OVERVIEW OF NATIONAL BLOOD TRANSFUSION

SERVICE (NBTS)

BY

OKEREKE BENSON CHIMEZIE BLOOD,NBTS/ CLUB 25/YEP FOCAL PERSON.

Health Status• Economic downturn in the mid-80s led to sharp

decline in social service _ health perhaps the worst hit.

• Most of disease burden is due to preventable diseases.

• Poverty is the major cause of these problems• Maternal mortality rate is one of the highest in the

world(800-1,000/100,000 births).• Under-5 mortality rate is higher than the average for

Sub Saharan Africa.• Life expectancy is 52years.

Health Institutions

• 60 Tertiary health institutions• About 700 General and District Hospitals• 15,000 private Health institutions

• Blood transfusion service in Nigeria was fragmented, mainly hospital-based and with little regulation before establishment of the National Blood Transfusion Service

• The prevention efforts targeted at HIV/AIDS was noted to be incomplete without prevention of new infections from unsafe blood

The Nigerian situation

• Where we are• Fragmented blood

transfusion services

• Use of paid donors and family replacement

• Screening of transfused blood with rapid test kits – mainly HIV only

• Poorly regulated and coordinated system

Where we hope to be• Nationally coordinated

blood transfusion service

• Acceptance of the concept of voluntary blood donation as entrenched in the National Blood Policy

• Screening of transfused blood for four mandatory TTIs by WHO minimum standards

• Well regulated and coordinated system with proper documentation

• NBTS was established in Dec 2004 by the Government of Nigeria in response to the poor blood safety practices in the country

• A National Blood Policy was approved and launched in the year 2006. This political will is the backbone of the progress of the NBTS in Nigeria

North West

North East

North Central

South West

South South

South East

MaiduguriKaduna

Abuja

Jos

Owerri

Ibadan

Port-Harcourt

Benin-City

Sokoto Nangere-Potiskum

Lokoja

Abeokuta

Calabar

Map Showing All NBTS Sites (established & proposed for 2008)

Ado-Ekiti

Enugu

Jalingo

Katsina

Lagos State Blood Service

The Progress So Far

• 17 established centers with 12 of these centers fully operational with support from PEPFAR

Also Lagos State Blood Service.• Guidelines on Blood Transfusion Practice available and

disseminated. • Guidelines on Appropriate Use of Blood and Blood

Products reviewed, awaiting final approval before printing and dissemination.

• Comprehensive baseline data on blood transfusion conducted in March 2007.

• Best practices instituted in all NBTS centres.

Blood Collection

• Estimated total number of blood units needed by Nigeria is 1,125,600 (WHO AFRO estimate) – based on12 beds per 10,000 populations, usage of 6.7 units of blood per bed multiple and a population of 140,000,000. The blood needs estimate represents 0.8% of Nigeria population.

• A total of 16,987 units of blood was collected in all the NBTS operational centres over the period 1st January, 2007 to 31st December, 2007.

• A total of 62,381 units of blood was collected over the same period above by NBTS and 53 pilot hospitals linking with the NBTS.

Blood Collection by NBTS Centres (1st Jan, 2007 - 31st Dec, 2007)

NBTS BLOOD COLLECTION 2007    

                           

CENTRE

MONTH    

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL

ABUJA (Commenced Dec. 2004) 104 89 169 139 167 107 251 130 266 412 276 332 2,442

KADUNA (Commenced Aug. 2005) 137 236 392 55 120 121 283 244 210 269 456 244 2,767

OWERRI (Comenced Nov. 2005) 109 297 267 23 151 236 260 254 178 195 228 201 2,399

IBADAN (C0mmenced Jul. 2006) 221 202 178 19 139 146 114 205 230 149 360 339 2,302

LOKOJA (Commenced Mar. 2007)     11 96 127 159 236 202 295 315 426 206 2,073

JOS (Cmmenced Mar. 2007     12 31 232 207 291 242 429 377 259 240 2,320

MAIDUGURI (Commenced May 2007)         17 147 110 114 69 219 255 117 1,048

Benin (commenced Sept 2007)                 157 362 403 627 1,549

Port-Harcourt (commenced Aug/Sept 2007)               3 2 8 61 13 87

TOTAL 571 824 1,029 363 953 1,123 1,545 1,394 1,836 2,306 2,724 2,319 16,987

NBTS/Hospitals Linkage Programme

The NBTS/Hospital Linkage programme is a collaboration between the NBTS, Lagos State Blood Transfusion Service and hospitals.

The goal of the programme is to ensure availability of safe blood in hospitals.

The objectives of the programme:• To encourage hospitals to send blood samples obtained from

family replacement and voluntary donors to NBTS for centralised screening for the mandatory 4 transfusion transmissible infections (HIV 1&2, Hepatitis B, Hepatitis C and Syphilis) by machine-readable ELISA method.

• To encourage the establishment of hospital transfusion committees where these do not already exist.

• To ensure that adequate amount of safe blood is available in hospitals.

NBTS/Hospitals Linkage Programme - 2

• As a result of advocacy towards the realisation of the above objectives, a total of 2,816 units of blood collected by hospitals have been submitted to the NBTS for screening as at 31st March, 2008.

• Fifteen(15) hospitals have either inaugurated or resuscitated their hospital transfusion committees.

