Ado-Yobo, EOD; (1990) Iatrogenic HIV via blood transfusion and hospitals-users' awareness in a region in Ghana (the size of the problem and change in hospital practice and knowledge needed). Masters thesis (M.Sc), UCL (University College London).

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Abstract

A study was done in the regional and 2 district hospitals in the Ashanti region in Ghana on the problem of transfusion-transmitted HIV infection with regard to 1)how much transmission has occurred in the past 5 years in children, 2)the prevalence of HIV infection among blood donors presently, 3)how much clinicians are contributing to the iatrogenic spread by their blood transfusion practices and 4) the potential role of the hospital-using public in reducing the spread of HIV infection in the community. Over a 6 week period, blood samples were obtained from a group of paediatric patients aged less than 12 years in the regional hospital who had a previous history of admission to the hospital, with and without blood transfusion (cases and controls), within the last 5 years. Samples were also collected from all donated blood in each of the 3 hospitals over a 3 week period in each case. All the blood samples were screened for HIV1 and HIV2 infection using "HIVCHEK 1+2". A sample of 6 positives and 8 negatives was chosen from all the screened samples randomly and were retested for HIV1 and HIV2 using Western Blot ("Biorad" and "New LAV Blot II"). Information for the other aspects of the study was obtained from transfusion patients' clinical records and from an open-ended questionnaire to the hospital users on blood transfusion and AIDS. There were similar prevalences of HIV infection of about 4% and 5% among children who had received 2 or more blood transfusions within the last 5 years and among blood donors in the three week period of the study. According to the preset criteria about 25% or more of all blood transfusion episodes in the hospitals were probably avoidable. Surgical practices were associated with many more avoidable blood transfusions than non-surgical medical practices. About 25% of all the hospital users interviewed resented blood donations and transfusions probably because they did not understand their relation with ill-health. Generally, it was felt that the public needed more information and discussions on the issue of HIV infection and AIDS in the community. The study draws attention to the problem of HIV screening results based on modern screening test which appear as indeterminate. Malaria may be interfering in West Africa. Within the broad range of estimation, the risk of iatrogenic HIV via blood transfusion is far too high and of serious concern as evidenced not only by the tests on children and practices. There is, therefore, a strong need for the development of guidelines for transfusions in all hospitals in the country, and also a need for clinicians to balance the risks and benefits of each transfusion with attempts to reduce the frequency of blood transfusion.

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