% of volunteers repeat donation limiting the considerably safety advantage of a pool of regular donors. Ó 2009 Published by Elsevier Ltd on behalf of The International Association for Biologicals.
Keywords: Blood donors Burkina Faso
1. General background Burkina Faso is a sub-Saharan country in the heart of West Africa. It is a landlocked and one of the poorest countries in the world. It has a surface area of 274.000 Km2 and a population of about 14,000,000 inhabitants. In terms of health services, Burkina Faso is subdivided into 13 regions and 55 districts including three national tertiary hospitals, nine regional hospitals, and 40 district hospitals. Approximately 30% of the population has access to public health services. Anemia among children and women is one of the main causes of morbidity and mortality in Burkina. There is therefore an important need for blood transfusion primarily for these two segments of the population. As part of its national health policy, Burkina Faso established a National Center for Blood Transfusion (CNTS) in September 2000, which, in the long run, is intended to be the only one in the whole country. Currently, the CNTS operates through four operational
* Correspondence to: Centre Re´gional de Transfusion Sanguine, BP 3169 Bobo Dioulasso, Burkina Faso. Tel.: þ33 226 20984100; fax: þ33 226 20984090. E-mail address: [email protected] (H. Dahourou).
entities, in the form of Regional Blood Transfusion Centers (CRTS). These four CRTS provide approximately 65% of the country’s blood supply and transfusion activities, the rest is the responsibility of Hospital Transfusion Centers (CHT) who receive technical assistance from the CNTS. Located in the Western part and in the main city of the Upper Niger basin, Bobo-Dioulasso is the economic capital of Burkina. The mission of the Bobo-Dioulasso CRTS is to cover the transfusion needs of the Upper Basins region’s health facilities, consisting of a tertiary University Hospital, five health districts (two urban and three rural) and five private clinics. The population of the area covered by the CRTS is estimated at 1.6 million inhabitants. 2. Introduction Blood transfusion is a replacement therapy, which calls for products of human origin taken from healthy subjects called blood donors and given to ill subjects called recipients. Because of its human origin, blood represents an ideal vehicle for many diseases that may thus be transmitted from the donor to the recipient. This is all the more a reality in developing countries like Burkina Faso where
1045-1056/$36.00 Ó 2009 Published by Elsevier Ltd on behalf of The International Association for Biologicals. doi:10.1016/j.biologicals.2009.10.017
40
H. Dahourou et al. / Biologicals 38 (2010) 39–42
blood transfusion transmitted diseases are a serious endemic problem within the population including blood donors [1,2]. In order to minimize the risks, WHO recommend among other things, to call on the safest category of donors, the volunteer, unpaid, donors [3]. However, in resource poor countries such as Burkina Faso, replacement donors have remained the main source of blood because it is considerably cheaper to produce than blood from volunteer donors [4]. This recommendation has been so widely accepted today that it is one of the ethical principles of blood donation. The other categories of donors are family members or replacement donors, and paid donors, both categories being assumed or demonstrated to represent a greater transmission risk [5,6]. In many developing countries and especially in Sub-Saharan Africa, blood transfusion, just like other sectors, faces organizational and operational challenges [4,6]. The shortage of blood products is a daily reality in hospitals. In Burkina Faso, according to health statistics, about 25% of maternal deaths are due to the unavailability of blood (statistical yearbook 2007). In pediatrics, every single day, children receive emergency blood transfusions as a result of severe primary malaria. Under such conditions, the most important life-saving therapy is to find blood (and receive anti-malarial treatment), and receiving blood from family members is a matter of survival. However, a few scattered experiences have been attempted to ensure a better blood component supply, in compliance with the ethical principles for blood donation. This is the case of the CRTS of Bobo-Dioulasso which has implemented a pilot strategy to avoid calling on family member donors. The purpose of the present study is to analyze the process and the results of this specific approach. 3. Objectives The objectives of this report are to describe the activities undertaken since 2002 for recruiting volunteer donors, to evaluate the results obtained by the CRTS of Bobo-Dioulasso, to evaluate the sustainability of the supply of the CRTS in Bobo-Dioulasso and to assess the repeatability of the approach in other CRTS or in other countries. 4. Methodology The idea to reduce the need for blood donations from family members in the area of Bobo-Dioulasso came up following a specialized training in blood transfusion attended by the head of University hospital blood services in France in 1998. Having understood that blood donations from family members were not the safest source of blood, when training in France, we proceeded with the implementation of a targeted action plan although this plan had not been formally drafted. This action plan followed five guidelines: 1) The organization of mobile collection sites, 2) the identification of new collection sites and the multiplication of mobile collection, 3) revitalizing blood donor associations, 4) training of blood component prescribers and users, 5) a subsidiary action was to motivate the blood service staff.
