Innocent lives lost and saved: the importance of blood transfusion for children in sub-Saharan Africa

In sub-Saharan Africa (SSA), the death of a child is an everyday tragedy. The sorrow
is compounded by the fact that most children die not as a result of complex congenital
abnormalities, from malignancy, or from chronic incurable diseases, but rather from
completely treatable and reversible conditions such as severe malarial anemia. Simply
stated, blood transfusion therapy for children in SSA is a matter of life and death.

In recent years, national blood transfusion programs in SSA have made steady and significant
progress 1]. Supported by government financing and through external aid from programs such as
the President’s Emergency Plan for AIDS Relief (PEPFAR), national initiatives for
volunteer donor blood collection, viral testing, and distribution to hospitals continue
to advance. Nevertheless, even in well-run programs, supply falls short of demand,
and blood donations per 1,000 citizens in low-income countries are far below that
seen in wealthy nations 2]. The pattern of blood usage is also changing in SSA with growing demands for blood
products to support cancer care and to treat the burden of trauma brought on by increasing
road traffic accidents, burns from open fires, and human violence 3]. Nevertheless, children with severe anemia remain one of the most important categories
for blood transfusion in SSA, and high-quality information focused on pediatric blood
transfusion is both useful and welcome.

In a research article published in BMC Medicine, Sarah Kiguli and colleagues present an important and data-rich report from East Africa
that details the use and the outcomes of blood transfusion in children 4]. The report analyzes data from the Fluid Expansion as Supportive Therapy (FEAST)
trial, which is a previously published randomized controlled trial of volume loading
in children who presented with severe febrile illness to six hospitals in three East
African nations during the period 2009 to 2011 5]. Enrollment required that children exhibit respiratory distress or impaired consciousness
plus signs of impaired tissue perfusion. As a result, the FEAST trial focused on very
sick children presenting for emergency care, and this is reflected by the fact that,
overall, one in ten children enrolled in the study died within the first 48 hours.