Exploring barriers and facilitators to blood donation in secondary schools in Malawi.

Background And Objective: Despite the Malawi Blood Transfusion Service (MBTS) increasing the amount of blood collected since its inception in 2004, Malawi remains with a 27% deficit in required blood supplies nationally. We sought to understand the facilitators and barriers to blood donation among secondary school students in Malawi.

Methods: We utilised a qualitative exploratory design, with a sample of 135 participants purposefully selected from 16 secondary schools across Malawi.

Use of routinely collected blood donation data for expanded HIV and Syphilis surveillance in Blantyre district, Malawi.

The World Health Organization recommends that all blood donations be screened for transfusion transmissible infections; these data are currently not incorporated into national disease surveillance efforts. We set out to use routinely collected data from blood donors in Blantyre district, Malawi to explore HIV and syphilis prevalence and identify sero-conversions among repeat donors. We conducted a retrospective cohort analysis of blood donation data collected by the Malawi Blood Transfusion Service from 2015 to 2021.

Systematic review of prevalence and risk factors of transfusion transmissible infections among blood donors, and blood safety improvements in Southern Africa.

Blood and blood products are listed as one of the essential medicines by the World Health Organization (WHO). In addition to inadequate supply, most sub-Saharan Africa (SSA) nations fail to meet their blood needs because many donated blood units are discarded because they are contaminated with transfusion-transmitted infections (TTIs). We sought to estimate the prevalence of TTIs, identify the risk factors for TTIs among blood donors, and identify the efforts and interventions that have been made to improve blood safety in Southern African nations, particularly the nations of the South African Development Community (SADC).

Automated measurement of malaria parasitaemia among asymptomatic blood donors in Malawi using the Sysmex XN-31 analyser: could such data be used to complement national malaria surveillance in real time?

Background: The recent worldwide increase in malaria cases highlights the need for renewed efforts to eliminate malaria. The World Health Organization advocates that malaria surveillance becomes a core intervention. Current methods to estimate the malaria burden rely on clinical malaria case reports and surveys of asymptomatic parasite infection mainly from children  < 5 years.

Meeting demand-Obstetric hemorrhage and blood availability in Malawi, a qualitative study.

Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in Malawi. Despite the presence of a centralized institution supplying blood and blood products for hospitals across the country, a lack of timely blood transfusion has been identified as a critical barrier to successful PPH management. This study aims to understand the factors that affect the blood delivery pipeline and adequate access to blood products for postpartum haemorrhage patients.

Evaluation of the Sysmex XN-31 automated analyser for blood donor malaria screening at Malawi Blood Transfusion Services.

Background And Objectives: Balancing blood supply safety and sufficiency is challenging in malaria-endemic countries where the risk of transfusion-transmitted malaria (TTM) is ever-present. In support of reducing this risk, our study aimed at evaluating the performance of the Sysmex XN-31 analyser in blood donor malaria screening, as compared with current practice in Malawi.

Materials And Methods: This prospective observational study was conducted on remnant venous donor blood samples collected at Malawi Blood Transfusion Service donation sites countrywide for routine blood-borne pathogen screening.

Transfusion management of severe anaemia in African children: a consensus algorithm.

The phase III Transfusion and Treatment of severe anaemia in African Children Trial (TRACT) found that conservative management of uncomplicated severe anaemia [haemoglobin (Hb) 40-60 g/l] was safe, and that transfusion volume (20 vs. 30 ml/kg whole blood equivalent) for children with severe anaemia (Hb <60 g/l) had strong but opposing effects on mortality, depending on fever status (>37·5°C). In 2020 a stakeholder meeting of paediatric and blood transfusion groups from Africa reviewed the results and additional analyses.

Seroprevalence and trends in transfusion transmissible infections among voluntary non-remunerated blood donors at the Malawi Blood Transfusion Service-a time trend study.

Introduction: Collecting blood from voluntary non-remunerated blood donors from low risk populations is a key strategy for blood safety. Identifying such populations involves analysis of population and blood donor data to identify risk factors for transfusion transmissible infections (TTIs). There are no recent seroprevalence statistics for blood donors in Malawi.

Transfusion Volume for Children with Severe Anemia in Africa.

Background: Severe anemia (hemoglobin level, <6 g per deciliter) is a leading cause of hospital admission and death in children in sub-Saharan Africa. The World Health Organization recommends transfusion of 20 ml of whole-blood equivalent per kilogram of body weight for anemia, regardless of hemoglobin level.

Methods: In this factorial, open-label trial, we randomly assigned Ugandan and Malawian children 2 months to 12 years of age with a hemoglobin level of less than 6 g per deciliter and severity features (e.

Immediate Transfusion in African Children with Uncomplicated Severe Anemia.

