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Indian Journal of Community Medicine

A Study on Awareness and Perceptions Regarding Blood Safety and Blood Donation Among Health Care Providers in a Teaching Hospital of Calcutta

Author(s): Kaninika Mitra, Pankaj Kumar Mandal, Saswati Nandy, Rabindranath Roy, Gautam Kumar Joardar, Raghunath Mishra

Vol. 26, No. 1 (2001-01 - 2001-03)

Deptt. of Community Medicine, R.G. Kar Medical College, Calcutta

Abstract:

Research question: How aware are health care providers about blood safety and blood donation and what are their perceptions about blood donation?

Objectives: 1. To assess awareness about blood safety and blood donation among different categories of health care providers (HCPs). 2. To ascertain their perceptions about blood donation.

Study design: Cross-sectional.

Setting: R.G. Kar Medical College, Calcutta.

Participants: Total 208 health care providers including doctors, trainee doctors, nurses, group D and other staff including technicians etc.

Results: Awareness about blood safety was least among group D but not satisfactory even among doctors and other HCPs. Trainee doctors were well aware about screening tests. Guidelines for blood donation were best known by 'other group' of staffs. Most were aware about needle safety but not about banning of professional donors. Most had positive attitude about blood donation except 'other group' of staff, less than 50% HCPs had ever donated blood and donor retention was variable. Commonest reason for non donation was 'never approached by anybody'. Most were, however, willing to donate in future.

Keywords: Safe blood, Blood donation, Health care provider, Awareness, Perception

Introduction:

Modern science is yet to find an ideal substitute of blood and hence blood transfusion still remains a vital component of patient management. Thus, availability and safety of blood and blood products are two very important issues of concern.

According to WHO, 'Safe Blood' is blood that does no harm to the person who receives it.

Unfortunately, 83% of global population living in developing countries have access to only 40% of blood supplied, and this blood in 60% of cases is collected from paid or replacement blood donors rather than from voluntary non-remunerated low risk donors1.

With the directive from Supreme Court of India, buying blood from blood sellers has been banned from 1st January 1998. Unfortunately, many pseudo-family donors still exist and many people are not aware of this. In our country, collected blood is tested for HIV, HBsAg, VDRL and Malaria. HBCAg test is being introduced in different parts of the country. Studies among blood donors regarding presence of infection in different cities have shown high rates in Delhi with 4.5% VDRL positive, 3.2% HBsAg positive and 1.35% HIV positive, whereas Calcutta has shown lower rates with 0.14% VDRL positive, 1.2% HBsAg positive and 0.04% HIV positive2.

Thus, there is an urgent need not only for encouraging voluntary blood donation, but also for generating awareness regarding blood safety.

Health care providers of teaching hospitals are those who directly come in contact with blood donors, recipients and their families. Some of them as teachers, are also responsible for inculcating the right message to their students. It is, therefore, necessary to assess their own awareness, knowledge, feelings, beliefs and attitude towards blood safety and blood donation.

Material and Methods:

The study was undertaken at R.G. Kar Medical College and Hospital, Calcutta in May 2000. The study population comprised of different categories of health care providers viz. doctors, trainee doctors, nursing staff, group 'D' staff and 'other group' of staff including technicians, pharmacists, social welfare officers, storekeepers etc. Office staff were excluded from the study.

A stratified random sampling technique was used and 10% sample from each of the above mentioned categories was taken for the study. A total of 208 health care providers were included in the study comprising of 30 doctors, 33 trainee doctors, 25 nurses, 90 group 'D' staff and 30 'other groups' of staff.

A pre-designed and pretested semi-structured questionnaire was used to collect data.

Results:

Table I: Awareness of health care providers regarding blood safety.

Correct awareness about Doctors n=30 Trainee doctors n=33 Nurses n=25 Other group of staff n=30 Group D n=90 Total n=208
The term 'safe blood' 28 (93.3) 27 (81.8) 22 (88) 24 (80) 37 (41.1) 138 (66.3)
World Health Day 2000 slogan 2 (6.7) 6 (18.2) 6 (24) 1 (3.3) 0 (0) 15 (7.2)
All mandatory screening tests* 7 (23.3) 23 (69.7) 2 (8) 13 (43.3) 0 (0) 45 (21.6)

Figures in parentheses are percentages; *Tests for HBsAg, HIV, Malaria, VDRL.

