title: Blood supply safety in Afghanistan: a national assessment of high-volume facilities.
abstract: BACKGROUND
  Little information is available regarding blood supply safety in Afghanistan. The purpose of this study was to assess blood safety through serologic and observational measures in Afghanistan.
  
  
  METHODS
  This cross-sectional assessment included the 40 highest-volume facilities collecting and transfusing blood nationally identified in a previous survey. At each facility, study representatives completed a standardized instrument assessing staff performance of transfusion-related activities and performed rapid testing for human immunodeficiency virus, syphilis, and hepatitis B and C with rapid diagnostic tests on clinically discarded specimens. Reactive samples received confirmatory testing. Descriptive statistics were generated, with differences analyzed using chi-square or Fisher's exact tests.
  
  
  RESULTS
  Between November 2010 and May 2011, a total of 332 blood donor collection procedures were observed. Only 52.4% of observed encounters correctly screened and deferred donors by international criteria. Public and private facilities demonstrated glove use, proper sharps disposal, and patient counseling and relayed screening test results in less than 75% of observed events, significantly less likely than military facilities (p < 0.01). Of 1612 specimens assessed, confirmed cases of hepatitis B (n = 6), hepatitis C (n = 1), and syphilis (n = 3) were detected among units already prescreened and accepted for transfusion.
  
  
  CONCLUSIONS
  Lapses in proper donor screening contributed to the presence of confirmed-positive units available for transfusion, as detected in this study. Steps must be taken to ensure standardization of testing kits requirements, documentation, and mandatory training and continuing education for blood bank staff with regard to counseling, drawing, processing, and transfusion of blood products.
authors.affiliation: Health Protection and Research Organisation, Afghan National Blood Safety and Transfusions Services, Ministry of Public Health, Islamic Republic of Afghanistan; School of Medicine, Yale University, New Haven, Connecticut; United States Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland; Armed Services Blood Program Office, United States Department of Defense, Washington, DC; Department of Obstetrics & Gynecology, Columbia University, New York, New York.
authors.forename: G Farooq
authors.initials: GF
authors.lastname: Mansoor
authors.forename: Ahmad Masoud
authors.initials: AM
authors.lastname: Rahmani
authors.forename: M Aziz
authors.initials: MA
authors.lastname: Kakar
authors.forename: Pashtoon
authors.initials: P
authors.lastname: Hashimy
authors.forename: Parwiz
authors.initials: P
authors.lastname: Abrahimi
authors.forename: Paul T
authors.initials: PT
authors.lastname: Scott
authors.forename: Sheila A
authors.initials: SA
authors.lastname: Peel
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Rentas
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Todd
mesh_terms: D000346:Afghanistan; D001771:Blood Banks / Q000592:standards*; D001782:Blood Donors; D058731:Blood Safety; D003430:Cross-Sectional Studies; D046148:Donor Selection / Q000379:methods* / Q000592:standards*; D006801:Humans; D000094902:Blood Banking / Q000379:methods*