By Professor Kathryn Maitland, Professor of Tropical Paediatric Infectious Diseases and Director of Centre of African Research and Engagement, Imperial College London.
Each year, World Blood Donor Day highlights the importance of blood donations as the transfusion of blood is a life-saving intervention. In any health system, the provision of adequate supplies of safe blood for transfusion is an essential undertaking.
The World Health Organization (WHO) estimates the blood requirement for countries to be in the region of 10 – 20 units per 1000 population per year. Yet in many sub-Saharan African countries, donations are far lower, in some countries as low as 2 units/1000 population/year. The demand for blood transfusion is very high, especially in children (largely due to infection) where up to 15% of children admitted to hospitals are transfused, with most being given as emergency interventions.
Over the past decade, several countries in sub-Saharan Africa have made progress in achieving the goals defined by the WHO to improve both the supply and blood safety, which have been financed largely by international donors. This has led to an increase in the number of total blood donations and the proportion from voluntary donors, and improved safety of blood; but this is expensive to maintain therefore concerns about the sustainability of systems requiring a high level of financial support in low-income countries when cost recovery is unlikely.
More research is needed, particularly in African children, to determine which children need transfusion and which children with severe anaemia can safely be treated with other supportive therapies. The TRACT trial (ISRCTN84086586) is a randomised controlled trial involving 4000 children with severe anaemia (SA) aims to provide this evidence to support rationale use of paediatric blood transfusion– as recommended by the WHO.
Blood transfusion use in sub-Saharan Africa: > 60% is used in children
For further information on TRACT and our work in sub-Saharan Africa, please visit our Centre of African Research and Engagement website.