Fig. 1. Type and percentage of donations in Burkina Faso, 2007. The number of donations and percentage of blood from three types of donors are indicated for the whole country. New gifts indicates first time volunteer donors, regular gifts indicates repeat donors on average twice a year. Familial gifts indicates family/replacement donors.
malaria epidemic, especially among children) and therefore in a shortage of blood and a need to tap into family/replacement donors. There was therefore a need to find a strategy to reduce to a minimum the number of death cases caused by blood shortage, hence the organization of mobile blood collection sessions as follows: 1) during the school year, sessions were organized in high schools; 2) during school breaks, blood collections were performed in barracks. 4.2. The identification of new collection sites and the multiplication of mobile blood collection sessions Organizing of mobile collections was not sufficient to completely avoid blood shortages and the need for family/replacement donations. There was therefore a need to find new sites and to increase the number of mobile collections. Hence the city’s different religious leaders (catholic, protestant, Muslims, etc.), traditional leaders and community associations were contacted in order to raise awareness and obtain agreement for mobile sessions. From one session per week during business hours, the number of mobile sessions went up to an average of three per week, some of which being carried out during week-ends. 4.3. Revitalizing blood donor associations The only organized association in operation that was more or less able to assist in mobile session activities had its leaders trained for the promotion of blood donation and in blood transfusion. In addition, this association was encouraged to have representatives in each targeted school. These leaders, acting as representatives of the association in view of promoting blood donation and organizing mobile sessions, were able to set up subsidiary associations called «regular donors clubs». The objective of these clubs was to recruit blood donation volunteers, organize mobile sessions and encourage repeat blood donation.
4.1. The organization of mobile collection sessions It should be stressed that the development of the action plan and its implementation began with the university hospital blood service of Bobo-Dioulasso. Mobile collection activities were not previously organized. Indeed, the main mobile collection targets were barracks and schools. Blood collection was indiscriminately carried out in these two types of sites, regardless of the time of the year. This resulted in the unavailability of collection sessions during school breaks (a time of the year coinciding with the rainy season and the
Fig. 2. Distribution of donations per type between the four RBTCs and other establishments in 2008. The National Blood Transfusion Service is composed of four regional centers collecting (CNBT) and a relatively large number of ‘‘other’’, smaller, hospitalbased blood transfusion centers.
H. Dahourou et al. / Biologicals 38 (2010) 39–42
41
Table 1 Evolution of blood donation and blood supply parameters between 1999 and 2008 at the RBTS Bob Dioulasso. Year of collection
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Total donations % Increase/year % Family/replacement Units/1000
2943
3253 10.5 2.9 2
3462 6.4 4.2 2.2
4482 29.5 1 2.8
5742 28.1 0 3.6
6144 7 0 3.8
8241 34 0 5.1
9119 10.7 0 5.7
11695 28.2 0 7.3
10700 8.5 0 6.7
0.3 1.8
4.4. The motivation of the blood transfusion staff The blood bank staff received compensation for mobile session activities carried out during weekend and in sites more than 15 km distant from Bobo-Dioulasso.
