Attitudes, Prevalence and Barriers towards Voluntary Blood Donation among Residents of the Western Urban Region, Zanzibar, Tanzania

Introduction

Blood is a vital body fluid that transports nutrients and oxygen to cells and removes their metabolic wastes.¹ It comprises plasma, red blood cells, white blood cells, and platelets. Donation is the sole source of blood.² Collecting blood from people who are not prone to endangering their health or the risk of infection during donation is the central aspect of blood donation.³ It is important for people who have suffered a significant loss of blood due to accidents, obstetric and reprodu-ctive bleeding, severe anemia, and cancer.⁴

There are three main types of blood donors: voluntary unpaid donors, replacement donors and paid donors. A voluntary non-remunerated donation is giving one's own blood, plasma, or other blood components willingly and without receiving any monetary or other compensation. Family/replacement blood donation involves giving blood when needed by a patient's family or community member. A paid donation is a different type of blood donation in which a person donates blood in exchange for money or another form of payment. This final type of blood donation is also called professional blood donation.⁵ The safest type of blood donation is voluntary non-remunerated or voluntary, as these donors have the lowest risk of transmitting infections through transfusions.⁶

The World Health Organization (WHO) suggests that a country should receive 10 donations per 1000 people to meet its blood supply requirements.6 Despite the WHO's recommendation for countries to prioritize young people to achieve 100% voluntary blood donation, there is a shortage of donated blood to meet the demand in various parts of the world.⁷ Worldwide, more than 80 million units of blood are donated annually. However, despite their siblooded, only two million units are donated in low-income countries.⁷ In Sub-Saharan Africa (SSA), with a population of over 12% of the world's total, only 38% of the annual estimated 18 million units of safe blood needed are collected.⁴ Several factors have been recognized as obstacles to blood donation. These include feeling unsuitable to donate blood, concern about anemia, attitudes toward donation, fear of health risks, and a lack of knowledge about the blood donation process.⁴

Tanzania encounters notable difficulties in collecting blood, which is crucial due to its large population and the substantial need for blood compared to neighboring nations such as Kenya and Uganda. The blood collection rate in the country is about 3.6 units per 1,000 individuals, less than Kenya's 4.¹ and Uganda's 6.3.⁸ Tanzania's National Blood Transfusion Services (NBTS) reported in 2017 that only about 36% of the total blood demand was being fulfilled.⁹ The primary source of blood supply for Tanzania hospitals is donors not affiliated with the National Blood Transfusion Service (NBTS) blood banks.¹⁰ Approximately 79% of the blood gathered in Tanzania by NBTS (blood bank) comes from voluntary non-remunerated blood donors (VNRBD), while the remaining 21% is obtained through family replacement.¹¹ Blood shortages are common in healthcare facilities in Zanzibar, where they typically collect around 10,000 units of blood each year, well below the necessary demand of 18,000 units annually.¹¹ It has been consistently advised for public institutions in Tanzania to enhance their VNRB campaigns continually.¹²

The challenges addressed in blood donation drove researchers to conduct this study to assess attitudes, prevalence, and barriers toward blood donation among residents in the Western Urban Region of Zanzibar. The results from this study can improve strategies to enhance voluntary blood donation and healthcare delivery in the country.

Materials and Methods

Area of Study

The study was conducted at Mwanakwerekwe ward, located within Mwanakwerekwe Constituency in the West urban region of Zanzibar, approximately 7 km from Zanzibar town. Mwanakwerekwe Constituency has two wards, Jitimai ward and Mwanakwerekwe ward.

Study design

A quantitative descriptive cross-sectional study was conducted at Mwanakwerekwe Ward in Zanzibar from 20 March 2023 to 19 June 2023.

Study population

The study included male and female adult community members at Mwanakwerekwe ward in Zanzibar.

Sampling and sample size

Simple random sampling was used in the formed clusters of eight streets where the respondents were allowed to participate by picking a paper from an enclosed box. Any respondent who picked a paper written YES was invited to participate. This technique was used to ensure that each member of the targeted population had an equal and independent chance of being included in the study sample to reduce bias. The sample size of 100 participants was calculated using the Krejcie and Morgan formula with a confidence level of 95% = 1.96, a population size of 20,215 people, a population proportion of 85% = 0.85, and a margin error of 7% = 0.07.

Data collection and analysis

The researcher used a self-administered questionnaire. The data collected was analyzed using the Statistical Package for Social Science (SPSS), version 26, which analyzed frequencies and percentages.

Operational definitions of attitude assessment

Attitude, as a psychological construct, refers to an individual's evaluation of an object, person, event, or idea, which can be positive, negative, or neutral. Various factors shape attitudes, including personal experiences, social influences, and cultural contexts.¹³ The attitude was assessed based on percentile: good if the positive attitude is above the 75th percentile (>75%), Moderate if the positive attitude is from the 50th to 75th percentile (50-75%), and Poor if the positive attitude is below the 50th percentile (<50%).

Ethical clearance

Zanzibar Health Research Institute (ZHRI) gave ethical clearance to conduct this study, with reference number ZAHREC/05/ST/MARCH/2023/89. All participants who agreed to participate in the study filled out an informed consent form and were assured confidentiality.

Results

The distribution of respondents by demographic characteristics

The results showed that the majority of the respondents, 33 (33.0%), were in the age range of 30-35 years, but only 14 (14.0%) of them were in the age range of 40-45, and the majority of respondents, 56 (56%) were males. About 33 (33.0%) of all respondents had a secondary education, and only 2 (2.0%) had postgraduate degrees. Also, the results showed that the majority of respondents, 28 (28%), were government employees, most of the respondents, 47(47.0%), were single in marital status, and the majority of respondents, 83 (83%), were Muslim, as shown in (Table 1).

Descriptive analysis of attitudes questions among participants

The results of the community members indicated different attitudes concerning voluntary blood donations among them. About 43% reported negative attitudes toward the importance of blood donation, while 51% reported positive attitudes, and others remained neutral. About 52% of the community members believed that donating blood saves lives, which is a positive attitude, while 40% disagreed. Regarding motivation for blood donors, 48% had a positive attitude, and 39% had a negative attitude. About 57% of participants were ready to donate blood in the future, depending on their health condition (Figure 1 & Table 2).

Awareness campaigns are needed, but 47% had a negative attitude, while 41% had a positive attitude. Regarding educating students on voluntary blood donations from formal education, 52% had positive attitudes, while 41% had negative attitudes. A total of 56% of participants had negative attitudes, believing that they could donate blood only when their blood groups were needed. In comparison 33% had a positive attitude toward donating at any time (Figure 1 & Table 2).

Understanding the health risks associated with blood donation is crucial, as demonstrated by the 50% who hold positive attitudes, while 39% were negative. A substantial 64% of participants viewed blood donation as not mandatory, which is positive. However, 45% of participants believed blood donated by an unknown person was safe for transfusion, while 48% were positive (Figure 1 & Table 2). The results showed that 49% presented positive attitudes across all responses, which is generally poor among the participants, and 41% had negative attitudes, while the remaining 10% were neutral (Figure 2).

Prevalence and Barriers to Blood Donation

Concerning the prevalence of blood donation, about 40 (40%) of participants donated blood before, 11 (27.5%) donated once, 22 (55.0%) donated twice, and 7 (17.5%) donated more than twice. Most of the participants, 31 (51.7%), reported that they did not donate blood due to lack of awareness, 15 (25%) of participants due to fear of needles, and 14 (23.3%) due to health issues (Table 3).

Among participants who donated blood before, 17 (42.5%) repeated the donation, and most of them, 6 (35.5%), revealed that they repeated it because their relatives or friends were demanding blood donations. Also, the same number admitted that friends encouraged them to donate to others. The majority, 12 (52.2%), reported that they did not donate blood because they were under medications, and 9 (39.1%) said they lacked motivation. About 32 (80%) of participants who donated blood reported experiencing side effects, with nausea being the most common at 13 (40.6%). Among those disqualified from donating blood, 17 (70.8%) were due to health conditions (Table 3).

