Blood Transfusion Service Challenges and Patterns at Kampala International University Teaching Hospital, Ishaka-Bushenyi, Western Uganda: Insights from a Comprehensive Prospective Study

Bamwesigye Sanon

Faculty of Clinical Medicine and Dentistry Kampala International University Western Campus Uganda.


Uganda, a developing East African nation with nearly 20% of its populace living below the poverty line, faces significant constraints in its national blood transfusion service. Despite serving over 3 million individuals in Regional Referral Hospitals, a chronic scarcity of blood persists, impacting critical healthcare provisions, notably at Mulago, Uganda’s National Referral Hospital. This study conducted a meticulous assessment of the indications and influential factors shaping blood transfusion services at Kampala International University Teaching Hospital, Ishaka-Bushenyi, adopting a prospective descriptive cross-sectional design encompassing a 100% review of the target patient population receiving blood transfusions. Employing a pretested questionnaire as the data collection instrument, the gathered information underwent meticulous coding, sorting, entry, and analysis utilizing statistical software. Results were systematically presented through tables and charts. The findings revealed that a considerable proportion (42.3%) of transfused individuals fell within the age range of 20-39 years, with infants and young children (<5 years) comprising 22.4% of the recipients. Males accounted for 58.7% of the transfused population. Predominant indications for blood transfusions included anemia (30.4%), obstetric and gynecological conditions (23.4%), surgical operations (19.0%), infections (14.2%), and incidents involving road traffic accidents or assault (13.0%). The study identified the availability of a blood storage facility as a significant factor motivating the utilization of blood transfusion services, with an 87.4% availability rate reported. Notably, the demand for transfusions was notably high among females (56.1%) compared to males (43.9%), with anemia (53.3%) and blood group O (48.6%) constituting the majority of cases. Blood group distributions varied across different indications, with group O being predominant in most categories. Additionally, the Rh factor played a role, with Rh+ constituting 90.5% of cases and Rh- comprising 9.5%. Blood Group O had the highest occurrence of Rh+, while Blood Group A had the highest occurrence of Rh-. In summary, the study outlined several prominent factors influencing blood transfusion indications at KIUTH, notably anemia, obstetric and gynecological conditions such as postpartum hemorrhage and cesarean sections, surgical procedures (e.g., abdominal obstructions), infections (e.g., malaria), and incidents involving road traffic accidents or assault. These indicators are influenced by factors such as blood availability, age, gender, medical conditions, and blood type, with Blood Group O Rh+ being the most prevalent.

Keywords: Blood transfusion, Gynaecology, Anaemia, Blood Group O.


Blood transfusion remains a mainstay in upholding a safe and ample blood supply and is crucial to ensuring positive results for patients in both emergent and non-emergent situations [1, 2]. However, low- and middle-income countries, including Uganda, frequently report insufficient blood supplies to meet their demand [3, 4]. Blood transfusion has long not been recommended for volume expansion alone, except in cases of severe hemorrhage. Similarly, transfusion is required to increase viscosity only in cases of severe hemodilution. High viscosity in itself may impede circulation. Transfused blood also does not immediately increase oxygen delivery or utilization at the tissue level [5]. Therefore, clinical situations where blood transfusion is beneficial to the patient and improves outcomes are limited.

Globally, since 2006, only an approximation of about 41.5% of the demand for blood in the World Health Organization (WHO) African Region was met [6]. Additionally, approximately 112.5 million blood units are collected worldwide annually, with 50% collected in high-income countries, comprising only 19% of the world’s population [7]. Thus, WHO recommends voluntary, non-remunerated blood donation and has set a standard of 10 blood donations per 1000 populations as a baseline value for all countries to meet [7].

Additionally, on average, 32.1 and only 4.6 donations per 1000 population donations are present in high and low-income countries (including Uganda) respectively[8]. Also, the WHO estimates that blood donation by only 1% of a country’s population is needed to meet the basic demand for blood used in transfusion [7]; to achieve this, the WHO advises that all activities related to blood donation, including collecting, testing, processing, and storage, be centralized at the national level. While many countries strive to achieve this, it can be more difficult for especially developing countries in Asia and Africa with poor infrastructure and lower healthcare funding.

