title: Investments in blood safety improve the availability of blood to underserved areas in a sub-Saharan African country.
abstract: OBJECTIVE
  Since 2004, several African countries, including Namibia, have received assistance from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Gains have been documented in the safety and number of collected units in these countries, but the distribution of blood has not been described.
  
  
  METHODS
  Nine years of data on blood requests and issues from Namibia were stratified by region to describe temporal and spatial changes in the number and type of blood components issued to Namibian healthcare facilities nationally.
  
  
  RESULTS
  Between 2004 and 2007 (early years of PEPFAR support) and 2008-2011 (peak years of PEPFAR support), the average number of red cell units issued annually increased by 23.5% in seven densely populated but less-developed regions in northern Namibia; by 30% in two regions with urban centres; and by 35.1% in four sparsely populated rural regions.
  
  
  CONCLUSIONS
  Investments in blood safety and a policy decision to emphasize distribution of blood to underserved regions improved blood availability in remote rural areas and increased the proportion of units distributed as components. However, disparities persist in the distribution of blood between Namibia's urban and rural regions.
authors.affiliation: Center for Global Health, Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Pitman
authors.affiliation: The Blood Transfusion Service of Namibia, Windhoek, Namibia.
authors.forename: R
authors.initials: R
authors.lastname: Wilkinson
authors.affiliation: Center for Global Health, Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: S V
authors.initials: SV
authors.lastname: Basavaraju
authors.affiliation: The Blood Transfusion Service of Namibia, Windhoek, Namibia.
authors.forename: B
authors.initials: B
authors.lastname: von Finckenstein
authors.affiliation: ID Consulting for IDTM, Zuidhorn, Netherlands.
authors.forename: C Smit
authors.initials: CS
authors.lastname: Sibinga
authors.affiliation: Center for Global Health, Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Marfin
authors.affiliation: Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, Netherlands ; Institute of Science in Healthy Aging & health caRE (SHARE), University Medical Center Groningen (UMCG), Groningen, Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Postma
authors.affiliation: Directorate for Clinical Support Services, Ministry of Health and Social Services, Windhoek, Namibia.
authors.forename: M
authors.initials: M
authors.lastname: Mataranyika
authors.affiliation: Center for Global Health, Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: J
authors.initials: J
authors.lastname: Tobias
authors.affiliation: Center for Global Health, Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: D W
authors.initials: DW
authors.lastname: Lowrance
keywords: Namibia; PEPFAR; blood safety