Discussion

This study provided valuable contributions from the community members who participated in this study to the attitudes, prevalence, and barriers of voluntary blood donations. Concerning the importance of blood donation, 51% reported positive attitudes. About 52% of the community members had a positive attitude and believed that donating blood saves lives, which is a moderate attitude. Similar previous studies in India revealed the positive attitudes towards blood donations that can save the lives of individuals and are widely accepted across different societies and cultures.^14,15 Regarding motivation for blood donors, 48% had a positive attitude that they could donate blood without being motivated. This aligns with another previous study in Zanzibar, which reported the need for motivation to donate blood.¹⁶ Like another study in India, about 57% of participants were ready to donate blood in the future, depending on their health condition.¹⁷ However, this contrasts with another study in Saudi Arabia.¹⁸ These discrepancies may be caused by cultural, social, and differences in awareness among communities concerning voluntary blood donation.

Awareness campaigns are needed, as about 41% had a poor positive attitude. About 56% of participants had negative attitudes, believing that they could donate blood only when their blood groups were needed. This finding is similar to another study conducted in Saudi Arabia, which recommended public education in raising the public’s willingness to donate blood.¹⁹ Regarding educating students on voluntary blood donations from formal education, 52% had positive attitudes, which is closely supported by another study in Ethiopia.²⁰ However, these findings differ from those of Kumar, who reported that despite increased educational efforts, misconceptions still exist among many students about blood donation, especially during the COVID-19 pandemic. The research showed great fear about visiting blood banks, which greatly affected the blood transfusion exercise and failed to reach targets.²¹ The great diversity causes the complexity of attitudes in donating blood, and emotional and psychological barriers should be addressed with educational interventions.

About 50% of participants demonstrated positive attitudes by agreeing that understanding the health risks associated with blood donation is crucial, similar to the study from Iran.²² However, this contrasts with the study of Ahmed et al., in Iraq.²³ About 64% of participants believed blood donation should not be mandatory, which is positive and nearly supported by Chauhan et al., in India.²⁴ The results showed that 49% presented positive attitudes across all responses, which is generally poor among the participants, and 41% had negative attitudes, while the remaining 10% were neutral (Figure 2). These overall results are similar to the study of Beyene in Ethiopia.²⁵ The finding contrasts with the study of Guerrero-García et al., in Western Mexico, which reported a significant positive attitude.²⁶

This study identified various impediments to blood donation. The key factors reported in this study include pharmaceutical use, lack of awareness, and lack of drive. These reasons are consistent with another similar study.²⁷ A large number of participants, about 81% of those who donated blood, experienced side effects after donation, with nausea being the most common, as revealed in the Nigerian study.²⁷ This reported prevalence of side effects is higher, which can deter donation practices in the future. Another significant barrier was health-related disqualification from donating blood. About 71.8% of disqualified donors reported health-related reasons. This finding is consistent with other studies that reported that donors were disqualified from donating blood due to their health conditions.^28,29 Health conditions like anemia, hypertension, and infections often disqualify donors from donating blood. Broader healthcare interventions need to be improved in the general public to pull up the eligibility of potential donors.

Recommendations and Limitations

i. Educational programs in targeted groups should be implemented to improve awareness on the importance of regular blood donation, discourage negative culture, and encourage more positive attitudes in the community.

ii. Healthcare providers should minimize the incidence of side effects experienced by donors to prevent potential donors from being deterred from donating blood in the future. This should be accompanied by post-donation care and monitoring.

iii. To pool more eligible donors, public health inter-ventions should improve general public health, especially among those disqualified from donating blood due to health conditions.

Conclusion

This study generally reported poor positive attitudes and significant barriers to blood donation among participants from the study population. This study found that people have a moderately good view toward the importance of blood donation and its major impact on saving lives. The incidences of side effects and disqualification due to health-related conditions were also reported in this study, which need more significant healthcare interventions to pull significant donors and strengthen blood donation practices in the future.

Limitations

The study's cross-sectional design provides a snapshot in time, making it difficult to assess changes in attitudes or behaviors over time. Future research should aim to include longitudinal designs better to capture trends in blood donation attitudes and behaviors.

Conflict of Interest

None

Acknowledgment

The authors hereby extend their gratitude to the Zanzibar Health Research Institute (ZHRI) for approving an ethical clearance letter to conduct this study and to the participants who made it possible.