Geopolitical Zone Hospitals with Hospital Transfusion Committees

South-South •University of Benin Teaching Hospital, Benin-City•Delta State University Teaching Hospital, Warri

South-West •University College Hospital, Ibadan•Lagos University Teaching Hospital, Lagos•Federal Medical Centre, Abeokuta

South-East •Imo State University Teaching Hospital, Orlu.•Federal Medical Centre, Owerri•Living word mission Hospital-Aba•General Hospital- Awka•St Charles Borroweo Hospital- Onitsha

North-Central •Jos University Teaching Hospital, Jos•Federal Medical Centre, Makurdi•Federal Medical Centre, Lokoja•Federal Medical Centre, Bida

North-East •University of Maiduguri Teaching Hospital, Maiduguri•State Specialist Hospital, Maiduguri•Federal Medical Centre, Nguru

North-West Barau Dikko Specialist Hospital

TTIs Prevalence Among Blood Donors and in the General Population

TTIs prevalence rates among blood donors and in the general population

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

HIV Hepatitis B HepatitisC

SyphilisTTIs

Preva

lence

Rates

(%)

National Prevalence Rates (%) NBTS Prevalence Rates Among Donors (%)

TTIs National Prevalence Rates (%)

NBTS Prevalence Rates Among Donors (%) (2006)

NBTS Prevalence Rates Among Donors (%) (2007)

HIV (2005) 4.4 3.0 (1st Time donors)0.1 (Regular donors)

2.5

Hepatitis B 12.0 9.7 10.9

Hepatitis C 3.0 3.0 2.5

Syphilis <1 0.8 0.3

Age & Sex Distribution of Blood Donors (Jan-Mar 2008)

% Age Distribution of Blood Donors

18-25 yrs (46.60%)

56-65yrs (2.10%)

26-35yrs (33.90%)

36-45yrs (12.20%)

46-55yrs ( 5.20%)

Sex Distribution of Donors

maleDonors

80%

FemaleDonors

20%

First Time & Repeat Donors, NBTS Kaduna

1st Time Donors, 82.30%

Repeat Donors, 17.70%

Walk-in Donors and Mobile Blood Drive Donors, NBTS Kaduna

Walk-in Blood Donors, 16.90%

Mobile Drive BloodDonors, 83.10%

Clinical Needs for Blood -Utilisation pattern

• Nutritional and malaria induced anaemias• Road Traffic Accidents• Surgical interventions• Gynaecological procedures• Internal Medicine

Blood Use

• 80% as whole blood• 15% as packed cells• 5% as components• Points to non-optimal use of blood and

components• Components produced in a few Centres –

mainly Teaching Hospitals• Not due to lack of knowledge but lack of

Equipment

Strengths and Weakness• Now, strong political will to organise a centralised

system.• Health System Reforms in progress.• Big country- 130 million people.• Some of the most endowed persons in Sub Saharan

Africa.• Centralised system expensive to establish.• Country is large(900,000sq km).• Poor, neglected infrastructures.

Success Stories• A centralised NBTS now in operation after 4 decades.• A revised National Blood Policy, Operational guidelines and

Baseline Data survey disseminated now.• Operational centres in Abuja, Kaduna and Owerri• Ibadan, Port-Harcourt, Jos, Maiduguri, Abeokuta to follow

this year.• Developed crop of young-volunteer, non-remunerated blood

donors.• Donor Clubs being organised Nationwide.• Developed awareness of healthy lifestyle among donors.• Organised local training for all categories of staff including

policy makers.• Developed concept of safe and best laboratory practices

Challenges• Shortage of skilled professionals particularly in donor

care management.• Overcome fears, myths, attitude and apathy of

Nigerians about blood donation.• Poor communication network and linkages.• Issues of regular supplies of laboratory equipment

and consumables.• Orientation of work attitudes in a service like the

NBTS.

Challenges cont.• Promotion of VNRD nationwide.• Conversion of FRD to VNRD.• Establishment of Hospital Transfusion Committees in

more hospitals.• Reduction of blood screened by rapid tests in

hospitals.• Need for centralised screening or centrally

coordinated screening through NBTS approved centres.

• Logistic challenges- poor road network, power supply (being addressed using solar power)

WAY FORWARD

• Stronger advocacy and sensitisation of policymakers at all levels ‘to buy’ into the programme

• Increased donor awareness campaigns. There is a need to conduct a KAP study so as to specifically address identified concerns on voluntary donation of blood

• Increased collaboration with hospitals to establish and strengthen NBTS linkage with hospitals

• Advocacy for hospital transfusion committees to standardize clinical use of blood and blood products.

Future Plans

• States persuaded on legislation to ban commercial blood donors & banks

• Public Private participation with telecommunication companies to enhance follow up of VNRD and encourage new donors

• Mount aggressive campaigns for development of donor clubs Nationwide

• Continuing staff training and capacity building• Improve on performance of the Zonal Centres

Opportunities

• Strong political will.

• Increasing number of NBTS Centres.

• Large pool of human resource.

• Large pool of potential donors.

• Support from donor agencies and developmental partners.

.

Threats

• Political instability.• Frequent posting of trained staff.• Reluctance to voluntary blood donation due to cultural and

religious taboos, myths etc.• Poor basic infrastructure making it expensive to run NBTS centres• Uncooperative attitude of health workers and blood service

outlets to change to a centrally coordinated system.

CONCLUSION

• NBTS is on track and has the human capacity to succeed.

We are sufficiently encouraged by the

Nigerian spirit which when it

ignites, fires on and on and on and

on………

Thank you for your attention!