Knowledge, Attitude, and Practice (KAP) of Voluntary Blood Donation among Nurses in Mosul Teaching Hospital

INTRODUCTION

Blood can save millions of lives. The requirement of blood and blood products in a country depends on the population, health care structure, prevalence of conditions requiring regular transfusions, such as hemophilia and thalassemia, etc., availability of surgical centers using modern sophisticated techniques, and awareness amongst clinicians regarding judicious use of blood.

 However, the problem regarding a permanent shortage of blood is observed in blood services all over the world (Sojka et al., 2003). The only source of blood is blood donation (Olaiya, 2004). However, recruitment of voluntary, non-remunerated blood donors poses major challenges to transfusion services throughout the world(Misje et al,2010). As per the World Health Organization (WHO) norms, 1% of the population is generally the minimum needed to meet the country’s most basic requirements for blood (WHO, 2008). donating blood is an act that can save the lives of thousands of people worldwide because blood is an essential element of human life and there are no substitutes for it. Despite extensive efforts and several blood donation programs being organized worldwide, the availability of blood remains short to meet the increased demand for it. World Health Organization advocates that 3-5% of the population should donate blood every year, which would be the ideal rate for maintaining a country’s stock of blood and blood products at an acceptable level (Zago et. al, 2010). The collection of blood should only be from voluntary donors (low-risk population), which is one of the four components of WHO’s integral strategy to promote global safety and minimize the risk associated with transfusion (WHO,2001). Unfortunately, 83% of the global population who are living in developing countries have access to only 40% of blood supplied, and this blood in 60% of cases is collected from paid or replacement blood donors rather than from voluntary non-remunerated low-risk donors (Mitra et. al., 2001).In India, there is a need of about 8 million units of blood every year, out of which only about one third are obtained from voluntary donors(Ghose and Basu, 1996). Despite extensive promising research, a true substitute for blood and blood components may not be available for many years (Loweand Ferguson, 2003). Therefore, blood donation by humans will continue to be the major source of blood and blood components. There are no national data in Iraq on blood donor demand (WHO,2011). The task of recruiting voluntary blood donors remains one of the major challenges for any blood transfusion service (Dorothy et. al, 2008). The numbers of potential donors were often reduced due to the strict selection criteria which were imposed to ensure the safety of the blood supplies. In addition to this, the blood centers find it difficult to recruit new donors and to retain them for arranging a regular blood supply for needy people. Consequently, the blood services need to organize more frequent blood drives to maintain a regular blood supply and to adopt an approach for enhancing new blood donor recruitment and retention of the donors (Ministry of Health and Family Welfare, India, 2003). One of the objectives of the National Blood Policy is to encourage research and development in the field of Transfusion Medicine. One of its strategies is to take the appropriate decision and/or to introduce policy initiatives based on the factual information, the operational 

RESULTS                                                            

Research on various aspects such as transfusion transmissible diseases, Knowledge, Attitude, and Practice (KAP) among donors, the clinical use of blood, etc (WHO, 2008). The aim of the study is to assess knowledge, attitude, and practice (KAP) of voluntary blood donation among nurses in Mosul Teaching Hospital. 

MATERIALS AND METHOD: -

A cross-sectional design was applied in this study that aimed at the assessment of the knowledge, Attitude, and practice of voluntary blood donation among nurses in Mosul Teaching Hospitals. The random sample consists of (152) nurses (99) Male, (53) Female, and the sample age range (median age) 18–60 (26.3±) years. Period of data collection extended from 1st December 2013 to 1st February 2014. Data were collected from all Mosul Teaching hospitals (IbnSena Teaching Hospital, AL-Zahrawee Teaching Hospital, AL-Salm Teaching Hospital, Ibn-AL Ather Teaching Hospital, and AL-KhansaTeahing Hospital). The questionnaire tool was used, data collection consisting of Four parts, Part one: This part included (6) items that focus on the nurses' demographic characteristics such as (age, sex, marital status, level of education, experience, and work setting). Part two: Knowledge of blood transfusion contains (8) items. Part three: Attitude towards blood donation. It consists of (5) items. Part four: Practice of blood donation included (6) items. An interview method was used for data collection. Data were analyzed as Frequency, percentage, and Chi-Squire to calculate the score of the true answer.

Table (1) Demographic Characteristics of the Study Sample (N=152)

 Table (2): Knowledge on Blood Donation N=152%

 Table (3): Attitude of Blood Donation

 Table (4): Practice of Blood Donation(N=152)

Table (5): The Association between Gender and Blood Donation.

This table indicated that the man was blood donation more than women.

Table (6): Distributions of Sample According to their Experience.

