Challenges to blood donor notification on transfusion transmissible infections: a case study of Lodwar County and Referal Hospital Blood Bank Satelite
Blood donor notification on transfusion transmissible infections (Hepatitis B/C, HIV and syphilis) status is a mandated requirement of blood bank healthcare workers. Transfusion-associated transmissible infections notification faces many challenges despite national blood bank efforts in blood donor notification. The current study was aimed to determine challenges faced by healthcare workers in Lodwar county and referral hospital blood satellite Centre. The study was done retrospectively where secondary data of blood donor records between January 2017 and December 2018 were analyzed. Primary data was collected through a survey questionnaire that was administered to healthcare workers working in Lodwar county and referral hospital blood bank satellite to identify challenges faced in blood donor notification. The study population for primary data comprised of all healthcare workers working in the blood bank satellite, Lodwar county and referral hospital chief executive officer and the deputy equal, Turkana county laboratory coordinator and deputy director for medical services in the office of medical director for medical services. A total of three thousand nine hundred and ninety six donors donated blood out of which two hundred and ninety seven were TTI positive and only ten were notified. Two hundred and twenty four males and seventy-three females were positive for the TTIs in both study years, more male were TTI positive compared to female, TTI positivity for 2017 was higher compared to 2018 while HBV positivity was higher than that of other TTIs. Donor notification challenges were, factors in relation to procedures, people and policies as the major contributors to the challenges faced by healthcare workers in blood donor notification in order of importance respectively. A number of the respondents agreed that procedure related challenges majorly contributed to lack of donor notification and these were either due to lack of donor appointments, absence of standard operating procedures, difficulty in reaching donors, lack of donor notification implementation structure and lack of donor awareness of their need to be notified. Some of respondents agreed that people challenges affected donor notification due to shortage of human resource, high workload, lack of support supervision, and lack of donor appointments. The respondents agreed that policies surrounding issues like lack of operational structure, lack of current updates on donor notification process, and lack of scheduled clinic days for donor notification were some of challenges making donor notification ineffective. Some of the respondents were neutral on provision related challenges with only a few agreeing with it. Provision and place related challenges were as not as important or highly contributing to challenges faced by healthcare workers in donor notification. Given that only 7.4% of donors were notified it means there were challenges to donor notification and this study recommended the blood bank to put up structure in relation to the three major factors associated with their challenges at the blood bank management and other stakeholder’s management level. There are donors who are TTI positive and yet they are not notified as required by the blood transfusion services guidelines clearly showing that there are challenges faced by healthcare workers in donor notification. There is no clear explanation why TTI positivity was high in 2017 than in 2018, this could be attributed by may be change of donor age population, may be most of the donors were from a family replacement source of which this study did not explore. High positivity of TTI in males than in females could be due to male population who seek out for blood donation than their female counter parts, it is not clear also why iv HBV positivity was higher than the other TTIs. This could be because of high risk involved in HBV transmission and cultural/ social practices. Recommendation for this study is since donors are not notified as required; the blood bank needs to put up measures for effective donor notification by addressing the factors causing the challenges to donor notification. TTI positivity should be further studied to include age and find reasons as to why males have more TTIs than their female counter parts, why HBV is highly positive than other TTIs and why their was a high TTI positivity in 2017 than in 2018 and also expand years of secondary data sample to more than two years, there is need to increase scope of study to include other blood bank satellites in Kenya in order to meet the required study population minimum standards. A low number of study population was small since donor population was selected for only two years, it was also only focusing on TTI positivity and notification, there was no segregation of TTI according to ages and which age group was mostly affected or were positive for the TTIs. The study population for primary data did not meet the required statistical data analysis threshold and may not actually represent a considerable true factors contributing to lack of donor notification challenges by healthcare workers and also the case study was limited to one blood bank satellite. Other researchers are encouraged to pursue the same research problem or topic but have to include a more elaborate scope of study to include other similar blood bank satellites in Kenya in order to increase geographical and study population coverage. Prevalence on TTI positivity can be done for all satellites unlike the previously limited studies done in Nyeri and Kisumu alone in order to widen the research area findings in all satellites. TTI positivity should be studied to ascertain which age group or gender is mostly positive with blood donor TTIs, this will help in policy formulation for development of interventions aimed to address specific issues on donor notification of positive TTI status, due to high HBV positivity in blood donor blood and in males, there need to study the reasons as to why HBV is higher than other TTIs and why the males are the mostly affected. Other research studies could focus on blood transfusion policies that support blood donation through research policy formulation especially on donor notification guidelines for school going donors.