Transfusion practice and knowledge in Mozambique

Abstract

Background: In Mozambique, there is a limited supply of blood and elevated risks for transmission of infections. Prior studies have documented that many transfusions in Mozambique are potentially avoidable. Transfusion training workshops with a survey and exam were held for providers to understand their perceptions and to improve knowledge and clinical practice.

Study design and methods: Health care providers completed a survey and a knowledge assessment. The Wilcoxon signed rank test was utilized to compare the relative importance of each factor in the survey, and pre- and posttraining exam scores were compared using Fisher's exact test.

Results: A total of 216 health care providers participated; the majority worked in a referral hospital (74%) and reported transfusing blood at least once per week (56%). Most acknowledged the limited blood supply and transfusion risks. Providers rated low hemoglobin (Hb) levels and pallor as significantly important indications for transfusion (p < 0.001). They were more likely to transfuse with age under 5 years when compared to other ages (p < 0.01). The three most potentially influential factors for transfusion practice were increased reliability of the blood supply, education about transfusion indications, and assessment of perfusion. Before training, the majority of participants identified an incorrect Hb threshold for preoperative or critically ill patients. Overall exam scores improved from a mean of 58% to 74% (p < 0.001).

Conclusions: Mozambican providers were knowledgeable about the risks of blood transfusions. Preoperative patients, the critically ill, and children appear to be at highest risk for receiving an avoidable blood transfusion. These results will help guide planning for future provider training.

Fig. 1

Opinions about transfusions. Box plots illustrate degree of agreement with statements about blood transfusions using Likert scale from survey. *p < 0.01 when compared with other statements.

Fig. 2

(A) Factors increasing likelihood of transfusion. Box plots illustrate the level of importance each factor has on the likelihood of ordering a transfusion using Likert scale from survey. *p < 0.001 when compared with all other factors. (B) Factors increasing likelihood of transfusion—age. Box plots illustrate the level of importance each age group has on the likelihood of ordering a transfusion using Likert scale from survey. *p < 0.001 when compared with other groups. †p < 0.02 when compared with age > 13 years.

Fig. 3

(A) Factors influencing transfusions. Box plots illustrate the degree of influence each factor has on transfusions using Likert scale from survey. *The three factors all achieved significance of p < 0.01 when compared with increased availability of lab testing and change in guidelines. (B) Factors influencing transfusions—guidelines. Box plots illustrate the degree of influence changes in guidelines would have by each organization on transfusions using Likert scale from survey. *p < 0.001 when compared with other factors. †p < 0.001 when compared with departmental guidelines.