The collection unit is the simplest type of center in a remote area in charge of collecting blood from donors and sending it to a bigger blood center (regional or national). They are not supposed to screen for TTI or to prepare blood products. Among the participating centers in this study, 12 were regional, six were national, six were hospital blood banks, and four were blood collection units only (). Among 14 centers that provided data on blood unit deficit, the majority (64%) reported a shortage of 1000 to 9999 units. Of 28 centers, 23 (82%) had a recruitment department to promote blood donation and organize blood collection. Among 24 centers who responded to the question regarding number of donor candidates for year 2009, 59% reported an estimated 10,000 or more donors in 2009, and 33% centers reported fewer than 5000 donors. Of 21 centers, 19 (90%) had excluded fewer than 5000 donors per year. Twenty centers provided the demand of blood products, which added up to 370,373 units in 2009, for a supply of 302,856 donations (representing only 82% [range, 27%–100%] fulfillment of the demand). The total numbers of units collected by each type of blood center were 98,445, 171,055, 20,622, and 12,734, respectively, for the national blood center, the regional blood center, the hospital-based blood center, and the collection unit. The median numbers (range) of units collected were, respectively, 21,630 [7104–29,045], 15,651 [7956–44,135], 2537 [161–12,500], and 2201 [1701–6632]. A median of 23% (range, 0%–96%) of blood products were obtained through mobile blood collection.
Collection characteristics among 28 participating blood donation centers in francophone Africa in 2009
The total number of donor candidates among all centers from January 1, 2009, to December 31, 2009, totaled 366,924 (). Among the candidates, a median of 12% (range, 0%–36%) were deferred based solely on the medical selection process. Voluntary non-remunerated blood donors constituted 61% of all blood donors. No center mentioned having paid blood donors. Only nine blood centers of 22 using the questionnaire asked the question on type of donation during interview. All of them (22) excluded paid donors ( and ). The others six centers did not mention paid donation in the interview nor during donor deferral. Repeat donors constituted 24% of all donors. The median age of donors (provided by 15 centers) was 35 years old (range, 25–42 years). All of the blood centers performed the test for HIV, HBV, HCV, and syphilis infections. The proportions of donors across centers having TTIs were 1.8, 6.8, 2.5, and 1.7% for HIV, HBV, HCV, and syphilis infections, respectively. Blood centers excluding more than 20% of their blood donor candidates did not have a lower prevalence of ID markers.
Blood donor characteristics among 366,924 donor candidates in 28 participating blood donation centers in francophone Africa in 2009
Donor medical history questionnaire content
Exclusion criteria for blood donors after the medical selection process
Donor education before the donation was done by all the centers but was systematically done in only 20 centers. The staff in charge of informing the donors was nonmedical personnel in nine centers, professionals (pharmacists, biologists, and physicians) in 23 centers, nurses in 17 centers, and technicians in 16 centers (). The information relayed to the donors included risk factors, possibility of self-exclusion, and criteria for donation blood. This information was conveyed verbally in 21 centers. Of 28 centers, 23 centers had a brochure or flyer as a way to educate donors. Among centers using posters to provide information, 60% were regional and 30% were collection units, but no posters were used in hospital-based settings. Among those using brochures or flyers, 52% were regional and 22% national. No collection units used verbal information. Among nurses, physicians, pharmacists, and biologists who provided predonation information and performed interviews, nearly half were in regional centers and less than 25% were in hospital-based centers. Among nonmedical personnel performing predonation interviews, 60% were in regional centers, 29% were in hospital-based settings, and none were in collection units.
Management of predonation donor-related information among 28 participating blood donation centers in francophone Africa in 2009*
Interviewing donors on their medical history was performed systematically in 22 centers and “not always” in four centers. Six centers did not provide a standard questionnaire (verbal or written) to determine the donor’s medical history. The questionnaire was verbal in seven centers and written in 15 centers. The questions were mostly aimed at determining the safety of the donor (able to donate) and of the recipient (risk factors and behaviors). Among the four centers having a questionnaire addressing all the topics evaluated by this study, two were regional, one was national, and one was hospital based.
The questions on the type of donation, complications relating to the donation, religious scarification, and history of sickle cell anemia and hemorrhage were the least frequently asked (). Informed consent was required in 27 centers and was written in eight of them.
All the centers administered a physical examination to the donor before the donation. The most commonly examined variables were blood pressure (28 centers), weight (24 centers), and pulse (12 centers); a complete physical examination was performed in 25 centers. Three centers recorded temperature and two recorded the height. The minimum weight allowed was 50 kg in 20 centers and not specified in the others. At completion of the physical examination, the centers retained the blood donors who did not present any of the deferral criteria listed in .
The main behaviors considered at risk for infectious agents reported by the participating centers were, in order of frequency, recent fever (28 centers), jaundice (28 centers), recent hospitalization (28 centers), sexual relationship with a prostitute (28 centers), transfusion (27 centers), and chronic cough (27 centers; ). Routine procedures (dental extractions, traditional bloodletting) and history of blood transfusions were identified as risk factors for infection by three centers.
Predonation testing was performed in 13 centers and was always accompanied by postdonation testing. The proportions of centers performing the screening tests before blood donation was 77, 70, 70, 46, and 31% for HIV, HBV, HCV, Hb concentration, and malaria, respectively. No biological screening for sickle cell anemia was completed. We did not gather data on the type of testing performed for each of these variables.
Regarding the centers’ hemovigilance after donation, 18 centers collected information from the donors in the hours or days after the donation. Ten centers placed the blood collected in quarantine for 1 to 5 days.