title: Clinical use of blood and blood components in post-abortion care in Botswana.
abstract: BACKGROUND
  Understanding the pattern and gaps in blood product utilisation in post-abortion care is crucial for evidence-based planning and priority setting.
  
  
  OBJECTIVE
  To describe the current use of blood and blood components in post-abortion care in Botswana.
  
  
  METHODS
  We conducted a retrospective cross-sectional study across four hospitals in Botswana using routine patients' records. We included all patients admitted for an abortion between January and August 2014. Descriptive statistics are used to report the results.
  
  
  RESULTS
  Whole blood and red cell concentrates were used in 59/619 (9·5%) of patients. Plasma and platelet use was 1·3 and 0·7%, respectively. The mean admission haemoglobin level was 10·07 g dL(-1) (SD 2·69) and differed significantly between referral and district hospitals. The mean number of blood units transfused per patient was 2·23 (standard deviation (SD) 1·23), with 15/55 (27·3%) receiving a single unit. A total of 43/288 (14·9%) of the patients had haemoglobin levels below 7 g dL(-1) but did not receive any transfusion. There was a moderate positive correlation between admission haemoglobin level and time to transfusion (Spearman's rho = 0·37, P = 0·01). The number of blood units given increased with decreasing admission haemoglobin level. The strength of this association was moderate (Spearman's rho = -0·48, P < 0·001).
  
  
  CONCLUSIONS
  There is a relatively low utilisation of blood and blood components in post-abortion care in Botswana despite an apparent clinical need in some instances. The reason for this shortfall, as well as its impact on morbidity and mortality, needs to be explored and be a focus of health systems research in Botswana.
authors.affiliation: Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana. billy.tsima@mopipi.ub.bw.
authors.forename: B M
authors.initials: BM
authors.lastname: Tsima
authors.affiliation: Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana.
authors.forename: T
authors.initials: T
authors.lastname: Melese
authors.affiliation: School of Nursing, University of Botswana, Gaborone, Botswana.
authors.forename: K D
authors.initials: KD
authors.lastname: Mogobe
authors.affiliation: Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana.
authors.forename: K
authors.initials: K
authors.lastname: Chabaesele
authors.affiliation: Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana.
authors.forename: G
authors.initials: G
authors.lastname: Rankgoane
authors.affiliation: Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana.
authors.forename: M
authors.initials: M
authors.lastname: Nassali
authors.affiliation: Department of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: D
authors.initials: D
authors.lastname: Habte
mesh_terms: D000029:Abortion, Legal; D000293:Adolescent; D000328:Adult; D016913:Blood Component Transfusion; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Botswana; abortion; blood; blood components