Today, in line with the tradition of the World Health Organisation (WHO), Nigeria joins countries around the world to mark this year’s edition of the World Blood Donor Day (WBDD).

But like many other African nations and some other developing countries globally, Nigeria suffers greatly from her poor culture of blood donation.

Due largely to challenges of poor policy formulation and implementation, lack of enabling legislative framework and funding difficulties, collection, distribution and use of safe blood for a healthier population has been a herculean task for government agencies and non-state actors in the line of such responsibilities in Nigeria.

Grim statistics

In her message to mark this year’s WBDD, the WHO Regional Director for Africa, Matshidiso Moeti, said on an annual basis, an average of seven million Africans need safe blood transfusion across the 54-nation continent for survival.

The World Health Organisation’s Regional Director for Africa, Matshidiso Moeti. [PHOTO CREDIT: AllAfrica.com]With a roughly 200 million population, the global health body says Nigeria needs an average of 1.8 million pints of blood annually to keep the health of her people safe and sound.

But the country’s agency in charge of blood donation- Nigeria’s National Blood Transfusion Service (NBTS) says it collects only 500,000 pints of blood every year, leaving a shortfall of about 73.3 per cent.

According to the NBTS’ head of planning, research and statistics department, Adaeze Oreh, only about 25,000 blood units sourced exclusively from voluntary unpaid blood donors were screened, collected and distributed in 2019 and 2020.

Mrs Oreh said recent available data show that only eight per cent of Nigerians donate blood freely, and that about 80 per cent of donors donate to relatives in need.

“From the data available to NBTS, approximately 80 per cent of donations are from family members, which we call family replacement donations,” she said.

‘Blood commercialisation’

With markedly inadequate blood supply to meet clinical demands, many Nigerian hospitals and patients depend on commercial donors for their blood needs.

Though NBTS says only about 14 per cent of Nigerians donate blood for monetary gain, Mrs Oreh said many families negotiate directly with paid donors who are referred to them by friends and family.

“Therefore, most of the donors that are classified as family replacement donors are actually paid commercial donors,” the official told PREMIUM TIMES in an interview on Friday.

In Africa, Nigeria has one of the lowest rates of donation by voluntary non-remunerated blood donors, widely recognised as the safest source of blood and blood products for patients.

The NBTS official said; “various research studies have established that commercial donors are more likely to live high risk lifestyles and have a higher burden of transfusion-transmissible infections (TTIs).

“Paid donors are also known not to be forthcoming about their health to avoid deferrals, because for many, the motivation for donation is either poverty or the satisfaction of drug habits.

“Studies have also revealed a predominance of low haemoglobin concentrations in commercial blood, thereby reducing the quality of blood available for transfusion. This, therefore, increases the burden of transfusion-transmissible infections in blood and blood products, and increases risks for the recipients.”

‘Poor blood donation culture’

Experts have said Nigeria’s uninviting culture of blood donation cannot be dissociated from the country’s poor transfusion system and lack of legal framework.

By virtue of the National Blood Policy of 2006, NBTS is mandated to develop a system of blood donor mobilisation and motivation based on a voluntary, non-remunerated donation of blood; and standardise its methods of collection, transportation, processing, testing, storage and distribution, blood components and derivatives which are safe for transfusion and other therapies.

2021 World Blood Donor Day report

The agency’s mandate, based on the provisions of the National Health Act of 2014, is to coordinate, regulate and ensure the provision of safe, quality blood and blood products to “all who may need it in Nigeria.”

However, to ensure that this mandate is achieved, the agency said it faces a herculean task, saying ensuring safe blood “from vein to vein” isn’t easy to achieve in the country.

The NBTS is facing challenges of not just making sufficient blood available, but also ensuring quality and safety.

Funding gaps

The agency said it faces serious funding gaps, which it said have hindered even its awareness and sensitisation programmes.

Findings by PREMIUM TIMES shows that from 2005 to 2015, the NBTS received substantial funding from the government of the United States of America under a cooperative agreement with the United States President’s Emergency Plan for AIDS Relief (PEPFAR), through the Centers for Disease Control and Prevention (CDC).

But the external funding support, which provided the bulk of the NBTS financing, has been withdrawn, leaving the country unprepared to fill the vacuum.

Mrs Oreh said, “this challenge of inadequate financing of the NBTS operations hinders activities such as media, advocacy, and public awareness campaigns down to the community level which would have tackled the deeply rooted cultural myths and misconceptions on voluntary blood donation by the public, and the lack of a voluntary blood donation culture in the country.

“Even ensuring the safety and quality of all blood and products available for transfusion within the blood service system generates enormous costs in fuelling and maintenance of power-generating sets and setting up of alternative power sources such as solar panels at NBTS centres due to frequent power outages in the country which stand to compromise the cold chain and blood safety. Also, maintaining NBTS infrastructure and equipment across Nigeria’s six geopolitical zones is hugely capital-intensive.”

