95% of donor blood units used in Nigeria ‘unsafe,’ experts warn

• WHO, NMA: Nigeria needs 2m units of safe blood yearly but produces only 25,000
• Lagos requires 260,000 units of blood to meet growing demand
• Only 5% of blood come from voluntary donors
• Family replacements, paid donors major sources of blood procurement
• Poor infrastructure, inadequate regulation, others mar provision of safe blood in Nigeria

Ahead of the World Blood Donor Day (WBDD) today, June 14, the World Health Organisation (WHO), Nigerian Medical Association (NMA) and National Association of Resident Doctors (NARD) have warned that 95 per cent of donor blood units used yearly in the country are unsafe, as it could be infected with Human Immuno-deficiency Virus (HIV) 1 and 2, syphilis, hepatitis B, hepatitis C and other deadly infectious diseases.

They said Nigeria needs two million units of safe blood yearly but produces only 25,000 even as only five per cent of donor blood used in Nigeria come from voluntary donors. According to them, family replacement and paid donors are still major sources of donor blood procurement, even as poor infrastructure, inadequate manpower, underfunding and inadequate regulation mar provision of safe blood in the country.

Of this number, the Executive Secretary of the Lagos State Blood Transfusion Service (LSBTS), Dr. Bodunrin Osikomaiya, said Lagos will require over 260,000 units of blood to meet the growing demand for blood transfusion.

The medical experts in recommendations made on how to improve funding and regulation of blood transfusion services in the country, urge President Muhammadu Buhari to assent to the National Blood Service Commission Bill, which was recently passed by the National Assembly.

According to WHO, the aim of WBDD is to raise global awareness on the need for safe blood for transfusion and the critical contribution voluntary, unpaid blood donors make to national health systems. The day also provides an opportunity to call to action governments and national health authorities to provide adequate resources and put in place systems to increase the collection of blood from voluntary, non-remunerated blood donors.

Everyday, 537 women in Sub-Saharan Africa die from pregnancy-related complications. Many of these deaths are due to lack of blood. Half of the maternal deaths from severe bleeding in the world occur in Sub-Saharan Africa. About 65 per cent of these deaths occur in the post-partum period, according to reports.

The maternal mortality ratio per 100,000 live births is estimated to be 542 in Sub-Saharan Africa and 10 in Europe. Up to 75 per cent of these maternal deaths are directly due to five complications: haemorrhage, sepsis, eclampsia, obstructed labour, and complications of abortion. Most of these complications require timely availability of blood to save the life of the mother and child.

This year, the WBDD slogan is ‘Give blood and keep the world beating.’ Committee Chairman, Blood Transfusion and Haematological Services of the NMA, Dr. Attah J. Ahmed, told The Guardian that blood banks as a component of the Nigerian health system is faced with the same challenge, which include poor infrastructure, inadequate manpower, underfunding and inadequate regulation.

Ahmed said these challenges combine to give the current picture of poor blood transfusion services in Nigeria. He said while the National Blood Transfusion Services (NBTS) under the Federal Ministry of Health is making frantic effort to bridge the yawning gap of challenges and provide safe and secure blood to the people, the practices are far from the standard in many centres across Nigeria.

Ahmed, who is also a consultant haematologist, Special Assistant on Health to Governor Yahaya Bello of Kogi State and former National Secretary of NMA, said WHO recommends a minimum of two million safe blood units yearly for the current population in Nigeria. This, he said, is a far cry from the current situation of 25,000 blood units via voluntary blood donation and one million via commercial blood donation yearly.

“Commercial blood donation is not considered as a good source of safe blood. This means we are left with 25,000 units of safe blood yearly in Nigeria, which is grossly inadequate and a huge challenge to the provision of quality healthcare to the people,” he said.

To improve the funding and regulatory powers of the NBTS, Ahmed said President Buhari should assent to the National Blood Service Commission Bill, which was recently passed by the National Assembly.

Ahmed said safe blood in Nigeria comes highly subsidised when you take into consideration what is needed to create awareness for voluntary blood donation, collection, screening and storage. “What is paid for a unit of blood ranges from N5,000 to N10,000 depending on the location and facility, which is small compared to the production cost of N20,000 to N30,000,” he said.

While urging residents to donate blood voluntarily, Osikomaiya said that efforts were being intensified by the state government through LSBTS to ensure that all blood for transfusion were from voluntary blood donors.

She said: “The demand for blood is ever present and increasing especially with the growing population of Lagos. At least, 260,000 units of blood yearly is required to meet our blood transfusion demand and this is according to the WHO estimate that blood donation from at least one to two percent of the population is needed to meet their blood needs. This is why we need residents to donate voluntarily to meet these demands and save precious lives.”

The Executive Secretary also hinted that Lagos has less than 10 per cent of voluntary blood donors, stressing that more than 90 per cent of blood was sourced from replacement donors who according to her, have a higher risk and prevalence of transmissible infections such as HIV, Hepatitis C and Syphilis.

