A policy on blood transfusion
IN the apparent absence of appropriate laws or regulations concerning blood transfusion either in Lagos State or the country as a whole, the bill recently passed by the Lagos House of Assembly is aimed at serving a useful purpose in that regard. For that, the bill is commendable. It specifically provides for the establishment of a committee for blood transfusion, and may become law if the Governor assents to it. The problems associated with blood transfusion, however, go beyond the mere enactment of a law to regulate it. Experts have found out that safe human blood for medical use is practically not available in Nigeria. The situation is not limited to Lagos.
What the Lagos House of Assembly desires is to empower the committee created in the bill to register, accredit and regulate blood transfusion service facilities in the state whether in the private or public sector. The whole idea is to ensure quality control and assurance on all matters relating to blood transfusion. There is also a provision for a sub-committee, which will specialise in monitoring and supervising blood transfusion activities. Anything that can be done to ensure transfusion of safe blood and prevent the spread of diseases through blood transfusion is worthy of encouragement.
At the moment, reports of experts on the safety of blood transfusion in the country should be worrisome. It was discovered for instance that most of the donors have background of risky lifestyles and high tendency for polluted blood. At the same time, the available methods for screening blood are suspect and inadequate. Understandably, the cause for the greatest concern is the possibility of spreading sexually transmitted diseases including the dreaded Human Immuno-deficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) during blood transfusion.
It is being speculated that the rise in cases of HIV/AIDS in recent times is traceable to blood transfusion. About 10 per cent of blood donated on a weekly basis reportedly tested positive to either HIV/AIDS or hepatitis. There are other equally dangerous transmissible infections like malaria parasites, microfilaria, salmonella and yersina species among others, which are also passed through the blood.
No doubt, it is alarming that the figures emerging from transfusion associated with HIV infection in the country show that between five and 10 per cent of those infected with the virus are possibly due to unsafe blood transfusion. Nigeria is also part of the African record of unscreened 2.5 million pints of blood transfused each year. To compound the matter is the reality of inadequate screening facilities, which result in 0.2 per cent chance that blood containing HIV is reported as safe.
Contributing to this situation is that, according to the experts, there is a window period for HIV/AIDS detection such that eight to 12 weeks may elapse from the time of infection to the time when the body reacts in a way to make the virus detectable. In this age of modern technology, and with the global concern on HIV/AIDS, coupled with the fact that a cure has still not been found, the need for prevention cannot be overstressed. It is deplorable and quite unacceptable that Nigeria, with its huge population and potential, has no standard in blood transfusion. The blood banks in some hospitals are more of death traps, in the marked absence of quality control measures, guidelines, regulations and implementation or enforcement machinery. Equally worthy of criticism is that where blood banks exist, this is not backed with the necessary public enlightenment to sensitise the people.
We cannot but note that the seeming ineptitude of government on the issue of blood bank is characteristic of it and not limited to the medical matter. In other spheres, the public sector displays incompetence and a lack of capacity that have continued to drag the nation backward. All the governments, federal as well as states are guilty. What Lagos State is doing through the House of Assembly therefore ought to be replicated by other states. Indeed the Federal Government should take the bull by the horns and evolve a national policy on blood transfusion and management of blood banks.
Official attention on issues involving blood transfusion can make a difference between life and death. Both the government and the public must recognise that blood transfusion, preservation and management is a critical area of preventing infections. Yet, it is an area where so little has been done. There is dire need for a policy. The situation has not been helped by the regular practice of public officers and top government functionaries going abroad for medical treatment at the slightest excuse. It is lamentable that these officers have not considered it necessary to upgrade the country's medical system toward the quality and standard available abroad. Not only is this attitude erroneous, it is most unpatriotic and the nation as a whole is the loser.
The bill passed in Lagos State should serve as a wake-up call for other states and the Federal Government. They should all work together to evolve an acceptable policy on blood transfusion. Until this is done and monitored to ensure correct implementation, efforts to fight HIV/AIDS and other STDs will remain uncoordinated and therefore ineffective. At the moment, doctors are reluctant to administer blood on patients needing it just because of the high risk resulting from the unethical, chaotic and substandard practice associated with it.
The Nigerian Medical Laboratory Scientists have already done a lot of work on the poor standard and have suggested ways out. Among others, they have identified the need for resuscitating a coordinated and properly regulated blood transfusion service in the Armed Forces so as to guarantee expertise and capacity to ensure continuous supply of blood to the hospitals. Apart from the enactment of appropriate laws, stringent donor qualification is also recommended, along with public awareness campaign.
The Federal Government, through the Ministry of Health should spearhead the incorporation of these suggestions into a workable National Blood Transfusion Service. For acceptability, the states must be carried along in perfecting the national policy.
