Blood supply in West Africa

 Here are some thoughts on blood shortages in West Africa by Jappah and Tao. (Jappah has just returned from Sierra Leone...)

To meet demand, blood donation should not rely solely on volunteers
A misalignment between supply and demand especially hurts people in low-income nations. by Jlateh Vincent Jappah and Ruoying (Carol) Tao, Harvard Public Health, December 4, 2024

"The World Health Organization advocates for 100 percent voluntary, non-remunerated blood donation—a position that was more defensible in the 1970s, before widespread screening for bloodborne diseases like hepatitis. Today, two-thirds of the world face shortages of blood and blood products, leading to many preventable deaths, especially among women and children. More than 80 percent of the world’s population has access to only 20 percent of the global blood supply. These global inequities in blood and blood product supplies are unacceptable.

"Africa, in particular, faces a disproportionate demand for blood and blood products. The continent relies heavily on family-based donation, which is not sustainable. Policies about blood supply in Africa, meanwhile, are generally based on research generated outside the continent—and in that research field, the idea of addressing blood shortages in Africa by providing adequate incentives and compensation to blood donors is met with skepticism.

"We are conducting research with nonprofit organizations such as Lifeline Nehemiah Projects and with government agencies in West Africa, and shortly we will begin field experiments, to study whether non-cash incentives increase blood donation.

...

"The misalignment between blood supply and demand is especially acute in low-income countries, where the demand for blood is high due to disease burdens, traumatic injuries, and medical conditions that require transfusions. Blood shortages in these regions are also driven by factors such as a higher prevalence of sickle cell anemia and bloodborne pathogens. And yet problems such as poor nutrition limit people’s ability to donate blood voluntarily.

...

"Blood donation should not rely solely on charity but also on empowering individuals and communities to meet their own needs. In Sierra Leone, for instance, humanitarian organizations provide food and transportation to blood banks, to encourage blood donations. These incentives have significantly increased donation rates, though blood banks sometimes struggle with supply shortages, such as blood bags and needles."

Jlateh Vincent Jappah is a physician and a Ph.D. candidate in health policy at Stanford University. He is a fellow at the McCoy Family Center for Ethics in Society at Stanford.

Ruoying (Carol) Tao
Ruoying (Carol) Tao is a Ph.D. student in health care management and economics at The Wharton School at the University of Pennsylvania. She previously worked in health care management consulting.

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Earlier:

Wednesday, August 28, 2024 WHO Says Countries Should Be Self-Sufficient In (Unremunerated) Organs And Blood, by Krawiec and Roth

 

A bride- price auction: “the most expensive bride in South Sudan”

 The Guardian has the story of a bride-price auction for a child bride in South Sudan:

A teenage bride wed for a record price: the ‘marriage competition’ that divided a nation   Underage marriage is illegal in South Sudan yet so commonplace it rarely attracts attention. But the case of Athiak Dau Riak, who her mother says is only 14, has gone viral, polarising her family and the country.  by Florence Miettaux 

"For months, Marial Garang Jil and Chol Marol Deng, two South Sudanese men in their 40s who come from two different Dinka clans in Jonglei state but now live abroad, had been vying to marry Athiak Dau Riak, a girl her mother says is 14.

...

"After the ceremonial part of the wedding in June, when she was given as a wife to Chol Marol Deng, for a payment of 123 cattle, 120m South Sudanese pounds (about $44,000 or £33,000) in cash and a plot of land, she was dubbed “the most expensive bride in South Sudan” in TikTok videos that gained thousands of likes.

...

"South Sudan’s 2008 Child Act prohibits early and forced marriage, but according to Unicef, child marriage is “still a common practice” and “recent figures indicate that 52% of girls [in South Sudan] are married before they turn 18, with some girls being married off as young as 12 years old”.

"An Edinburgh University-led report on the “brideprice” system in South Sudan says “customary courts often accept menstruation as the criteria for eligibility to marry” and early marriage is “a common practice … likely motivated by families’ ambitions to gain brideprices for their daughters as soon as possible”.