To bridge this gap, in 2016, Mrs. Temie Giwa-Tubosun developed an initiative to use technology to save lives. Having seen how hospitals find it difficult to get blood on time for patients, she co-founded Lifebank to make it easier. Giwa-Tubosun is able to bridge the gap between hospitals and blood donors or providers through tech app and by drones. It currently services over 500 hospitals in Nigeria and Kenya.

A consultant oncologist and radiologist at the College of Medicine, University of Nigeria Teaching Hospital Enugu (UNTH), Prof. Ifeoma Okoye, told The Guardian that Nigeria does not have a centralised blood supply body like the United Kingdom (UK) does with National Health Service (NHS) Blood and Transplant. Okoye said the blood supply system here is fragmented as private hospitals rely on private blood banks.

She said the closest approximation to a national blood bank is the NBTS, which collects only about 66,000 units per year and currently operates from 17 centres across the six geo-political zones.

Okoye said the blood banking system in Nigeria is still poorly developed as a number of centres depend on paid donors whose hematological and infectious status may not be determined oftentimes prior to blood donations.

She added that patients die in hospitals due to inadequate safe blood at blood banks in Nigeria and despite the need, there is a yawning shortfall in the level of access to safe blood.

According to reports, the average donation rate in developed countries is 38.1 donations/1000 populations, 7.5 in transitional countries, and 2.3 donations per 1000 population in developing countries, including Nigeria.

She said certain factors contribute to the paucity of safe blood availability. These include: inadequate information about safe blood donation through electronic and print media; people’s phobia of being detected as HIV positive persons; people’s phobia of possible contraction of HIV in the hospitals through blood donation; federal and state governments’ non-commitment and support for effective national, state and local safe blood programmes; inadequate blood banks and equipment in hospitals and other health facilities; inadequate trained professional staff to manage blood banks professionally; and inadequate funds to establish more blood banks, as well as manage the existing ones.

Okoye said, notwithstanding the foregoing, there has been some significant innovation within the biotech space to help widen the access to safe blood.

She said startups such as LifeBank have successfully joined forces with Google Africa to address the logistical and inventory challenges posed by navigating through a patchwork of unconnected private blood banks to locate and deliver safe blood in a timely and efficient manner to patients in Lagos and Abuja.

Okoye said, according to a price survey, the average cost to collect, test and store a unit of blood is about $94. “Cost to patients: About N5,000 ($13.93) per unit if blood is available in private hospitals patronised by a large population of Nigerians, the cost of blood is higher. A pint of blood, for example, may cost between N15,000 and N25,000, depending on the blood group, that is AB, O- and O+,” she said.

The oncologist said while blood donation is free, when donating blood for a relative or patient directly, hospitals will generally charge an administrative fee for screening the blood, which could range from N1,500 to N10,000. “Moreover, the above costs have not been adjusted to reflect current inflationary pressures, which may hike up costs,” the oncologist said.

However, President, National Association of Resident Doctors (NARD) and a consultant orthopaedic surgeon, Dr. Okhuaihesuyi Uyilawa, told The Guardian that Nigeria’s blood banks are safe and secure in the sense that all blood and blood products are carefully drawn from screened donors and are subjected to standard precautionary laboratory procedures.

Uyilawa said safe blood are most often not readily available, due to the high daily demands of blood and blood products compared with the proportion of available voluntary blood donors.

He said safe blood is relatively cheap in the blood banks, a unit of blood can cost as low as the sum of N4,000 in northern Nigeria, it may be way higher in other regions or facilities. Uyilawa said this only covers for the routine laboratory screening tests, and consumables.

The NARD President, however, said due to the socio-economic status of most Nigerians, there seems to be a challenge for many to afford even the cost of screening above.

MEANWHILE, the WHO said safe blood and blood products and their transfusion are a critical aspect of care and public health. They save millions of lives and improve the health and quality of life of many patients every day. The need for blood is universal, but access to blood for all those who need it is not. Blood shortages are particularly acute in developing countries.

To ensure that everyone who needs safe blood has access to it, the WHO said all countries need voluntary, unpaid donors who give blood regularly. Throughout the COVID-19 pandemic, despite limited mobility and other challenges, blood donors in many countries have continued to donate blood and plasma to patients who need transfusion. This extraordinary effort during a time of unprecedented crisis highlights the crucial role of well-organised, committed voluntary, non-remunerated blood donors in ensuring safe and sufficient blood supply during normal and emergency times.

On the impact of COVID-19 on blood donation, WHO notes that coronavirus has disrupted blood transfusion services worldwide. Diminished donor inflow, lack of uniform donor selection criteria during the initial period, fear of COVID-19 spread to blood donors and staff personnel, shortage of available blood units, handling of medical records, and concerns about transfusion-transmitted COVID-19 were the major challenges faced in blood centres.

This year’s slogan, “Give blood and keep the world beating,” aims to raise awareness during a time of crisis, reaching out to all eligible donors to contribute towards maintaining supplies of safe blood.

WHO estimated that the COVID-19 pandemic caused 20 per cent to 30 per cent reduction of blood supply. Demand for blood also decreased by 13 per cent.