This project is directed towards transforming the blood donor pool in Ghana from family replacement donations (FRD) to voluntary collections. In line with WHO recommendations, the national blood policy in Ghana aims at 100% voluntary blood donation pool to secure and sustain an adequate and safe blood supply, since voluntary blood donors are more likely to donate on a regular basis. The major challenge for blood transfusion services in sub-Saharan Africa (SSA) is the juxtaposition of an increasing clinical demand for blood and a historically insufficient supply of safe blood in the region. The inadequate and irregular supply of blood readily available for emergency transfusions play a cardinal role in the high mortality rates in obstetric haemorrhage. We have identified the system of blood donation in Ghana as the major barrier to providing adequate and regular blood to meet the transfusion needs of the country. Currently, over 70% of blood collection in Ghana is obtained in a Family Replacement Donor (FRD) system, which is associated with insufficient, unsustainable and relatively unsafe supply of blood for emergencies. In contrast with an average rate of 31 per 1000 population in countries with a 100% voluntary blood donor base, blood donation in Ghana remains at only 5 per 1000 population. As a direct result, blood supply is characterized by chronic inadequacy with frequent critical shortages, and represents a major developmental challenge. Our long-term goal is to secure a sustainable supply of adequate and safe blood in Ghana by establishing a new paradigm of blood donation in the country focused on a community-based volunteer system and nutritional donor enrichment. Anaemia accounts for up to 53% of voluntary donor deferrals and is, therefore, a major focus of the current application. In addition, fears associated with misconceptions about blood donation, and the lack of knowledge and information on blood donation contribute to the low number of blood donation volunteers in Ghana. The targeting of communities to donate blood not as individuals but as communities (communal collectivism), with a reciprocity model that ensures blood is available for future use by their own communities offers an attractive strategy to recruit new volunteers. Interventions based on communal collectivism and aided by communication strategies are culturally appropriate in SSA but have not yet been explored for increasing blood donation rates. Additionally, other modifiable causes of inadequate blood donation?motivation, access to donation facilities, nutrition?will be targeted using improved communication, behavioural change methods, and iron supplementation to improve overall donor recruitment and retention. We will evaluate the impact of increased availability of volunteer community-sourced blood on reduction of haemorrhage-related maternal deaths in community hospitals. Based on these ideas, we will test the OVERALL HYPOTHESIS ?A community-based volunteer and nutritional donor enrichment model towards recurring blood donors will help to overcome the developmental challenge of blood availability in Ghana?.
The blood transfusion service is a health facility aimed at ensuring the availability of a sustainable supply of safe blood and blood products to hospitals for use in patients who require transfusion as part of their clinical management. This aim is achieved through the altruism of voluntary unpaid and family replacement blood donors. The World Health Organization estimates that blood donation by 1% of the population is generally the minimum needed to meet a nation's most basic requirements for blood. Blood donors are healthy subjects usually between the ages of 17 to 60 although the upper and lower limit vary from country to country who donate their whole blood or blood components. The lower limit is to take account of the national legal requirements for consent, the increased risk of vasovagal reactions in younger donors, and the increased iron requirements of adolescents and young menstruating females, and upper age limit is so set because of increase in various medical conditions with age especially cardiovascular diseases making donations more hazardous. The voluntary unpaid blood donor is the blood donor who gives blood or blood products of their own free will and will not receive money or any form of payment while the regular voluntary blood donor has donated at least 3 times and continues to donate at least once a year. A stringent screening and selection process aimed at assessing the suitability of prospective donors is therefore essential in ensuring the safety and sufficiency of the blood supply; safeguarding the health of the recipients of transfusion as well as that of the donors; and at the same time ensuring that suitable donors are not unnecessarily deferred. Frequent and unnecessary temporary deferral of blood donors lead to loss of potential blood donors some of whom may be reluctant to return for future donations. It is apparent that a lot of attention is given to ensure the safety of the blood and blood products to the recipient but less attention is accorded the blood donors who donate the essential and scarce raw material. With continuous depletion of iron stores from repeat donations and inadequate replacement, the body adapts to reduced concentrations of iron or develops iron deficiency and anaemia. Greater frequency of blood donation is accompanied by lower iron status. Inadequate and irregular blood supply play a cardinal role in the high mortality rates in obstetric haemorrhage and other causes of severe anaemia in Ghana. Though significant efforts were made to achieve the 5th millennium development goal (MDG5), the targets were missed due to the impact of major direct causes of maternal death such as haemorrhage, hypertensive diseases and abortion complications. Comparing the maternal mortality trends across Ghana, haemorrhage as a cause of maternal death has dropped to second place in most urban centers and teaching hospitals where haemorrhage is now second leading cause of maternal death. Maternal mortality surveys in district hospitals and other community health facilities show very high rates and are predominantly due to haemorrhage. Our long-term goal is to provide adequate safe blood in Ghana by establishing a new paradigm of blood collection in the country focused on a community-based volunteer system and nutritional donor enrichment.
