CHANGES IN BLOOD-TRANSFUSION PRACTICES AFTER THE INTRODUCTION OF CONSENSUS GUIDELINES IN MWANZA REGION, TANZANIA

Objective: To assess the effect of introducing consensus guidelines on avoidable blood transfusions in Mwanza region, Tanzania. Methods: Avo idable blood transfusions were determined among 842 blood transfusion recipients in eight hospitals in 1991. In a workshop with senior healt h workers from the region, consensus guidelines for the prescription o f blood transfusions were developed and introduced in the hospitals an d after 7 months intervention data were collected on 1042 blood transf usion recipients. The 1991 and 1992 data were compared to estimate the change in the proportion of avoidable blood transfusions. Results: In blood transfusion recipients aged <5 years there was a significant re duction in the proportion of avoidable blood transfusions from 257 (52 %) out of 498 to 197 (33%) out of 595 (P<0.001), especially at the per ipheral hospitals. For children the proportion decreased from 25 to 17 % (P<0.05) and for operated patients the percentage remained at 24%. I n pregnant women there was a significant increase in the proportion of avoidable blood transfusions from 10 to 27% and in adults from 37 (25 %) out of 146 to 121 (50%) out of 242. The improvement in peripheral h ospitals was offset by a similar deterioration in the referral hospita l, thus no overall reduction was achieved in the proportion of avoidab le blood transfusions. Conclusion: The development and introduction of consensus guidelines was not sufficient to change prescribing practic e. The proportion of avoidable blood transfusions decreased only in ho spitals where compliance was maintained through regular clinic meeting s and strict supervision by senior medical staff.