Evolving strategies to encourage repeat donations among first time voluntary and replacement blood donors in southern Ghana

Low- and middle-income countries have about 81% of the world’s population, but contribute only about 50% of the 112.5 million donations of blood collected annually worldwide. In Ghana, there is shortage of blood all year round, with a deficit of about 35% of the national requirement of 250,000 units. Voluntary non-remunerated blood donors (VNRBDs) are uncommon and contribute only about 36% of the donated blood. Repeat donations constituted only 38.2% of donations by VNRBDs at the Southern Area Blood Centre of the National Blood Service, Ghana (NBSG) in 2016, despite the recognition that repeat donors are safer. To increase the safety and adequacy of blood supply in low- and middle-income countries, locally relevant evidence is needed about how to better motivate blood donors. This study examined the perceptions about blood and blood donation; motivators for, and deterrents to blood donation; first-time blood donors’ intention to return to donate blood; and recommended interventions to promote blood donation in Ghana. Two scoping literature reviews, 24 individual in-depth interviews, five focus group discussions with a total of 39 participants, and a cross-sectional survey of 250 first time VNRBDs and 255 first-time family replacement blood donors (FRDs) were conducted in southern Ghana. A sequential exploratory mixed methods design was used. Key perceptions that influence blood donation in Ghana were the perception that blood is life, the symbolism of blood as a spiritual, religious and cultural entity, the knowledge of blood as a physical/biological substance; and that blood donation is a good and lifesaving act with health benefits and negative health effects. Key motivating factors were altruism, collectivism, education, awareness, publicity/advertisement, reminders, and some non-monetary incentives. Important deterrents were: fear, negative service experience, negative influence of other persons, inconvenience, discouraging religious and cultural beliefs. First time donors were young (median age, 25 years; interquartile range 21-31 years), with 87.4% below 35 years of age, male (72.5%), single (73.3%), Christian (93.7%), employed (58.8%), with at least a basic education (98%), and lived with parents/family (54.3%). VNRBDs were younger (median, 23 years; interquartile range 20-29 years) than FRDs (median, 28 years; interquartile range 23-33 years). Most FRDs considered themselves as VNRBDs (82.6%). Factors that positively predicted intention to return to donate were: convenient access to donation sessions (OR=2.6, 95% CI 1.5–4.6; p=0.001); if Ghana needs blood (OR=2.5, 95% CI 1.1–6.0; p=0.033); if it makes one feel good about himself/herself (OR=1.8, 95% CI 1.0-3.2; p=0.040); SMS/email reminders (OR=2,7, 95% CI 1.5–4.8; p=0.001); TV, radio or newspaper advertisement (OR=2.9, 95% CI 1.6–5.1; p<0.001). Factors that negatively predicted intention to donate again included blood credits (OR=0.4, 95% CI 0.2–0.8; p=0.013); free TTI test results (OR=0.4, 95% CI 0.2–0.9; p=0.018); and not knowing what happens to the donated blood (OR=0.5, 95% CI 0.3-0.9; p=0.028). This study describes original research which suggests that interventions and recommendations that are likely to increase first-time donor return in Ghana include those aimed at education, improving access to donation sites, and encouraging FRDs to become regular donors; a functioning donor contact centre; and evaluation, rationalising and implementation of an incentive system. There are examples in the literature of successful interventions for motivating blood donors in Ghana, but the challenge is a lack of quality evaluations and scale-up studies

Perceptions of a mobile phone-based approach to promote medication adherence: A cross-sectional application of the technology acceptance model

Background: In several African and Asian countries, callers to mobile phones sometimes hear a song or message in place of the typical ringing sound. This application, called caller tunes, may offer a unique opportunity to promote medication adherence that is yet to be explored. Objectives: Assess the application of the technology acceptance model to a potential caller tunes approach designed to enhance medication adherence, with a specific focus on the interrelationships of perceived ease of use, perceived usefulness, cost, and intention. Methods: Data from a cross-sectional sample of 996 adult mobile phone users in Ghana, approximately half of whom were current caller tunes users, was examined using exploratory factor analysis for scale evaluation and structural equation modeling to assess associations among perceived ease of use, perceived usefulness, and cost on intention to use mobile phone caller tunes to promote medication adherence. Results: Consistent with the technology acceptance model, intention to use the caller tunes as a means of enhancing medication adherence was higher among those who viewed the application positively in terms of ease of use and usefulness. Among those who were already caller tunes users, availability as a free download was also associated with more positive intentions. Conclusion: The present study provides preliminary evidence in support of caller tunes as a novel strategy to promote medication adherence. Future studies interested in using this approach would be advised to consider factors such as participants\u27 current use of caller tunes, age, availability as a free download, and perceptions of ease of use and perceived usefulness of the approach as potential moderators of study outcomes

