Knowledge, attitude and practices of people towards voluntary blood donation in Uttarakhand.

INTRODUCTION: Blood transfusions form a crucial and irreplaceable part in the medical management of many diseases. The collection of blood from voluntary, non-remunerated blood donors from low risk populations is an important measure for ensuring the availability and safety of blood transfusion. In a state like Uttarakhand which is visited by lakhs of visitors during pilgrimage season and where natural calamities and accidents are very common, the availability of blood is of utmost importance. AIM: To find out knowledge, attitude and practices of people towards voluntary blood donation to comprehend the situation and find ways to enhance voluntary blood donation in the state of Uttarakhand.
MATERIALS AND METHODS: Multi stage methodology was designed to target population including general population, influencers (doctors) and supporting organizations (camp organizers, State AIDS Control Society Officials) who were subjected to in-depth interview using pre-structured questionnaires to assess knowledge/awareness about voluntary blood donation, factors preventing and source of knowledge about voluntary blood donation. RESULT: The sample population consisted of mostly men (67%) in the age-group of 26-35 years. Requirement of blood and the measures to promote voluntary blood donation have a direct relationship with the total population and literacy level of the population. Awareness about blood donation, source of knowledge about blood donation, reasons for not donating blood are particularly stressed. With increase in educational level, the awareness level was also found to increase. While among illiterates 81 percent of the respondents knew about blood donation, among the post graduates the same ratio was found to be almost cent-percent. Among various reasons cited for not donating blood, lack of awareness being the most common reason. People gathered information about blood donation from several different sources with electronic media being the most prominent.
CONCLUSION: This study illustrates how increasing awareness and marketing 'Voluntary blood donation' can enhance adequacy of blood needs of a state or for that matter the entire country. This study also underlines how different media, especially electronic media, can be used to propagate altruistic blood donation.

Introduction

Human blood is an essential element of human life and there are no substitutes to blood as yet.[1] Availability of safe blood and blood products is a critical component in improving health care. Millions of lives are saved each year through blood transfusions, but the concern is quality and safety of blood transfusion particularly in the developing countries.[2] Blood will be safe if there is a nationally coordinated blood transfusion service, collection of blood only from voluntary non-remunerated donors, testing of blood for transfusion transmissible infection and transfusion of the right blood to the right patient through the appropriate clinical use of blood.[3] The need for blood is growing day by day as a result of advancement in the clinical medicine. The collection of blood only from voluntary, non-remunerated blood donors from low-risk populations is an important measure to ensure the safety, quality, availability and accessibility of blood transfusion.[4]

There is very little published data on status of Blood transfusion service (BTS) in different states in the country. This study was therefore conducted with an aim to find out knowledge, attitude and practices of people towards voluntary blood donation to comprehend the situation and find ways to enhance voluntary blood donation in the state of Uttarakhand.

Materials and Methods

Place of study

Uttarakhand came into existence on the 9th of November 2000 and constituted the 27th state of the Republic of India. Uttarakhand lies in the higher Himalayan region, which is highly dissected, undulating, rugged and earth quake prone with cold climate and poor quality soils. About 93 percent of the area is hilly, while around 63 percent is covered by forests. It is an ecologically fragile and economically marginalized and is at disadvantage in comparison to other regions. As per census 2001, the total population of the newly created state of Uttarakhand stood at 8,479,562 persons. Uttarakhand is predominantly rural with about 74 percent of its 8.5 million populations living in rural settlements. Almost 73 percent of the population in the State is literate, with significant inter-district variations. There are substantial differences in male and female literacy rates, eighty-four percent of males are literate compared to 60 percent of females.[56]

Study design

During the study, relevant information was gathered from multiple sources with a broad framework for the study depicted in Figure 1. The respondents were categorized into three broad categories:

Figure 1

Respondents of the study

General Population (Students and employees of industries)

Influencers (doctors, blood bank officials, etc.)

Supporting Organizations (Camp Organizers, Uttarakhand State AIDS Control Society (USACS) officials)

Sampling methodology

A multi stage sampling methodology was followed. In the first stage, in each city, wards were selected, using the probability proportional to size (PPS) sampling technique. The detail of wards selected for the study is given in Table 1. The respondents who were administered the questionnaire were selected according to the plan shown in Table 2.

Table 1

Sample distribution

Table 2

Respondents interviewed

Data regarding status of BTS and voluntary blood donation in the state was collected from USACS officials.

