Low Blood Donation Practice of Health Sciences College Students in Northeast Ethiopia: A Cross-Sectional Study
Received 18 October 2020
Accepted for publication 26 December 2020
Published 28 January 2021 Volume 2021:12 Pages 43—51
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 4
Editor who approved publication: Dr Martin Bluth
Mekedes Dejene,1 Azeb Tefera,1 Abebe Dires,2 Sisay Gedamu,2 Yemiamrew Getachew,3 Sewunet Ademe2
1Emergency Department, Dessie Referral Hospital, Dessie, Ethiopia; 2Department of Nursing, School of Nursing and Midwifery, College of Medicine & Health Sciences, Wollo University, Dessie, Ethiopia; 3Department of Community and Mental Health, School of Nursing and Midwifery, College of Medicine & Health Sciences, Wollo University, Dessie, Ethiopia
Correspondence: Abebe Dires Email email@example.com
Introduction: Blood transfusion is a basic and an emergency intervention in health care facilities which has a great role in reducing significant morbidity and mortality. However, there is a major shortage of blood and blood products in developing countries including Ethiopia. This study aimed to assess practice of blood donation and associated factors among health science college students in Dessie town, northeast Ethiopia.
Methods: An institution-based cross-sectional study was conducted among health science college students from May to June 2019. A pre-tested and self-administered structured questionnaire was used for data collection. Multivariable logistic regression analysis model was applied to identify independent predictors of blood donation practice at the level of significance below 0.05.
Results: Overall, 12.4% (95% CI: 9.5– 15.5) of participants had been donated blood at least once in their lifetime. However, 59.2% of participants have willingness to donate blood in the future. In this study, older age (≥ 25years) (AOR=2.30, 95% CI: 1.18– 4.46), had family history of blood transfusion (AOR=3.55, 95% CI: 1.71– 7.36), had knowledge (AOR=2.09, 95% CI: 1.04– 4.17) and favorable attitude (AOR=2.41, 95% CI: 1.01– 5.75) about blood donation were significantly associated with practice of donating blood.
Conclusion: In this study, blood donation practice of health sciences college students was found to be low. Age, family history of blood transfusion, knowledge and attitude towards blood donation were independent predictors of blood donation practice. Therefore, Red Cross societies, Dessie town health office, health science colleges and other stakeholders should enhance the awareness of college students regarding the importance of donating blood.
Keywords: blood donation, college students, northeast Ethiopia
Blood transfusions help to save millions of lives every year and support complex medical and surgical procedures.1 It is a basic and an emergency intervention in health care facilities which has a significant role in reducing morbidity and mortality. In addition, blood has an essential life-saving role in maternal and childcare interventions that could occur in human made and natural disasters. However, in many countries there is no adequate supply of blood available to fulfill the demand.2
There was a marked difference in the accessibility of blood between high and low income countries. The average annual collection of blood per blood center was 30,000 units of blood in high-income countries as compared to 3,700 in low-income countries.3 In principle, there are three types of blood donors. These are; replacement, paid, and voluntary donors.4 The World Health Organization (WHO) is recommending all countries should obtain their blood supplies from voluntary donors by the year 2020. But the majority of blood donation practices are replacement type of donation.5
From the 92 million units of blood collected annually, almost half was collected in high-income countries.3 Similarly, more than 34 million peoples were donated blood from 189 national societies.6 Collected bloods could be discarded due to different reasons. The WHO's global database on blood safety indicated that, about 1.6 million units of collected blood was discarded annually due to the presence of infections like HIV, hepatitis virus and syphilis.7
In developing countries, the habit of blood donation was much lower than that of high income countries.6 In sub-Saharan Africa, blood helps to reduce morbidity and mortality of young children and pregnant women in particular. However, many deaths could be prevented if national blood services and hospitals have adequate supplies of blood.8 From 2011 to 2014, the overall blood collections were increased by 19% among 14 African countries, and in Ethiopia the services was increased by 73.8%.9 The Ethiopian Red Cross Society (ERCS) is the first organization in establishing blood bank service in the country. After the federal ministry of health has taken over the service from ERCS in 2012, the rate of national blood collection was increased from 40,000 units of blood in 2011 to 88,000 in 2014 and the involvement of voluntary blood donors had been increased from 10% in 2011 to 70% in 2014.10 According to WHO, countries’ blood transfusion service was recommended to be based on voluntary blood donors by 2020.11
The global burden of injuries and death from road traffic accidents was increased, particularly in Africa.12 The majority of deaths after traumatic injuries is as a result of hemorrhage.2 In addition, hemorrhage has been identified as the leading cause of maternal mortality worldwide and in Ethiopia.13–18 Generally, 50–80% of all blood transfusions were given to treat patients with severe anemia as a result of hemorrhage and trauma.19 Thus, timely access to blood transfusion has a great role to reduce significant morbidity and mortality in health care facilities. Although the global need of blood supply has been increased progressively, there is still evidence of a shortage of blood and blood products in developing countries including Ethiopia. In low income countries, lack of knowledge and poor attitude about donating blood were the major factors affecting blood donation practice.20 To what extent eligible segments of the population in Ethiopia have donated blood is vital to enhance community awareness interventions which are essential to meet the demand for blood. In Ethiopia, numerous studies have been conducted regarding blood donation at community level. However, there are few studies about the practice of blood donation among health science college students.