"Globally, 12 million girls are married in childhood every year, according to another Unicef report. Across sub-Saharan Africa, more than a third of young women were married before the age of 18."

Why Mpox Vaccines Aren’t Flowing to Africans in Desperate Need.

 The NYT has the story: read it and weep...

Why Mpox Vaccines Aren’t Flowing to Africans in Desperate Need. Drugmakers have supplies ready to ship that are necessary to stop a potential pandemic. But W.H.O. regulations have slowed access. By Stephanie Nolen

"There are no vaccines for mpox available in the Democratic Republic of Congo, the epicenter of a global health emergency declared last week, even though the country first asked for the shots two years ago and the manufacturers say they have supplies.

...

"So where are the shots? They are trapped in a byzantine drug regulatory process at the World Health Organization.

...

"Three years after the last worldwide mpox outbreak, the W.H.O. still has neither officially approved the vaccines — although the United States and Europe have — nor has it issued an emergency use license that would speed access.

"One of these two approvals is necessary for UNICEF and Gavi, the organization that helps facilitate immunizations in developing nations, to buy and distribute mpox vaccines in low-income countries like Congo.

"While high-income nations rely on their own drug regulators, such as the Food and Drug Administration in the United States, many low- and middle-income countries depend on the W.H.O. to judge what vaccines and treatments are safe and effective, a process called prequalification.

"But the organization is painfully risk-averse, concerned with a need to protect its trustworthiness and ill-prepared to act swiftly in emergencies, said Blair Hanewall, a global health consultant who managed the W.H.O. approvals portfolio as a deputy director of the Bill & Melinda Gates Foundation, a key funder, for more than a decade."

Repugnance watch: same sex weddings in Nigeria are illegal even for guests

 The NYT has the story:

Nigeria Arrests Dozens Over Same-Sex Wedding. A 2014 law makes such unions illegal in the country. Anyone found guilty of taking part can also face up to 10 years in prison. By Emma Bubola 

"The police in Nigeria have arrested over 60 people who were in attendance at what the authorities claimed was a same-sex wedding, reinforcing a crackdown on L.G.B.T.Q. people in Africa’s most populous nation.

"The police also broadcast the identities of some of those arrested on social media and encouraged members of the public to help “uphold the moral standards of the society” by providing relevant information — moves that raised concern that those who attended the event would be subjected to stigma or violence.

"Under a 2014 law, anyone entering a same-sex marriage or civil union in Nigeria can be imprisoned for up to 14 years. Those who administer or witness such a ceremony can face up to 10 years in prison. At the time it was enacted, the U.S. secretary of state, John Kerry, said the law violated basic human rights protections."

Kidney disease in war-torn Sudan

 The Lancet brings us this news from Sudan.

Kidney failure in Sudan: thousands of lives at risk by Hatim A Hassan, Mohamed Hany Hafez, Valerie A Luyckx, Serhan Tuğlular, and Ali K Abu-Alfa, The Lancet, August 09, 2023DOI:https://doi.org/10.1016/S0140-6736(23)01370-3

"Sudan is one of few countries in Africa that has provided dialysis and transplantation under universal health coverage for several decades.2 Before the war, around 8000 patients required ongoing dialysis and around 4500 were living with kidney transplants (appendix). Haemodialysis was provided twice per week instead of three times per week to permit access to more patients within budget constraints.3

Haemodialysis requires continuous water, electricity, staffing, and disposable supplies. Since fighting began, dialysis services, which are mostly located in Khartoum, have been severely disrupted (appendix). Patients who can, have fled to dialysis units in other cities. Despite some units reducing haemodialysis frequency to once weekly, shortening sessions at times to 2 h, and offering appointments all day and all night, they are struggling to cope with demand. Most haemodialysis staff continue to work without being paid and are at high risk of burn-out. Egypt is accepting patients needing dialysis, but the cost and risk of the journey are prohibitively high for most.

