In poor countries, blood is neither plentiful nor safe.
The Challenge of Sufficiency
WHO estimates that the average donor participation rate in the high-income countries is 37 per 1000 (3.7%) of population; in low-income countries this is 4 per 1000 (0.4%).
They suggest that even in a country lacking a sophisticated health infrastructure, 1% is the minimum participation rate for a sustainable blood supply. But of 168 countries surveyed a total of 75 have less than 1% participation – and all are low or middle-income. Sub-Saharan Africa has a population of over 700 million people but only around four million units of blood.
There are simply not enough donors coming forward to meet even the most basic needs of patients in these countries.
The Challenge of Safety
Around the globe, it is estimated that over 100 million donations of blood are collected each year.
The developed world – accounting for most of these donations – has two strategies for managing the risk of what are known as transfusion transmitted infections (TTIs) and thus ensuring blood safety.
- Blood is taken only from those who are seen as “safe donors” and who therefore present a low risk to patients
- All blood collected is then tested for a range of blood-borne viruses including HIV, syphilis, malaria and hepatitis.
In contrast, in resource-poor countries, blood is often accepted from whoever can or will donate – and many millions of units undergo no or limited, poor quality testing.
These untested units from donors of unknown provenance are then transfused to vulnerable patients.
In meeting their critical clinical need in this way, they may consequently be condemned to a lifetime of chronic illness and a condition that may lead directly to premature death.