decrease in the blood supply particularly problematic during the rainy season which is also the peak of malaria primary infections. The generally short blood supply was made more acute between June and September. 6. Discussion
4.5. Training for blood component usage rationalization In 2 sessions over a period of four days, almost all the transfusion prescribers and users were trained on the rational prescription of blood products. In addition, a transfusion committee was organized within the hospital in order to manage blood transfusion activities. 5. Results The total number of blood units collected in Burkina Faso in 2008 is shown in Fig. 1. Overall, 66,210 units were collected including 38% from family/replacement donors, the rest being from volunteer non-remunerated donors. This can be translated into an average of 4.5 Units per 1000 inhabitants (the population is approximately 14 million). In 2008, the four regional blood centers in the country collected 37,751 units (Fig. 2) and other establishments collected 25,401 (40.2%) units. While the RBTCs collected 94.3% from VNRD, other establishments collected 13.1% donations from volunteers, the rest being collected from family/replacement donors. At the RTBCs, the percentage of blood collected from repeat volunteer was only 19.5% of total volunteers while there were none in other, hospital-based, establishments. At the RBTC of Bobo-Dioulasso blood collection data in the pre2003 period shown in Table 1, the number of donations progressively increased from 1.8 to 2.8 units/1000 inhabitants with a percentage of family/replacement donors ranging between 0.3 and 4.2% of total number of donations. After 2002, no family/ replacement donations were collected while the total number of units collected regularly increased until 2007 by 6–29% per year. In this 10-year period, the availability of blood in the region rose from 1.8 to nearly 7 units/1000 inhabitants. The collection of voluntary blood was concentrated in secondary schools during the school year. During school recesses, other types of establishments were visited for mobile sessions, primarily barracks where army recruits sere available but also others such as place of worship whether Christians or Muslims (Fig. 3). Despites this diversification of mobile session sites, there was a repeatable
Blood transfusion is a medical procedure that is not without risks. If in a number of situations it can help save lives, it remains that there are some risks involved. To minimize these risks, WHO has developed strategies, one of which is blood collections from voluntary donors. Burkina Faso, just like other developing countries, is often confronted with problems of blood shortages because of the insufficient number of volunteer blood donors. To avoid deaths resulting from the lack of blood products, most institutions call on family/replacement donors or paid donors [4,6]. The CRTS of Bobo-Dioulasso, as part of its low risk blood transfusion policy, has opted for the elimination of donations from family members/replacement donations. To accomplish this, first, mobile blood collection activities were organized, along with collection activities in a permanent facility and this helped increasing the number of volunteer donors. The approach has been to collect blood from students only during the school year and operate other sites during school breaks [7,8]. To this end, it was necessary to raise public awareness in alternative sites in order to make more people aware of the importance of this activity [9,10]. The message was well received by a range of socio-professional categories, which led to positive results. Second, the identification of other collection sites has helped come in contact with religious groups, customary authorities and community associations in order to raise awareness and to use them as mobile session sites [9]. Furthermore, mobile collection activities which used to be undertaken at most once a week are now being carried out 2–3 times a week, occasionally during weekends. In addition, blood collection activities are no longer limited to the city of Bobo-Dioulasso, but are also carried out outside the city into areas up to 120 km distant. The staff of the blood transfusion center received compensation when the collections are organized in remote locations or when they happen on week-ends. Third, blood donor associations have been encouraged to develop their activities in order to strengthen the promotion of blood donation. Hence the only operational association in the city was able to help setting clubs of regular donors in high schools.
Fig. 3. Evolution of the types of donations from 1999 to 2002 at the Bobo-Dioulasso RBTC. ‘‘Scolaires’’ indicate blood collection sessions in secondary schools, ‘‘Casernes’’ in army barracks, ‘‘Divers’’ indicates other types of mobile session sites, particularly places of worship. ‘‘Site fixe’’ indicates collection being performed at the RBTC itself.
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H. Dahourou et al. / Biologicals 38 (2010) 39–42
Indeed, students who make up most of the donors used to make only a single donation. The number of loyal donors remained at about the same level even though several collections were organized in the schools. The creation of these clubs was an opportunity to initiate a repeat donation policy. Finally, the training of prescribers for the rational use of blood products helped better manage the little blood products available. Indeed, the analysis of product requests within the University Hospital has shown that nurses prescribed nearly 70% of transfusions. After the training, this rate dropped to less than 10% along with a reduction of about 40% of the number of prescriptions, without this leading to a noticeable increase in the number of deaths. This means that initially prescriptions were definitely not justified because made by an unqualified staff. The suppression of donations from family members/substitute donations within the CRTS of Bobo-Dioulasso, as opposed to what could be expected, has not had an adverse effect on satisfying the needs. Indeed, we saw through answers to a questionnaire that there is an increase in the satisfaction of needs from the moment donations from family donors were discontinued. The rational use of blood components can be one of the reasons. 7. Conclusion The combination of several different actions has helped put a stop to family/replacement donations at the regional blood service of Bobo-Dioulasso over a period of six years. These results were obtained with the use of an informal action plan and with very limited resources. This experience suggests that in a developing country like Burkina Faso, with a proper organization and limited resources, it is possible to get quality blood products from volunteer donors. Since, the experience of Bobo-Dioulasso has been spreading
to the rest of the country, leading to an important reduction of donations from family members all over the national territory. This rate has gone from nearly 60% in 2005 to less than 30% in 2008. The objective of this report is to share the experience of BoboDioulasso in Burkina Faso with other developing countries in order for them to use it as one potential approach to improve blood transfusion safety in their country.
