title: Blood Transfusion Delay and Outcome in County Hospitals in Kenya.
abstract: Severe anemia is a leading indication for blood transfusion and a major cause of hospital admission and mortality in African children. Failure to initiate blood transfusion rapidly enough contributes to anemia deaths in sub-Saharan Africa. This article examines delays in accessing blood and outcomes in transfused children in Kenyan hospitals. Children admitted with nonsurgical conditions in 10 Kenyan county hospitals participating in the Clinical Information Network who had blood transfusion ordered from September 2013 to March 2016 were studied. The delay in blood transfusion was calculated from the date when blood transfusion was prescribed to date of actual transfusion. Five percent (2,875/53,174) of admissions had blood transfusion ordered. Approximately half (45%, 1,295/2,875) of children who had blood transfusion ordered at admission had a documented hemoglobin < 5 g/dl and 36% (2,232/6,198) of all children admitted with a diagnosis of anemia were reported to have hemoglobin < 5 g/dL. Of all the ordered transfusions, 82% were administered and documented in clinical records, and three-quarters of these (75%, 1,760/2,352) were given on the same day as ordered but these proportions varied from 71% to 100% across the 10 hospitals. Children who had a transfusion ordered but did not receive the prescribed transfusion had a mortality of 20%, compared with 12% among those transfused. Malaria-associated anemia remains the leading indication for blood transfusion in acute childhood illness admissions. Delays in transfusion are common and associated with poor outcomes. Variance in delay across hospitals may be a useful indicator of health system performance.
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Julius
authors.initials: J
authors.lastname: Thomas
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Philip
authors.initials: P
authors.lastname: Ayieko
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Morris
authors.initials: M
authors.lastname: Ogero
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Susan
authors.initials: S
authors.lastname: Gachau
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Boniface
authors.initials: B
authors.lastname: Makone
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Wycliffe
authors.initials: W
authors.lastname: Nyachiro
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: George
authors.initials: G
authors.lastname: Mbevi
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Mercy
authors.initials: M
authors.lastname: Chepkirui
authors.affiliation: Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.|KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Lucas
authors.initials: L
authors.lastname: Malla
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Jacquie
authors.initials: J
authors.lastname: Oliwa
authors.affiliation: Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.|KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Grace
authors.initials: G
authors.lastname: Irimu
authors.affiliation: Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.|KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Mike
authors.initials: M
authors.lastname: English
mesh_terms: D000740:Anemia / Q000401:mortality* / Q000628:therapy*; D001803:Blood Transfusion; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007630:Kenya; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome