Regulation of blood services in Africa.

Blood and blood products save lives and are a part of the WHO Essential Medicines List. Access to safe and quality-assured blood and blood products are essential for health systems strengthening and it is a global concern. Their use is associated with infectious and immunologic risks. At global level, many resolutions have been adopted by the World Health Assembly that urged Member States to ensure regulatory control of access to quality-assured blood and blood products along the entire transfusion chain. The WHO has also developed an action framework to advance universal access to blood. As part of the implementation of these resolutions and guidelines, the WHO Regional Office for Africa and some partners provided support to countries in the region to strengthen their capacity to establish an effective blood regulatory system through organization of regional training workshops on blood regulation, benchmarking of blood regulatory systems, internship at Paul Ehrlich Institut and establishment of the African Blood Regulators Forum. The current status of blood regulation reveals that there are weak transfusion legislation and blood regulatory systems in most African countries, since many national blood transfusion services still rely on self-regulation. However, the national regulatory authorities have reached the maturity level 3 in two countries (Ghana and Tanzania), but only the experience from Ghana has been described in this paper. Like in other low- and middle-income countries, the regulatory systems for associated substances and medical devices including IVDs are not well established in the African region. Misunderstanding by different stakeholders, lack of legislation that provides legal basis, weak capacity and insufficiency of resources are main challenges facing countries to establish an effective national blood regulatory system. To address these challenges, strong advocacy with governments and collaboration with partners are needed to strengthen national blood regulatory systems.

Ethnic differences in out-of-hospital cardiac arrest among Middle Eastern Arabs and North African populations living in Qatar.

Aims: There are very few studies comparing epidemiology and outcomes of out-of-hospital cardiac arrest (OHCA) in different ethnic groups. Previous ethnicity studies have mostly determined OHCA differences between African American and Caucasian populations. The aim of this study was to compare epidemiology, clinical presentation, and outcomes of OHCA between the local Middle Eastern Gulf Cooperation Council (GCC) Arab and the migrant North African populations living in Qatar.Methods: This was a retrospective cohort study of Middle Eastern GCC Arabs and migrant North African patients with presumed cardiac origin OHCA resuscitated by Emergency Medical Services (EMS) in Qatar, between June 2012 and May 2015.Results: There were 285 Middle Eastern GCC Arabs and 112 North African OHCA patients enrolled during the study period. Compared with the local GCC Arabs, univariate analysis showed that the migrant North African OHCA patients were younger and had higher odds of initial shockable rhythm, pre-hospital interventions (defibrillation and amioderone), pre-hospital scene time, and decreased odds of risk factors (hypertension, respiratory disease, and diabetes) and pre-hospital response time. The survival to hospital discharge had greater odds for North African OHCA patients which did not persist after adjustment. Multivariable logistic regression showed that North Africans were associated with lower odds of diabetes (OR 0.48, 95% CI 0.25-0.91, p = 0.03), and higher odds of initial shockable rhythm (OR 2.86, 95% CI 1.30-6.33, p = 0.01) and greater scene time (OR 1.02 95% CI 1.0-1.04, p = 0.02).Conclusions: North African migrant OHCA patients were younger, had decreased risk factors and favourable OHCA rhythm and received greater ACLS interventions with shorter pre-hospital response times and longer scene times leading to better survival.

Transfusion in the WHO African Region.

INTRODUCTION: Different evaluations conducted on blood safety between 2004 and 2013 in Africa showed some progress in most countries. This paper describes the current status of the availability and access to safe blood in the Region. METHODS: A cross-sectional survey was conducted from January to December 2018. Data were collected through a questionnaire prepared using key indicators of blood safety and analysis was done using Excel 2010 and results were compared to those of the 2013. RESULTS: A total of 2,678 blood centres were reported including 244 (9%) stand-alone and 2,434 (91%) hospital based. Amongst these countries, 90.2% had a blood policy, 60.1% participated in an External Quality Assessment Scheme for Transfusion Transmissible Infections screening, 12% had accredited blood services, 73.2% had national guidelines on clinical use of blood and 78% had a government budget. The total number of blood units collected was 4,899,913 and the average proportion of voluntary blood donations was 71%. Plasma-derived medicinal products were included in the national essential medicines list in 52.6% of countries. The average proportion of units of blood tested for infections was 99.5% for HIV, 92.3% for HBV, 98.9% for HCV, 98.8% for syphilis. The percentage of whole blood separated into blood components was 63.4%. CONCLUSION: Countries in the region continue to improve availability and access to safe blood, but challenges still remain and call for concrete actions required to reach universal access to quality and safe blood for transfusion throughout the region.

HIV-1 subtypes D and F are prevalent in Guinea Conakry.

BACKGROUND: Limited data is available upon the distribution of different HIV-1/2 genotypes in the blood donor population from Guinea Conakry. OBJECTIVES: To investigate the prevalence of HIV-1/2 subtypes in asymptomatic blood donors in Guinea Conakry, in order to update knowledge of HIV-1/2 epidemiology within this country. STUDY DESIGN: Samples from 104 blood donors seropositive for HIV-1/2 were tested for HIV-1 by real-time RT-PCR. Those negative for HIV-1 were tested with HIV-2 nested RT-PCR. Positive samples were further amplified in the HIV-1 gag and pol regions and sequenced. Subtypes were determined by phylogenetic analysis on amplicon sequences. RESULTS: 61 samples were positive by HIV-1 real-time RT-PCR. Of the 43 negative, 2 (4.6%) were positive for HIV-2. 52/61 (85.3%) samples were positive by nested RT-PCR. Of the 52, 43 (70.5%) and 31(59.6%) sequences were obtained in the gag and pol regions, respectively; 23 for both regions. HIV-1 subtype distribution was 1 B (2.1%), 8 F (17%), 8 D (17%) and 28 CRF02_AG (59.6%) with 2 unclassified recombinants (4.3%). Unique clusters for subtype D and F distinguished Guinea from HIV-1 subtype distribution in neighboring countries. CONCLUSIONS: Subtype F and subtype D strains, uncommon in West Africa, are a substantial part of HIV-1 epidemiology in Guinea.

