Prevalence and factors associated with delays in accessing transfusion among children at Mulago National Referral Hospital, a cross-sectional study

Abstract

Background: Blood transfusion is a life-saving intervention for managing various medical conditions. According to the World Health Organization, approximately 120 million units of blood are collected globally each year. However, blood shortages persist, often leading to delays in transfusion. While such issues are well documented in high-income countries, with established haemovigilance systems, in low-income settings such as Uganda, these systems are often weak or nonexistent. As a result, transfusion delays may be more severe and less understood. This study aimed to determine the prevalence and factors associated with transfusion delays among children at Mulago National Referral Hospital (MNRH). Methods: This was a cross-sectional study that used quantitative data collection methods. Children admitted to the pediatric wards of MNRH with a request form for transfusion with any blood component were consecutively enrolled into the study. A delay was defined as transfusion not occurring within 1 hour, 4 hours, or 24 hours for ‘urgent’, ‘as soon as possible’, and ‘routine’ orders, respectively. The data were collected using an observation checklist. Stata version 16/MP was used to analyze the data. Bivariate and multivariable modified Poisson regression determined associated factors, with p-values <0.05 considered significant. Results: Out of 393 children requiring transfusion in the study, 279 (71%) experienced delays in accessing transfusion. 276/279(98.9%) were delayed but transfused whereas 3/279 (1.1%) died before receiving transfusion. Overall, the median time from when the transfusion order was received at the laboratory to the actual transfusion was 120 minutes (IQR: 66–288 minutes). The highest delays occurred in ‘urgent transfusions’, with 257/279 (92.11%), followed by ‘as soon as possible’ orders 19/279 (6.8%) patients and only 3/279 (1.08%) delays for ’routine possible need for blood’ orders. Unavailability of blood component and unavailability of Personal Protective Equipment (medical gloves in particular) were significantly associated with delays in accessing blood transfusion (APR=1.46, p<0.001) and (APR=1.20, p=0.036) respectively. Conclusion: The study found unacceptable delays in accessing urgent blood transfusions among children admitted at Mulago National Referral Hospital. Improving the supply and availability of blood components to the hospital and availing medical gloves to laboratory staff who perform pretransfusion grouping and cross-matching represent areas for quality improvement to ensure the timeliness of care.