Background: The World Health Organization recommends not performing transfusions in African children hospitalized for uncomplicated severe anemia (hemoglobin level of 4 to 6 g per deciliter and no signs of clinical severity). However, high mortality and readmission rates suggest that less restrictive transfusion strategies might improve outcomes.

Methods: In this factorial, open-label, randomized, controlled trial, we assigned Ugandan and Malawian children 2 months to 12 years of age with uncomplicated severe anemia to immediate transfusion with 20 ml or 30 ml of whole-blood equivalent per kilogram of body weight, as determined in a second simultaneous randomization, or no immediate transfusion (control group), in which transfusion with 20 ml of whole-blood equivalent per kilogram was triggered by new signs of clinical severity or a drop in hemoglobin to below 4 g per deciliter.

Haematological quality and age of donor blood issued for paediatric transfusion to four hospitals in sub-Saharan Africa.

Background And Objectives: Paediatric blood transfusion for severe anaemia in hospitals in sub-Saharan Africa remains common. Yet, reports describing the haematological quality of donor blood or storage duration in routine practice are very limited. Both factors are likely to affect transfusion outcomes.

A pilot study to determine the normal haematological indices for young Malawian adults in Blantyre, Malawi.

Background: Reference ranges for haematological and other laboratory tests in most African countries are based on populations in Europe and America and, because of environmental and genetic factors, these may not accurately reflect the normal reference ranges in African populations.

Aim: To determine the distribution of haematological parameters in healthy individuals residing in Blantyre, Malawi. We also examined the effect of sociodemographic and nutritional factors on the haematological variables.

Transfusion and Treatment of severe anaemia in African children (TRACT): a study protocol for a randomised controlled trial.

Background: In sub-Saharan Africa, where infectious diseases and nutritional deficiencies are common, severe anaemia is a common cause of paediatric hospital admission, yet the evidence to support current treatment recommendations is limited. To avert overuse of blood products, the World Health Organisation advocates a conservative transfusion policy and recommends iron, folate and anti-helminthics at discharge. Outcomes are unsatisfactory with high rates of in-hospital mortality (9-10%), 6-month mortality and relapse (6%).

Validation of the haemoglobin colour scale for screening blood donors in Malawi.

Background: In 2009 Malawi introduced a new protocol to screen potential blood donors for anaemia, using the WHO Haemoglobin Colour Scale (HCS) for initial screening. Published studies of the accuracy of the HCS to screen potential blood donors show varying levels of accuracy and opinion varies whether this is an appropriate screening test. The aim of the study was to assess the validity of the HCS, as a screening test, by comparison to HemoCue in potential blood donors in Malawi.

Quality in practice: implementation of hospital guidelines for patient identification in Malawi.

Quality Problem Or Issue: Patient identification in a teaching hospital in Malawi. Initial assessment 34% of hospital staff recalled a misidentification event in the preceding year; less than 10% of staff described the use of unique patient identifiers other than name when taking blood samples and 98% of laboratory requests included no identifiers other than name.

Choice Of Solution: Hospital identification guidelines based on WHO guidelines to introduce identification wristbands; encourage routine use of an identifier in addition to name on laboratory requests and improve bedside identification procedures.

Elevated plasma von Willebrand factor and propeptide levels in Malawian children with malaria.

Background: In spite of the significant mortality associated with Plasmodium falciparum infection, the mechanisms underlying severe disease remain poorly understood. We have previously shown evidence of endothelial activation in Ghanaian children with malaria, indicated by elevated plasma levels of both von Willebrand factor (VWF) and its propeptide. In the current prospective study of children in Malawi with retinopathy confirmed cerebral malaria, we compared these markers with uncomplicated malaria, non malarial febrile illness and controls.

Development and evaluation of a new paediatric blood transfusion protocol for Africa.

Severe anaemia is a common childhood emergency in developing countries. Practical evidence-based guidance on when to transfuse, volume of transfusion and ideal duration of transfusion is lacking. The aim of this study is to develop a paediatric transfusion protocol for use in under-resourced environments and evaluate its usability in a busy African hospital setting.

The prevalence of red-cell antigens and antibodies in Malawi.

As there were no reliable data in Malawi for the prevalence of red cell alloantibodies or antigens in the population, a study was conducted to screen 1000 patients for the presence of antibodies and to type them for ABO, RhD, C, c, E, e and K antigens and to test 500 donors for these antigens plus Fy(a), Fy(b), Jk(a), Jk(b), S and s. Red cell antibodies were identified in 11 patients [1.1%]; 2 were anti-D, 2 anti-S, 1 anti-Le(a+b) and 6 anti-M, 4 of which were found in non-transfused males suggesting they might be naturally acquired.

Regulation of squalene synthetase and squalene epoxidase activities in Saccharomyces cerevisiae.

Squalene synthetase (EC 2.5.1.