22 January 2018

Uganda: Why Blood Shortage Hit Uganda's Hospitals

Photo: The Independent
Blood donation

This is not a good time to be sick and in need of a blood transfusion as hospitals across the country experience an acute shortage.

"We only have 10% of what we need," says Micheal Mukundane the Coordinator Blood Donation at the National Blood Bank based at the Uganda Blood Transfusion Services (UBTS) headquarters in Nakasero in Kampala.

And he offers no hope of respite soon.

"We can only have good news if more people come out and give us blood," he told The Independent on Jan.11.

Mariam Nantongo who has a daughter who suffers an inherited blood disorder - sickle cell anemia, has felt the pain of failing to get blood. As the recent shortage raged, we found her camped at St. Stephen's hospital in Mpererwe, North of Kampala city.

Sitting on a bench in the waiting area, with her arms crossed and legs tucked tightly to her body as her long black dress swept the floor, panic was written all over her and her eyes remained glued on an a door marked 'Laboratory Room'.

Inside was a lab technician who had just given her a ray of hope about getting blood for her anemic daughter, Fathira Mbaziira. She said he was making some calls.

"You know her blood group is O+ and these people don't have it," she said, adding that her five year old had just gone through a severe crisis that put her in the acute care unit at the National Referral Hospital Mulago for about 40 days. She is worried about a repeat of the same.

Faced with cases like this from all over the country, Mukundane spoke of the frustrations his team endures as they cajole Ugandans to donate blood.

"Ugandans lack humanitarianism," he says, "They will tell you they fear the needle. Others will say they just don't want. "

He says it's because of such attitude that Uganda has failed to meet the World Health Organisation recommendation of collecting blood equivalent to 1 percent of the country's total population.

One percent, for Uganda with population of 37million, would be 370,000 units. But by end of 2017, for instance, the country had collected only 240,000 units and this was a reduction from the previous year when they collected 260,000 units.

Mukundane anticipates the collection could sink further. And yet, the daily blood needs seem to be increasing. Accident victims, cancer patients, women in labour, and children requiring transfusion, are on the rise. Ministry of Health figures show that Uganda's blood needs are increasing at 20% per year.

The ideal now, according to Mukundane, would be to collect 1200 units of blood daily. He says his team struggles to make 800 units.

Dr. Dorothy Kyeyune Byabazaire, the UTBS Executive Director, says the institution has always had challenges but they worsened when donors pulled out in March 2016. Before that, despite inadequate funding, blood collections by UTBS had been increasingly annually. They started experiencing a drop when donors pulled out and yet the annual budget allocation from the government was not increasing. This meant most of the activities; including blood donation drives, were reduced.

"The budget for fuel of over Shs190 million was cut and at the wrong time when our donor support was also expiring. A lot of money is spent on movements and maintenance of the cold chain. On fuel alone we spend about 1.2 billion," Byabazaire says.

The U.S. President's Emergency Plan For AIDS Relief (PEPFAR) had been contributing $2 million (approx. Shs7 billion) in addition to the government allocation of Shs9 billion.

With the gap left by PEPFAR, health experts say government should be looking for alternatives of ensuring that blood is available; especially now that the country is moving into carrying out more specialised procedures like organ transplants which require a lot of transfusion.

But, according to the just released National Budget Framework Paper that gives a picture of how much money each sector is likely to receive in a financial year, UBTS is proposed to get just Shs8.8 billion - a further reduction.

This trend worries Dr. Sam Uringi Uringtho; a hematologist. Although he acknowledges that some corporate companies are already considering blood donation drives as part of their Corporate Social Responsibility plans, he says it's time for everybody to get involved and not to just rely on students, who comprise 90% of the donors. Apparently students are easy to catch as they are always found at school and easily agree to donate. Once they go for holidays; usually blood challenges come up. Uringtho says Uganda should emulate countries in Europe where civil society spearheads blood collection drives and the community is fully aware of why they should donate. Statistics show about 30% of global blood donations occur in Europe, which has about a tenth of the world's population. Africa, which has a larger share of the global population accounts for less than 5% of blood supplies.

Uringtho says the challenge of relying on students for donations is that they are not regular. Uringtho says people become reluctant to give blood after school with lifestyle changes that come with joining the corporate class whereby the safety of their blood becomes questionable as some start drinking alcohol and engaging in sexual activities. He adds that adequate and reliable supplies of blood can only be guaranteed by a stable base of voluntary unpaid donors. He says these donors are the safest group because prevalence of blood borne infections is lowest among such people who voluntarily offer to donate.

According to the World Health Organisation, anybody wanting to donate should first be screened for HIV, hepatitis B, hepatitis C, and syphilis. In Uganda, up to 10% of the blood is discarded annually due to infections. This too cuts off some people.

Fortunately, there are regular donors like Christopher Mukwaya. In an interview with the Independent on Jan.12, he said he started donating ten years ago giving birth to a child with sickle cell anemia - a condition that found him needing blood almost on a monthly basis.

"We would struggle looking for blood and I saw many children dying because they couldn't be transfused. Then I realised I needed to thank God for the blood he gave me. My daughter is an O+ and I am an A+. I can't donate to her but I know my blood saves someone out there," he says. He recounts a night when his being a regular blood donor saved the whole children's ward when he run to Nakasero with his card and was given a full box of blood even after the laboratory at Mulago had suffered a stock out. Mukwaya now donates thrice every year.

Mukwaya believes many Ugandans do not donate blood because they lack basic information, including why they need to donate, what's likely to happen to them when their blood is drawn, and even where to go when they need to donate.

While Mukwaya's point of people's ignorance is rubbished by Mukundane who says Ugandans just have an 'I don't care attitude', it was also pointed out in a value for money audit done on UBTS by the Auditor General (AG).

The AG found that UBTS was setting its blood collection targets the wrong way; according to the number of teams it has rather than the number of people they have to reach to get blood and that the public was unaware of the institutions' activities. The auditors also found that the institution was understating the country's blood requirement needs by over 67% in addition to observing that UBTS was not employing common standards throughout its blood bank network and lacked a system for regulating deviations from standard procedures.

Basics about blood and donation

Uringtho says blood transfusion is an expensive venture that requires constant investment in maintenance. He explains that blood's shelf life is 35 days but one has to maintain an appropriate cold chain of 2 to 6 degrees Celsius for it to stay safe. Beyond 6 degrees, it will become warm enabling the bacteria in it to multiply and below 2 degrees, the cells will be destroyed. In some cases, blood has a shorter shelf life. The platelets concentrates used by cancer patients, for example, must be stored under room temperature and can only last five days.

Uringtho gives facts about blood and donation

While a man's blood can be drawn every after three months, a woman can donate every after four months.

There are four blood group types - O, A, B and AB whereby one's blood group is determined by the genes they inherit from their parents.

Most Ugandans are of blood group O. Group O donors contribute to 48% of blood collections annually.

There are four types of transfusable items that can be derived from blood - red cells, platelets, plasma and cryoprecipitate. A single donation can potentially help up to three patients.

In Uganda just like other low income countries, up to 65% of the transfusions are for children below five years. In high income countries, the most frequently transfused patient group is of over 65 years of age.

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