Socio-Cultural Barriers to Voluntary Blood Donation for Obstetric Use in a Rural Nigerian Village

ArticleinAfrican Journal of Reproductive Health 9(3):72-6 · January 2006with38 Reads
DOI: 10.2307/3583413 · Source: PubMed
Abstract

Availability of blood for transfusion is of utmost importance in the fight against maternal morbidity and mortality. This study was conducted to identify the socio-demographic characteristics and reasons of persons declining voluntary blood donation. Patients' relatives declining blood donation in rural Ebonyi State were randomly recruited and interviewed using standardised questionnaire after obtaining informed consent from each of them. Responses were ranked according to frequency of positive respondents. Illiteracy was prevalent among the population: over 76% had no formal education. 'Not being strong enough' and 'not having enough blood' were the two major reasons for declining blood donation, while loss of manhood/libido and exposure of blood to witchcraft were the other reasons given. Respondents' level of awareness of HIV/AIDS was appreciable. Socio-cultural barriers to voluntary blood donation exist in predominantly illiterate rural communities of the country. Most of the reasons given were based on misconception, misinformation and ignorance about the effect and safety of blood donation.

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Available from: Odidika Ugochukwu Joannes Umeora, Jun 19, 2014
Socio-Cultural Barriers to Voluntary Blood Dona-
tion for Obstetric Use in a Rural Nigerian Village
OUJ Umeora
1
, SO Onuh
2
and MC Umeora
3
ABSTRACT
Availability of blood for transfusion is of utmost importance in the fight against maternal morbidity and mortality. This
study was conducted to identify the socio-demographic characteristics and reasons of persons declining voluntary blood
donation. Patients’ relatives declining blood donation in rural Ebonyi State were randomly recruited and interviewed
using standardised questionnaire after obtaining informed consent from each of them. Responses were ranked according
to frequency of positive respondents. Illiteracy was prevalent among the population: over 76% had no formal education.
‘Not being strong enough’ and ‘not having enough blood’ were the two major reasons for declining blood donation, while
loss of manhood/libido and exposure of blood to witchcraft were the other reasons given. Respondents’ level of
awareness of HIV/AIDS was appreciable. Socio-cultural barriers to voluntary blood donation exist in predominantly
illiterate rural communities of the country. Most of the reasons given were based on misconception, misinformation and
ignorance about the effect and safety of blood donation. (Afr J Reprod Health 2005; 9[3]:72-76)
RÉSUMÉ
Obstacles socio-culturels au don volontaire du sang destiné à l'usage obstétrical dans un village Nigérian
rural La disponibilité du sang destiné à la transfusion est d'une importance capitale dans le combat contre la morbidité et
la mortalité maternelles. Cette étude a été menée afin d'identifier les caractéristiques socio-démographiques et les raisons
pour lesquelles les gens ne veulent pas faire le don volontaire du sang. Les parents des patients qui ne veulent pas faire le
don volontaire du sang dans l'état d'Ebonyi rural ont été recrutés et interviewés au hasard à l'aide d'un questionnaire
standardisé, suite à l'obtentionn du consentement éclairé de chacun d'eux. Nous avons classifié les réponses selon la
fréquence des repondants positifs. L'analphabétisme était prévalent auprès de la population; plus de 76% n'avaient pas
reçu une instruction formelle. Les deux principales raisons pour lesquelles ils ne donnaient pas du sang étaient "n'est pas
assez en bonne santé" et" on n'a pas assez de sang", alors que la perte de sa virilité, ainsi que le fait d'exposer le sang à la
sorcellerie étaient les deux autres raisons avancées. Le niveau de la conscience du VIH/SIDA était considérable. Les
obstacles socio-culturels au don volontaire de sang existent dans les communautés essentiellement illetrées et rurales du
pays. La plupart des raisons données ont été fondées sur des opinions fausses, des désinformations et l'ignorance au sujet
de l'effet et de la sécurité du don de sang. (Rev Afr Santé Reprod 2005; 9[3]:72-76)
KEY WORDS: Culture, blood, donation, transfusion,HIV/AIDS, Ebonyi
1
Department of Obstetrics & Gynaecology, Ebonyi State University Teaching Hospital, Abakaliki. Ebonyi State, Ni-
geria.
2
Department of Obstetrics & Gynaecology, Nisa Premier Hospital, Alex Ekwueme Way, Jabi, Abuja, Nigeria.
3
Department of Paediatrics, Ebonyi State University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
Correspondence: Dr OUJ Umeora, P. O. Box 980, Abakaliki 480001, Ebonyi State, Nigeria. E-mail: oujair@yahoo.com;
Tel: 234 803 955 8074
Introduction
Globally, an estimated 600,000 women die annually during childbirth, majority of who are in sub-
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African Journal of Reproductive Health Vol. 9 No.3 December 2005
Saharan Africa.
