Study of Blood-Transfusion Services in Maharashtra and Gujarat States, India
Ramani, K. V., Mavalankar, Dileep V., Govil, Dipti, Journal of Health Population and Nutrition
Blood is a vital healthcare resource used in a broad range of hospital procedures, viz. accidents, emergency obstetric services, and other surgeries. It is also a potential vector for harmful, and sometimes fatal, infectious diseases, such as HIV, hepatitis B and C. Every year, millions of people are exposed to avoidable, life-threatening risks through the transfusion of unsafe blood. As per a global database, 6 million of 81 million units of blood collected annually in 178 countries are not screened for transfusion-transmissible infections (1).
Shortfalls in supply of safe blood have a particular impact on women with pregnancy and delivery-related complications and with severe life-threatening anaemia. Worldwide, more than half a million women die each year during childbirth or in the postpartum period (2). Over 90% of maternal deaths occur in Asia and sub-Saharan Africa, with India alone accounting for 20% of such deaths (3). Severe bleeding during delivery or after childbirth is the most common cause of maternal mortality globally (25%) and contributes to around 31% of maternal deaths in Asia (2).
Because of the unpredictable nature of postpartum bleeding, blood transfusion has been identified as one of eight key life-saving functions that should be available in healthcare facilities providing comprehensive emergency obstetric care (EmOC) (2,4). Access to a safe and sufficient blood supply could help prevent deaths of a significant number of mothers and their newborn children. As per estimates globally, each year up to 150,000 pregnancy-related deaths could be avoided through access to safe blood (5).
Results of a study of the circumstances for maternal deaths in Indonesia indicate that the lack of blood supplies and inability of some healthcare professionals to administer a transfusion contributed to deaths due to haemorrhage (6). Similarly, estimates from Latin American and Caribbean countries show that the limited availability of blood for transfusion in countries with high ratios of maternal mortality may hinder comprehensive care of mothers (4). Also, the supply of blood to obstetric facilities was one of the central topics of the clinical audit of maternal deaths in Morocco. However, the effectiveness of this audit process was hindered due to poor record-keeping of availability or otherwise of blood and blood products in obstetric cases (7).
In India alone, according to a review of the Sample Registration Survey (1997-2003), postpartum haemorrhage accounts for nearly 38% of all maternal deaths (8); this is more than the Indian Council of Medical Research's estimate of 25,000 deaths every year (9). As more than half of the women of reproductive age are mild to severely anaemic (10), they are very vulnerable to dying from bleeding. As the majority (65%) of births take place at home (in some areas, it is almost 92%), and a large proportion are assisted by unskilled personnel (3), women experiencing life-threatening complications may not receive the required life-saving emergency services because of the 'four delays'. These delays can result in maternal mortality or increased severity of morbidity. These four delays include recognizing the problem, deciding to seek care and reaching the health facility, plus the delay in receiving adequate treatment once a woman has arrived at the health facility (3). Ensuring that the health facility is adequately equipped and supplied for blood transfusion would decrease this last delay. However, a search through the PubMed and Google Scholar databases showed that the organization and management of blood-transfusion services in India has received little attention (11-15).
This global scenario is evidenced from a statement by Director General of the World Health Organization made on the World Health Day 2000. He said, "Despite all the technological marvels that humanity is experiencing, a reliable and safe blood supply is still out of the reach for untold millions of people around the world". …