Running low: The story of Kenya’s blood bank

“Do you donate blood? When was the last time you donated blood?” These are the questions that won’t escape any conversation you have with Josephine Githaiga.”

And it makes sense because, she’s not just a trained doctor who often saw the need for blood when she was in practice in hospitals, she’s also the director of the Kenya National Blood Transfusion Service (KNBTS), which is charged with collecting, screening, processing and distributing the different components of blood that patients in transfusing hospitals around the country need.

Whenever she asks the questions, she is met with the raw fears and superstitious beliefs that Kenyans have about donating blood.

“I might collapse and die in the process.”

“I don’t want to be diagnosed with HIV.”

“I barely have enough for myself, let alone any extra to give others.”

“What if someone uses my blood to bewitch me?”

“What if I get infected with a disease?”

“I’m saving my blood for my loved ones, so that if they fall sick, I’ll have enough for them.”

These are some of the reasons Kenyans give for not donating blood, and the national blood bank is badly off for it.

Going by World Health Organisation’s recommendations that national blood banks should collect a unit of blood from at least one per cent of the population every year to be considered blood-sufficient, Kenya should collect about 500,000 units of blood per year, with current population estimates of 50 million people.

However, the national blood bank barely scrapes the surface, even with its not-so-ambitious targets. For instance, last year, KNBTS set a target of 182,000 units, but only managed to collect 149,642 units, most of which were collected in Nairobi. Mombasa registered the lowest amount of donated blood.

Yet, every 10 minutes a patient needs that lifesaving unit of blood. At least 1,100 patients need blood every day. According to KNBTS, 60 per cent of the donated blood is used up by mothers and their children for birth-related needs before or after childbirth including Caesarian sections, which now account for half the births in both private and public hospitals.

Pregnant women may also need blood replacement if they lose too much blood during delivery.

BLOOD LOSS

Post-partum haemorrhage which is the leading cause of mother deaths in Kenya, accounts for 34 per cent of those deaths. It is defined as losing 500 millilitres (just over one unit) of blood or more in the 24 hours after giving birth.

Blood loss of more than 1,000 millilitres within the same timeframe is considered more severe.

Other patients who need blood transfusion include road accident and disaster victims who take up about three per cent of total blood bank supplies, those undergoing surgery, those with haemophilia (a clotting disorder), those suffering from sickle cell anaemia and those with leukaemia. Cancer and kidney patients may also need blood.

“The public tends to focus on the needs of accident and disaster victims, because there is sustained news coverage on the events and even calls for people to donate blood for the victims,” notes Joseph Kamotho, a national blood donor recruiter and public communications officer at the KNBTS.

“Everyday incidents like a mother bleeding heavily during pregnancy do not attract as much attention, yet they need blood just as much,” he adds.

This means that hospitals often have to rely on family replacement donors, who donate blood for their kin in need, to replace the one used up from the hospital’s blood bank. In Kenya, such donors account for about 20,000 units of blood collected by public hospitals every year.

NO HARD AND FAST FIGURES

Although there are no hard and fast figures of the number of patients who need blood, not all patients require a standard amount. Some need several units, while others need just one. Some need a component of blood, for example, platelets, red blood cells, plasma or cryoprecipitate.

For 37-year-old accountant Hannington Opondo, the thought of donating blood had never crossed his mind, until his wife needed it.

“I thought blood donation is only required when a friend or relative is sick, and for a long time nobody in my circle had ever needed blood. Moreover, because I haven’t been eating meat since childhood, I assumed that I was either too weak or had some deficiency that wouldn’t allow me to donate blood anyway,” he explains why he had never donated blood until his pregnant wife needed it last year, and Kenyatta National Hospital, where she was to deliver, asked for blood, just in case she’d need a transfusion.

Although it went well, he doesn’t plan to donate blood again any time soon.

“It is not something I am particularly fond of … but I can donate if called upon to,” the father of one explains hesitantly.

The same case applies to Timothy Siran, who has donated blood twice in his life, and only because someone he knew needed it. He says that the experience makes him nervous and puts him off the exercise.

“I fear the pain of the injection during the procedure,” he says weakly.

Hannington and Timothy form the larger percentage of the population who have either never donated blood or are not regular donors. According to KNBTS, 70 per cent of blood donors do it once, and only three in 10 people are repeat donors.

It is no wonder that the country is still struggling to meet its blood bank targets years after the national blood bank was established in 2000, even though it has progressively collected more blood every year, from a start of 40,857 units in 2003.

By 2005, the amount had doubled to 80,762 years and crossed the 100,000-unit mark the next year with 113,080 units and 155,000 units about a decade later, in 2015.