Pharmacists and COVID-19 vaccination – Considering mobile phone caller tunes as a novel approach to promote vaccine uptake in low- and middle-income countries

As several low- and middle-income countries roll out their COVID-19 vaccination programmes, COVID-19 vaccines hesitancy could threaten the success of such programmes. But pharmacists can play a leading role in addressing COVID-19 vaccine hesitancy by using a critical mobile phone-based technology. This technology, known as caller tunes or ringback tones, is flourishing in low- and middle-income countries such as those in Africa and Asia where it is used to promote popular songs and religious messages. With this technology, callers to mobile phones hear a message or a song instead of the typical ringing sound. There is a need for pharmacists associations to collaborate with the creative arts industry and telecommunication companies to have caller tunes on COVID-19 vaccines. As pharmacists and others download COVID-19 vaccine caller tunes onto their mobile phones, their callers will hear COVID-19 vaccines messages or songs. This could help combat disinformation and hesitancy, and promote widespread vaccination as availability increases

The status of blood supply in sub-Saharan Africa: barriers and health impact

Commen

Determinants of intention to return to donate blood among first-time blood donors in Ghana

Objective This study seeks to identify factors that are predictive of intention to return to donate blood among first‐time blood donors. Methods A cross‐sectional survey of 505 first‐time blood donors, selected from blood donation sessions across three regions in Ghana. Data were obtained on their intention to donate blood in the next four months, factors that would influence this decision. Logistic regression models were used to test factors that were predictive of intention to return. Results First‐time donors were young with 87·4% below 35 years of age, male (72·5%), single (73·3%), Christian (93·7%), employed (58·8%), with at least a basic education (98%). Factors that positively predicted intention to return included: motivational incentives (OR = 1·67, 95%CI: 1·01–2·78; P = 0·045); ease of access to the donation site (OR = 2·65, 95%CI: 1·48–4·73; P = 0·001); SMS and email reminders (OR = 2·84, 95%CI: 1·60–5·06; P < 0·001); and television, radio or newspaper advertisements (OR = 2·97, 95%CI: 1·66–5·31; P < 0·001). Factors that negatively predicted intention included preferential access to transfusions (i.e. ‘blood credits’) (OR = 0·43, 95%CI: 0·23–0·83; P = 0·012); getting to know test results (OR = 0·40, 95%CI: 0·20–0·80; P = 0·010); and not knowing and/or trusting what happens to the blood after donating (OR = 0·50, 95%CI: 0·28–0·88; P = 0·016). Conclusion Motivational incentives, convenient access to donation sessions, reminders and mass media advertisements appear to positively influence intention to return to donate. Conversely not knowing what happens to the blood after donation negatively influenced intention to return. Interventions to promote repeat blood donation should consider the identified factors

Determinants of Intention to Use Mobile Phone Caller Tunes to Promote Voluntary Blood Donation: Cross-Sectional Study

Background: Voluntary blood donation rates are low in sub-Saharan Africa. Sociobehavioral factors such as a belief that donated blood would be used for performing rituals deter people from donating blood. There is a need for culturally appropriate communication interventions to encourage individuals to donate blood. Health care interventions that use mobile phones have increased in developing countries, although many of them focus on SMS text messaging (short message service, SMS). A unique feature of mobile phones that has so far not been used for aiding blood donation is caller tunes. Caller tunes replace the ringing sound heard by a caller to a mobile phone before the called party answers the call. In African countries such as Ghana, instead of the typical ringing sound, a caller may hear a message or song. Despite the popularity of such caller tunes, there is a lack of empirical studies on their potential use for promoting blood donation. Objective: The aim of this study was to use the technology acceptance model to explore the influence of the factors—perceived ease of use, perceived usefulness, attitude, and free of cost—on intentions of blood or nonblood donors to download blood donation-themed caller tunes to promote blood donation, if available. Methods: A total of 478 blood donors and 477 nonblood donors were purposively sampled for an interviewer-administered questionnaire survey at blood donation sites in Accra, Ghana. Data were analyzed using descriptive statistics, exploratory factor analysis, and confirmatory factory analysis or structural equation modeling, leading to hypothesis testing to examine factors that determine intention to use caller tunes for blood donation among blood or nonblood donors who use or do not use mobile phone caller tunes. Results: Perceived usefulness had a significant effect on intention to use caller tunes among blood donors with caller tunes (beta=.293, P<.001), blood donors without caller tunes (beta=.165, P=.02, nonblood donors with caller tunes (beta=.278, P<.001), and nonblood donors without caller tunes (beta=.164, P=.01). Attitudes had significant effect on intention to use caller tunes among blood donors without caller tunes (beta=.351, P<.001), nonblood donors with caller tunes (beta=.384, P<.001), nonblood donors without caller tunes (beta=.539, P<.001) but not among blood donors with caller tunes (beta=.056, P=.44). The effect of free-of-cost caller tunes on the intention to use for blood donation was statistically significant (beta=.169, P<.001) only in the case of nonblood donors without caller tunes, whereas this path was statistically not significant in other models. Conclusions: Our results provide empirical evidence for designing caller tunes to promote blood donation in Ghana. The study found that making caller tunes free is particularly relevant for nonblood donors with no caller tunes