This study aimed to assess blood donation practices of health science college students and any associated factors in Dessie town, northeast Ethiopia.
Methods and Materials
Study Design, Period and Setting
An institution-based cross-sectional study was conducted among health science college students in Dessie town, northeast Ethiopia from May to June 2019. Dessie town is located 523 kilometers (KM) far from Bahir Dar (Regional city of Amhara) and 401 KM northeast of Addis Ababa (the capital city of Ethiopia). The town has one public referral hospital and three private hospitals. The referral hospital is designed to serve up to 5,000,000 populations. There is one blood bank in the town that works in conjunction with the Red Cross society. There are four health science colleges in the town, with a total of 3,560 students. Nursing, midwifery, public health officers and medical laboratory were the main programs executed in those colleges.
The source populations were all health science college students founded in Dessie town and the study populations were randomly selected health science college students during data collection period.
A single population proportion formula [n = (Z a/2)2 P(1-P)/d2] was used to estimate the sample size by considering the following assumptions: Proportion of 50%, 95% confidence level, 5% margin of error, and 10% non-response rate.21 Therefore, the final sample size was 423.
Sampling Technique and Procedure
From the four health science colleges found in Dessie town, the total number of students in each college was determined. Proportional allocation was made at the level of college and year of entry to select students. Finally, a simple random sampling technique was used to select study participants (Figure 1).
Figure 1 Sampling procedures on the practice of blood donation among health science college students of Dessie town, northeast Ethiopia, 2019.
Abbreviation: HSC, health science college.
Data Collection Tool and Procedures
For data collection, self-administered structured questionnaire was used which was adopted from previous studies.21–24 Socio-demographic variables, questions assessing the knowledge, attitude and practice of students about blood donation were included in the questionnaire. In addition, participants’ willingness to donate blood was also assessed (Supplementary material).
Data Quality Management
To maintain the quality of the data, four nurse data collectors and two public health officers as a supervisor were recruited and trained for two days regarding the objective of the study and other ethical issue. In addition, the data collection tool was pre-tested by assumption of 5% of the total sample size within one week prior to the actual data collection period in Wollo University health science students. Based on pre-test evaluation, the tool was modified and the necessary corrections were made. Finally, an organized and valuable tool was made ready and used for the actual data collection.
Practice of blood donation: Students who had donated blood at least once in his or her lifetime.
Knowledgeable about blood donation: Among knowledge assessing questions, students who score was greater than or equal to a mean value of 0.5 were considered knowledgeable. Whereas, those who scored less than the mean value 0.5 were not considered to be knowledgeable.
Favorable attitude towards blood donation: Those respondents who scored the mean value of 0.3 and above among attitude assessing questions.
Unfavorable attitude towards blood donation: Those respondents who had scored below the mean value of 0.3 answering attitude assessing questions.
Data was entered using Epi-info version 7 and analyzed by SPSS (statistical package for social science) version 20. Data were reported using mean for continuous variables and proportions and tables were used to describe categorical variables. Bivariable and multivariable logistic analyses model were used with odds ratio and 95% confidence interval. In bivariable analysis, variables with p-value of 0.2 and below were entered into multivariable analysis model. In multivariable analysis model, variables with p-value < 0.05 were considered statistically significant.
Socio-Demographic Characteristics of Study Participants
In this study, 412 students were participated with response rate of 97.4%. The mean age of participant was 19.5 years and 62.6% were in the age group of 18–24 years. Overall, 55.6% of the participants were male, 64.8% were from an urban area, 36.9% were students of public health, and 28.9% were second year students (Table 1).
Table 1 Socio-Demographic Characteristics of Respondents for Practice of Blood Donation Among Health Science College Students in Dessie Town, 2019 (n = 412)
Respondents’ Practice of Blood Donation and Related Factors
Among all participants, 5.6% had been transfused with blood and 23% had family history of blood transfusion. Of all respondents, 40.5% and 67.2% had knowledge and favorable attitude about blood donation, respectively. Overall, 12.4% (95% CI: 9.5–15.5) of participants had donated blood at least once in their lifetime, of which, 62.7% were donated voluntarily. Fear of health problems after screening (39.3%) and lack of information (31.5%) were the main reasons identified by non-blood donors. In this study, 59.2% of students are willingto donate blood voluntarily in the future (Table 2).