[Frequency of blood groups ABO and rhesus D in the Guinean population]. / Fréquence des groupes sanguins ABO et rhésus D dans la population guinéenne.

AIMS: Few documented work were devoted to the study blood groups in Guinea. The objective of this study was to determine the phenotypical and genic frequencies of antigens of ABO and rhesus D systems in the guinean population. METHODS: Grouping ABO and rhesus D related to 59,452 subjects, including the donors blood and the patients taken in the four natural regions and the special zone of Conakry. The phenotypes ABO and rhesus D were determined by the double method of Beth-Vincent and Simonin on plate or in tube with monoclonal serums tests and red blood cells locally prepared. The genic frequencies were calculated according to formulas' of Bernstein. RESULTS: The phenotypical frequencies of the antigens of blood groups A, B, AB and O are respectively equal to 0.2254, 0.2386, 0.0472 and 0.4888. That of the rhesus D antigen is of 0.9594 for the Rh positive and 0.0406 for the Rh negative. The frequencies of the genes A, B and O in the population are 0.1470, 0.1548, 0.6983. These frequencies are not significantly varying between in the regions and among ethnics groups. They are close to those observed in the Subsaharan Africa region. CONCLUSION: The results obtained confirm the negroïd character of guinean population.

[Four year management of HIV serology at the National Center of Blood Transfusion in Conakry]. / Bilan de 4 ans de sérologie VIH au Centre national de transfusion sanguine de Conakry.

From January 1997 to December 2000, 21145 blood donations have been collected and tested for anti-HIV antibodies by the National Center of Blood Transfusion of Conakry (NCBT). 347 were positive, confirmed by Western Blot (312 HIV-1, 20 HIV-2 and 15 HIV1-2). HIV seroprevalence in tested blood donations showed a slow decrease by year: 1.87% in 1997 to 1.79% in 2000. The distribution according to donation type was 1% for volunteer donors and 2% for family donors. Seropositivity HIV rates according to sex indicate that the female donors are more infected than male donors. Among 347 seropositive, 83% were more than 20 years old. The seroprevalence is higher in soldier blood donors 3.72% (53/1422) than in student donors 0.55% (43/7712). The number of seropositive results found during these 4 years is not really representative of the HIV spreading infection in Guinean population, but their distribution according to sex and age is very close to the distribution of the AIDS cases in Guinea.

[Evaluation of residual infectious risk among blood donors in National Center of Blood Transfusion in Conakry]. / Evaluation du risque infectieux résiduel chez les donneurs de sang au Centre national de transfusion sanguine de Conakry.

To estimate the risk of transmitting human immunodeficiency virus (HIV) and hepatitis B virus (HBV) by blood transfusion. Residual risks for each of infections have been calculated from incidence cases number, rate incidence for 100,000 person-years has been estimated and multiplied by the period of mute serological window for each agent (22 days for HIV and 56 for HBV) in order to estimate the residual risk. This study shows that risk residual is 1/121 blood donations for HBV and 1/8562 blood donations for HIV. The obtained results show that the HIV and HBV transmission risk due to blood transfusion according to the present practice at the NCBT of Conakry is important.

[Validity of an ELISA test for CD4+ T lymphocyte count and validity of total lymphocyte count in the assessment of immunodeficiency status in HIV infection]. / Validité d'un test ELISA pour la numération des lymphocytes T CD4+ et validité de la numération des lymphocytes totaux dans l'évaluation des états d'immunodéficience par VIH.

A newly available commercial ELISA (TRAx CD4, T Cell Diagnostics USA) for enumerating CD4+ T lymphocytes has been evaluated with blood samples of 105 HIV seropositive and 6 seronegative subjects. Results from the flow cytometric analysis were used as reference. The sensitivity and specificity of the ELISA to identify HIV seropositive subjects having less than 200 CD4+ T lymphocytes/microliters were assessed and studied using the ROC curve. The reproducibility of the ELISA test was analyzed on 40 samples. The results of the ELISA correlated well with these of the flow cytometric analysis (r = 0.79, p < 0.001). However, the ELISA test tends to overestimate the true CD4 count in HIV seropositives. This overestimation could not be explained by the aspecific contribution of monocytic CD4. The threshold for identifying HIV seropositive subjects with less than 200 CD4+ T lymphocytes with a maximum sensitivity and specificity was determined with ROC curve and equalled 400 cell equivalents with the ELISA (sensitivity and specificity were equal to 80%) and 1,450 lymphocytes/microliters with the total absolute lymphocyte count (sensitivity and specificity were equal to 75%). Using this curve, a threshold of 300 cell equivalents for the ELISA test and of 1,100 lymphocytes/microliters for the absolute lymphocyte count was shown to maximize the specificity (> 95%) without a significant loss of sensitivity.