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Impact of Inconsistent Policies for Transfusion-Transmitted Malaria on Clinical Practice in Ghana

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Owusu-Ofori, Alex K. and Bates, Imelda ORCID: https://orcid.org/0000-0002-0862-8199 (2012) 'Impact of Inconsistent Policies for Transfusion-Transmitted Malaria on Clinical Practice in Ghana'. PLoS ONE, Vol 7, Issue 3, e34201.

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Abstract

Background
Policies concerning the prevention of transfusion transmitted malaria (TTM) are the responsibility of blood transfusion services and malaria control programmes. To prevent spreading drug resistance due to over-use of malaria drugs, recent malaria treatment guidelines recommend prompt parasitological confirmation before treatment is started. In contrast, blood safety policies from the World Health Organisation (WHO) recommend presumptive malaria treatment for recipients of blood in endemic countries but evidence supporting this approach is lacking. Our study documented how these conflicting policies relating to malaria transmission through blood transfusion impact on clinical practice in a teaching hospital in West Africa.

Methods/Principal Findings
We randomly selected and reviewed case notes of 151 patients within 24 hours of their receiving a blood transfusion. Transfusion practices including the confirmation of diagnosis and anti-malarial treatment given were compared across three departments; Obstetrics and Gynaecology (O&G), Paediatrics and Medicine. Overall, 66 (44%) of patients received malaria treatment within 24 hrs of their blood transfusion; of which only 2 (3%) received anti-malarials based on a laboratory confirmation of malaria. Paediatric patients (87%) received the most anti-malarials and only 7% and 24% of recipients in medicine and O&G respectively received anti malarials. In 51 patients (78%), the anti-malarials were prescribed at the same time as the blood transfusion and anti-malarials prescriptions exceeded the number of patients with a presumptive diagnosis of malaria.

Conclusions
It is common practice in paediatrics to prescribe anti-malarials routinely with blood transfusions. This contravenes the malaria treatment guidelines of laboratory confirmation before treatment but is in accordance with the less-well evidenced blood safety guidelines. There is an urgent need for more evidence about the clinical impact of transfusion transmitted malaria to enable malaria and blood transfusion programmes to harmonize their policies and give clear guidance to clinicians who prescribe blood transfusions in malaria-endemic areas

Item Type: Article
Subjects: WA Public Health > Preventive Medicine > WA 110 Prevention and control of communicable diseases. Transmission of infectious diseases
WA Public Health > Health Administration and Organization > WA 525 General works
WB Practice of Medicine > Therapeutics > WB 356 Blood transfusion
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
Faculty: Department: Groups (2002 - 2012) > International Health Group
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pone.0034201
Depositing User: Rachel Dominguez
Date Deposited: 08 Feb 2013 10:49
Last Modified: 06 Feb 2018 13:06
URI: https://archive.lstmed.ac.uk/id/eprint/3288

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