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Peter Chimkupete Correspondent
Post-partum haemorrhage is one of the leading causes of maternal deaths in Zimbabwe, and in Africa as a whole.
As Zimbabwe continues to grapple with unacceptably high maternal mortality rates, working together, to see how we can lower these figures, and providing timely blood transfusion to new mothers at the onset of haemorrhaging, is a good start.
Zimbabwe’s National Blood Policy states unequivocally that blood is a scarce national resource, and should be collected and transfused in the national interest and should be available to all citizens in need – including rural mothers in the hard to reach parts of the country.
Currently in Zimbabwe the cost of blood is too high for the majority patients who require transfusion at the district and provincial levels.
This is compounded by the dwindling numbers of willing donors partly due to potential donors protesting that their sick relatives cannot afford to pay for the blood they donated, as well as the limited locations for those willing to donate to give their blood.
The Health Transition Fund has provided high impact and cost effective interventions including improved coverage of institutional delivery and skilled birth attendance.
This includes providing pregnant mothers with blood coupons to allow them to access blood should they need it. Unfortunately, the coupons are inadequate to cater for all mothers therefore some needy mothers are not transfused unless they can come up with the money to pay for the blood.
Currently the price for one unit of blood starts from $132, and understandably, many mothers especially in the rural areas will not be able to afford blood at this price.
Equally, there are many instances where mothers are transferred to central hospitals due to lack of blood at their nearest provincial hospital.
Transfusion of fresh whole blood has been shown to greatly improve outcomes in patients with severe haemorrhage. Access to blood can improve greatly if provincial hospitals are empowered to screen blood from potential donors for HIV, hepatitis and syphilis as well as determining their blood group.
Suitable donors can then be called to donate locally when required and patients can thus be transfused with fresh whole blood.
Fresh whole blood is widely used by the military forces in cases of trauma-induced massive haemorrhage. It has the advantage of containing all the components of blood without the negative by-products of stored blood. The challenge would be to keep track of the tested potential donors and to get hold of them when blood is needed.
Alternatively fresh whole blood can easily be separated into cells and plasma with the plasma being frozen at -30o C soon after separation.
Patients presenting with massive haemorrhage can then be transfused with cells and plasma to make up for the lost volume.
This approach would require that provincial hospital blood banks be equipped with adequate blood bank refrigerators and freezers.
Both approaches require reliable HIV, hepatitis B and syphilis testing systems as well as establishment and training of provincial hospital transfusion committees. Additionally all staff involved in transfusion need to undertake training and competency assessment annually or at least biannually.
Investment in the above will ensure that the costs of blood are much lower than at present since blood is collected and tested at the province without transport costs.
Costs will also be reduced since the blood will not be processed into such products as platelets and cryoprecipitate.
Mothers with obstetric haemorrhage will be able to get the required blood transfusion in a timely manner at provincial hospital level and with time the process can be cascaded to the district level.
It should be our collective goal to ensure that in the near future, a mother who has suffered from post-partum haemorrhaging in a hard to reach clinic like Kanyaga in Makonde District can receive timely lifesaving fresh blood from her nearest district hospital – thus saving her life, and safeguarding her child’s future.
The author is a Senior Lecturer in Biomedical Science/Transfusion Science Programme lead for Advanced Biomedical Science at DeMontfort University, Leicester, United Kingdom. For comments and contributions, email: [email protected]
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