On Sunday, June 4, Nigeria was shaken by the news of a horrendous attack on a Christian Catholic Church in Owo, Ondo State, South-West Nigeria, in which over thirty people – men, women, and children – were killed, and hundreds critically injured. Barely two months earlier, a violent attack on an Abuja-Kaduna train left several passengers killed, and numerous others either taken hostage, or left terribly injured.
In Ondo, as it had occurred earlier in Kaduna, almost immediately, the State was hit by a massive blood shortage, and desperate calls were made to the public to donate blood and save those whose lives were hanging in the balance. Social media was awash with tweets and posts stressing the urgent need for blood, and people responded in large numbers, with young people trooping to Federal Medical Centre, Owo to donate blood for people they knew, and even more people donated for those who they didn’t know.
Over the past decade and a half, numerous disasters on a national scale have led to this kind of widespread call for blood donations. Building collapses; oil tanker explosions; and bomb blasts at the United Nations office in Abuja, bus terminals, markets, and the capital’s Eagle Square, are examples of the events that have threatened lives, and strained national blood supplies. But the truth is, as horrific as these headline-grabbing incidents have been, they represent a small portion of the incidents that lead people to need lifesaving blood donations.
For instance, road traffic accidents and complications from childbirth are also major contributors to the loss of hundreds of lives daily. Every minute in Nigeria, approximately six women die from pregnancy and childbirth-related causes, especially from blood loss; and every day up to 104 people lose their lives on the country’s roads and highways. Many families are therefore left bereft of their loved ones in situations that should have been joyous – pregnancy, childbirth, and even journeys home.
Currently, 49 per cent of Nigeria’s population is female, and 51 per cent of that demography are in their reproductive years (15-49 years), which is a staggering nearly 50 million women who stand the risk of dying either during pregnancy or delivery. In addition to this gruesome statistic, according to the World Health Organisation (WHO), approximately three-quarters of all road traffic deaths occur among young males below 25 years of age, and road traffic injuries are reportedly the leading cause of death for children and young adults aged 5-29 years. A significant cause of these deaths in both cases is the lack of prompt access to blood in such scenarios. For low- and middle-income countries, for whom a large proportion of the population are within these age categories, the unavailability of safe blood has implications not only for health, but also the economy.
As a family physician often at the frontlines of medical care, I have seen that the demand for blood for transfusion in Nigeria is driven not only due to bleeding in pregnancy and childbirth, or road traffic accidents, but also by the world’s heaviest burden of malaria and sickle cell disease, in addition to other disease conditions such as cancer.
Country studies in the African region have revealed that as low as 4.6 blood donations are collected per 1000 people, compared to 33.1 in higher income countries. Thus, in addition to the steady need for blood and the gaps in safe blood supplies, the demand for blood on our continent is further constrained by the storage shelf-life of blood, which can no longer be transfused on expiration. In countries like Nigeria, up to 65 per cent of blood transfusions are given to children under five years of age; whereas in high-income countries, patients aged above 65 years are the most frequently transfused. This further underlines the fact that in our environment, younger populations are hardest hit by the lack of safe blood supplies.
Therefore, to ensure that there is enough safe blood available for disease conditions and following terror attacks, such as those that have occurred in Owo, Kaduna, and around the country, regular voluntary blood donations by enough healthy donors are needed. This is how we can ensure there is sufficient safe blood available to be transfused whenever and wherever it is required. Unfortunately, over 80 per cent of Nigeria’s blood supply right now remains reliant on family members and paid blood donors, and that needs to change.
The World Health Organisation recommends that a country of Nigeria’s size should have a minimum of two million voluntary blood donations annually to assure blood safety and availability for transfusion. Instead, only about half a million voluntary donations are made across all the country’s hospitals and blood establishments each year, leaving a shortfall of over 1.5 million blood units. Several studies reveal the reasons why Nigerians are hesitant to donate blood voluntarily and regularly. These hindrances include fears of infections, side effects such as weight loss, sudden death, sexual problems, high blood pressure, and convulsions, and additionally, various religious beliefs are frequently cited as reasons not to donate blood.
Developed countries with optimally structured health systems and robust blood transfusion services that are based on voluntary blood donation can meet their population demands for blood and blood products. Despite periodic or seasonal shortages, their patients are largely assured of access to safe blood when needed. Therefore, for developing countries like Nigeria, which are plagued by incessant incidents of shortages in safe, quality blood and blood products, harnessing the power of our youthful population is a key to tackling the unavailability of safe blood.
According to Nigeria’s National Blood Policy, the acceptable age range for voluntary blood donation is 18-65 years, and the average age of the Nigerian citizen is 18.4 years. With a population of over 210 million people, 54 per cent of whom are aged between 15 and 64 years (110 million people), the country has a huge untapped population of potential voluntary blood donors. Voluntary blood donors, particularly regular donors, are the first line of defence in preventing the transmission of HIV, hepatitis viruses and other bloodborne infections, while saving lives through transfusion.
Both males and females can donate blood voluntarily, and male donors can donate up to four times a year, while females can donate three times a year. Asides donating blood personally, one can also encourage their colleagues, friends, and family to become regular blood donors. Furthermore, individuals can volunteer to reach out to members of their communities, thereby providing support for blood services nationally. As a volunteer, one can help to provide care to donors, and assist with arrangements during blood donation drives. These can be done through different organisations, community groups, and higher institutions collaborating with state and regional blood transfusion services.
Without a substantial pool of regular, voluntary unpaid blood donors, blood banks will continue to be empty when there is need for safe blood and blood products, and population access to safe blood supplies will remain unattainable in Nigeria. Therefore, there is an urgent need for wide and active participation of the population to meet daily blood transfusion requirements. Additionally, population engagement in regular voluntary blood donation would cater to urgent requirements following emergencies or disasters, as recently experienced in Owo and Kaduna, when a rapidly escalating surge in blood demand overwhelms the normal operations of entire state blood services.
The theme of the recently celebrated World Blood Donor Day on June 14 was “Donating blood is an act of solidarity. Join the effort and save lives”. Developing a strong, resilient, and effective national blood donation system based on voluntary donors relies on an “enabling social and cultural atmosphere” with strong unity. However, it is specifically at times like these that are fraught with polarity, fear and uncertainty that call for unity. The act of voluntary blood donation in our communities can thus contribute to rebuilding our social ties with equanimity and building a united society, regardless of differences in our tribes and our tongues – for our collective survival.
*Adaeze Oreh is a Consultant Family Physician in Abuja and Country Head of Planning, Research and Statistics for Nigeria’s National Blood Service Commission. She is also a Senior Fellow for Global Health with the Aspen Institute in Washington D.C and a Doctoral Researcher in Global Health with University of Groningen, Netherlands.
*The views and opinions expressed in this article are those of the author and do not necessarily express official policy or the position of National Blood Service Commission.
Credit: Adaeze Oreh, PT