Impact of Iron Supplementation in Anemic Voluntary First-Time Blood Donors-Results of a Pilot Trial in Ghana

Introduction Blood transfusion is a major developmental challenge in sub-Saharan Africa due to chronic inadequacy and shortage of major blood products. In Ghana, deferral of potential blood donors has been identified as a significant challenge. Anemia, accounts for nearly half of ineligible blood donors. The estimated prevalence of anemia is 42.4% in women of reproductive age and 18.8% among peri-urban men ( Spring and Ghana Health service 2016). Thus, a high prevalence of anemia accounting for nearly half of voluntary blood donor deferrals, may contribute to the country's poor availability of safe blood for transfusion. No prior investigation had been carried out in Ghana on whether potential blood donors, deferred due to anemia, would consider donating blood after receiving counselling and appropriate treatment. This study tested the hypothesis that low-dose iron supplementation will increase hemoglobin levels sufficiently among anemic individuals to make them eligible to donate blood. Data from this trial informed the design of a larger randomized control type 1 pragmatic effectiveness implementation hybrid trial. Methods:This was a longitudinal two-arm parallel-group trial (participants aged 18 - 60 years). We compared the hemoglobin levels among those with anemia, iron deficiency (ID) or iron deficiency anemia (IDA) who received iron supplementation to donors without ID or IDA (Control group) in a non-inferiority design(NCT04949165). Anemia, IDA and ID were defined and determined using World Health Organization cut-off values (WHO, 2011). Potential blood donors with hemoglobin values less than 10 g/dl were excluded from the study. Participants in the iron supplementation arm were given low-dose iron (65 mg elemental iron) three times weekly for four months while the control arm received the standard nutritional counselling practice. In-person visits occurred at two, four and six months and included blood draws for full blood count, peripheral blood film smear, malaria rapid test and serum ferritin. The primary outcome was hemoglobin level after four months. A structured questionnaire assessed adherence, nutritional counselling and adverse events every two weeks via phone. Results: Two hundred and twenty-three first-time voluntary blood donors consented and passed pre-screening donation requirements (105 in iron supplementation arm vs. 118 in the control arm). The mean ages were similar between the iron supplementation and control groups (19.7±2.5 vs. 20.1±3.1 years). In both groups, there were more females than males (iron: 75.2%; control: 51.7%). At screening, 43.9% (98/223) had anemia while 3.1% (7/223) had ID. Of those who had anemia, 84.7% (83/98) had ferritin at least 15 g/l while 15.3% (15/98) had IDA. Among controls who donated blood at screening with an interim 1 visit, 42.6% (20/47) of females and 20.9% (9/43) of males were anemic. Only 23.4% (11/47) of females but no male was ID after one blood donation. Among participants assigned to iron supplementation who were anemic at screening, 31.7% (20/63) of females and 28.6% (6/21) of males were no longer anemic at interim visit 1. Among iron participants who were ID at screening 53.3% (8/15) of females and no male (0/2) were iron replete at interim visit 1. Only half of the participants receiving iron supplementation self-reported perfect adherence at the first and second interim visits (end of iron supplementation). A small proportion of participants reported side effects of dark stools and abdominal pain. We did not observe bacterial infections or increased malaria incidence. The mean hemoglobin values decreased over time from baseline to month four in the control group (screening: N=118, 13.4±1.3 g/dl; interim visit 2: N=74, 12.3±1.5 g/dl) and increased in the iron supplementation group (screening: N=105, 11.3±0.9 g/dl; interim visit 2: N=56, 11.4±1.3 g/dl). However, the primary comparison, mean hemoglobin difference between the iron supplementation and control arm at four months, did not meet the threshold to reject the inferiority hypothesis. Conclusion: The prevalence of ID and IDA among voluntary first-time blood donors was lower than previously published estimates. Adherence to low-dose iron supplementation three times a week was poor. Hemoglobin levels in the iron supplementation arm were not close enough to those in the control group after four months of iron supplementation to declare non-inferiority

Hepatitis C virus in sub-Saharan Africa: a long road to elimination

The development of direct-acting antivirals against hepatitis C virus (HCV) has transformed the treatment landscape and underpinned the WHO goal of HCV elimination by 2030. However, as of 2021, few countries remain on track to achieve this goal. Reliable data remain scarce, especially those on national plans for HCV elimination in many regions of the world and particularly in sub-Saharan Africa, which accounts for around 11 million of 71 million people estimated to be living with HCV