1
In Nigeria the average maternal
mortality ratio (MMR) is 1,000 per 100,000
maternities.
2
Obstetric haemorrhage accounts
largely for these mortalities. Massive blood loss
results rapidly in mortality if prompt and ad-
equate life-saving measures, including blood trans-
fusion, are not taken on time.
1
Blood for transfusion is not readily available
in Nigeria.
3
The wastage implicit in the inability
to separate available blood into various useful
components further compounds the scarcity.
Most blood bank operators in the country are
also known to rely on touts for their supply.
4
With
the high prevalence of HIV in Nigeria (5.4%)
2
and the increasing number of HIV positive blood
donors, the obstetric patient in need of blood
transfusion faces a precarious situation.
More often, blood bank operators turn to
patients’ relatives for blood donation during
emergencies. Studies from some parts of Africa
have revealed attitudinal barriers to such donations.
5
Few studies on the subject have been undertaken
in Nigeria. This study, therefore, aimed at
identifying the socio-cultural barriers to blood
transfusion in a rural village in south-east Nigeria.
Methods
This study was conducted at St Vincent’s Catholic
Hospital, Ndubia, an agrarian community in rural
Ebonyi State of Nigeria, over a 12-month period
(September 1, 2003 to August 31, 2004). The
hospital serves both as a primary contact with
orthodox medicine and a referral centre for the
community and surrounding towns in Ebonyi
and neighbouring Cross River State. Staffed with
medical officers and a resident consultant
obstetrician and gynaecologist, the hospital
attends to numerous obstetric and gynaecologi-
cal cases including those requiring blood transfu-
sion. Patients’ relations and friends are often called
upon for blood donation whenever the need
arises. Blood from donors are screened for in-
fectious diseases including HIV/AIDS before
transfusion.
Patients’ relations and friends who declined
blood donation were randomly recruited into the
study. Informed consent was obtained in each
case before subsequent interview by the
investigators. Pre-tested questionnaire was
administered to the respondents in Igbo or Eng-
lish language to ensure adequate understanding.
Reasons given by the respondents were ranked
according to frequency of response.
Findings
A total of 143 respondents were recruited into
the study, out of which 118 (82.5%) were males
and the remaining (17.5%) females. Seventy-two
(50.3%) of them were aged between 25 and 34
years, an overwhelming majority 109 (76.2%) had
no formal education. None of the respondents
had post-secondary education. Majority (71.3%)
of the respondents were farmers and petty
traders, while 80.4% of them were Christians.
Jehovah’s Witnesses were excluded from the study
because of their religious aversion to blood
donation and transfusion.
The two commonest reasons for not
donating blood (Table 2) were ‘not feeling well/
strong enough’ (63.6%) and ‘not having enough
blood’ (58%). Seventy-eight respondents (54.5%)
believed that they would collapse if they donated
blood, while 46 (32.1%) of them felt that it could
shorten their lifespan. Other reasons included for
not wanting to donate blood included loss of
‘manhood’ (libido) (27.1% of the men), increased
risk of illness/infection (35.7%) and possibility
of blood being exposed to rituals/witchcraft
(28.7%). Sixteen respondents (11.2%) had no
particular reason for refusing to donate blood.
Level of awareness about HIV/AIDS was
appreciable among the respondents but none of
them was aware of his/her HIV status. Twenty-
four of the respondents (16.8%) feared that their
HIV status might be positive and could be exposed
because of lack of confidentiality by the medical
personnel. Almost 19% of the respondents be-
lieved that cases requiring blood transfusion are
Socio-Cultural Barriers to Voluntary Blood Donation for Obstetric Use in a Rural Nigerian Village
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74 African Journal of Reproductive Health
African Journal of Reproductive Health Vol. 9 No.3 December 2005
already beyond medical remedy. Fifteen of the
respondents (34.9%) said that they would consider
donating blood if the patient were their relative.
Only two (1.4%) respondents said that their
traditional norms was against blood donation,
while four (2.8%) of them said that they were
fasting and hence could not donate blood. Al-
most 50% of the respondents would consider
donating blood if there would be a financial re-
ward.
