High rate of inappropriate blood transfusions in the management of children with severe anemia in Ugandan hospitals

Robert O. Opoka, Andrew S. Ssemata, William Oyang, Harriet Nambuya, Chandy John, James K. Tumwine, Charles Karamagi

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Severe anaemia (SA) is a common reason for hospitalisation of children in sub-Saharan Africa but the extent to which blood transfusion is used appropriately in the management of severe anemia has hitherto remained unknown. We report on the use of blood transfusion in the management of anemic children in two hospitals in Uganda. Methods: Inpatient records of children 0-5 years of age admitted to Lira and Jinja regional referral hospitals in Uganda were reviewed for children admitted on selected days between June 2016 and May 2017. Data was extracted on the results, if any, of pre-transfusion hemoglobin (Hb) level, whether or not a blood transfusion was given and inpatient outcome for all children with a diagnosis of 'severe anemia'. Qualitative data was also collected from health workers to explain the reasons for the clinical practices at the two hospitals. Results: Overall, 574/2275 (25.2%) of the children admitted in the two hospitals were assigned a diagnosis of SA. However 551 (95.9%) of children assigned a diagnosis of SA received a blood transfusion, accounting for 551/560 (98.4%) of the blood transfusions in the pediatric wards. Of the blood transfusions in SA children, only 245 (44.5%) was given appropriately per criteria (Pre-transfusion Hb ≤ 6 g/dL), while 306 (55.5%) was given inappropriately; (pre-transfusion Hb not done, n = 216, or when a transfusion is not indicated [Hb > 6.0 g/dl], n = 90). SA children transfused appropriately per Hb criteria had lower inpatient mortality compared to those transfused inappropriately, (7 (2.9%) vs. 22 (7.2%), [OR 0.4, 95% CI 0.16, 0.90]). Major issues identified by health workers as affecting use of blood transfusion included late presentation of SA children to hospital and unreliable availability of equipment for measurement of Hb. Conclusion: More than half the blood transfusions given in the management of anemic children admitted to Lira and Jinja hospitals was given inappropriately either without pre-transfusion Hb testing or when not indicated. Verification of Hb level by laboratory testing and training of health workers to adhere to transfusion guidelines could result in a substantial decrease in inappropriate blood transfusion in Ugandan hospitals.

Original languageEnglish (US)
Article number566
JournalBMC Health Services Research
Volume18
Issue number1
DOIs
StatePublished - Jul 18 2018

Fingerprint

Blood Transfusion
Anemia
Hemoglobins
Inpatients
Uganda
Health
Africa South of the Sahara
Hospitalization
Referral and Consultation
Guidelines
Pediatrics
Equipment and Supplies
Mortality

Keywords

  • Appropriate use
  • Blood transfusion
  • Severe anemia

ASJC Scopus subject areas

  • Health Policy

Cite this

High rate of inappropriate blood transfusions in the management of children with severe anemia in Ugandan hospitals. / Opoka, Robert O.; Ssemata, Andrew S.; Oyang, William; Nambuya, Harriet; John, Chandy; Tumwine, James K.; Karamagi, Charles.

In: BMC Health Services Research, Vol. 18, No. 1, 566, 18.07.2018.

Research output: Contribution to journalArticle

Opoka, Robert O. ; Ssemata, Andrew S. ; Oyang, William ; Nambuya, Harriet ; John, Chandy ; Tumwine, James K. ; Karamagi, Charles. / High rate of inappropriate blood transfusions in the management of children with severe anemia in Ugandan hospitals. In: BMC Health Services Research. 2018 ; Vol. 18, No. 1.
@article{13c3443a289c443f95c340c64e972662,
title = "High rate of inappropriate blood transfusions in the management of children with severe anemia in Ugandan hospitals",
abstract = "Background: Severe anaemia (SA) is a common reason for hospitalisation of children in sub-Saharan Africa but the extent to which blood transfusion is used appropriately in the management of severe anemia has hitherto remained unknown. We report on the use of blood transfusion in the management of anemic children in two hospitals in Uganda. Methods: Inpatient records of children 0-5 years of age admitted to Lira and Jinja regional referral hospitals in Uganda were reviewed for children admitted on selected days between June 2016 and May 2017. Data was extracted on the results, if any, of pre-transfusion hemoglobin (Hb) level, whether or not a blood transfusion was given and inpatient outcome for all children with a diagnosis of 'severe anemia'. Qualitative data was also collected from health workers to explain the reasons for the clinical practices at the two hospitals. Results: Overall, 574/2275 (25.2{\%}) of the children admitted in the two hospitals were assigned a diagnosis of SA. However 551 (95.9{\%}) of children assigned a diagnosis of SA received a blood transfusion, accounting for 551/560 (98.4{\%}) of the blood transfusions in the pediatric wards. Of the blood transfusions in SA children, only 245 (44.5{\%}) was given appropriately per criteria (Pre-transfusion Hb ≤ 6 g/dL), while 306 (55.5{\%}) was given inappropriately; (pre-transfusion Hb not done, n = 216, or when a transfusion is not indicated [Hb > 6.0 g/dl], n = 90). SA children transfused appropriately per Hb criteria had lower inpatient mortality compared to those transfused inappropriately, (7 (2.9{\%}) vs. 22 (7.2{\%}), [OR 0.4, 95{\%} CI 0.16, 0.90]). Major issues identified by health workers as affecting use of blood transfusion included late presentation of SA children to hospital and unreliable availability of equipment for measurement of Hb. Conclusion: More than half the blood transfusions given in the management of anemic children admitted to Lira and Jinja hospitals was given inappropriately either without pre-transfusion Hb testing or when not indicated. Verification of Hb level by laboratory testing and training of health workers to adhere to transfusion guidelines could result in a substantial decrease in inappropriate blood transfusion in Ugandan hospitals.",
keywords = "Appropriate use, Blood transfusion, Severe anemia",
author = "Opoka, {Robert O.} and Ssemata, {Andrew S.} and William Oyang and Harriet Nambuya and Chandy John and Tumwine, {James K.} and Charles Karamagi",
year = "2018",
month = "7",
day = "18",
doi = "10.1186/s12913-018-3382-5",
language = "English (US)",
volume = "18",
journal = "BMC Health Services Research",
issn = "1472-6963",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - High rate of inappropriate blood transfusions in the management of children with severe anemia in Ugandan hospitals

AU - Opoka, Robert O.

