Auditors find blood with maggots in hospitals
Aug 13, 2013
A report by the Auditor General paints a disturbing picture of the Uganda Blood Transfusion Service (UBTS), with grave implications on public health. It raises serious questions about the quality of blood transfused to patients in health centres countrywide.
By Steven Candia
A report by the Auditor General paints a disturbing picture of the Uganda Blood Transfusion Service (UBTS), with grave implications on public health. It raises serious questions about the quality of blood transfused to patients in health centres countrywide.
The audit contains graphic details spawned out of gross neglect or inefficiency at UBTS, arising out of poor maintenance of the database, non-compliance to standards in seven regional blood banks as well as lack of routine maintenance, repairs and testing of equipment.
The other issues include an absence of quality assurance measures, including guidelines and principles, in addition to poor blood collection and storage facilities and equipment.
The audit discovered that blood was being stored outside the required temperature range in hospitals and health centre IVs, with some developing maggots, hence creating a risk of rotten blood being transfused to patients.
The audit was carried out to ascertain whether UBTS is efficiently, economically and effectively performing its role of availing safe and adequate blood and blood products to hospitals and health centre IVs countrywide.
The audit covered operations in the three financial years of 2009/2010, 2010/2011 and 2011/2012. The report, which contains pictures, cites the example of Mbale Hospital, where blood was found contaminated with maggots. The pictures were taken in November 2012.
“Such blood could be transfused to patients if care is not taken to ensure a clean environment in which it is stored,” the report notes.
The audit also noted that there was spilled blood in a fridge in Mbale. “On inquiry, it was discovered that the lab attendant was not aware of the blood with maggots, in spite of the fact that the fridges are required to be kept clean because blood is a good medium for the growth of microorganisms such as bacteria,” the report stated.
The Uganda Blood Transfusion Service
Countrywide, blood transfusion services are provided by UBTS, which is responsible for blood collection, processing, testing, waste management and quality assurance.
It was established as a semi-autonomous institution and commissioned in January 2003.
Its headquarters are at the Nakasero Blood Bank and it is a centrally-coordinated department in the Ministry of Health.
It is decentralised to render services to the whole country and acts as a reference centre for the regional blood banks in addition to public and private hospitals.
The organisation has seven regional blood banks in Arua, Fort Portal, Gulu, Kitovu (in Masaka), Mbale, Mbarara and Nakasero. It also has six blood collection centres in Hoima, Jinja, Kabale, Rukungiri, Lira and Soroti.
What the audit discovered
The report notes that at Mbarara regional blood bank, spilled blood was found on other units undergoing processing last year. It adds that this presented a high possibility of contamination with serious consequences to health and safety.
“This could lead to potential contamination of all blood undergoing processing and or blood scheduled to be issued to transfusing units,” the report notes.
Six out of 10 hospitals and health centre IVs, including Arua, Mbarara, Soroti and Mbale regional referral hospitals, were found to be storing blood outside the required temperature range, thus posing a threat to the quality of blood.
The report also states: “UBTS is not following up on its product right to the final consumer. This might be leading to poor quality products being transfused to the end-user.
UBTS does not also fully appreciate the blood needs of the hospitals they supply. Consequently, its objective of promoting clinical use of blood and blood products in hospitals and health centre IVs is not being realised.”
The report notes that there is no law that establishes UBTS as an autonomous, self-accounting organisation, thus the weaknesses.
It also notes that UBTS is not accredited and lacks certification, is dogged by blood collection problems and, thereby, does not know the overall actual blood requirement of the country.
The report also observes that the organisation lacks a fully-fledged quality management unit and quality control systems for handling blood, has a shortfall of 70% on laboratory equipment for blood processing and did not provide adequate supplies for blood collection equipment to all regional blood banks and blood collection centres.
It also notes that the gaps include monitoring and evaluation, pre-and in-service education, ICT development and clinical interface.
According to the report, UBTS received funding to the tune of sh32m from both the Government and development partners in the financial years 2009/10 to 2011/12.
Lack of safe and adequate blood can lead to avoidable deaths and the spread of infections to recipients of unsafe blood.
According to the report, the UBTS blood bank records relating to issuance of blood to transfusing units were inaccurate. UBTS was also understating the blood requirement needs of the country by over 67%.
According to UBTS, the estimated blood need for the country stands at 200,000 units per year.
However, the report notes that UBTS does not know the actual blood requirement for the country.
The World Health Organisation (WHO) recommends collection from 2% of a country’s total population per year. However, for the period under review, Uganda’s annual average blood collection was short by 72.1 %.
The report notes that this is because UBTS sets its blood collection targets according to the number of teams available, instead of the recommended WHO standard of 2% of the total population of a country, especially for developing countries.
UBTS has another challenge of meeting the increased demand for safe blood, especially at health centre IVs, which are located in rural areas where most of the populace live, the report notes.
About 50% of the blood collected is used for treating children with severe anaemia, largely due to malaria, worms and malnutrition. Another 25% of the blood is used to treat pregnant women with anaemia and complications of child birth and 25% is used to treat accident or surgical cases.
The report has come out at a time when the country is grappling with an acute blood shortage, blamed on interruptions in the supply of blood donor kits and testing reagents. The blood shortage culminated in deaths in Jinja, Kumi and Soroti districts, which were hit hard.
UBTS speaks out
William Mugisha, the UBTS principal blood donor recruiter, yesterday defended the organisation, saying they explained a number of issues to the auditors, which they seem not to have captured.
“Our responsibility stops with distribution of blood. How hospitals store the blood is their responsibility and UBTS should not be blamed if the hospitals store the blood wrongly” Mugisha said.
“If hospitals are transfusing blood with maggots, I would take them to prison myself. It is unacceptable. May be you can blame us for lack of supervision, but not the rest,” he said.
Mugisha blamed some of the weaknesses at UBTS on what he termed as a narrow and restricted structure.