Study instruments

For conducting the interview of various categories of respondents a structured questionnaire was developed. Besides capturing their general profile, the questionnaire for the respondents probed the following key issues:

Knowledge/awareness about Voluntary blood donation

Knowledge about the reasons why ‘Voluntary Blood Donation’ should be encouraged

Exposure to various communication media/channel

Sources(s) of information on the above issues

Statistical analysis

Data was collected in excel sheet and analysis of data done through Fox Base software.

Results

Demographics

The sample population of respondents consisted of mostly men (67%) in the age-group of 26-35 years. As depicted in Table 3, the proportion of the females having donated blood was found to be much less than that of the males. While around 84% of the males reported having ever donated blood, the same proportion was found to be 13% among females.

Table 3

Ratio of blood donation (gender wise)

Voluntary/Replacement blood donation

During 2008 a total of 56869 units of blood were collected in the state of Uttarakhand. As shown in Figure 2, 24455 units were collected through voluntary blood donations and 32314 units were collected through replacement donations and various modes of blood collection in Figure 3.

Figure 2

Share of voluntary and replacement blood donation during 2008 in Uttarakhand

Figure 3

Blood units collected through various modes during 2008 in Uttarakhand

Awareness about blood donation

With increase in educational level, the awareness level was also found to increase. As shown in Table 4, among illiterates, 81 percent of the respondents knew about blood donation, among the post graduates the same ratio was found to be almost cent-percent.

Table 4

Awareness about blood donation

What prevents people from donating blood?

Various reasons were cited by people for not donating blood Table 5 with lack of awareness being the most common reason.

Table 5

Reasons for not donating blood

Source of knowledge about blood donation

People gathered information about blood donation from several different sources [Table 6] with electronic media being the most prominent.

Table 6

Source of knowledge about blood donation

Discussion

There are hardly any published reports on knowledge attitude and practices (KAP) towards voluntary blood donation and ways to enhance the same. This baseline information was important for understanding the KAP about voluntary blood donation. This information can be the basis for improving or augmenting the BTS at the state level and may be even at the national level.

In Uttarakhand, blood banking services are provided mostly by the government blood banks working mainly on replacement donation. There is only one stand-alone blood bank (Regional Blood Transfusion Centre) in the state working on 100% voluntary blood donation and component separation. Every year lakhs of visitors come to Uttarakhand for pilgrimage to few well known religious places together called as ‘Chardham’. As per estimate Chardham is visited by 250,000 visitors during pilgrimage season[7] and in case of causalities it would be very difficult for visitors to arrange the blood components.

Gender-wise greater proportion of the blood donors were males (84%) than the female (16%) counterparts. These findings are comparable with the study conducted in Sikkim in 2004 where males were (84.2%) and females (15.8%).[3]

The proportion of voluntary donation (44%) in the present study was lower than the national average of 61%.[8] However these findings are comparable with study conducted in Sikkim in 2004 where voluntary blood donation was 46%.[3] The study findings are further corroborated by the NACO data of 2008-09 which also puts voluntary blood donation in Uttarakhand at 45.5%[8] These percentages of voluntary blood donation is surprisingly even lower than that reported in a study conducted in Kenya where 17,940 people were surveyed. In the Kenyan study 64% were voluntary donors while the rest were Family Replacement Donors.[9]

The observation of awareness about blood donation being directly proportional to the education levels seems to be logical since education would also increase awareness about all possible information including that related to blood donation. There is also a higher probability of having been exposed to a voluntary blood donation camp in one's educational institute since these camps are common in educational institutes. This is in agreement with study carried out in Tanzania where voluntary blood donation correlated with secondary school attendance.[10] However, these findings are in contradiction with the study conducted among the students of Chulalongkon University, Thailand[11] where they did not find any significant correlation of gender, age, and educational level with knowledge about blood donation.

In the present study 45% of the participants did not donate blood because of lack of awareness. This is very similar to the study carried out on 500 Saudi individuals, where eighty-nine non donors (42.6%) replied that they were ‘not approached by anybody’ for blood donation.[12] This opens up a huge possibility of marketing the concept of “Voluntary blood donation”. There have been such marketing efforts by National AIDS Control Organization (NACO) since recent past.

The observation that electronic media is the most prominent way of how people gather information about blood donation seems to be in parallel with NACO's recent efforts of using this media for disseminating the information and emphasizing the importance of voluntary blood donation.[13]

Conclusion

This study illustrates how increasing awareness and marketing ‘Voluntary blood donation’ can enhance adequacy of blood needs of a state or for that matter the entire country. This study also underlines how different media, especially electronic media, can be used to propagate altruistic blood donation.