Knowledge, attitude and practices (KAP) regarding voluntary non-remunerated blood donation (VNRBD) among the students of colleges of Jammu, India

INTRODUCTION

Blood transfusion services in India have gained special significance in recent years and forms a vital part of national health care system as it saves millions of lives each year, permits complex medical and surgical interventions, improves life expectancy and quality of life in variety of acute and chronic conditions. Because of increasing incidence of HIV/AIDS, blood safety Programme was initiated in India in the year 1989-1990 and subsequently became an integral part of National AIDS Control Organisation (NACO). Voluntary Non-Remunerated Blood Donation (VNRBD) is the safest of all types of blood donations.¹ Voluntary blood donors are not under pressure to donate blood and they meet the standard criteria of blood donation of low risk behaviour and can easily be motivated to become regular and permanent voluntary donors. Because of the knowledge they possess regarding donor deferral, they self-exclude themselves whenever they feel that they are unfit to donate blood. They easily respond to calls for emergency requirement of blood and its components especially for rare blood groups. Beside these advantages, there are certain medical benefits of regular Voluntary Blood Donation (VBD). VBD reduces the incidence of acute myocardial infarction.² Voluntary blood donation also reduces the insulin resistance and increases the insulin sensitivity and thus improves the glucose balance in the body.³ Seropositivity of HIV, HBsAg, HCV and syphilis is more in replacement blood donors as compared to VNRBD.^4,5 WHO also advocates for 100% VNRBD, citing it as the first line defence against transmission of diseases through the transfusion route. Because of all these advantages, VNRBD forms the firm foundation of Blood Transfusion Services of the country.

As per the action plan of national blood policy, there should have been 100% VNRBD in India by December 2005 which has not been achieved. In India, 5.5 million blood units per year were collected whereas the need was 8.5-9 million units and the percentage of blood units collected from voluntary blood donors was 54.4% in the year 2006-2007.⁶ Percentage of blood units collected from VBD increased to 59.1% in 2007-08, 61.7% in 2008-09 and further to 74.1% in 2009-10 (till January 2010) but did not achieve the target of National AIDS Control Programme III (NACP-III) which was 90 percent.⁷

There are five licensed blood banks in Jammu city and seven more licensed blood banks functioning at district and emergency hospitals in Jammu region. In spite of such a large network of blood banks National Blood Policy target of 100% was not achieved.

Study aims

Increase in the level of awareness and development of positive attitude towards blood donation is the topmost priority of almost all national blood transfusion centres. Recruitment of young adults as voluntary blood donors could meet the on-going demand of blood and blood components in the country; especially this group has the potential to donate blood over decades. Keeping in view this point, this study was initiated

• 1) To find out the prevalence of blood donors;
• 2) To explore the knowledge, attitude and practices (KAP) of the college students of Jammu regarding voluntary non-remunerated blood donation (VNRBD).

METHODS

This study was carried out after obtaining approval from hospital’s ethical committee at department of immunohematology and blood transfusion medicine, government medical college, Jammu over a period of one year i.e. from 1^st November 2008 to 31^st October 2009. It involved 1520 college students of six degree colleges. Both male and female students of age group 18-26 years were involved in the study. Self-administered structured donor questionnaire regarding KAP on VNRBD were distributed among the college students. Questionnaire was prepared by referring to recommended blood donation criteria and the national blood donation practice. It comprised of 4 major parts. Part one designed to measure socio-demographic data and part two, three and four were about the knowledge (awareness), attitude and practices regarding blood donation. These questionnaires were collected from the students after getting appropriately filled by them along with the written informed consent. No knowledge or information regarding blood donation was imparted to these students prior to filling of these questionnaire.

Statistical analysis

The information obtained was entered into a computer data sheet (Microsoft excels) and the responses to the questions were expressed where applicable, as percent, yes or no. All the information was compiled, tabulated and analysed from the input gathered from the students involved in the study. Prevalence of both male blood donors and female blood donors was calculated with 95% Confidence Interval (CI).

RESULTS

The present study involved 1520 college students which comprised of 880 females and 640 males. All the students studied were in the age group of 18-26 years. Out of 1520 students 210 were blood donors and 1310 were non donors. From these 210 voluntary donors, 85 were female and 125 were male.

The prevalence of blood donors was 13.81% with CI (Confidence Interval): 12.09 to 15.53. Prevalence of female blood donors was 9.65% and male blood donors were 19.53%. 81.57% of students were aware of and 18.42% of students were not aware of VBD. 57.10% students were not aware of their blood group.

