Protocol: identifying policy, system, and environment change interventions to enhance availability of blood for transfusion in Kenya, a mixed-methods study

BMC Health Services Research

Study Protocol

Kevin Ochieng¹  Bernard Olayo¹  Gatwiri Murithi¹  Muthoni Mate¹  Hellen Nyagol¹  Kristina E. Rudd²  Alejandro Munoz-Valencia³  Bopaya Bidanda⁴  Jayant Rajgopal⁴  Bo Zeng⁴  Yiqi Tian⁴  Jennifer Makin⁵  Mark H. Yazer⁶  Nakul P. Raykar⁷  Juan Carlos Puyana⁸  Jackline O. Aridi⁹  Cindy M. Makanga⁹  Tecla Kivuli⁹  Pratap Kumar⁹  Tonny Epuu⁹  Robert Kamu⁹  Carolyne Njoki Muiru^1,10  Jana Macleod^1,11  Abdirahaman Musa^1,12  Linda S. Barnes^1,13 

[1] Center for Public Health and Development, Kisumu, Kenya;Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA;Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA;Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA;Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center Magee Women’s Hospital, Pittsburgh, PA, USA;Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA;Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA;Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA;Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA;Departments of Surgery and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA;Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya;Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya;Department of Surgery, Egerton University, Nakuru, Kenya;Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya;Department of Surgery, Kenyatta University, Nairobi, Kenya;Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya;Ministry of Health & Sanitation, Turkana County Government, Turkana, Kenya;Linda S. Barnes Consulting, Seattle, WA, USA;Doctor of Public Health Leadership, University of Illinois-Chicago, Chicago, IL, USA;

关键词: Blood transfusion;    Blood supply;    Bleeding;    Anemia;    Process mapping;    Industrial engineering;    Policy system and environment change;    Mixed-methods;    Kenya;    Sub-Saharan Africa;   

DOI  :  10.1186/s12913-023-09936-0

 received in 2022-04-16, accepted in 2023-08-17,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSafe blood is essential for the care of patients with life-threatening anemia and hemorrhage. Low blood donation rates, inefficient testing procedures, and other supply chain disruptions in blood administration affect patients in low-resource settings across Sub-Saharan countries, including Kenya. Most efforts to improve access to transfusion have been unidimensional, usually focusing on only point along the blood system continuum, and have excluded community stakeholders from early stages of intervention development. Context-appropriate interventions to improve the availability of safe blood at the point of use in low-resource settings are of paramount importance. Thus, this protocol proposes a multifaceted approach to characterize the Kenyan blood supply chain through quantitative and qualitative analyses as well as an industrial engineering approach.MethodsThis study will use a mixed-methods approach in addition to engineering process mapping, modeling and simulation of blood availability in Kenya. It will be guided by a multidimensional three-by-three-by-three matrix: three socioeconomic settings, three components of the blood system continuum, and three levels of urgency of blood transfusion. Qualitative data collection includes one-on-one interviews and focus group discussions with stakeholders across the continuum to characterize ground-level deficits and potential policy, systems, and environment (PSE) interventions. Prospectively-collected quantitative data will be used to estimate blood collection and transfusion of blood. We will create a process map of the blood system continuum to model the response to PSE changes proposed by stakeholders. Lastly, we will identify those PSE changes that may have the greatest impact on blood transfusion availability, accounting for differences across socioeconomic settings and levels of urgency.DiscussionIdentifying and prioritizing community-driven interventions to improve blood supply in low-resource settings are of utmost importance. Varied constraints in blood collection, processing, delivery, and use make each socioeconomic setting unique. Using a multifaceted approach to understand the Kenyan blood supply and model the response to stakeholder-proposed PSE changes may lead to identification of contextually appropriate intervention targets to meet the transfusion needs of the population.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

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