Dialysis supplies have mostly run out by early August, 2023, despite dialysis sessions being reduced to weekly. A donation of supplies for a third of the patients for 3 weeks was obtained from one company. Reliance on donations of the large quantities of dialysis supplies needed for around 8000 patients is unrealistic. Dialysis supplies are not only expensive, but are bulky and costly to transport. Patients with kidney transplants are experiencing dangerous interruptions in their access to immunosuppressive medication. A reliable source of financing is urgently required to meet the needs of patients requiring dialysis and people with kidney transplants.

Support is needed to prevent adding a further layer of tragedy to this war if dialysis services cannot continue and transplant medication is not provided. Wars elsewhere pose similar threats to dialysis provision. The global health agenda must address the urgent need for transparent decision making and affordable access to vital treatments such as dialysis and transplantation during crises. Finding solutions to meet the needs of patients with kidney failure who depend on these therapies in low-resource settings in times of peace is also long overdue."

Africa continues to suffer severe shortages of blood and plasma

 Blood and plasma are in short supply in Africa, partly due to the insistence, by the WHO and others, that  blood and plasma be supplied domestically from unpaid donors. (Much of the world buys blood plasma from the United States, where donors can be paid.)

Here's an update from the Lancet:

The status of blood supply in sub-Saharan Africa: barriers and health impact, by Lucy Asamoah-Akuoko Bernard Appiah  Meghan Delaney  Bridon M'baya  Claude Tayou Tagny  Imelda Bates Published:June 13, 2023DOI:https://doi.org/10.1016/S0140-6736(23)01164-9

"Sub-Saharan African countries continue to struggle with chronic, year-round blood shortages, limiting their ability to support patients and deliver on the health-related Sustainable Development Goals (SDGs).1 Most blood recipients in sub-Saharan African countries are children and women around the time of childbirth,2 so achieving the health-related SDGs depends on blood and blood product availability to reduce maternal mortality, end preventable deaths of newborn babies and children younger than 5 years, and achieve universal health coverage. Blood shortages in sub-Saharan Africa can have devastating consequences. An estimated 70% of 287 000 pregnancy-associated deaths in the world in 2020 occurred in sub-Saharan African countries,3 predominantly due to obstetric haemorrhage. Insufficient blood supply for transfusion contributes substantially to such maternal deaths in hospitals in sub-Saharan Africa.4 Blood transfusions are also essential for managing sub-Saharan Africa's high rates of traffic accidents5 and childhood anaemia, which is commonly due to infections such as malaria, helminthiasis, and haemoglobinopathies. Sub-Saharan Africa is home to more than 75% of the 300 000–400 000 babies born each year globally with sickle cell disease;6 blood shortages contribute to 50–90% of these children dying before their fifth birthday.7

...

"But there are several barriers to achieving an adequate and sustainable blood supply in sub-Saharan Africa. The average number of blood donations across the WHO African region is less than 6 units per 1000 population, with some countries such as Cameroon, Eritrea, and Madagascar collecting less than two units per 1000 population.8 Insufficient blood supply in sub-Saharan African countries is due to many factors, including inadequate organisation, regulation, and coordination of national blood services, and challenges with geographical distribution of blood for transfusion. There are also cultural barriers and stigma associated with knowing HIV status9 that deter some voluntary blood donors, compounded by inefficient donor recruitment programmes, and inadequate funding and sustainable financing models for blood services. Several sub-Saharan African countries including Kenya, Lesotho, Malawi, and Uganda, built their national blood transfusion services on the back of HIV funding from donor agencies such as President's Emergency Plan for AIDS Relief, The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the EU, but this funding has reduced considerably.

...

