Browsing by Author "van Hensbroek, Michael B."

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    Blood use in sub‐Saharan Africa: a systematic review of current data
    (Wiley, 2019-07) Dhabangi, Aggrey; Dzik, Walter H.; Idro, Richard; John, Chandy C.; Butler, Elissa K.; Spijker, Rene; van Hensbroek, Michael B.; Pediatrics, School of Medicine
    Background: Data on the use of blood products in sub-Saharan Africa (SSA) are scarce. A systematic review of published data on blood utilization according to diagnosis in SSA was performed. Study design and methods: Studies published from January 2000 to June 2018 were searched in PubMed, Embase and African Index Medicus. Data were extracted and synthesized. The proportion of blood products used for different diagnostic categories is presented. Results: 37 studies representing 159,746 transfusions to 96,690 patients from 14 countries in SSA were included. Data from six of 37 studies were pooled to determine blood product use according to diagnosis. The primary diagnostic categories were pediatric malaria (20%), sickle cell anemia [SCA] (18%), obstetric hemorrhage (16%), and other causes of bleeding (16%). About 8%, 6% and 2% of products were used for other infections, cancer treatment, and surgery respectively. Overall, 58.5% of the products transfused were red blood cells, 31.7 % whole blood, 7.2% fresh frozen plasma, and 2.6% as platelets. Estimated blood product use per population in SSA was 5.3 transfusions per 1000 people, compared with 52 and 34 per thousand for Australia and United States respectively. Conclusion: This study provides a systematic attempt to quantify blood utilization for SSA. Blood products in SSA are used primarily for pediatric malaria, SCA, obstetric hemorrhage and other causes of bleeding. Studies such as this represent an important early step towards improving hemovigilance in SSA.
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    Caregivers and community perceptions of blood transfusion for children with severe anaemia in Uganda
    (Wiley, 2019-02) Dhabangi, Aggrey; Idro, Richard; John, Chandy C.; Dzik, Walter H.; Opoka, Robert; Siu, Godfrey E.; Ayebare, Florence; van Hensbroek, Michael B.; Pediatrics, School of Medicine
    Objective To describe local perceptions of blood transfusion for children with severe anaemia in Uganda. Background Blood transfusion is a common emergency treatment for children with severe anaemia and saves millions of lives of African children. However, the perceptions of transfusion recipients have not been well studied. A better understanding of the perceived risk may improve transfusion care. Methods A qualitative study based on 16 in‐depth interviews of caregivers of transfused children, and six focus group discussions with community members was conducted in three regions of Uganda between October and November 2017. Results Caregivers of children and community members held blood transfusion in high regard and valued it as life‐saving. However, there were widespread perceived transfusion risks, including: Human immunodeficiency virus (HIV) transmission, too rapid blood infusion and blood incompatibility. Other concerns were: fatality, changes in behaviour, donor blood being ‘too strong’ and use of animal blood. In contrast, recent transfusion, older age, knowledge of HIV screening of blood for transfusion, faith in God and having a critically ill child were associated with less fear about transfusion. Respondents also emphasised challenges to transfusion services access including distance to hospitals, scarcity of blood and health workers' attitudes. Conclusion Perceptions of the community and caregivers of transfused children in Uganda about blood transfusion were complex: transfusion is considered life‐saving but there were strong perceived transfusion risks of HIV transmission and blood incompatibility. Addressing community perceptions and facilitating access to blood transfusion represent important strategies to improve paediatric transfusion care.
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    Community perceptions of paediatric severe anaemia in Uganda
    (PLOS, 2019-01-03) Dhabangi, Aggrey; Idro, Richard; John, Chandy C.; Dzik, Walter H.; Siu, Godfrey E.; Opoka, Robert O.; Ayebare, Florence; van Hensbroek, Michael B.; Pediatrics, School of Medicine
    BACKGROUND: Severe anaemia remains a major cause of morbidity and mortality among children in sub-Saharan Africa. There is limited research on the beliefs and knowledge for paediatric severe anaemia in the region. The effect of these local beliefs and knowledge on the healthcare seeking of paediatric severe anaemia remains unknown. OBJECTIVE: To describe community perceptions of paediatric severe anaemia in Uganda. METHODS: Sixteen in-depth interviews of caregivers of children treated for severe anaemia and six focus group discussions of community members were conducted in three regions of Uganda between October and November 2017. RESULTS: There was no common local name used to describe paediatric severe anaemia, but the disease was understood in context as 'having no blood'. Severe anaemia was identified to be a serious disease and the majority felt blood transfusion was the ideal treatment, but concomitant use of traditional and home remedies was also widespread. Participants articulated signs of severe pediatric anemia, such as palmar, conjunctival, and tongue pallor. Other signs described included jaundice, splenomegaly, difficulty in breathing and poor appetite. Poor feeding, malaria, splenomegaly and evil spirits were perceived to be the common causes of severe anaemia. Other causes included: human immunodeficiency virus (HIV), haemoglobinuria, fever, witchcraft, mosquito bites, and sickle cell. Splenomegaly and jaundice were perceived to be both signs and causes of severe anaemia. Severe anaemia was interpreted to be caused by evil spirits if it was either recurrent, led to sudden death, or manifested with cold extremities. CONCLUSION: The community in Uganda perceived paediatric severe anaemia as a serious disease. Their understanding of the signs and perceived causes of severe anaemia to a large extent aligned with known clinical signs and biological causes. Belief in evil spirits persists and may be one obstacle to seeking timely medical care for paediatric severe anaemia.