References [1] Ne´bie´ KY, Olinger CM, Kafando E, et al. Lack of knowledge of blood donor in Burkina Faso (West Africa); potential obstacle to transfusion security. Transfus Clin Biol 2007;14:446–52. [2] Collenberg E, Ouedraogo T, Ganame J, et al. Seroprevalence of six different viruses among pregnant women and blood donors in rural and urban Burkina Faso: a comparative analysis. J Med Virol 2006;78:683–92. [3] Takpo JB, Sam O, Diarra-Nama A. Report on the status of Blood Safety in the WHO African region for 2004. WHO, AFRO, Brazzaville, Republic of Congo [4] Bates I, Manyasi A, Medina Lara A. Reducing replacement donors in SubSaharan Africa: challenges and affordability. Transfus Med 2007;17:434–42. [5] Owusu-Ofori S, Temple J, Sarkodie F, Anokwa M, Candotti D, Allain JP. Predonation screening of blood donors with rapid tests: implementation and efficacy of a novel approach to blood safety in resource-poor settings. Transfusion 2005;45:133–40. [6] Allain JP, Owusu-Ofori S, Bates I. Blood transfusion in sub-Saharan Africa. TATM 2004;6:16–23. [7] Jacobs B, Berege ZA, Schalula PJ, Klokke AH. Secondary school students: a safer blood donor population in an urban area with high HIV prevalence in East Africa. East Afr Med J 1994;71:720–3. [8] Mandisodza AR, Charuma H, Masoha A, Musekiwa Z, Mvere D, Abayomi A. Prevalence of HIV infection in school based and other young donors during the 2002 and 2003 period. Afr J Med Med Sci 2006;35:69–72. [9] Tagny C, Owusu-Ofori S, Mbanya D, Deneys V. The blood donor in sub-Saharan Africa: a review. Transfus Med 2009. Epub. [10] Tagny CT, Diarra A, Yahaya R, Hakizimana M, Nguessan A, Mbensa G, et al. Characteristics of blood donors and donated blood in sub-Saharan Francophone Africa. Transfusion 2009. Epub.
Contents lists available at ScienceDirect
Biologicals journal homepage: www.elsevier.com/locate/biologicals
Recruitment of blood donors in Burkina Faso: how to avoid donations from family members? Honorine Dahourou a, *, Jean-Baptiste Tapko b, Kisito Kienou c, Koumpingnin Nebie c, Mahamoudou Sanou c a b c
Regional Blood Transfusion Center (RBTC), Bobo Dioulasso, Burkina Faso World Health Organisation, Regional Office for Africa, Brazzaville, Congo National Blood Transfusion Center (NBTC), Ouagadougou, Burkina Faso
a r t i c l e i n f o
a b s t r a c t
Article history: Received 23 October 2009 Accepted 23 October 2009
Burkina Faso is a continental West African country of approximately 16 M people whose transfusion needs were covered by 66,210 blood units collected mostly in 4 regional transfusion centers part of a national network but also from hospital-based smaller blood centers. The first group of blood centers relies almost exclusively on volunteer, non-remunerated, blood donors and only approximately 32.7% of them are repeating donation. In contrast, hospital-based blood centers rely nearly exclusively on family/ replacement donors. The general strategy of the national blood transfusion network was to base the system exclusively on volunteer donors, which was nearly accomplished overall and completely at BoboDioulasso, the largest center. However, despite considerable increase in blood collection, the overall blood supply remains low (4.7 units/1000 inhabitants) and worsens during the secondary school recesses since young student blood constitutes the most part of volunteer donors. To overcome such shortages, mobile blood collection sessions are organized in alternate sites such as military barracks or places of worship but with limited success. Another critical issue is that despite considerable efforts and help from community advocates, only 32.7% of volunteers repeat donation limiting the considerably safety advantage of a pool of regular donors. Ó 2009 Published by Elsevier Ltd on behalf of The International Association for Biologicals.
