Blood safety and maternal mortality in the African Region

Every day, about 800 women die from pregnancy or childbirth-related complications. Almost all of these deaths occur in developing countries. More than half of them occur in sub-Saharan Africa. The African Health Observatory (AHO) gives an overview of the situation in the African Region concerning blood donations, supply and safety. Great progress has been made in recent years, however universal access to safe blood supply remains a challenge for many countries in the Region.

Severe bleeding during delivery or after childbirth is the commonest cause of maternal mortality and contributes to around 34% of maternal deaths in Africa. Timely access to safe supplies of blood for transfusion is critical to saving these women’s lives.

In many countries, family members are often pressured to donate blood or find a replacement donor in an emergency situation. This causes emotional and financial stress for both the family and the blood donors and may result in significant delays in obtaining suitable blood. It also puts women at risk of bloodborne infections, as there is often no time or facilities to properly screen the donated blood.

Equitable blood access

In many low and middle-income countries, blood supply is critically inadequate. Sub-Saharan Africa, which has the highest maternal mortality rate in the world also has the lowest blood donation rates.

There is a marked difference in the level of access to blood between low and high-income countries: About 108 million blood donations are collected worldwide every year; almost half of these are collected in high-income countries, home to just 15% of the world’s population.

37 African countries collect less than 10 blood donations per 1000 population per year; of these, 25 countries collect less than half the blood that they need to meet transfusion requirements. High-income countries collect around 35 donations per 1000 population per year.

In low-income countries, above 70% of blood transfusions are given to children and mothers; whereas in high-income countries, the most frequently transfused patient group is over 65 years of age (76% of all transfusions).

Life-saving interventions

Blood transfusion has been identified as one of the nine key life-saving interventions for the management of pregnancy-related complications, as part of a comprehensive approach to maternal and newborn care that should be available in all facilities providing comprehensive emergency obstetric care.

Yet in 2014, almost 40 years after the first World Health Assembly resolution (WHA28.72) addressed the issue, equitable access to safe blood for obstetric care still remains a major challenge.

The safest source of blood is from regular, voluntary unpaid donors whose blood is previously screened for infections. These donors are also the safest group of donors as the prevalence of bloodborne infections is lowest among this group.

Data reported to WHO shows significant increases of voluntary unpaid blood donations in low and middle-income countries. The voluntary unpaid blood donations in the African Region increased 51% from 2004 to 2012.

Twenty four countries in the Region reported collection of blood from at least 80% or more voluntary non-remunerated blood donors in 2012: Algeria, Benin, Botswana, Burkina Faso, Burundi, Cabo Verde, Central African Republic, Côte d’Ivoire, Eritrea, Kenya, Lesotho, Malawi, Mauritius, Namibia, Nigeria, Rwanda, Senegal, South Africa, Swaziland, Togo, Uganda, United Republic of Tanzania, Zambia and Zimbabwe.

WHO’s goal is for all countries to obtain 100% of blood supplies from voluntary unpaid donors by 2020.

Improvements in the Region

At Regional level, the Blood Safety, Laboratories & Health Technology Programme Area Component from WHO Regional Office for Africa supports Member States in attaining improved health and reduced morbidity and mortality through the safety, availability and appropriate use of essential health technologies within health systems.

In 2001, the Regional Office adopted a strategy for blood safety with the aim of improving both the quality and adequacy of blood supply through sustainable implementation of blood transfusion policies in all countries in the Region. Reports on the status of blood safety in the WHO African Region in 2004, 2006 and 2010 showed improvements in the status of blood transfusion services.

According to the 2010 report, the number of countries with national blood policies and those implementing their policies through strategic plans has increased although the enactment of enabling legislation remains a matter of concern in most of the countries. The progress made differed from country to country. For instance, Cabo Verde made great progress from 2006 to 2010, increasing the proportion of voluntary non-remunerated blood donors from 35% to 77.3%. Yet, other countries show decline in the same period. Paid donations were reported only in the Democratic Republic of the Congo, representing a small proportion (4.98%) of their total collections.

Useful resources
The Atlas of African Health Statistics 2014
Status of blood safety in the WHO African Region 2010
Brochure “Towards 100% voluntary blood donation”
WHO guidelines “Blood Donor Selection”
Blood safety and availability, WHO Fact sheet n. 279, updated June 2014

Other resources
Blood Safety, Laboratories & Health Technology Programme Area Component, WHO Regional Office for Africa
WHO Blood transfusion safety documentation centre
WHO Global database on blood safety
WHO World Blood Donor Day 2014 brochure
World Blood Donor Day 2014 video

Photos: World Blood Donor Day 2014 in WHO Regional Office for Africa, Brazzaville, Congo.             WHO/AFRO