Severe consequences

A professor of hematology and transfusion medicine at the College of Medicine of the University of Lagos (CMUL), Sulaiman Akanmu, links Nigeria’s high maternal mortality rate to the nation’s transfusion programme.

Lagos University Teaching Hospital (LUTH]). [PHOTO CREDIT: The Guardian Nigeria]Mr Akanmu, who doubles as a consultant hematologist at the Lagos University Teaching Hospital (LUTH), Idi-Araba, said between 800 and 840 women lose their lives per 100,000 childbirths in Nigeria.

He compares this figure to less than 10 deaths associated with childbirths per 100,000 cases in developed countries.

According to Mr Akanmu, a huge chunk of the victims of maternal mortality in Nigeria is as a result of shortage of blood supply.

He said; “in Nigeria, 80-90 per cent of maternal mortality is as a result of bleeding complications that we are not able to manage due to shortage of blood. So this is the situation in Nigeria and it is not different from the situation in other African and developing countries with the exception of a few like Mauritius and Rwanda.

“Mauritius has a very low maternal mortality rate because it has a fantastic transfusion programme, and Rwanda is toeing the same path very fast.”

Though he could not give the statistics of accident victims in the country, Mr Akanmu said the larger percentage of those who make it to the hospital but still die eventually are victims of shortage of blood.

The hematologist also spoke about the prevalence of what he described as ‘under five hemolytic problems’, which he said has to do with malaria anaemia.

“Majority of under five children have weakened immunity. The under five deaths that we have predominantly in the malaria region of the world, and particularly Nigeria, is because of anemic heart failure which is as a result of malaria that infects and damages the red cell,” Mr Akanmu said, adding that it is one of the major reasons for blood transfusion in the children emergency department.

“Malaria anaemia is like 10 times more common than anaemia of sickle cell disease that also kills our children. So we must make sure that blood is available for these children,” he said.

He also spoke about children with cerebral palsy, which he noted is caused by a disease entity referred to as neonatal jaundice.

“And for that particular kind of situation, we need to do a blood transfusion for them but most of these babies are born in private hospitals during the day, and do not get to public hospitals where correct diagnosis is made and transfusion can be guaranteed until late at night.

“Majority of blood transfusion for babies in this category is done at midnight because these babies are brought in late and something must be done to ensure the children get blood. When it is left until the second day, bilirubin, which is what is causing the jaundice, enters the baby’s brains and knocks out an area and once that happens, the baby will not be able to develop normally,” he added.

Meanwhile, Nigeria’s health ministry also says 10 per cent of new HIV infections in Nigeria is from blood transfusions. This, the ministry says, is linked to commercial blood donation.

The ministry said the poor turnout of Nigerians to freely donate blood translates to “an increased risk of infections such as HIV, hepatitis B, hepatitis C, syphilis and many other diseases which could lead to lifelong treatment, chronic illnesses such as liver and kidney disease, disability or even death.”

Way forward

For several years, a lack of an enabling legislative framework for NBTS regulation has also been identified to have hindered the organisation’s structure and ability to adequately ensure the provision of safe blood countrywide.

However, with the recent passage of the National Blood Service Commission (NBSC) Bill by the National Assembly, the agency said it anticipates a more robust regulation of blood services in Nigeria “where sharp and nefarious practices which jeopardise the health of Nigerians are prevented or punished by law where ascertained.”

It is hoped that the bill which is currently awaiting presidential assent would solve all administrative and technical encumbrances hindering the effectiveness of the NBTS.

Mrs Oreh said the new legislation will empower the NBTS to tackle quackery and unauthorised blood service practices that daily jeopardise the lives of Nigerians.

She added: “The regulatory activities of NBTS in this regard include identifying blood safety needs in blood collection centres; screening centres and production centres; developing and disseminating guidelines on best practice across the blood services value chain to all relevant stakeholders. Also, registration of all establishments carrying out blood transfusion services and blood banks in both public and private sectors to ensure a comprehensive database of all facilities carrying out such services for regular assessment, inspection, and accreditation of such.

“The legal framework will also strengthen the National Blood Service’ ability to collaborate with states to carry out blood transfusion services.”

Apart from this legal framework, some Nigerians including a former Red Cross official, Akhigbe Allwell, suggested inclusion of topics on benefits of blood donation and other relevant issues around blood donation in some basic and high school subjects such as Civic Education, Health Sciences and or Social Studies.

He also suggested that all Primary Healthcare Centres (PHCs) should be made to have a compulsory blood bank for easy donation and transfusion.

Also, a health advocate, Paschal Onuarah, said there was the need for blood transfusion to be included under the National Health Insurance Scheme (NHIS).

NHIS Office

“Many people in need of blood find it difficult to buy due to poverty and scarcity,” he said.

‘LifeBank’

Meanwhile, a 2017 study in the Journal of Clinical Investigation has said donated blood has about a six-week lifespan, and as a result, health experts have suggested involvement of individuals, private organisations and non-governmental bodies to drive the campaign for massive blood donation among Nigerians.