 Table (7): Distributions of the sample according to their level of education

DISCUSSION  

There are lots of publications assessing the knowledge, attitude, and practice of voluntary blood donation; however, very few studies have been published which assess the same on the healthcare workers in our environment and globally (Benedict et. al., 2013). The nurses who respondent in this study were (152) and (18-50 years or more) median age was (26.3±) years. Males in our society are more likely to donate blood than females approximately (65.1%), and the majority of the study sample were married (71.1%), while (27.6%) were singles (Table 1). These studies found the majority of nurses with (1-5 years) experience approximately (52.6%). Nurses worker in four departments, including ward (50.0%), operational unit (19.1%), emergency (17.1%), and intensive unit (13.8%). Their education level, most of the sample were a college of nursing (35.5%). Table (1). Figure (1) shows that there is the nurse’s knowledge toward blood donation is good knowledge (81.40%). Table (2) knowledge of blood transfusion. A total of 152 respondents expressed good knowledge of the common blood group types. And 131(85.2%) knew their blood group. A (23.7%), B (23.7%), AB (12,5%), O (26.3%) and (13.8%) did not know the blood group, (Table 2). The current study is in agreement with the study of (Benedict et.al, 2013) shown as expected that healthcare workers have a good knowledge of blood groups. Most respondents (91.3%) were aware of the risk of transmission of infection by transfusion. The risk of transmission of HBV, HIV, HCV, Malaria, and Syphilis (88.8%), (80.3%), (78.9%), (46.1%), and (32.9%) respectively. A similar study in Iran, (Reza et al., 2009) assessed the knowledge of 122 health care workers and found that 51.6% (just above average) have an acceptable knowledge of proper methods of blood and component transfusion. Fifty- seven (37.5%) stated that the minimum interval between donation is 6 months, 52(34.2%) said 3 months, and 20(13.2%) said a month, 6(3.9%) said annually, while 17(11.2%) they do not know of this. With knowledge of the volume of blood collected at each donation, 94(61.8%) stated less than 500 ml, 27(17.8%) ticked 500-1000 ml while 31 (20.4%) experts no knowledge of it. Figure (2) show that there is a nurse’s attitude toward blood donation is a positive attitude (78.20%). Table (3) Attitude towards blood donation. A hundred and seventeen (77.0%) respondents said blood donation was good. A voluntary donation was accepted as the best source of blood donors by 130(85.5%), replacement donors by 5(3.3%), remunerated by 2(1.3%), and self-donation by 15(9.9%).One hundred and thirty- six (89.5%) said the donor may experience temporary weakness, and 12(7.9%)said a donor can contact infection and 4(2.6%) said the donor may fall sick. One hundred and forty-two (93.4%) feels that patient relative should be asked to donate, and 142 respondents have asked relatives in the past to donate. The results of my study are in agreement with the study of (Hossain et. al., 1997) Found that (82%) of participants showed a positive attitude towards blood donation. In this study, we recorded (34.9%) blood donated by nurses in the past with23(43.4%) of them donating less than once a year, 25(47.2%) between 1-3 times a year, and 5(9.4%) more than thrice a years. This was a far cry from the knowledge and attitude indicated by the questionnaire. Voluntary blood donation among nurses though low generally, nurses in this study performed higher than their colleagues in the developed countries as documented in the studies by (Gilani et. al, 2007). Most (62.3%) donated voluntary, (34.0%) donated for friends and relatives (1.9%), for remuneration. The reasons for non-donation by those who have not donated include nobody approached them for donation 70 (46%), unfit to donate 30(19.7%), need to donate for a friend or relative in future 29 (19.1%), fear of knowing my status 13(8.6%), fear of needle 5(3.3%)the donated blood may be sold 4 (2.6%)and no remuneration 1(0.7%). This study is in Disagreement with the study that (Rajagopalan and  Pulimood, 1998) Attitudes of medical and nursing students towards blood donation mention that Ninety percent of the respondents in this study intended to donate blood in future and they thought that fear (40.9%), ignorance (31%) and lack of motivations (19.1%) were the main reasons for not donating blood by people. One hundred and twenty (78.9%) encourage relatives to donate Table (4). Figure (3) show that there are the nurses’ disparities in their practices of blood donation about (56.7%) have an answer correct. This study found a significant association between blood donation and gender. The results are in agreement with the study of (Gillespie et al., 2002) The reasons for the less percentage of female donors could be a low donor turnover and temporary deferral conditions like low hemoglobin values, low weight, and fear of pain. In a study which was done by (Hollingsworth and Wildman 2004), female donors constituted only 1% of the donor population. (WHO) in report affirmation (2011) mentions that the causes less female donation frequent menstrual cycles, pregnancy, and lactation. Table (5). Table (6) demonstrated the sample of the study according to their experience of nurse’s work that more ratio of blood donation between (1-6 years) about (20.76%). Table (7) demonstrated the sample of the study according to their level of education more nurses of blood donation those obtaining the certificate of the Institute of Nursing approximately (39.63%). There is a need to properly harness this potential pool of donors if the drive for 100% voluntary donor targeted by the WHO will be achieved. For a sustainable blood banking system aimed at providing adequate and safe blood to all in need, a proper sensitization, and massive donor recruitment from all potential donors must be implemented. CONCLUSION

The study concluded that the Nurses in hospitals have good knowledge of voluntary donation and a positive attitude towards donation but there were disparities in their practices of blood donation and the study elicits the importance of adopting effective measures in hospitals to motivate about voluntary blood donation among nurses.

RECOMMENDATIONS

There is an urgent need to create and strengthen programs for motivation, recruitment and retention of voluntary blood Donors in our country and implementation a larger study needs to be conducted with a wider pool of participants in order to gain more insights about nurses’ knowledge, attitudes and practices about blood donation.

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