Availability and safety of blood for transfusion in three districts in Malawi

Abstract

Objective: Since its establishment in 2003, the Malawi Blood Transfusion Service (MBTS) has co-existed with an earlier decentralised hospital-based system for collecting, testing and distributing blood. The aim of this study was to assess the availability of blood for transfusion in Malawi and explore the challenges facing the current dual system of blood supply.
Methods: A survey of all hospitals (8 hospitals) in three districts in Central Malawi.
Results: MBTS provides two-thirds (66.7%) of the blood used by hospitals, and the hospital-based system provides the other one-third. MBTS centrally tests blood for HIV (ELISA), hepatitis B virus (HBsAg), hepatitis C virus (anti-HCV), syphilis and malaria parasite, and uses standard operating procedures (SOPs) to prevent errors. The hospital-based system does not routinely test for hepatitis C virus and malaria but routinely tests for HIV (rapid tests), hepatitis B virus (HBsAg), and syphilis. The major challenges faced by this dual system include poor communication, inadequate knowledge of the availability and clinical use of blood, difficulties recruiting and retaining donors, difficulties distributing blood, high prevalence of HIV and costs of running the two systems.
Conclusions: The nationally coordinated centralised system provides high quality blood which is insufficient to meet demand and the hospital-based system supplements the deficit in blood supply by providing blood which is not routinely screened for all transfusion-transmitted infections. Both the centralised and decentralised systems of blood transfusion will continue to co-exist until the transition period is over. It is important that the hospital-based system be operated according to the same quality standards as the centralised system and that some form of regulatory control be put in place.