AU - Ssemata, Andrew S.

AU - Oyang, William

AU - Nambuya, Harriet

AU - John, Chandy

AU - Tumwine, James K.

AU - Karamagi, Charles

PY - 2018/7/18

Y1 - 2018/7/18

N2 - Background: Severe anaemia (SA) is a common reason for hospitalisation of children in sub-Saharan Africa but the extent to which blood transfusion is used appropriately in the management of severe anemia has hitherto remained unknown. We report on the use of blood transfusion in the management of anemic children in two hospitals in Uganda. Methods: Inpatient records of children 0-5 years of age admitted to Lira and Jinja regional referral hospitals in Uganda were reviewed for children admitted on selected days between June 2016 and May 2017. Data was extracted on the results, if any, of pre-transfusion hemoglobin (Hb) level, whether or not a blood transfusion was given and inpatient outcome for all children with a diagnosis of 'severe anemia'. Qualitative data was also collected from health workers to explain the reasons for the clinical practices at the two hospitals. Results: Overall, 574/2275 (25.2%) of the children admitted in the two hospitals were assigned a diagnosis of SA. However 551 (95.9%) of children assigned a diagnosis of SA received a blood transfusion, accounting for 551/560 (98.4%) of the blood transfusions in the pediatric wards. Of the blood transfusions in SA children, only 245 (44.5%) was given appropriately per criteria (Pre-transfusion Hb ≤ 6 g/dL), while 306 (55.5%) was given inappropriately; (pre-transfusion Hb not done, n = 216, or when a transfusion is not indicated [Hb > 6.0 g/dl], n = 90). SA children transfused appropriately per Hb criteria had lower inpatient mortality compared to those transfused inappropriately, (7 (2.9%) vs. 22 (7.2%), [OR 0.4, 95% CI 0.16, 0.90]). Major issues identified by health workers as affecting use of blood transfusion included late presentation of SA children to hospital and unreliable availability of equipment for measurement of Hb. Conclusion: More than half the blood transfusions given in the management of anemic children admitted to Lira and Jinja hospitals was given inappropriately either without pre-transfusion Hb testing or when not indicated. Verification of Hb level by laboratory testing and training of health workers to adhere to transfusion guidelines could result in a substantial decrease in inappropriate blood transfusion in Ugandan hospitals.

AB - Background: Severe anaemia (SA) is a common reason for hospitalisation of children in sub-Saharan Africa but the extent to which blood transfusion is used appropriately in the management of severe anemia has hitherto remained unknown. We report on the use of blood transfusion in the management of anemic children in two hospitals in Uganda. Methods: Inpatient records of children 0-5 years of age admitted to Lira and Jinja regional referral hospitals in Uganda were reviewed for children admitted on selected days between June 2016 and May 2017. Data was extracted on the results, if any, of pre-transfusion hemoglobin (Hb) level, whether or not a blood transfusion was given and inpatient outcome for all children with a diagnosis of 'severe anemia'. Qualitative data was also collected from health workers to explain the reasons for the clinical practices at the two hospitals. Results: Overall, 574/2275 (25.2%) of the children admitted in the two hospitals were assigned a diagnosis of SA. However 551 (95.9%) of children assigned a diagnosis of SA received a blood transfusion, accounting for 551/560 (98.4%) of the blood transfusions in the pediatric wards. Of the blood transfusions in SA children, only 245 (44.5%) was given appropriately per criteria (Pre-transfusion Hb ≤ 6 g/dL), while 306 (55.5%) was given inappropriately; (pre-transfusion Hb not done, n = 216, or when a transfusion is not indicated [Hb > 6.0 g/dl], n = 90). SA children transfused appropriately per Hb criteria had lower inpatient mortality compared to those transfused inappropriately, (7 (2.9%) vs. 22 (7.2%), [OR 0.4, 95% CI 0.16, 0.90]). Major issues identified by health workers as affecting use of blood transfusion included late presentation of SA children to hospital and unreliable availability of equipment for measurement of Hb. Conclusion: More than half the blood transfusions given in the management of anemic children admitted to Lira and Jinja hospitals was given inappropriately either without pre-transfusion Hb testing or when not indicated. Verification of Hb level by laboratory testing and training of health workers to adhere to transfusion guidelines could result in a substantial decrease in inappropriate blood transfusion in Ugandan hospitals.

KW - Appropriate use

KW - Blood transfusion

KW - Severe anemia

UR - http://www.scopus.com/inward/record.url?scp=85050341031&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85050341031&partnerID=8YFLogxK

U2 - 10.1186/s12913-018-3382-5

DO - 10.1186/s12913-018-3382-5

M3 - Article

C2 - 30021576

AN - SCOPUS:85050341031

VL - 18

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

IS - 1

M1 - 566

ER -