Impact of Inconsistent Policies for Transfusion-Transmitted Malaria on Clinical Practice in Ghana

Background: Policies concerning the prevention of transfusion transmitted malaria (TTM) are the responsibility of blood transfusion services and malaria control programmes. To prevent spreading drug resistance due to over-use of malaria drugs, recent malaria treatment guidelines recommend prompt parasitological confirmation before treatment is started. In contrast, blood safety policies from the World Health Organisation (WHO) recommend presumptive malaria treatment for recipients of blood in endemic countries but evidence supporting this approach is lacking. Our study documented how these conflicting policies relating to malaria transmission through blood transfusion impact on clinical practice in a teaching hospital in West Africa. Methods/Principal Findings: We randomly selected and reviewed case notes of 151 patients within 24 hours of their receiving a blood transfusion. Transfusion practices including the confirmation of diagnosis and anti-malarial treatment given were compared across three departments; Obstetrics and Gynaecology (O&G), Paediatrics and Medicine. Overall, 66 (44%) of patients received malaria treatment within 24 hrs of their blood transfusion; of which only 2 (3%) received antimalarials based on a laboratory confirmation of malaria. Paediatric patients (87%) received the most anti-malarials and only 7 % and 24 % of recipients in medicine and O&G respectively received anti malarials. In 51 patients (78%), the anti-malarials were prescribed at the same time as the blood transfusion and anti-malarials prescriptions exceeded the number of patient

Micronutrient Deficits Are Still Public Health Issues among Women and Young Children in Vietnam

Background: The 2000 Vietnamese National Nutrition Survey showed that the population’s dietary intake had improved since 1987. However, inequalities were found in food consumption between socioeconomic groups. As no national data exist on the prevalence of micronutrient deficiencies, a survey was conducted in 2010 to assess the micronutrient status of randomly selected 1526 women of reproductive age and 586 children aged 6–75 mo. Principal Findings: In women, according to international thresholds, prevalence of zinc deficiency (ZnD, 67.262.6%) and vitamin B12 deficiency (11.761.7%) represented public health problems, whereas prevalence of anemia (11.661.0%) and iron deficiency (ID, 13.761.1%) were considered low, and folate (,3%) and vitamin A (VAD,,2%) deficiencies were considered negligible. However, many women had marginal folate (25.1%) and vitamin A status (13.6%). Moreover, overweight (BMI$23 kg/m 2 for Asian population) or underweight occurred in 20 % of women respectively highlighting the double burden of malnutrition. In children, a similar pattern was observed for ZnD (51.963.5%), anemia (9.161.4%) and ID (12.961.5%) whereas prevalence of marginal vitamin A status was also high (47.362.2%). There was a significant effect of age on anemia and ID prevalence, with the youngest age group (6–17 mo) having the highest risk for anemia, ID, ZnD and marginal vitamin A status as compared to other groups. Moreover, the poorest groups of population had a higher risk for zinc, anemia and ID

Challenges in transfusion-transmitted infection screening in Sub-Saharan Africa

International audienceIn Sub-Saharan Africa, high clinical demand for transfusion faces endemic bloodborne infections and limited resources. Blood screening for transfusion-transmitted bloodborne pathogens is the cornerstone of blood safety. Although there have been substantial improvements over the years, challenges in transfusion-transmitted infection screening that have been identified repeatedly long ago still need to be addressed. Affordability and sustainability of state-of-the-art quality assessed serological and molecular assays, and associated confirmation strategies remain of real concern. In addition, limited resources and infrastructures hamper the development of adequate facilities, quality management, and staff qualification, and exacerbate shortage of reagents and equipment maintenance. It is also important to maintain effort in constituting pools of repeat voluntary non-remunerated donors. Alternative strategies for blood screening that take into account local circumstances might be desirable but they should rely on appropriate field evaluation and careful economic assessment rather than dogma established from high-resource settings

Influence of plasmodium Falciparum malaria on sickle cell Vaso-occlusive Crisis in Yaoundé, Cameroon

BackgroundSickle cell disease and malaria infections are common in Cameroon. Malaria infection is thought to influence the occurrence and severity of crisis in sickle cell patients.ObjectiveTo investigate the relationship between malaria infection and vasoocclusive crisis in sickle cell disease patients.MethodsIn order to investigate the clinical severity of painful vaso-occlusive crisis in sickle cell anaemia patients suffering from malaria infection, 60 SS Homozygous patients aged 2 – 35 years (median = 15 years) with painful crisis and 40 SS Homozygous sickle cell patients in ‘steady state’ aged 1 – 38 years (median = 17 years) were recruited into the study. The clinical severity of the crisis was graded as 0.1 and 2 based on an arbitrary scale for increasing pain. For each participant thin and thick blood films were made from capillary blood, stained according to standard methods and examined for malaria parasites. Chi square and student t tests were used for statistical analysis.ResultsOf the 60 patients in crisis, pain in 46.7% was classified as Grade 1, in 46.7% as Grade 2 and in 6.6% as Grade 0. There were 66.6% of them with positive thick films for malaria parasites compared to 35.0% of the patients in ‘steady state’ (p=0.003). All parasites were shown on thin film to be Plasmodium falciparum. More than 50% of the patients in crisis with positive thick films were in Grade 2 of the clinical grading.ConclusionThese findings show that falciparum malaria remains a major cause of morbidity and contributes significantly to the occurrence and severity of painful vaso-occlusive crisis in sickle cell disease patients.Keywords:Plasmodium Falciparum, Malaria, Sickle Cell Diseas

La formation en médecine transfusionnelle reste insuffisante dans les centres d'Afrique subsaharienne francophone: Résultats d'une étude préliminaire

Purpose of the study: To evaluate the needs in staff training in transfusion centres of Sub-Saharan Africa. Material and methods: This preliminary study analyzed the training level of each personnel of four blood banks of Sub-Saharan Africa, their training fields, duration and training structures. Results: The needs remain high in all the fields and are critical regarding the administration of blood transfusion services, equipment maintenance and clinical use of blood. © 2011 Elsevier Masson SAS