International Journal of Gynecology & Obstetrics
Volume 98, Issue 3 , Pages 291-293, September 2007

Reduction of maternal mortality: The need for voluntary blood donors

  • J.R. Cruz

      Affiliations

    • Corresponding Author InformationTel.: +1 202 974 3230; fax: +1 202 974 3610.

Technology and Health Services Delivery Area, Pan American Health Organization, NW, Washington DC, USA

Received 10 January 2007; received in revised form 17 January 2007; accepted 17 January 2007. published online 13 March 2007.

Article Outline

Abstract 

Objective

To explore the relationship between maternal mortality and availability of blood for transfusion at the country level in Latin American and Caribbean countries.

Method

The association of blood availability with maternal mortality, expressed either as national maternal mortality ratio or proportion of maternal deaths due to hemorrhage, in selected Latin American and Caribbean countries was analyzed by non-parametric methods.

Result

An inverse correlation was found between blood availability and both maternal mortality ratio (p<0.002) and proportion of deaths due to hemorrhage (p<0.05).

Conclusion

Limited availability of blood for transfusion in countries with high maternal mortality ratios may hinder comprehensive care of mothers. The results presented here underscore the need for the formation of voluntary blood donors in the pursuit of improved maternal health.

Keywords: Maternal mortality, Postpartum hemorrhage, Blood donation, Latin America, Caribbean

 

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1. Introduction 

Maternal mortality (MM) is an important global health problem [1], with hemorrhage as the major cause in developing countries. In Latin America and the Caribbean the proportions of maternal deaths associated with excessive bleeding vary from 1 to 47% [2].

With the adoption of the Millennium Development Goals, the international community set up to reduce MM by 75% between 1990 and 2015 [3]. Provision of health center intrapartum and emergency obstetric care has been identified as vital for the reduction of MM [4]. Effective implementation of emergency obstetric care, which requires transfusions [5], [6], [7], needs to consider the local availability of safe blood [8], [9]. In the Region of the Americas, 68% of the blood is collected in seven countries with Gross National Product per capita above US $ 10,000 where 38% of the population lives [10].

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2. Materials and methods 

Maternal mortality ratios (MMR) [11] and proportions of maternal deaths associated with hemorrhage (MDH) [12], [13], [14], [15], [16], [17], [18], [19], [20], [21] were used in the analyses. To calculate blood donation rates, the number of blood units collected during 2003 [22] was divided by the corresponding country population [11], and multiplying by 10,000. To estimate blood availability, the proportion of units that were reactive/positive in the tests for infectious markers [22] was subtracted from the donation rate. The Spearman Rank Correlation Coefficient Test [23] was used to examine the relationship of blood availability with national MMR, and with MDH.

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3. Results 

Blood donation rates ranged from 10.4 to 521.3, with a median of 110.9 (Table 1); 25 (86.2%) countries had donation rates under 200. The proportion of blood units that were reactive/positive in the laboratory screening tests varied from 0.11% to 10.42%, with a median of 3.56 (Table 1). Eighteen (62.1%) countries had more than 3% reactive/positive donors. Blood availability rates ranged from 9.45 to 505.28, with a median of 108.77 (Table 1). Twelve countries (41.4%) had blood availability rates under 100. MMR varied from 11.1 to 523.0, with a median of 82.0 [11] (Table 1). Twelve (41.4%) countries had MMR over 100.

Table 1. Blood donation rate (per 10,000 inhabitants), proportion of donors with infectious markers, blood availabilityrate (per 10,000 inhabitants), maternal mortality ratio (per 100,000 live births) and proportion of deaths due to hemorrhage in Latin American and Caribbean countries, 2003
CountryBlood donation ratePercent infectious markersBlood availability rateMaternal mortality ratioPercent deaths due to hemorrhage
Cuba521.33.07505.2841.81.050
Uruguay291.91.97286.1511.1NA
Curacao274.40.11274.1032.0aNA
Argentina203.16.85189.1943.510.498
Antigua and Barbuda182.11.20181.1065.4aNA
Brazil164.33.03159.3244.9NA
Bahamas163.53.70157.4538.0aNA
Panama148.01.45145.8571.3NA
Suriname143.10.33142.63153.0a39.062
Venezuela133.33.56128.5567.215.982
Costa Rica116.52.49113.6038.0NA
El Salvador116.94.68111.43120.0NA
St. Lucia110.91.50109.2434.7aNA
Chile109.90.68109.1518.76.349
Belize112.63.40108.7768.4aNA
Colombia111.92.94108.61104.9NA
Mexico109.82.05107.5576.97.891
St. Kitts and Nevis100.05.2294.78246.6aNA
Jamaica98.47.2991.23106.2NA
Dominican Republic88.22.9785.5882.010.959
Nicaragua85.23.6682.0997.0NA
Paraguay87.010.4277.93160.722.641
Honduras70.34.1067.42108.046.871
Ecuador60.95.0457.8397.0NA
Guyana59.14.3056.56133.3aNA
Guatemala55.65.2852.66153.0NA
Peru53.63.8651.53185.039.504
Bolivia43.86.7940.82390.0NA
Haiti10.49.069.46523.0NA

NA: Data not available.

For blood availability and maternal mortality ratio: SumD2=7216.5; rs=−0.7775; p<0.002.

For blood availability and proportion of deaths due to hemorrhage: SumD2=272; rs=−0.6485; p<0.05.

aData for 2002.

Statistical analyses showed an inversed relationship (SumD2=7216.5; rs=−0.7775; p<0.002) between blood availability rates and MMR, and that higher blood availability was associated with lower MDH (SumD2=272; rs=−0.6485; p<0.05, Table 1).

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4. Discussion 

The data presented here show that MM is associated with availability of blood, and therefore, that sufficiency of blood in the facilities that provide comprehensive emergency obstetric care must be assured [24], [25].

Despite the fact that, from 2000 to 2003, the composite blood donation rate for Latin America and the Caribbean went from 127 to 139 [26], the rate for 12 countries decreased during the same period. Twenty five (86.2%) of the countries included in the present report had donation rates below 200 in 2003. The high proportion of donors with infectious markers further diminishes blood availability.

Countries with higher blood donation rates tend to have higher proportion of voluntary donors [10], lower proportion of reactive/positive donors, and lower MM (Table 1). Repeat voluntary donors are less likely than replacement and remunerated donors to carry infections that may be transmitted through transfusions [27], [28]. Forming voluntary blood donors, therefore, is central for achieving blood sufficiency.

The concept of formation of voluntary blood donors encompasses consolidated approaches by the national systems for health education and promotion among the general population, for public information regarding the need for donors, and the reengineering of the national blood systems to provide quality services to donors [26], [29], [30], [31]. Appropriate access to blood for transfusions should be considered in the pursuit of better health and decreased mortality among mothers of developing nations.

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Acknowledgements 

The opinions expressed in this paper are of the author only and are not intended to represent the position of the Pan American Health Organization. Dr. Lale Say provided a copy of the report on maternal mortality from the Dominican Republic [12], and facilitated the access to the reports from Honduras [13] and Surinam [14].

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PII: S0020-7292(07)00090-2

doi:10.1016/j.ijgo.2007.01.020

International Journal of Gynecology & Obstetrics
Volume 98, Issue 3 , Pages 291-293, September 2007

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