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 threequarters 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.