Table I shows that most HCPs except group D staff had heard the term 'Safe Blood', but overall only 7.2% knew the WHO slogan for World Health day 2000 'Safe Blood starts with me' correctly.

Though 69.7% of trainee doctors knew correctly about all the mandatory tests for collected blood, only 23.3% of doctors and none of the group 'D' knew them correctly.

Table II: Knowledge of health care providers about guidelines for blood donation.

Correct awareness about Doctors n=30 Trainee doctors n=33 Nurses n=25 Other group of staff n=30 Group D n=90 Total n=208
Age limit of donors (18-60 years) 0 (0) 2 (6.1) 1 (4) 3 (10) 2 (2.2) 8 (3.8)
Minimum weight of donors (45kg) 10 (33.3) 12 (36.4) 6 (24) 17 (56.7) 4 (4.4) 49 (23.5)
Minimum gap between 2  donations (3 months) 7 (23.3) 16 (48.5) 6 (24) 17 (56.7) 17 (18.8) 63 (30.3)
Needle safety 28 (93.3) 27 (81.8) 21 (84) 23 (76.7) 48 (53.3) 147 (70.7)
Professional donors 8 (26.7) 7 (21.2) 15 (60) 16 (53.3) 29 (32.2) 75 (36.1)

Figures in parentheses are percentages.

Table II reveals that among all the HCPs, 'other group' of staff were knowledgeable about most guidelines of blood donation. Majority of HCPs except group D staff were aware about needle safety. Nurses (60%) were most knowledgeable about banning of professional donors. Knowledge about age limit of blood donors was very poor.

Table III: Perceptions of health care providers regarding blood donation.

Perception Doctors n=30 Trainee
doctors n=33
Nurses n=25 Other group
of staff
n=30
Group D n=90 Total n=208
Blood donation is a noble act 30 (100) 30 (90.9) 25 (100) 28 (93.3) 72 (80) 185 (88.9)
Has motivated others for donation 23 (76.7) 25 (75.7) 18 (72) 23 (76.7) 46 (51.1) 135 (64.9)
Blood donation is a harmless practice 30 (100) 31 (93.9) 25 (100) 30 (100) 72 (80) 188 (90.4)
Willing to donate in future* n=19 n=18 n=21 n=8 n=60 n=126
17 (89.4) 15 (83.3) 17 (80.9) 5 (62.5) 38 (63.3) 92 (73)

Figures in parentheses are percentages; *Among those who have never donated blood.

Table III shows that overall about 89% of all HCPs considered blood donation to be a noble act. Except group D staff, more than 70% of all other HCPs have motivated others for blood donation. More than 90% HCPs considered blood donation to be a harmless practice. Among the HCPs who have never donated blood, more than 80% doctors, trainee doctors and nurses and more than 60% of 'other group' of staff and group 'D' were willing to donate in future.

Regarding frequency of blood donation by HCPs - among doctors 63.3% never donated blood, 13.3% donated blood once and 23.4% donated more than once. Among trainee doctors, 54.5% never donated blood, 18.2% donated it once and 27.3% more than once. Only 4% nurses donated blood more than once while 84% never donated blood and 12% donated once only. 26.7% 'other group' staff never donated blood, 30% once and 43.3% more than once. From among group D staff 66.7% never donated blood, 18.9% donated blood once and 14.4% more than once. Highest number of blood donors were in the 'other group' of staff (73.3%) and the lowest number was from the nurses (16%). Regarding frequency of donation also, 43.3% of 'other group' staff donated blood more than once, whereas, only 4% of nurses donated more than once.

Table IV: Reasons for never donating blood as cited by health care providers.

Reasons Doctors n=19 Trainee doctors n=18 Nurses n=21 Other group of staff n=8 Group D n=60 Total n=126
Not approached by anybody 7 (36.8) 10 (55.5) 6 (28.6) 2 (25) 16 (26.7) 41 (32.5)
No opportunity 4 (21.1) 3 (16.7) 9 (42.8) 2 (25) 10 (16.7) 28 (22.2)
Ill health/Unfit 7 (36.8) 3 (16.7) 6 (28.6) 4 (50) 16 (26.7) 36 (28.6)
Unwilling 0 (0) 0 (0) 0 (0) 0 (0) 3 (5) 3 (2.4)
Fear 0 (0) 0 (0) 0 (0) 0 (0) 4 (6.7) 4 (3.2)
No reasons/Others 1 (5.3) 2 (11.1) 0 (0) 0 (0) 11 (18.3) 14 (11.1)

Figures in parentheses are percentages.

