Perception of blood donation among employees of healthcare organizations during COVID-19 pandemic: A national multicenter cross-sectional study

BACKGROUND

Maintaining a safe and adequate blood supply during a crisis is a major challenge facing blood banks around the world. With the recent global COVID-19 crisis and the enforced "stay at home" lockdown, access to blood donors was limited. Since employees of healthcare facilities may act as potential blood donors, their perception of blood donation and their willingness to donate during the pandemic period is important to be assessed.

STUDY DESIGN AND METHOD

A national cross-sectional study at six centers in Saudi Arabia was conducted using an online-based questionnaire that was distributed to all healthcare employees in these facilities between June and August 2020.

RESULTS

Among the total of 1664 participants, 63.2% (n = 1051) did not donate blood during the last 2 years. However, 53% (n = 882) of participants reported they are likely to donate blood during the COVID-19 crisis. Furthermore, 85% (n = 1424) did not donate blood during the current pandemic, with the biggest worries of getting the COVID-19 infection in the donor center. The main concerns of participants were about adherence to physical distancing requirements and the safety of the donation procedure. The majority of health care participants (88.2%) support implementing a hospital policy for a voluntary blood donation by employees during crises.

CONCLUSION

Recruitment of more blood donors among health care employees is a feasible solution to improve the blood supply during a crisis. This should be based on efforts throughout the year including regular awareness campaigns and effective communication.

The role of parental health care utilization in children's unnecessary utilization in China: evidence from Shaanxi province

Background

China has a large population of children under 18 years of age, whose health is of great concern to the Chinese health care system. However, few studies have been conducted to analyze the factors associated with children’s unnecessary health care utilization in China. The objective of this study is to provide some empirical evidence on this issue by investigating the role of parental health care utilization in children’s unnecessary health care use.

Methods

The data were obtained from the fifth Health Service Survey of Shaanxi province in 2013. We employed three dependent variables to measure children’s health care utilization: the number of children’s outpatient visits during the past 2 weeks, whether or not infusion was used if the child had any outpatient visits during the past 2 weeks, and the number of children’s inpatient visits during last year. Based on specific characteristics of these outcome variables, negative binomial models were used for the non-negative numbers of outpatient and inpatient visits, while a probit model was used for the zero-one indicator variable showing whether infusion was used during outpatient visits.

Results

Based on a sample of 11,024 children, our results of multivariate analysis showed that children whose parents used outpatient care were estimated to have a larger number of outpatient visits than those whose parents did not have outpatient visits in the past 2 weeks (with a difference of 0.0393 visits). Among children having outpatient visits in the last 2 weeks, the probability of obtaining infusion was 57.01 percentage points higher for children whose parents used infusion in the past 2 weeks than the probability for those whose parents did not use infusion. The predicted number of inpatient visits was higher for children whose parents used inpatient services in the last year, compared with the group whose parents did not use (with a difference of 0.0567 visits). Moreover, we noted that the positive association between parental and children’s health care use was more prominent among younger children.

Conclusions

Chinese children whose parents were high health care users were more likely to overuse health care services, holding other factors constant. Parents can play an important role in reducing children’s unnecessary outpatient visits, infusion use, and inpatient visits. The results suggest that interventions aimed at affecting patterns of parental use may be helpful in improving appropriate health care utilization for children.

Are There Differences in Antibiotic Use Between the Recent-Immigrants from Mainland China and the Local-Born in Hong Kong?

Immigrants, especially the first-generation, were thought to have different knowledge, attitudes and practice (KAP) with antibiotics. Doctors often perceived extra pressure from them to prescribe antibiotics. To test these perceptions, we studied the difference in KAP with antibiotics between the recent-immigrants from mainland China and the local-born of Hong Kong-places with significantly different healthcare and socio-economic systems. Focus groups (including one specific group of recent-immigrants) with 56 participants and territory-wide telephone questionnaire survey with 2,471 randomly selected respondents. Recent-immigrants shared similar KAP with the local-born. After adjustment for age, sex and education, the main significant difference was the new-immigrants' behaviour of acquiring antibiotics without prescription and keeping the leftover. They, like the local-born, preferred doctors who prescribed antibiotics cautiously. Immigration status could be the surrogate for age, sex and education in the KAP with antibiotics. For antibiotic use, health education and patient care could be similar between the recent-immigrants and the local-born.

Institutional incentives for altruism: gifting blood in China

BACKGROUND

In mainland China, the motivation behind voluntary blood donation is a relatively new and understudied behavior. In recent times provincial governments in China have implemented various institutional incentive measures. However, little is known regarding the effectiveness of such measures. This qualitative study investigated the nature and outcomes of some identified institutionalized mechanisms, in particular how these were created and distributed in the form of incentives for voluntary blood donation.

METHODS

Participatory observations were conducted at two blood donation stations and four blood collecting vehicles in Changsha city, China. In-depth interviews were conducted with 17 staff and 58 blood donors at the aforementioned venues from May to October 2008 in Changsha.