MOMENTUM HAS REMAINED

But the momentum has remained rather slow after that with 149,642 units collected last year against a target of 180,00 units.

This has left KNBTS scratching its head, wondering how to get more Kenyans to donate blood by trying to tap into corporate donations where companies get their staff to donate blood and campaigns like the Valentine’s Day themed “Show Your Love” blood donation campaign in February.
Although it didn’t hit the ambitious 10,000-unit target that had been set — with just 2,602 units collected around the country — it did manage to reach more than a million people with blood donation messages, driven by a vibrant social media campaign. It also registered a surprising 600 units collected at the Kenyatta International Convention Centre in Nairobi, which was the largest single collection ever from adults in one day. By March, KNBTS had collected 46,000 units, with a target of 250,000 units by the end of this year.

Most of the blood (80 per cent) in Kenya’s bank is collected from students in secondary schools and colleges aged 16 to 25 years.

The former donate 60 per cent, while the latter donate 20 per cent. And when schools close in April, August and December, blood stocks run low and the gap has to be bridged by reaching out to reluctant Kenyans who might be touched to respond to donation drives.

KNBTS wants to tap into this group as a regular source of blood, through the Pledge 25 campaign, which was first launched in Zimbabwe in 1989 to build and retain a pool of voluntary student blood donors who would pledge to donate blood at least 25 times by the time they reached age 25 or in their lifetime.

Part of the pledge is to maintain a healthy lifestyle so as to provide safe blood that is free from sexually transmitted infections and transfusion-transmissible infections such as hepatitis B, hepatitis C, HIV and syphilis.

Pledge 25 members are also encouraged to educate their peers and other members of the community on safe and healthy lifestyles that are compatible with blood donation and to recruit them as donors. There are currently 65 Pledge 25 clubs in the world, with more than 100,000 members.

Although the Kenyan chapter was set up back in 2012, it has only picked up steam recently after being adopted by KNBTS. It hopes to get Kenyans to join the club of regular donors by pledging to donate blood at least 25 times in their lifetime and to maintain risk-free and health lifestyles while at it to ensure a safe and sufficient blood supply.

The icing on the cake would be zero incidence of HIV among Kenyans who pledge to donate blood regularly, so that blood is not discarded for being unsafe.

TRAINED ON LIFE SKILLS

Members are also trained on life skills and encouraged to organise blood donation campaigns and blood drives. There are 108 donor clubs in schools and communities with 10,000 members across the country. Even those who cannot donate blood for whatever reason, are encouraged to organise a blood drive and recruit suitable donors.

In Zimbabwe, where about 70 per cent of blood collected is from students, the HIV infection rates among blood donors fell from four per cent in 1989 to less than one per cent (0.35 per cent) in 2005, when the infection rate in the sexually active population was 21 per cent. This was attributed to the efforts of the pioneer Pledge 25 Club.

The WHO says that such clubs can kill two birds with one stone: providing a constant supply of sufficient blood while spawning a generation of HIV-negative adults. And given that blood cannot be manufactured, and has no substitute, there is need for networks of regular donors to meet demand, especially because blood products have a short shelf life and need to be replenished regularly. For instance, whole blood expires after 35 days, as do red blood cells. Platelets expire within a shorter time – seven days, while plasma and cryoprecipitate (required by haemophiliacs) last longer, take a year to expire.

Ahead of World Blood Donor day on Thursday, Pledge 25 Kenya, which was named the best donor club in 2017, embarked on a walk from Kisumu to Mombasa to create awareness on the need for regular blood donation and get more Kenyans on board as regular donors.

Four donors each from six blood bank regions – Kisumu, Eldoret, Nakuru, Embu, Nairobi and Mombasa – with a Pledge 25 Club, and drawn from the four blood groups (A, B, AB and O) carried a pint of blood, passing it to the next representative in a blood relay. They covered 30 kilometres a day from May 20 to June 8, registering 150 donors in the process, in a nationwide campaign to recruit 100,000 regular blood donors.

Their message is: Blood donation is a simple medical procedure that takes less than 10 minutes to extract one unit of blood that can save up to four lives. A man can donate blood every three months or four times a year, while a woman can donate every four months or thrice a year. Women cannot donate as often as men due to regular loss of blood during menstruation. If you start to donate at 16 years, at four times for men and three times for women, by age 65 you’ll have donated for 49 years or 196 times/units, which can save about 784 lives.

“If we all gave blood at least twice a year, there would be no need for the constant blood appeals that are usually made on social media,” says KNBTS Director Dr Josephine Githaiga, stressing that blood donation should go beyond school-based drives.

Additional reporting by Magdalene Wanja