Development and evaluation of community-based approaches and donor care intervention models for improving availability and safety of blood for the management of severe anemia in Ghana

摘要 该项目旨在将加纳的献血者池从家庭替代捐献转变为 (FRD)到自愿收集。根据世卫组织的建议，加纳的国家血液政策旨在 100%自愿献血池，以确保和维持充足和安全的血液供应，自自愿以来 献血者更有可能定期献血。输血服务面临的主要挑战 在撒哈拉以南非洲(SSA)，越来越多的临床对血液的需求和历史上 该地区安全血液供应不足。随时可以获得的血液供应不足和不规律 紧急输血是产科出血死亡率高的主要原因。我们有 确认加纳的献血制度是提供充足和定期血液的主要障碍 以满足国家的输血需求。目前，加纳70%以上的血液采集是通过 家庭替代捐赠者制度(FRD)，与不足、不可持续和相对 紧急情况下不安全的血液供应。相比之下，各国的平均比率为每1000人31人 加纳拥有100%自愿献血的基础，每1000人中只有5人献血。作为一名 直接结果，血液供应的特点是长期不足，经常出现严重短缺，以及 这是一项重大的发展挑战。我们的长期目标是确保充足的可持续供应 通过在加纳建立一种新的献血模式，专注于 以社区为基础的志愿者制度和营养捐赠者的充实。贫血占高达53%的 自愿捐赠者延期，因此，这是目前应用的主要重点。此外，恐惧， 与对献血的误解以及缺乏关于血液的知识和信息有关 献血是加纳献血志愿者数量较少的原因之一。以社区为目标 献血不是作为个人，而是作为社区(社区集体主义)，以互惠模式 确保血液可供自己的社区未来使用提供了一个有吸引力的战略，以招募新的 志愿者。以社区集体主义为基础，以沟通策略为辅助的干预措施 SSA在文化上是合适的，但尚未被探索用于提高献血率。另外， 献血不足的其他可改变的原因--动机、获得献血设施的机会、营养-意志 使用改进的沟通、行为改变方法和铁质补充剂成为目标 改善捐助者的整体招募和留住情况。我们将评估提高可用性的影响 志愿者社区来源的血液减少社区与出血相关的孕产妇死亡 医院。基于这些想法，我们将检验总体假设：一名社区志愿者 针对复发献血者的营养补充模式将有助于克服 加纳血液供应的发展挑战“。

Summary This project is directed towards transforming the blood donor pool in Ghana from family replacement donations (FRD) to voluntary collections. In line with WHO recommendations, the national blood policy in Ghana aims at 100% voluntary blood donation pool to secure and sustain an adequate and safe blood supply, since voluntary blood donors are more likely to donate on a regular basis. The major challenge for blood transfusion services in sub-Saharan Africa (SSA) is the juxtaposition of an increasing clinical demand for blood and a historically insufficient supply of safe blood in the region. The inadequate and irregular supply of blood readily available for emergency transfusions play a cardinal role in the high mortality rates in obstetric haemorrhage. We have identified the system of blood donation in Ghana as the major barrier to providing adequate and regular blood to meet the transfusion needs of the country. Currently, over 70% of blood collection in Ghana is obtained in a Family Replacement Donor (FRD) system, which is associated with insufficient, unsustainable and relatively unsafe supply of blood for emergencies. In contrast with an average rate of 31 per 1000 population in countries with a 100% voluntary blood donor base, blood donation in Ghana remains at only 5 per 1000 population. As a direct result, blood supply is characterized by chronic inadequacy with frequent critical shortages, and represents a major developmental challenge. Our long-term goal is to secure a sustainable supply of adequate and safe blood in Ghana by establishing a new paradigm of blood donation in the country focused on a community-based volunteer system and nutritional donor enrichment. Anaemia accounts for up to 53% of voluntary donor deferrals and is, therefore, a major focus of the current application. In addition, fears associated with misconceptions about blood donation, and the lack of knowledge and information on blood donation contribute to the low number of blood donation volunteers in Ghana. The targeting of communities to donate blood not as individuals but as communities (communal collectivism), with a reciprocity model that ensures blood is available for future use by their own communities offers an attractive strategy to recruit new volunteers. Interventions based on communal collectivism and aided by communication strategies are culturally appropriate in SSA but have not yet been explored for increasing blood donation rates. Additionally, other modifiable causes of inadequate blood donation—motivation, access to donation facilities, nutrition—will be targeted using improved communication, behavioural change methods, and iron supplementation to improve overall donor recruitment and retention. We will evaluate the impact of increased availability of volunteer community-sourced blood on reduction of haemorrhage-related maternal deaths in community hospitals. Based on these ideas, we will test the OVERALL HYPOTHESIS “A community-based volunteer and nutritional donor enrichment model towards recurring blood donors will help to overcome the developmental challenge of blood availability in Ghana”.