Discussion
Table 1 Socio-Demographic Characteristics of Respondents
Characteristic Number Percentage
Age (years)
< 19 3 2.1
20–24 15 10.5
25–29 29 20.3
30–34 43 30.1
35–39 27 18.9
40–44 15 10.5
> 45 11 7.7
Educational status
No formal education 109 76.2
Primary 31 21.7
Secondary 3 2.1
Tertiary 0 0
Occupation
Farming 60 41.9
Tailor/seamstress 14 9.8
Artisan 13 9.1
Civil servant 14 9.8
Trading 42 29.4
Religion
Christianity 115 80.4
African Traditional Religion 28 19.6
Table 2 Reasons for Declining Blood Donation
Reason Number %
‘Yes’ response to questions
Not well/not strong enough 91 63.6
Not having enough blood 83 58.0
Fear of collapse 78 54.5
Increased risk of illness/infection 51 35.7
Exposure of blood to witchcraft 41 28.7
Not related to patient 43 30.1
Loss of manhood (libido) 32 22.4
Not medically helpful 27 18.9
Fear of being HIV positive 24 16.8
Reduces life span 46 32.2
No particular reason 16 11.2
Fasting 4 2.8
Against traditional norm 2 1.4
Would donate for financial gain 71 49.7
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African Journal of Reproductive Health Vol. 9 No.3 December 2005
Despite the general trend towards a reduction in
blood transfusion in obstetric and gynaecologi-
cal practice for reasons of HIV transmission and
cost, there still exist conditions that of necessity
require transfusion,
6
it is, therefore, of utmost
importance that blood is readily available in such
instances.
Worldwide, haemorrhage accounts for about
25% of maternal deaths.
7
In Nigeria, a ten-year
analysis of maternal mortality across the six geo-
political zones showed that haemorrhage
accounted for 21% of deaths if the general
diagnosis was just ‘haemorrhage’, rising to 32.9%
if ectopic gestation and ruptured uterus were
included.
2
One of the millennium development
goals is the reduction in maternal mortality as an
important step towards improving maternal
health globally.
8
Effective blood banking services
play crucial role in intervention strategies aimed
at reducing maternal mortality as a result of
obstetric haemorrhage. Blood for transfusion is
not readily available, and some regions of the
world like South-East Asia face severe shortage
of safe blood.
9
Some illegal blood banks source
blood from touts, and this has made blood
transfusion the second largest source of HIV
infection in Nigeria after unsafe sex.
4
The use of
adequately screened volunteers would go a long
way in making available safe units of blood for
transfusion. Unfortunately, these volunteers are
not readily available, as blood donation in Africa
is seen to represent extreme sacrifice.
10
The literacy level of respondents in this study
was very low (Table 1), farming and petty trading
being the predominant occupations. The poor
educational status might have grossly affected their
perception of blood transfusion. An earlier study
in Tanzania
5
showed that voluntary blood dona-
tion was correlated to secondary school attend-
ance. In our series only 2.1% of the subjects had
post-primary education. The health behaviour and
health-seeking practices of a population is grossly
affected by personal, communal and societal be-
liefs and norms, as well as their perception of
health and disease.
2
The perception of the re-
spondents’ state of health was the most com-
mon reason for declining blood donation. While
some believed that they were not strong enough,
would collapse, or did not have enough blood,
others reasoned that they could be infected (Ta-
ble 2). The superstitious beliefs and myths preva-
lent in these communities were evident by the
reasons of exposure of blood to witchcraft, loss
of manhood and reduction in lifespan (Table
2).
Only a few of the respondents said that it
was against their traditional values. However,
about half of the respondents would donate
blood for some form of financial gain. This may
provide a leeway for most blood bank operators
through encouraging patients’ relatives with some
form of material or health reward. This revelation
was also evident in the Tanzanian study.
5
The fear
of discovering that one is HIV positive was
another reason for some respondents’ negative
attitude to blood donation. Such fear is common
in Africa.
5,10
Voluntary HIV/AIDS counselling
and testing is highly recommended before re-
cruiting donors who are afraid they could be HIV
positive, while ways of reducing blood transfu-
sion in obstetrics and gynaecology should be
sought. A group and screening policy should be
acceptable for most procedures.
6
Autologous
transfusion should also be encouraged. Institut-
ing a multidisciplinary committee on blood trans-
fusion would enhance proper monitoring, evalu-
ation and control of blood utilization in the hos-
pital.
6,11
Conclusion
Some socio-cultural barriers to voluntary blood
donation exist in predominantly illiterate rural
communities in Nigeria. Most of the reasons were
based on misconception, misinformation and
ignorance about the effect and safety of blood
donation. Massive public health and literacy
campaigns are advocated to inform and educate
the rural populace. This will allay their un-
Socio-Cultural Barriers to Voluntary Blood Donation for Obstetric Use in a Rural Nigerian Village
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76 African Journal of Reproductive Health
African Journal of Reproductive Health Vol. 9 No.3 December 2005
founded but real fears and dispel some unrea-
sonable but deep-rooted beliefs. Voluntary
rather than commercial blood donation
should be encouraged to ensure steady sup-
ply and availability of safe blood for transfu-
sion in hospitals. Some derivable interests in
terms of financial remuneration, knowledge of
HIV status and blood group should also accrue
to blood donors as inducement.
Acknowledgement
The authors are grateful to Mr. Dom Fot, the
laboratory scientist, for his immense contribu-
tion to this study.
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