MamaYe Factsheet on Sierra Leone's Blood Services 2013

Download the easy to read factsheet version here >Each year, an estimated 287,000 women die worldwide from complications related to pregnancy and childbirth[i]. More than half of these maternal deaths (56%) occur in sub-Saharan Africa[i] with haemorrhage (severe bleeding) as the leading cause[ii].Efforts have been made to reduce maternal deaths from haemorrhage through skilled birth attendance and ensuring the availability of Emergency Obstetric Care (EmOC)[iii]. Despite the fact that Caesarean Sections (CSs) and blood transfusions are key components of Comprehensive Emergency Obstetric Care (CEmOC)[iv], improving the effectiveness of Blood Transfusion Services (BTS) has not received enough attention[v].  It is estimated that 26% of maternal deaths in sub-Saharan Africa were directly related to a lack of blood[iii]. A major reason why so many women die from haemorrhage is because once bleeding starts death can occur in around two hours, compared with 10 hours for eclampsia and 72 hours for obstructed labour[vi].Therefore, among other strategies to prevent maternal deaths from haemhorrage, it is crucial to make available rapid access to adequate, safe, and affordable blood for transfusion[iii]. To ensure the provision of safe and effective BTS, the World Health Organization (WHO) recommends[iii] [vii]:

• The establishment of a centralised, nationally-coordinated Blood Transfusion Service;
• The collection of blood only from voluntary non-remunerated  blood donors from low-risk populations;
• Testing of all donated blood, including screening for  transfusion-transmissible infections, blood grouping and  compatibility testing;

What we know of the situation in Sierra Leone: Blood supply[viii]Total whole blood collectionsNearly 34,800 units (2012)Blood usedNearly, 38,900 units (2012)(Please note that blood used is more than collected because some blood collected into 450mls blood bags were further shared into paediatrics blood bags of 150 - 250mls bags for 2 to 3 children)Blood needed120, 000 units (2012)Blood gapJust over 81,100 units (2012)Whole blood donations (units)/1,000 population5.7 units/1,000 population (2012)Blood use/1000 population6.4 units /1,000 population (2012)(Please note that blood used is more than collected because some blood collected into 450ml blood bags were further shared into paediatrics blood bags of 150 - 250ml bags for 2 to 3 children)Blood needed/1000 population19.6 units /1,000 population (2012)Blood gap per 1000 population13.2 units /1,000 population (2012)Blood use- Maternal and Child[ix]Blood use- MaternalAn estimated 30.5% (2012)Blood use - under-five childrenAn estimated 37.5% (2012)Donor population[x]Voluntary donors10%(2006) (WHO recommends 100%)Family replacement donors90% (2006)Organisation of the Blood Transfusion Services [x]Established national policyYesFull implementation of policyNo, only partiallyBlood systemCentralised: if blood collection, testing, and distribution are co-ordinated centrally[iii]. Decentralised: if blood collection, testing, and distribution are co-ordinated at the hospital-level[iii].Decentralised – centralised system plannedBlood Safety and Screening [x]Transfusion Transmissible Infections (TTIs) Prevalence % [viii]Quality management systemPoor Blood tested for HIVYesHIV- 2.8%Blood tested for Hepatitis B Virus (HBV)YesHepatitis B Virus (HBV)- 10.1%Blood tested for Hepatitis C Virus (HCV)YesHepatitis C Virus (HCV)- 1.4%Blood tested for malariaNot known Blood tested for syphilisYesSyphilis- 2.2%What we need more information on: Reliable, up-to-date, and publically accessible information on:

• Blood supply;
• Blood used, especially for mothers and newborns;
• Blood need. This will highlight whether the amount used is meeting blood need;
• The whole donor population. It will be useful to know the break-down and calculation of voluntary non-remunerated donors, paid donors, and family-replacement donors.
• Blood safety and screening; and
• The organisation of the Blood Transfusion Services.

References:[i] WHO, UNICEF, UNFPA and The World Bank. 2012.  Trends in Maternal Mortality: 1990 to 2010: WHO, UNICEF, UNFPA and The World Bank Estimates.  Geneva: WHO. http://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Trends_in_maternal_mortality_A4-1.pdf[ii] Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet 2006;367:1066–74. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16581405 (accessed 13/06/13)[iii] Bates I, Chapotera G, McKew S, van den Broek N. Maternal mortality in sub-Saharan Africa: the contribution of ineffective blood transfusion services. BJOG 2008;115:1331–1339. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2008.01866.x/pdf[iv] WHO, UNFPA, UNICEF and AMDD. 2009. A handbook on monitoring emergency obstetric care. Geneva: WHO. Available at: http://whqlibdoc.who.int/publications/2009/9789241547734_eng.pdf[v] Ronsmans C, Graham WJ. Lancet maternal survival series steering group. Maternal mortality: who, when, where, and why. Lancet 2006;368:1189–200. As cited in Bates I, et al. Maternal mortality in sub-Saharan Africa: the contribution of ineffective blood transfusion services. BJOG 2008;115:1331–1339. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2008.01866.x/pdf[vi] Walraven G, Telfer M, Rowley J, Ronsmans C. Maternal mortality in rural Gambia: levels, causes and contributing factors. Bull World HealthOrgan 2000;78:603–13. As cited in Bates, I et al Maternal mortality in sub-Saharan Africa: the contribution of ineffective blood transfusion services. BJOG 2008;115: 1331–1339. http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2008.01866.x/pdf[vii] WHO. 2002 (re-printed in 2009). Aide-memoire: Blood Safety for National Blood Programmes. Geneva: WHO. Available at: http://www.searo.who.int/entity/bloodsafety/Blood_Safety_Eng.pdf[viii] Sierra Leone National Safe Blood Services database 2012.[ix] Baker S, Adeyemo A, Yilla M, Nam S, Kabba M. The Viral Infections and Blood Use for Mothers and Children under 5 Years in Sierra Leone- International AIDS Society conference 2013[x] Ministry of Health and Sanitation [Sierra Leone]. 2010. National Strategic Plan for Blood Safety 2011-2014 (Revised). Freetown: Government of Sierra Leone.Evidence for Action. (2013). MamaYe Factsheet on Sierra Leone's Blood Services 2013. Evidence for Action: London.