RESULTS

Thematic analysis revealed the operation of four primary type incentives: policy-driven, symbolic, information feedback and role models, which constituted the system of institutional incentives. The current blood reimbursement system was not the primary motivation for blood donation; instead this system was a subtheme of future assurance for emergency blood needs. It was evident that symbolic incentives stressed the meaning and value of blood donation. Furthermore, post-donation information services and the inherent mechanisms of communication, enhanced by some public role models, served to draw the public to donate blood.

CONCLUSIONS

At the institutional level, blood donation was not only informed by altruism, but also carried a system of benefit and reward for the donors and their family members. We would recommend that such arrangements, if accommodated effectively into China's health promotion strategies, would increase the likelihood of blood donation.

Blood safety and availability: continuing challenges in China's blood banking system

Social and economic development, along with increased health care coverage, has caused a sharp increase in the clinical demand for blood in China. Whole blood collection has increased rapidly in the past decade but has failed to keep pace with the ever-increasing demand. Overall, the country's blood safety has been improved with 99% of whole blood donations collected from voluntary unpaid donors. However, the unmet clinical demand for blood and the increasing incidence of human immunodeficiency virus and syphilis in the general population pose new challenges to China's blood banking system. To ensure a safe and adequate blood supply, continued efforts are required to recruit and retain a sufficient number of low-risk voluntary blood donors, improve donor prescreening and blood testing process, ease donor restrictions, and strengthen patient blood management.

Serve the people or close the sale? Profit-driven overuse of injections and infusions in China's market-based healthcare system

Treatment by injection or infusion is widespread in China. Using the common cold as a tracer condition, we explored the reasons for over-prescription of injections and infusions in Guizhou, China. Interviews with prescribers, patients and key informants were supplemented by focus groups. These revealed how historical ideas encourage unnecessary use of percutaneous treatment: faith in the healing power of needles is locally attributed to association with acupuncture. Many patients and some staff believe that injections per se are therapeutic. However, the structure of health service financing and remuneration now reinforces this irrational faith. Market-based reforms have attempted to control costs and increase productivity with an incentive scheme which rewards prescribers financially for over-prescription in general and for use of injections and infusions in particular. Aggressive marketing has displaced oral treatment from health facilities into independent pharmacies, leaving doctors functioning mainly as injection providers. There is a need for a multi-faceted response encompassing education and reform of financial incentives to reduce the use of unnecessary treatment.

Treatment and complications of thalassemia major in Guangxi, Southern China

BACKGROUND

β-Thalassemia is extremely prevalent in Guangxi province, Southern China. However, little is known about the treatment and complications of patients with thalassemia major (TM) in Guangxi. The first thalassemia center in China was opened in Guangxi in 2003. Since that time, more than 400 patients have been enrolled.

PROCEDURE

From December 2009 to February 2010, data was collected from TM patients visiting the thalassemia center including the circumstances of diagnosis, biological and clinical data, markers of iron overload and treatment.

RESULTS

Data on 231 patients (median age, 5 years; range, 5 months to 21 years) were recorded. Only 44.6% of patients maintained their hemoglobin levels >9.0 g/dl. In 186 patients with ferritin levels >1,000 ng/ml, an iron chelator was used regularly in 44.6%, irregularly in 26.9%, and was not used in 28.5%. The mean serum ferritin level was 3,143 ng/ml and levels increased with age. Height and weight retardation were found in 48.3% and 11.1% patients, respectively. Compared to patients treated outside of the center, patients completing treatment in the thalassemia center had a higher hemoglobin level before transfusion, higher height and weight SD score, and less splenomegaly, but a similar ratio of regular or irregular iron chelation. Six (18.2%) of 33 patients >10 years of age (14.3 ± 2.8 years; range, 11-19 years) were diagnosed as hypothyroid.

CONCLUSIONS

Although survival status of patients with TM in Guangxi has improved since the opening of the thalassemia center, TM complications remain high and with an early onset.

Payment, compensation and replacement--the ethics and motivation of blood and plasma donation

The supply of blood and plasma to produce haemotherapies varies around the world, but all environments need donors to furnish the raw material. Many countries still lack adequate supply, and the question of what amounts of blood and plasma are required for optimal treatment is still unresolved. The issue of compensating donors has been a controversial and emotive one in blood transfusion for many decades. Donors are conventionally classified as paid, voluntary or replacement, and a level of stigma, based on safety and ethical considerations, has been attached to paid donation. This review points to evidence which renders many of these concerns redundant. Purist arguments against compensated donation have little basis in evidence and would lead to many of today's voluntary donors being designated as paid, because of the large range of incentives used to recruit and retain them. Misplaced application of 'Titmussian' volunteerism has precipitated its own safety and supply problems. Current systems of compensation and replacement are needed to maintain supplies of essential products and lead to safe products in controlled environments. We propose that a plurality of routes towards donation is an appropriate paradigm in the heterogeneous landscape of blood and plasma product supply.