Keywords: Blood donors Burkina Faso
1. General background Burkina Faso is a sub-Saharan country in the heart of West Africa. It is a landlocked and one of the poorest countries in the world. It has a surface area of 274.000 Km2 and a population of about 14,000,000 inhabitants. In terms of health services, Burkina Faso is subdivided into 13 regions and 55 districts including three national tertiary hospitals, nine regional hospitals, and 40 district hospitals. Approximately 30% of the population has access to public health services. Anemia among children and women is one of the main causes of morbidity and mortality in Burkina. There is therefore an important need for blood transfusion primarily for these two segments of the population. As part of its national health policy, Burkina Faso established a National Center for Blood Transfusion (CNTS) in September 2000, which, in the long run, is intended to be the only one in the whole country. Currently, the CNTS operates through four operational
* Correspondence to: Centre Re´gional de Transfusion Sanguine, BP 3169 Bobo Dioulasso, Burkina Faso. Tel.: þ33 226 20984100; fax: þ33 226 20984090. E-mail address: [email protected] (H. Dahourou).
entities, in the form of Regional Blood Transfusion Centers (CRTS). These four CRTS provide approximately 65% of the country’s blood supply and transfusion activities, the rest is the responsibility of Hospital Transfusion Centers (CHT) who receive technical assistance from the CNTS. Located in the Western part and in the main city of the Upper Niger basin, Bobo-Dioulasso is the economic capital of Burkina. The mission of the Bobo-Dioulasso CRTS is to cover the transfusion needs of the Upper Basins region’s health facilities, consisting of a tertiary University Hospital, five health districts (two urban and three rural) and five private clinics. The population of the area covered by the CRTS is estimated at 1.6 million inhabitants. 2. Introduction Blood transfusion is a replacement therapy, which calls for products of human origin taken from healthy subjects called blood donors and given to ill subjects called recipients. Because of its human origin, blood represents an ideal vehicle for many diseases that may thus be transmitted from the donor to the recipient. This is all the more a reality in developing countries like Burkina Faso where
1045-1056/$36.00 Ó 2009 Published by Elsevier Ltd on behalf of The International Association for Biologicals. doi:10.1016/j.biologicals.2009.10.017
40
H. Dahourou et al. / Biologicals 38 (2010) 39–42
blood transfusion transmitted diseases are a serious endemic problem within the population including blood donors [1,2]. In order to minimize the risks, WHO recommend among other things, to call on the safest category of donors, the volunteer, unpaid, donors [3]. However, in resource poor countries such as Burkina Faso, replacement donors have remained the main source of blood because it is considerably cheaper to produce than blood from volunteer donors [4]. This recommendation has been so widely accepted today that it is one of the ethical principles of blood donation. The other categories of donors are family members or replacement donors, and paid donors, both categories being assumed or demonstrated to represent a greater transmission risk [5,6]. In many developing countries and especially in Sub-Saharan Africa, blood transfusion, just like other sectors, faces organizational and operational challenges [4,6]. The shortage of blood products is a daily reality in hospitals. In Burkina Faso, according to health statistics, about 25% of maternal deaths are due to the unavailability of blood (statistical yearbook 2007). In pediatrics, every single day, children receive emergency blood transfusions as a result of severe primary malaria. Under such conditions, the most important life-saving therapy is to find blood (and receive anti-malarial treatment), and receiving blood from family members is a matter of survival. However, a few scattered experiences have been attempted to ensure a better blood component supply, in compliance with the ethical principles for blood donation. This is the case of the CRTS of Bobo-Dioulasso which has implemented a pilot strategy to avoid calling on family member donors. The purpose of the present study is to analyze the process and the results of this specific approach. 3. Objectives The objectives of this report are to describe the activities undertaken since 2002 for recruiting volunteer donors, to evaluate the results obtained by the CRTS of Bobo-Dioulasso, to evaluate the sustainability of the supply of the CRTS in Bobo-Dioulasso and to assess the repeatability of the approach in other CRTS or in other countries. 4. Methodology The idea to reduce the need for blood donations from family members in the area of Bobo-Dioulasso came up following a specialized training in blood transfusion attended by the head of University hospital blood services in France in 1998. Having understood that blood donations from family members were not the safest source of blood, when training in France, we proceeded with the implementation of a targeted action plan although this plan had not been formally drafted. This action plan followed five guidelines: 1) The organization of mobile collection sites, 2) the identification of new collection sites and the multiplication of mobile collection, 3) revitalizing blood donor associations, 4) training of blood component prescribers and users, 5) a subsidiary action was to motivate the blood service staff.