One of such initiatives is by a group- LifeBank, which currently connects registered blood banks to hospitals in Nigeria’s federal capital territory (FCT), Abuja, and the nation’s commercial nervecentre, Lagos.

The company, according to a report by the Guardian UK, has 40 blood banks and 300 hospitals on its platform. “It sorts orders based on urgency, location and price and preserves blood in a cold chain system that keeps it at 10C.”

“So far, LifeBank has moved nearly 7,000 pints from blood banks to hospitals,” the Guardian UK reported, with the group’s founder, Temie Giwa-Tubosun, saying; “We aim to move 106,000 pints of blood in the next two years, and to become the supply chain engine for every hospital.”

World Blood Donor Day

Every year on 14 June, countries around the world celebrate World Blood Donor Day (WBDD). The event, established in 2004, serves to raise awareness of the need for safe blood and blood products, and to thank blood donors for their voluntary, life-saving gifts of blood.

With the theme, ‘Give blood and keep the world beating,’ this year’s campaign highlights the essential contribution blood donors make to keeping the world pulsating by saving lives and improving others’ health. It reinforces the global call for more people all over the world to donate blood regularly.

A special focus of this year’s campaign will be the role of young people in ensuring a safe blood supply.

According to the WHO, ensuring safe and sufficient blood supplies requires the development of a nationally coordinated blood transfusion service based on voluntary non-remunerated blood donations.

In her message to Africans on the occasion of this year’s annual event, Ms Moeti said though the coronavirus pandemic has significantly reduced the number of donors across the world, and in Africa in particular.

She said; “over the past year, blood stocks decreased in the African Region as movement restrictions and fears of infection hindered people from accessing donation sites. The average blood donation rate dropped by 17 per cent and the frequency of blood drives reduced by 25 per cent. Demand for blood also decreased by 13 per cent with the suspension of routine surgeries in some countries and fewer people seeking care in health facilities.

“However, even during the pandemic, blood donors in many countries have made extraordinary efforts to continue to donate blood. Awareness campaigns backed by the collaboration of donor associations, civil society organisations, and armed and security forces, have led to good levels of voluntary donor recruitment in eight African countries.”

She revealed that as part of the COVID-19 response, 10 African countries are investigating the use of COVID-19 convalescent plasma (CCP) therapy. Among them, she said Ethiopia, Guinea and Mauritius have collected CCP for compassionate use and that randomised control trials are ongoing in South Africa and Uganda.

Ms Moeti added; “safe blood and its transfusion are key aspects in providing quality care to save mothers haemorrhaging during childbirth and people with serious injuries. Blood is needed for surgical procedures, as well as to treat severe anaemia, inherited blood disorders, and other conditions. Blood can only be stored for a limited time and so a steady supply of donations is important to make sure adequate blood products are always available.

“As WHO we are working with a range of stakeholders to improve access to quality blood supplies. We have partnered with the Coalition of Blood for Africa (CoBA), launched in November 2020, to drive this agenda, including engaging the Organization of African First Ladies for Development (OAFLAD) and the private sector. The BloodSafe Program funded by the United States of America National Institutes of Health supports research to enhance availability of safe blood in African countries. Through this partnership, research projects in Ghana, Kenya and Malawi are underway in collaboration with universities in the United States.”

The WHO official said the global organisation has partnered the leading networking site, Facebook, to set up a Regional Blood Donations feature, which she noted connects people with nearby blood banks. “The tool is now live in 12 countries and over 3.8 million Facebook users have signed up to be notified of blood donation opportunities.”

Who should donate blood?

The WHO says some countries recognise less than 18-year-olds to donate blood but with the direct supervision and guidance of their parents or guardians.

However, in Nigeria, Mr Akanmu says donors are pegged to be between the ages 18 and 65 years. He advanced many reasons for the peg, saying blood donations come with regulations such as blood donor safety criteria and donor selection criteria.

According to the expert, weight, health status and the blood volume of willing donors are also considered before donation is permitted.

The hematology professor said; “we must also ensure that you are not underweight, so anyone that weighs less than 50kg will not be fit to donate blood. The volume of blood we have in our body is weight dependent and for every kilogram of our body, we have about 70 mills of blood. If for example, your body weight is 70 kg, it means the blood volume will be 70 multiply by 70.

“The physiological experiment that we have is that if you lose 13 per cent of your blood volume rapidly, you will collapse. The way we collect blood when people come for blood donation is rapid loss of blood because we collect about 50 mills of blood within 10 minutes. So we check the blood volume and weight before taking blood from a donor.”

He said fewer women can donate blood when compared to men, saying pregnant women, those on their menstrual cycle and those lactating are not allowed to donate blood for medical reasons.

Meanwhile, the World Health Organisation said it is encouraging more young people to donate blood to save lives and to inspire their peers and families to do so too.

“In some countries, in line with national guidance, people aged 16 and 17 can donate blood with their parent’s or guardian’s consent, and in all countries anyone over 18 can save someone’s life by donating blood,” Ms Moeti, said.

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