We have a CDC Uganda developed database blood bank management system that is currently in use in all the Regional Blood Banks.
We have standard operating procedures (SOPS), which are available at all blood banks in the country. Quality management and control systems Quality in all aspects of care and services is the primary goal of UBTS.
A quality system in the form of organizational structure, responsibilities, policies, processes, procedures and resources has been established by the management to achieve and ensure quality.
Many activities such as competence assessment of laboratory personnel, participation in laboratory proficiency testing programmes (SA and France), quality control of reagents, procedures for equipment maintenance and documentation of blood product deviation investigations are standard practices in place throughout the Regional Blood Banks though not at the same level of development.
The use of different testing algorithm is due to different levels of infrastructure in place but is well-controlled to ensure the overall safety of the transfusion process from vein to vein.
Technical assistance has been secured from WHO to review the current testing algorithm/test equipment then recommend improvements to optimise the sensitivity and specificity of testing.
On acceptance of the recommendations, revision will be undertaken. Technical assistance has been secured from WHO to develop materials then conduct Quality Assurance training – train 15 QA trainers per region; work with them to train Regional staff on Quality.
Underestimation of blood requirement and target setting
The audit report indicates that WHO recommends that the number of blood units to be collected should be 2% of the total population.
This should translate to 680,000 units per year assuming that the Ugandan population is 34m people. The true fact is that WHO recommends 1% of the total population which is 340,000 units.
National requirements for blood are determined by the capacity of the country’s health care system and its coverage of the population.
WHO estimates that blood donation by 1% of the population (not 2% as indicated in the report) is generally the minimum needed to meet a nation’s most basic requirements for blood; the requirements are higher in countries with more advanced health care systems (see WHO reference attached).
There are other methods of estimating the country’s blood needs which include: blood supply data/ clinical blood use ( currently in use by UBTS -10% increase on previous blood usage)and calculations based hospital beds.
In developed countries with advanced health care systems, the demand for blood continues to rise to support increasingly sophisticated medical and surgical procedures, trauma care and management of blood disorders.
In countries like Uganda where diagnostic facilities and treatment options are limited, the majority of transfusions are prescribed for the treatment of complications during pregnancy and childbirth (30% of all collected blood), severe childhood anaemia (50% of all collected blood), trauma and medical emergencies – HIV (10%).
It should also be understood that this is a guide and the need for blood will vary from country to country, depending on peculiar conditions that exist in the affected country.
Our target for 2012/2013 FY was 240,000 units, not 200,000 as reported in the paper.
This was guided mainly by the resource envelop. Collecting a unit of blood costs approximately sh100,000, hence one should guard against collecting excess blood, which may expire.
It should also be understood that as malaria cases decrease, the need for blood will equally decrease because malaria induced anaemia in children accounts for 50% of blood use.
The shortage of blood that was reported recently was not due to lack of blood per se but due to lack of reagents to assess its safety.
We want to assure our blood donors and users that we have adequate blood at all our regional blood banks. Our blood is very safe.
Our donor selection is rigorous (we have HIV prevalence of 0.7% of our donors compared to 7.2% in the general population), our processing is meticulous and our machines are highly sensitive and specific.
We want to assure Ugandans that our blood and blood components are very safe and we are leaders in the region.
Anybody really interested can contact WHO offices or our other partners such as CDC to get authentic information from technically competent people instead of relying on inflammatory, biased and sensational reports from journalists.
Dr. Dorothy Kyeyune Byabazaire Director, Uganda Blood Transfusion service