Responses of the study population to the questions exploring their knowledge regarding blood donation were summarised in Table 1 and the questions exploring their attitude and practices were summarised in Table 2. Reasons for blood donation by the blood donors and the reasons for not donating blood by the non-donors were also compared (Table 3 and Table 4). Sense of social responsibility was the commonest reason for donating blood and the fear of illness was the commonest reason for not donating blood.

3.33% of the blood donors did not want to donate blood in future because of unpleasant experience of blood donation while 11.22% of the non-donors did not want to donate blood in future.

DISCUSSION

Targeting the beliefs associated with blood donation enhances the effectiveness of recruitment campaigns and the prevalence of blood donors annually. Prevalence (13.81%) of blood donors in this study was quite low similar to the study from Sikkim (12.7%).^8-11 Prevalence of female blood donors was also very less (9.65%) compared to male blood donors (19.53%). Low VBD was an important indicator for us to modify and strengthen the recruitment and motivational strategies. Previous studies have shown that the path from attitude to intention was more strongly weighted in men than in women. Self-efficacy played a larger role in determining donation intention in females which can be a reason for high voluntary blood donation among men than in women.¹²

Awareness on VBD was quite high (81.57%) which was similar to the KAP study of Thai students.^13,14 Awareness of the appropriate age for blood donation and the donor deferral criteria were very important factors. Lack of information on blood donation lowers the prevalence of voluntary blood donation.^15,16 Deferral of a donor is not only unpleasant for the donor but it also leads to wastage of precious time and money of the transfusion centre. Therefore, appropriate education of society regarding deferral factors of blood donation both temporary and permanent can lead to decrease in deferrals rate. Every individual should know their ABO and Rh D blood group so that they can donate blood whenever emergency requirement arises. Knowledge of ABO and Rh D blood groups is even more important in Jammu Region as it is prone to accidents and militancy related incidents. Youngsters like college students must know their ABO and Rh D blood group so that they can donate blood easily whenever there is demand of their particular blood group. Specially, those with the rare blood groups should get their names enrolled as voluntary blood donors in rare blood group donor’s records maintained by Regional Transfusion centres. 61.18% of the students were aware of this fact that a healthy adult human being can donate blood after every 3 months. Knowledge of this fact can increase the frequency of repeat blood donations and can turn first time blood donors into regular blood donors. Awareness of AIDS was not satisfactory in Indian society and for that more intensive public awareness campaigns by government with the help of non-governmental organizations are required.¹⁷ Although all the students in our study were aware of AIDS/HIV still, 37.5 % believed that blood donation causes HIV/ AIDS to the donor.¹⁸

More than 50 % of the students gave the correct answers for the questions pertaining to Blood Donation. Frequent blood loss through voluntary blood donations is associated with reduced risk of acute myocardial infarction in middle aged men.² High frequency blood donors had evidence of decreased iron stores, decreased oxidative stress and enhanced vascular function when compared with low frequency donors and thus, there is a potential link between blood donation and reduced cardiovascular risk.¹⁹ Blood donation is also associated with decreased risk of type II diabetes and cardiovascular diseases.³

The time to return for next donation was associated with total number of donations made.²⁰ Sex, Age and other donor Demographic factors influence the probability of subsequent donations.²¹ It also depends on the time since the index (first) donation. Social pressures and rewards were the factors that influence the decision for repeat blood donations at the early stages while self-originating factors influence the decision for blood donation in later stages.²² Since our study involved a younger age group (18-26 years), in which most of students (1350 students were in the age group of 18-20 years) just got eligible for blood donation, therefore, the number of blood donors who had donated only once or twice were more.

Social causes were the major motivational factors for blood donation. “Altruism, doing good to others”, “Sense of social responsibility” and “For helping friends or relatives” were the major reasons for blood donation. In a study from Norway, 2.8% respondents donated blood in order to be tested for HIV.²³ Younger donors donate blood for blood donor’s credit cards and items of limited value while elder people donate for medical check-ups and blood tests.²⁴ The motivations to donate are altruism, humanitarian, social pressure, replacement and rewards.²⁵ Altruism dominated the reasons for donating blood followed by social influence and ego enhancement.²⁶ Among students major determinants to become a blood donor were self-efficacy (for gaining experience), attitude, personal moral norm (personal responsibility, social obligation) and subjective norm (to help friends and relatives).^27-30 In our study, main reasons for not donating blood were Fear of needle, sight of blood, Fear of ill effects, objection from elder and never been asked for blood donation. The commonest of them were fear of ill effects and never been asked for blood donation. Most of the students who were willing to donate, but they had not donated blood because of lack of opportunity to do so. This finding showed that sufficient steps to involve students, to create opportunities for them to donate blood is something that needs to give due consideration. Among most first-time donors temporary deferral becomes the permanent excuse for not donating blood.^31-33 Fear of contracting AIDS or other TTD’s was also a major reason for not donating.²⁸ In our society parents have a wrong concept that blood donation causes weakness and hence they have a discouraging attitude towards donation of blood by their children especially by girls.