Fig. 1. Type and percentage of donations in Burkina Faso, 2007. The number of donations and percentage of blood from three types of donors are indicated for the whole country. New gifts indicates first time volunteer donors, regular gifts indicates repeat donors on average twice a year. Familial gifts indicates family/replacement donors.
malaria epidemic, especially among children) and therefore in a shortage of blood and a need to tap into family/replacement donors. There was therefore a need to find a strategy to reduce to a minimum the number of death cases caused by blood shortage, hence the organization of mobile blood collection sessions as follows: 1) during the school year, sessions were organized in high schools; 2) during school breaks, blood collections were performed in barracks. 4.2. The identification of new collection sites and the multiplication of mobile blood collection sessions Organizing of mobile collections was not sufficient to completely avoid blood shortages and the need for family/replacement donations. There was therefore a need to find new sites and to increase the number of mobile collections. Hence the city’s different religious leaders (catholic, protestant, Muslims, etc.), traditional leaders and community associations were contacted in order to raise awareness and obtain agreement for mobile sessions. From one session per week during business hours, the number of mobile sessions went up to an average of three per week, some of which being carried out during week-ends. 4.3. Revitalizing blood donor associations The only organized association in operation that was more or less able to assist in mobile session activities had its leaders trained for the promotion of blood donation and in blood transfusion. In addition, this association was encouraged to have representatives in each targeted school. These leaders, acting as representatives of the association in view of promoting blood donation and organizing mobile sessions, were able to set up subsidiary associations called «regular donors clubs». The objective of these clubs was to recruit blood donation volunteers, organize mobile sessions and encourage repeat blood donation.
4.1. The organization of mobile collection sessions It should be stressed that the development of the action plan and its implementation began with the university hospital blood service of Bobo-Dioulasso. Mobile collection activities were not previously organized. Indeed, the main mobile collection targets were barracks and schools. Blood collection was indiscriminately carried out in these two types of sites, regardless of the time of the year. This resulted in the unavailability of collection sessions during school breaks (a time of the year coinciding with the rainy season and the
Fig. 2. Distribution of donations per type between the four RBTCs and other establishments in 2008. The National Blood Transfusion Service is composed of four regional centers collecting (CNBT) and a relatively large number of ‘‘other’’, smaller, hospitalbased blood transfusion centers.
H. Dahourou et al. / Biologicals 38 (2010) 39–42
41
Table 1 Evolution of blood donation and blood supply parameters between 1999 and 2008 at the RBTS Bob Dioulasso. Year of collection
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Total donations % Increase/year % Family/replacement Units/1000
2943
3253 10.5 2.9 2
3462 6.4 4.2 2.2
4482 29.5 1 2.8
5742 28.1 0 3.6
6144 7 0 3.8
8241 34 0 5.1
9119 10.7 0 5.7
11695 28.2 0 7.3
10700 8.5 0 6.7
0.3 1.8
4.4. The motivation of the blood transfusion staff The blood bank staff received compensation for mobile session activities carried out during weekend and in sites more than 15 km distant from Bobo-Dioulasso.
