‘There is insufficient data on exact amount of blood needed in Nigeria’

• More than 85% of 1.3m units collected coming from commercial donors
AHEAD of the World Blood Donor Day (WBDD) on June 14, Project Coordinator, Abuja centre of the National Blood Transfusion Service (NBTS), Dr. Omo Izedonmwen, said one of the greatest challenges Nigeria faces is the non-availability of accurate data and the practice of blood safety.

Izedonmwen in a chat with journalists last week said there is insufficient data on the exact amount of blood that is needed or utilized. However, the NBTS estimates that about 1.5 to 1.7 million units of blood is needed per annum, given the current population and the level of development of the country’s health system.

He, however, said it is estimated that between 1.1 to 1.3 million units of blood is collected from various sources, with more than 85 per cent coming from commercial donors.

The NBTS boss said the deficit accounts for many deaths, including the death of women and children thus leading to the high maternal and child mortality rates.

He said in an attempt to address this deficit, the NBTS has instituted various programmes such as: the Hospital Linkage Programme, Conversion of Family Replacement Donors to regular donors, encourage pregnant ‘father’ donations, media campaigns among others.

Izedonmwen said amongst intending blood donors, hepatitis B ranks the highest of all the Blood Borne Infections (BBIs), with eight to nine per cent of potential donors reactive for the hepatitis B surface antigen. “It is followed by Hepatitis C with two to four per cent then Human Immuno-deficiency Virus (HIV) with 1.8 to 2.3 per cent,” he said.

On what percentage of donors that comes forward have safe blood, Izedonmwen said between 85 to 90 per cent of the blood collected within the NBTS network return safe after screening. “Again this is not unexpected, because the donors are voluntary non-remunerated, they tend to lead healthy life styles as opposed to commercial that is paid or family replacement donors who are compelled to donating blood beyond altruistic reasons,” he said.

Izedonmwen insisted that adequate supply can only be assured through regular donations by voluntary unpaid blood donors.

Every year, on June 14, countries around the world celebrate World Blood Donor Day. The event serves to thank voluntary unpaid blood donors for their life-saving gifts of blood and to raise awareness of the need for regular blood donations to ensure quality, safety and availability of blood and blood products for patients in need.

Izedonmwen said transfusion of blood and blood products helps save millions of lives every year. It can help patients suffering from life-threatening conditions live longer and with higher quality of life, and supports complex medical and surgical procedures. It also has an essential, life-saving role in maternal and childcare and during man-made and natural disasters.

Izedonmwen, however, said in many countries, demand exceeds supply, and blood services face the challenge of making sufficient blood available, while also ensuring its quality and safety.

He said the goal of all stakeholders including the World Health Organisation (WHO) is for all countries to obtain all their blood supplies from voluntary unpaid donors by 2020.

According to the WHO, today, in just 62 countries, national blood supplies are based on close to 100 per cent voluntary unpaid blood donations, with 40 countries still dependent on family donors and even paid donors.

On the promotion of regular voluntary blood donation to ensure blood safety, Izedonmwen said: “In Nigeria, regardless of the myriad of challenges confronting the blood service, it strives to promote regular voluntary blood donations through diverse means, such as: media engagement to promote public awareness, engaging Faith Based Organisations (FBOs), engaging communities and higher institutions of learning

“To create wider public awareness, the NBTS has partnered with the media in several ways, and the partnership continues to blossom. Many national newspapers have written their editorials on blood safety and regular, voluntary non remunerated blood donations. The social media has also been a veritable tool of campaign.

“The donor’s health is paramount and takes the front seat in all the activities of the NBTS. Before blood donation, a mini health check is conducted on the potential donor to ensure he or she is fit to donate blood. Subsequently, during blood donation and post donation, other health measures are taken to maintain the donor at optimum health.

“During the blood donation process, the donor is continuously monitored, and continues to be observed for 30 minutes thereafter. She or he is offered a drink to replenish the fluid lost, and given instructions about what to do in the following 24hours. Post-donation counseling also includes general health and nutrition advice and avoidance of harmful practices, and donors are told when to return for results of the blood tests and the date for the next donation.”

He said the NBTS is intricately connected with the ministries of health, both at federal and state levels, therefore most of the activities of the NBTS which also includes appreciating regular unpaid blood donors, are conducted on behalf of the ministries at all levels.