Experience of blood donation is an important factor for determining the future blood donations especially in the first time Blood donors. Those blood donors who have a pleasant blood donation experience usually return back for donating blood in future and turns into regular VNRBD while those who experience it unpleasant often do not return for repeat blood donation. In our study, 92.38% had pleasant experience of blood donation while 7.61% felt it unpleasant. The percentage of non-donors who don’t want to donate blood in future is more than the blood donors who don’t want to donate blood in future.^34,35 Interactive awareness sessions on blood donation should be organized among students and opportunities for blood donation should be created, which can greatly enhance the movement for “voluntary non-remunerated blood donation”, to ensure good quality of blood and safe modern medical care.^36,37

All countries in SEAR are trying to phase out replacement system and move towards 100% voluntary non-remunerated regular blood donation.¹⁰ Lack of resources, lack of professional management, myths and misconceptions arising from cultural and social differences forms a barrier to blood donation. As young people can be prospective regular blood donors, education in the fields of blood donation, need for safe blood and healthy lifestyles for young people are needed. Students are the most important target group and can easily be targeted in schools, colleges and universities.

CONCLUSION

Being knowledgeable and having positive attitude regarding voluntary blood donation does not transform into actual practice of blood donation, but this study shows a positive correlation between knowledge and donation practice. Therefore, specific recruitment and motivational campaigns are needed targeting the younger adults. Our efforts should be towards bringing the knowledge, awareness and the positive attitude of the students into application by motivating them and creating opportunities for them to become regular voluntary non-remunerated blood donor.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the hospital’s ethics committee at department of immunohematology and blood transfusion medicine, government medical college, Jammu