decrease in the blood supply particularly problematic during the rainy season which is also the peak of malaria primary infections. The generally short blood supply was made more acute between June and September. 6. Discussion
4.5. Training for blood component usage rationalization In 2 sessions over a period of four days, almost all the transfusion prescribers and users were trained on the rational prescription of blood products. In addition, a transfusion committee was organized within the hospital in order to manage blood transfusion activities. 5. Results The total number of blood units collected in Burkina Faso in 2008 is shown in Fig. 1. Overall, 66,210 units were collected including 38% from family/replacement donors, the rest being from volunteer non-remunerated donors. This can be translated into an average of 4.5 Units per 1000 inhabitants (the population is approximately 14 million). In 2008, the four regional blood centers in the country collected 37,751 units (Fig. 2) and other establishments collected 25,401 (40.2%) units. While the RBTCs collected 94.3% from VNRD, other establishments collected 13.1% donations from volunteers, the rest being collected from family/replacement donors. At the RTBCs, the percentage of blood collected from repeat volunteer was only 19.5% of total volunteers while there were none in other, hospital-based, establishments. At the RBTC of Bobo-Dioulasso blood collection data in the pre2003 period shown in Table 1, the number of donations progressively increased from 1.8 to 2.8 units/1000 inhabitants with a percentage of family/replacement donors ranging between 0.3 and 4.2% of total number of donations. After 2002, no family/ replacement donations were collected while the total number of units collected regularly increased until 2007 by 6–29% per year. In this 10-year period, the availability of blood in the region rose from 1.8 to nearly 7 units/1000 inhabitants. The collection of voluntary blood was concentrated in secondary schools during the school year. During school recesses, other types of establishments were visited for mobile sessions, primarily barracks where army recruits sere available but also others such as place of worship whether Christians or Muslims (Fig. 3). Despites this diversification of mobile session sites, there was a repeatable
Blood transfusion is a medical procedure that is not without risks. If in a number of situations it can help save lives, it remains that there are some risks involved. To minimize these risks, WHO has developed strategies, one of which is blood collections from voluntary donors. Burkina Faso, just like other developing countries, is often confronted with problems of blood shortages because of the insufficient number of volunteer blood donors. To avoid deaths resulting from the lack of blood products, most institutions call on family/replacement donors or paid donors [4,6]. The CRTS of Bobo-Dioulasso, as part of its low risk blood transfusion policy, has opted for the elimination of donations from family members/replacement donations. To accomplish this, first, mobile blood collection activities were organized, along with collection activities in a permanent facility and this helped increasing the number of volunteer donors. The approach has been to collect blood from students only during the school year and operate other sites during school breaks [7,8]. To this end, it was necessary to raise public awareness in alternative sites in order to make more people aware of the importance of this activity [9,10]. The message was well received by a range of socio-professional categories, which led to positive results. Second, the identification of other collection sites has helped come in contact with religious groups, customary authorities and community associations in order to raise awareness and to use them as mobile session sites [9]. Furthermore, mobile collection activities which used to be undertaken at most once a week are now being carried out 2–3 times a week, occasionally during weekends. In addition, blood collection activities are no longer limited to the city of Bobo-Dioulasso, but are also carried out outside the city into areas up to 120 km distant. The staff of the blood transfusion center received compensation when the collections are organized in remote locations or when they happen on week-ends. Third, blood donor associations have been encouraged to develop their activities in order to strengthen the promotion of blood donation. Hence the only operational association in the city was able to help setting clubs of regular donors in high schools.
Fig. 3. Evolution of the types of donations from 1999 to 2002 at the Bobo-Dioulasso RBTC. ‘‘Scolaires’’ indicate blood collection sessions in secondary schools, ‘‘Casernes’’ in army barracks, ‘‘Divers’’ indicates other types of mobile session sites, particularly places of worship. ‘‘Site fixe’’ indicates collection being performed at the RBTC itself.
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Indeed, students who make up most of the donors used to make only a single donation. The number of loyal donors remained at about the same level even though several collections were organized in the schools. The creation of these clubs was an opportunity to initiate a repeat donation policy. Finally, the training of prescribers for the rational use of blood products helped better manage the little blood products available. Indeed, the analysis of product requests within the University Hospital has shown that nurses prescribed nearly 70% of transfusions. After the training, this rate dropped to less than 10% along with a reduction of about 40% of the number of prescriptions, without this leading to a noticeable increase in the number of deaths. This means that initially prescriptions were definitely not justified because made by an unqualified staff. The suppression of donations from family members/substitute donations within the CRTS of Bobo-Dioulasso, as opposed to what could be expected, has not had an adverse effect on satisfying the needs. Indeed, we saw through answers to a questionnaire that there is an increase in the satisfaction of needs from the moment donations from family donors were discontinued. The rational use of blood components can be one of the reasons. 7. Conclusion The combination of several different actions has helped put a stop to family/replacement donations at the regional blood service of Bobo-Dioulasso over a period of six years. These results were obtained with the use of an informal action plan and with very limited resources. This experience suggests that in a developing country like Burkina Faso, with a proper organization and limited resources, it is possible to get quality blood products from volunteer donors. Since, the experience of Bobo-Dioulasso has been spreading
to the rest of the country, leading to an important reduction of donations from family members all over the national territory. This rate has gone from nearly 60% in 2005 to less than 30% in 2008. The objective of this report is to share the experience of BoboDioulasso in Burkina Faso with other developing countries in order for them to use it as one potential approach to improve blood transfusion safety in their country.
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