Is providing safe and adequate blood an integral part of Nigeria’s national health care policy and infrastructure? Izedonmwen said: “In terms of policy, and policy formulation, Nigeria has done well. The new National Health Act clearly enunciates the role of the blood service in the health sector and gives meaning to blood safety. However, there are more gaps to be filled in terms infrastructural integration of the service into the health service.
On its part, the NBTS has been able to establish 17 operational centers across the six geopolitical zones of Nigeria. It is the hope of the NBTS that States will take full advantage of these centres, by taking ownership of them and integrating them into the local health infrastructure.”

Are all activities related to blood collection, testing processing, storage and distribution coordinated at the national through effective organization and integrated blood supply networks? He explained: “The mandate of the NBTS is to centrally coordinate all activities related to blood collection, testing processing, storage and distribution at the national level, through effective organization and integrated blood supply networks.

Unfortunately it is yet to completely fulfill this mandate. However, considering its age and challenges, the NBTS has been forward looking in achieving this mandate.”

Is the national blood system governed by a national blood policy and legislative framework to promote uniform implementation of standards and consistency in the quality safety of blood and blood products? Izedonmwen said the national blood policy was first formulated in 1996, and has undergone many revisions, the last being 2006. He said the policy enunciates the governing principles for blood safety in Nigeria but has not been backed by a legislative framework; thus resulting in challenges in enforcement and proper implementation.

He, however, said a draft legislative framework is going through the different stages of drafting a bill; and when fully drafted and passed into law, it will give the National Blood Policy the needed impetus to drive blood safety in Nigeria.

WHO recommends that all blood donations should be screened for infections prior to use and that screening should be mandatory for HIV, Hepatitis B, Hepatitis C and Syphilis. What is the situation in Nigeria? Izedonwen explained: “Within the NBTS network, all blood donated are screened for the four BBI as mandated by WHO, using fourth generation ELISA technique and only safe blood units are released for transfusion. However, the same cannot be said of most of the practice outside the NBTS network. Most health facilities do not screen for the four BBI, and when they do they usually make use of Rapid Test Kits (RTK), which are fraught with a margin of error that is unacceptable.

“Realizing the inherent dangers in the use of RTKs for screening blood for transfusion purposes, the 56th session of the National Council on Health (NCH) made it mandatory for all blood meant for transfusion purpose to be screened by a minimum of ELISA technique.”

Is the federal government ensuring sufficient and equitable supply of plasma-derived medicinal products namely immunoglobulins and coagulation factors, which are needed to prevent and treat a variety of serious conditions? He said: “Medicine and medical therapy have evolved tremendously in the last five decades and continue to do so at an alarming pace. Unfortunately health systems, especially those in developing countries have not evolved as fast, therefore there are gaps to fill.

“In Nigeria, the use of blood products in the treatment of ailments is one of those huge gaps that is yearning to be filled. While there are a few significant successes scattered across the country notably stem cell transplantation at University of Benin Teaching Hospital (UBTH), there is really no coordinated system in place to ensure equitable distribution and sufficiency of blood products.

Does Nigeria have systems to monitor and improve the safety of the transfusion process such as hospital transfusion committees and haemovigilance? Izedonmwen said: “Haemovigilance is key in blood safety and in the practice of transfusion medicine. To attain its goals and objectives, it requires a properly coordinated health system and commitment from all stakeholders at the different levels. Accurate documentation of blood use and any adverse effects emanating there-from, is absolutely essential. The Nigerian health system is still evolving.”

How many blood banks do we have in Nigeria? Are they government or privately owned? How are they ran? The NBTS boss explained: “In the year 2007, the Federal Ministry of Health (FMoH) conducted a country wide survey on blood safety practice. Though the study did not ascertain the number of blood banks in the country, it was able to survey 164 blood banks. The study revealed that the blood banks in Nigeria were at different levels of sophistication and practice, some of them are privately owned. Since then the NBTS has grown with 17 functional centers in 17 states of the federation, in all the six geopolitical zones.”

How many pints of blood does the country need daily and how many can it provide today? Izedonmwen said: “Using WHO standard for estimating a country’s blood needs, the NBTS estimates that about 1.5 to 1.7 million units of blood is needed per annum that is about 4000 to 5000 units per day, given the current population and sophistication of our medical practice. However, it estimates that between 1.1 to 1.3 million units of blood, about 3000 to 3500 units per day, is collected from various sources.”

Some religious organizations such as Jehovah Witness refuse blood donations and transfusion. What are you doing about this? He said the Nigerian constitution guarantees the right of an individual to freedom of worship and belief, so long as such religious practice does not offend the rights of others nor jeopardize public health. “Specifically in this case any adult living in Nigeria is entitled to that unassailable right. The right to receive or donate blood resides in the individual. However, when a minor is involved, the decision is subject to judicial interpretation,” Izedonmwen explained.