In Africa, various barriers commonly across these low-income developing countries, ranging from blood donation and processing of blood units, make it easier said than done to maintain an adequate blood supply for transfusion purposes [9]. Thus, according to a review of 35 studies by Asamoah et al[10].  on the motivations and deterrents to blood donation and transfusion in 16 Sub-Saharan African countries, it concluded that fear is a major deterrent, including fear of needles, adverse effects, and discouraging spiritual, religious, and cultural perceptions of blood donation [10], thus low practice of, and low volumes of blood available for transfusion.

Given the various factors that may affect one’s perception of blood transfusion, community-specific education is essential to recruiting a steady blood pool in pursuit of transfusion services. In patients with acute severe upper gastrointestinal hemorrhage, a restrictive transfusion strategy (trigger Hb < 7 g/dl, target Hb: 7-9 g/dl) resulted in lower 45 days all-cause mortality (5% vs. 9%, P = 0.02) than a liberal strategy (trigger Hb < 9 g/dl, target Hb: 9-11 g/dl). Also, the incidence of further bleeding and other serious adverse effects was reduced. However, the results of this single-center trial with strict protocol adherence may not be generalizable. A multicentric pragmatic cluster-randomized feasibility trial reflecting real-world settings in patients with upper gastrointestinal hemorrhage is currently underway in the UK (TRIGGER trial) [11].

In a multicentric RCT (Transfusion Requirements in Septic Shock (TRISS) trial) in 1000 patients with septic shock in 32 ICUs, there was no difference in the 90-day mortality (RR 0.94 [0.78‑1.09]), the number of patients with ischemic events (0.90 [0.58-1.39]), or in the use of life support in patients receiving Leuk reduced RBCs at a transfusion trigger of 7 or 9 gm/dl [12].

Despite blood transfusion being the mainstay of treatment, upholding a safe and ample blood supply and crucial to ensuring positive results for patients in both emergent and non-emergent situations, there has been an increase in blood collection requirements by the Uganda Blood Transfusion Service (UBTS) from 187,000 units in 2010 to 266,800 units in 2016, which is still inadequate to serve its purpose [1]. Suggesting either inappropriate use or excessive transfusion indication coupled with fear as a major deterrent, including fear of needles, adverse effects, and discouraging spiritual, religious, and cultural perceptions of blood donation and transfusion [10], thus low practice of, and low volumes of blood available for transfusion. Furthermore, various factors have been identified to cause hemorrhage, thus requiring transfusion of blood as treatment, including advanced age-related issues, road traffic accidents, anemia (including those due to infections as well as genetic anaemia-causing conditions), and the presence of a history of pregnancy-related issues or complications such as postpartum hemorrhage, operative vaginal deliveries, and emergency cesarean delivery, as well as multiple pregnancies in women[13–17]

Similarly, in case of any complications involving bleeding, emergency surgical intervention, application of medical treatments, and rapid supply and replacement of necessary blood and blood products remain very important steps in treatment [18]. However, there exists no comprehensive publication at KIU Teaching Hospital detailing blood transfusion practices at the facility. Therefore, this study intends to determine the common indications, factors affecting blood transfusion, and quantities used. This will aid in proper patient management, planning, and implementation at the facility level and provide feedback to UBTS.


Blood transfusion indications at KIUTH are anemia, obstetric and gynecological such as PPH and C/S, surgical operations (Abdominal Obstructions), infection (Malaria), and RTA/Assault. It’s affected by blood availability, age, sex, and condition as well as blood type with the majority being Blood Group O Rh+.


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CITE AS: Bamwesigye Sanon (2023). Blood Transfusion Service Challenges and Patterns at Kampala International University Teaching Hospital, Ishaka-Bushenyi, Western Uganda: Insights from a Comprehensive Prospective Study. IDOSR JOURNAL OF BIOCHEMISTRY, BIOTECHNOLOGY AND ALLIED FIELDS 8(3): 1-11.