Table 2 Respondents’ Practice of Blood Donation and Related Factors Among Health Science College Students in Dessie Town, 2019 (n = 412)
Factors Associated with Practice of Blood Donation
A total of eleven independent variables were included in the bivariable logistic regression analysis. Those variables associated with the dependent variable at p-value of less than 0.2 were subjected into multivariable logistic analysis. Thus, after adjusted for confounding variables in multivariable analysis; older age (≥25 year) (AOR=2.30, 95% CI: 1.18–4.46), those who had a family history of blood transfusion (AOR=3.55, 95% CI: 1.71–7.36), knowledge (AOR=2.09, 95% CI: 1.04–4.17), and a favorable attitude (AOR=2.41, 95% CI: 1.01–5.75) about blood donation were significantly associated with the practice of donating blood (Table 3).
Table 3 Bivariable and Multivariable Analysis for the Practice of Blood Donation Among Health Science College Students in Dessie Town, 2019 (n = 412)
Blood transfusion is a basic and vital tool in emergency lifesaving interventions. Globally, the need for blood and blood products has been increasing and evidence showed that the habit of donating blood in the population was not satisfactory. In our study, 12.4% of students had been donated blood at least once in their lifetime. This finding was comparable with a previously reported study done in Nigeria (15%).25 However, it was higher compared to a study done in India (1.4%)26 and it was lower compared to studies conducted in three settings of Ethiopia Ambo (23.6%),27 Arsi (27.2%),28 and Addis Ababa university students (24.3%).29
It was also lower compared to studies done in Africa; Tanzania (30%),30 Sudan (27%),31 Malaysia (29.7%),32 Nigeria (59.5%),33 Nepal (28.5%)34 as well as in three setting of India (38.4%),35 (17.3%),36 (23%),37 and Saudi Arabia (19%).38 This discrepancy could be due to difference in socio demography and economical characteristics of study participants and the study period.
WHO is recommending all countries should obtain their blood from voluntary blood donors.11 In this study, of the total respondents who had been donated blood, about 62.7% were donated voluntarily. In Ethiopia, voluntary blood donation showed a significant increase in the past decade.10 Although the proportion of voluntary blood donors were moderate in the country, it is still not enough to meet the need required amount of blood so as to prevent the morbidity and mortality of children and women, in particular. The most significant increases in the percentage of voluntary blood donation were reported in India, Bulgaria, Afghanistan, Belarus, Algeria, and Costa Rica.3
In our study, participants aged ≥ 25 years were 2.3 times more likely donated blood as compared to those who were found between 18 and 24 years. It was in line with the study done in Addis Ababa, Ethiopia.29 The odds of blood donation practice was higher in those students who had family history of blood transfusion compared to those who had not family history. This was in line with the study done in Ambo, Ethiopia.27 This could be explained by people voluntarily donating blood after experiencing a family member's health problems which required a blood transfusion. Furthermore, students who had knowledge about blood donation were twice as likely to donate blood compared to those who had no knowledge, which was similar to the studies done in Ambo, Ethiopia27 and Ghana.20 Students who had favorable attitudes towards blood donation were 2.4 times more likely to donate blood compared to their counterparts. In this study, 87.6% of participants had never donated blood and fear of health problems after screening and lack of information were the main reasons identified for not donating. However, a significant proportion of students are willingto donate blood in the future, which is an opportunity to increase the number of blood donors in the country.
A strength of this study is that we have assessed blood donation practices of health science college students who would be involved in direct patient care. The possible limitations of this study could be related to the nature of the cross-sectional study design used and there could be social desirability and recall bias. Additionally, since this study was carried out on selected health science college students of Dessie town, our findings may not be generalized to the overall college students of the town.
In this study, blood donation practices of health science college students was found to be low. Age, family history of blood transfusion, knowledge, and attitude towards blood donation were independent predictors of blood donation practice. Therefore, Red Cross societies, Dessie town health office, health science colleges and other stakeholders should enhance the awareness of college students regarding the importance of donating blood. Furthermore, frequent promotional campaigns should be conducted by media and health care providers.
Data Sharing Statement
The used data set and analyzed during this study are available from the corresponding author on reasonable request.
Ethical Approval and Consent
Ethical approval was obtained from ethical review committee of Wollo University, school of nursing and midwifery, department of nursing. Study participants were informed that participation was on a voluntary basis and they can leave the study at any time if they are not comfortable about the questionnaire. Verbal informed consent taken from study participants was approved by the Ethical Review Committee of Wollo University and that this study was conducted in accordance with the Declaration of Helsinki. Confidentiality was preserved for all data collected.
We would like to thank coordinators’ of health science colleges in Dessie town for their cooperation and all study participants for this study.
All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.
There is no funding to report.
The authors report no conflicts of interest for this work.
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