"WHO recognises three types of blood donors: voluntary non-remunerated blood donors (VNRBD); family replacement blood donors (FRD) who donate blood for family members, friends or acquaintances; and paid donors. In high-income countries such as Denmark and the UK, the use of VNRBD ensures reliability of adequate national blood supply. In the WHO Africa region, the number of VNRBD increased from 1·89 million in 2008 to 3·42 million in 2018 (increasing total donations from 2·41 million units to 4·46 million units).11 Despite this, donations from VNRBD are unable to meet the demand for blood in many sub-Saharan African countries. For example, of 21 sub-Saharan African countries with more than 80% VNRBD, only five (Botswana, Mauritius, Namibia, South Africa, and Eswatini) have met the minimum blood requirement of 10 units per 1000 population2—a target that, although globally adopted, is not based on robust evidence.12 Paid donors have a lower safety profile as compared with VNRBD and do not contribute to achieving adequate an cd safe blood supply.13"

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And here is reference 13, a WHO pamphlet published in 2010 calling on all donations to achieve self sufficiency in unpaid blood donation

13. WHO, 2010, "Towards 100% voluntary blood donation: a global framework for action"  

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Earlier:

Monday, May 18, 2020

Plasma and plasma products (such as antibodies) are a big business (and the U.S. dominates the international market)

Drought, hunger, and early marriage in Ethiopia

 Sometimes the problem is hunger, and early marriage is seen as the solution.

The Guardian has the story

Ethiopian drought leading to ‘dramatic’ increase in child marriage, Unicef warns. With hunger across Horn of Africa and 600,000 children out of school, ‘desperate’ parents push more girls into early marriage by Lizzy Davies

"Three consecutive failed rainy seasons have brought hunger, malnutrition and mass displacement to millions of people in the Horn of Africa, including parts of Ethiopia, Somalia, Kenya and Djibouti.

"Many girls in Ethiopia now face being married at a young age as their parents seek to find extra resources through dowries from the husband’s family, and hope their daughters will be fed and protected by wealthier families, warned Catherine Russell, Unicef’s executive director.

...

"In the East Hararghe zone, home to 2.7 million people, child marriage cases increased by 51%, from 70 recorded during a six-month period in 2020-21 to 106 in the same period a year later.

"It was just one of six drought-affected areas in Oromia to have seen a sharp rise in child marriages, Unicef said. Across those zones, cases have almost quadrupled. According to data received by Unicef this week, 672 cases of child marriage were recorded between February and August last year, whereas in the six months from last September to March this year, that number leapt to 2,282, local government figures showed.

"“We’re seeing increases in child marriage that are quite dramatic,” Russell said, noting that more than 600,000 children are thought to have dropped out of school as a result of the drought.

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“These people [have their daughters married] because they’re desperate for one reason or another: they’re afraid of violence; they’re afraid for the safety of the girls; they need resources; they can’t afford to feed them,” Russell said.

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"According to demographic data from 2016, 40% of girls in the east African country are married before the age of 18 and 14% are married before their 15th birthday.

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"The drought is also pushing up the rates of severe acute malnutrition in the affected areas, with admission rates for children under five years old 15% higher in February this year than February last year."

Laws about gay sex in Africa

While many countries have legalized same sex marriages, including South Africa, in the rest of Africa the question is whether engaging in same-sex sex will be legalized.  The Guardian has the story of one step forward and maybe back again in Botswana:

Botswana government to appeal against law legalising gay sex
Attorney general says high court was mistaken in its ruling decriminalising homosexuality

"Botswana’s government will appeal against a high court ruling that decriminalised homosexuality, potentially resuscitating a law that punished gay sex by up to seven years in prison.

"The court’s ruling in June, which was praised by international organisations and activists, meant Botswana joined a handful of African countries that have legalised same-sex relationships.
...
"Same-sex relationships are illegal in more than 70 countries worldwide; almost half of them in Africa, where homosexuality is broadly taboo and persecution is rife.

"Botswana’s ruling came after Kenya’s high court upheld its law banning gay sex, keeping same-sex relations punishable by 14 years in jail, drawing strong criticism from the United Nations and rights activists.

...
Botswana is the latest country in Africa to decriminalise same-sex relations, with Amnesty saying it follows Angola in January, the Seychelles in June 2016, Mozambique in June 2015, and São Tomé and Principe, and Lesotho, in 2012.

South Africa is the only African nation to have legalised gay marriage."