REFERENCES

1. 1. Leikola J. Non-remunerated donations. Devel Biol Stds. 1993;81:51-6.
2. 2. Salonen JT, Tuomainen TP, Salonen R, Lakka TA, Nyyssonen K. Donation of blood is associated with reduced risk of myocardial infarction. Am J Epidemiol. 1998;148(5):445-51.
3. 3. Real JMF, Bermejo AL, Ricart W. Iron stores, blood donation and insulin sensitivity and secretion. Clin Chem. 2005;51:1201-5.
4. 4. Garg S, Mathur DR, Garg DK. Comparison of seropositivity of HIV, HBV, HCV and syphilis in replacement and voluntary donors in Western India. Indian J Pathol Microbiol. 2001;44(4):409-12.
5. 5. Marshall DA, Kleinman SH, Wong JB, AuBuchon JP, Grima DT, Kulin NA, et al. Cost effectiveness of nucleic acid test screening of volunteer blood donations for hepatitis B, hepatitis C and human immuno deficiency virus in United States. Vox Sang. 2004;86(1):28-40.
6. 6. National AIDS Control Organisation (NACO). Voluntary blood donation programme - an operational guideline. In: NACO, eds. NACO Guideline. New Delhi: Ministry of Health & Family Welfare, Government of India; July, 2007.
7. 7. National AIDS Control Organisation (NACO). Annual report 2010-11. In: NACO, eds. NACO Report. New Delhi: Ministry of Health & Family Welfare, Government of India; 2012.
8. 8. Shenga N, Pal R, Sengupta S. Behaviour disparities towards blood donation in Sikkim, India. Asian J Transfus Sci. 2008;2:56-60.
9. 9. Emeribe AO, Ejele AO, Attai EE, Usanga EA. Blood donation and patterns of use in South Eastern Nigeria. Transfusion. 1993;33(4):330-2.
10. 10. Bharucha ZS. Donor management in South East Asian Region (SEAR). Devel Biol (Basel). 2005;120:145-53.
11. 11. Marantidou O, Loukopoulou L, Zervou E, Martinis G, Egglezou A, Fountouli P, et al. Factors that motivate and hinder blood donation in Greece. Transfus Med. 2007;17(6):443-50.
12. 12. France JL, France CR, Himawan LK. Redonation intentions among experienced blood donors: does gender make a difference? Transfus Apher Sci. 2008;38:159-66.
13. 13. Wiwanitkit V. Knowledge about blood donation among sample of Thai University students. Vox Sang. 2008;83(2):97-9.
14. 14. Androulaki Z, Merkouris A, Tsouras C, Androulakis M. Knowledge, attitudes and practices towards voluntary blood donation among a sample of students in TEI of Crete, Greece. ICUS Nurs WEB J. 2005;23:2005.
15. 15. Santana JDM, Palacio AB. Potential donor segregation to promote blood donation. Transfus Apher Sci. 2008;38(2):133-40.
16. 16. Shahshahani HJ, Yavari MT, Attar M, Ahmadiyeh MH. Knowledge, attitude and practice study about blood donation in the urban population of Yazd, Iran. Transfus Med. 2004;16(6):403-9.
17. 17. Choudhury N, Ayagiri A, Ray VL. True HIV seroprevalence in Indian blood donor’s. Transfus Med. 2000;10(1):1-4.
18. 18. Shah R, Tiwari AK, Shah P, Tulsiani S, Harimoorthy V, Choudhury N. Knowledge about HIV /AIDS among first time and regular voluntary non-remunerated blood donors. Indian J Pathol Microbiol. 2007;50(4):896-900.
19. 19. Zheng H, Cable R, Spencer B, Votto N, Katz SD. Iron stores and vascular function in voluntary blood donors. Arterioscler Thromb Vasc Biol. 2005;25:1577-83.
20. 20. Ownby HE, Kong F, Watanabe K, Tu Y, Nass CC. Analysis of donor returns behaviour. Retrovirus Epidemiology Donor Study. Transfusion. 2002;39:(10):1128-35.
21. 21. James RC, Mathews DE. Analysis of blood donor return behaviour using survival regression methods. Transfus Med. 2003;6(1):21-30.
22. 22. Peter LC, Piliavin JA. Developing a commitment to blood donation: the impact of one’s first experience. J Appl Soc Psychol. 2006;13(1):1-16.
23. 23. Stigum H, Bosnes V, Magnus P, Orjasaeter H. Risk behaviour among blood donors who give blood in order to be tested for the human immunodeficiency virus. Vox Sang. 2001;80:24-7.
24. 24. Glynn SA, Schreiber GB, Murphy EL, Kessler D, Higgins M, Wright DJ, et al. Factors influencing the decision to donate: racial and ethnic comparisons. Transfusion. 2006;46:980-90.
25. 25. Oswalt RM. A review of blood donor motivation recruitment. Transfusion. 2003;17(3):123-35.
26. 26. Hupfer ME, Taylor DW, Letwin JA. Understanding Canadian student motivations and beliefs about giving blood. Transfusion. 2005;45(2):149-61.
27. 27. Lemmens KPH, Abraham C, Hoekstra T, Ruiter RA, De Kort WL, Brug J, et al. Why don’t young people volunteer to donate blood? An investigation of the correlates of donation intentions among young non donors. Transfusion. 2005;45:945-55.
28. 28. Sampath S, Ramsaran V, Parasram S, Mohammed S, Latchman S, Khunja R, et al. Attitudes towards blood donation in Trinidad and Tobago. Transfus Med. 2005;17(2):83-7.
29. 29. Sojka BN, Sojka, P. The blood donation experience: self-reported motives and obstacles for donating blood. Vox Sang. 2007;94(1):56-63.
30. 30. Nguyen DD, Devita DA, Hirschler NV, Murphy EL. Blood donor satisfaction and intention of future donation. Transfusion. 2008;48(4):742-8.
31. 31. Hosain GMM, Annisuzzaman M, Begum. Knowledge and attitude towards voluntary blood donation among Dhaka University students in Bangladesh. East Afr Med J. 1997;74(9):549-53.
32. 32. Piliavin JA. Temporary deferral and donor return. Transfusion. 2003;27(2):123-35.
33. 33. Maqbool A, Bourhan EDM. Knowledge attitudes and practices regarding blood donation among the Saudi population. Saudi Med J. 2004;25(3):318-21.
34. 34. Sojka BN, Sojka P. The blood donation experience: perceived physical, psychological and social impact of blood donation on the donor. Vox Sang. 2003;84(2):120-8.
35. 35. Misje AH, Bosnes V, Heier HE. Recruiting and retaining young people as voluntary blood donors. Vox Sang. 2008;94(2):119-24.
36. 36. Ahmed Z, Zafar M, Khan AA, Anjum UM, Siddique MA. Knowledge, attitude and practices about blood donation among undergraduate medical students in Karachi. J Infect Dis Ther. 2014;2(2):134.
37. 37. Amatya M. Study on knowledge, attitude and practice of blood donation among students of different colleges of Kathmandu, Nepal. Int J Pharmaceut Biol Arch. 2013;4(3):424-8.