Table IV shows that among the reasons of non-donation as cited by never-donors, overall 'not approached by anybody' was the commonest reason (32.5%), followed by 28.6% who considered themselves 'unfit' for donation. Overall 22.2% cited 'no opportunity' as reason for never donating blood. Among group D staff - 5% and 6.7% respectively were unwilling to donate and had fear of donation. These reasons were not cited by any other category of staff.

Discussion:

The study reveals that though most HCPs except group 'D' staff were aware of the 'safe blood', overall only 7.2% knew the WHO slogan for world health day 2000 correctly. Among HCPs, 69.7% of trainee doctors, 43.3% of 'other group' of staff, 23.3% doctors, 8% of nurses and no group D staff knew about all the mandatory tests for collected blood. In a study, among senior secondary students in Delhi, 86% knew that AIDS can be spread by blood transfusion3. In another study, in south India, 2.2% out of 14.2% of illiterate and 52.9% out of 85.8% literate respondents attributed blood transfusion as a means of spread of AIDS4.

Regarding awareness about guidelines for blood donors and blood donation, most HCPs were aware about needle safety (70.7%), highest being the doctors (93.3%), followed by nurses (84%) and trainee doctors (81.8%). This finding is comparable to the finding of a study among senior school students in Delhi, where 94% were aware that sharing of needles may cause AIDS3. However, knowledge about other guidelines was overall not satisfactory. 'Other group' of staff were most knowledgeable among all HCPs in most of these aspects probably because a high percentage among them were also blood donors.

Most of the HCPs considered blood donation to be a noble act as well as a harmless practice and more than 70% of them except group D staff, have motivated others for blood donation. Data collected from different blood banks in India shows that in eastern region, 68% of blood donors have donated blood on humanitarian ground, 60% in self motivation and 35% as an act of social responsibility5.

In contrast, in practice, except 'other group' of staff, less than 50% of all categories of HCPs have actually ever donated blood, the lowest being the nurses (16%). Regarding donor retention, a higher percentage of doctors, trainee doctors and 'other group' of staff have donated blood more than once, Globally, it has been found that about 80% of first time donors every year give up the practice of blood donation5.

A high percentage of HCPs ranging from 62.5% of 'other group' of staff to 89.4% doctors among those who have never donated blood were, however, willing to donate blood in future. Among the donors, overall 59.8% had donated blood in blood donation camps, a finding which corroborates with studies which show that except in northern India, in all other regions, 70-75% people donated blood in donation camps5.

In our study, 32.5% of HCPs who have never donated blood have said they were 'never approached by anybody' - this response is higher than other studies in eastern India, where 10% cited this reason for never donating blood. Only 3.2%, all of them in group 'D', gave fear as a reason for not donating, a finding which corroborates with the earlier study, where 2% had fear of AIDS5.

Conclusions:

This study is highly revealing in the context of global endeavour initiated by WHO to generate awareness and motivation for voluntary blood donation. This calls for immediate continuous medical education (CME) involving all categories of staff with particular thrust for the group 'D' staff who constitute the largest section of health care providers with huge potentiality for blood donation and motivation for the same. This will also help removing misconceptions and allaying fear.

Acknowledgment:

We are thankful to all faculty members and other staff of department of Community Medicine, R.G. Kar Medical College, Principal, R.G. Kar Medical College and all the respondents who have participated in this study.

References:

  1. WHO.org/homepage/world health day 2000.
  2. Deodhar NS. Epidemiology of HIV infection - a critique. Indian Journal of Community Medicine 1998; 23(4): 178-84.
  3. Francis PT, Gill JS, Chowdhury S. Knowledge, beliefs and attitudes regarding AIDS, STDs and human sexuality among senior secondary students in Delhi. Indian Journal of Community Medicine 1994; 19(1): 16-20.
  4. Balaganesh G, Chandrasekar V et al. Survey on public awareness on AIDS in a rural south Indian community. Indian Journal of Community Medicine. 1994; 19(1): 31-35.
  5. Ghosh A. Blood. A book on donor motivation and safe transfusion programme. West Bengal: Voluntary Blood Donor's forum. 1996. p.148-53.
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