Third-world countries should not spend money on new, more sensitive tests to prevent infection with HIV and hepatitis through blood transfusions. This is the conclusion reached by René van Hulst on the strength of his international research. Instead, it would wise to invest in better quality systems and more highly trained staff. Van Hulst will be awarded his PhD on 21 November 2008 for the research he carried out at the University of Groningen.
The risk of contracting a disease through a blood transfusion in developing countries is considerably higher than in the developed world. In relation to other groups, children with malaria and postnatal women are given the most blood transfusions. Unfortunately, this also makes them the most common victims of mistakes in the testing, administering and storing of donor blood.
In many cases, the blood used in developing countries originates from donors who have not been tested for HIV or hepatitis in advance. The blood is only checked for the presence of antibodies to HIV after it has been taken. Although more reliable tests based on DNA and RNA analysis do exist, Van Hulst’s research shows that it would not be cost-effective to introduce them alongside the regular tests. Public health would benefit more if the money was spent otherwise.
Test before donating
Research in a hospital in Kumasi, Ghana shows that the best option would be to test the donors before they donate blood. As a result, no blood would have to be thrown away, blood would not need to be taken unnecessarily and savings could be made. More importantly, it would be safer: blood that has not been taken cannot be administered to a patient by accident.
The Netherlands as an example
Anything that applies to developing countries will also apply mutatis mutandis to developed countries. Introducing more sensitive tests for HIV and hepatitis alongside the existing tests is expensive, would prevent few people from being infected and would be of relatively little benefit to health. Van Hulst: ‘In developing countries, people are remarkably receptive to rational arguments about introducing health-care innovations. Here in the Netherlands, we must also work towards optimum rather than maximum blood safety. We should not automatically implement every new piece of technology. The first step should be to ascertain the costs in relation to the number of infections that can be prevented. On occasion, our politicians will have to bite the bullet and make unpopular decisions based on research into health-economics. This is the only way of ensuring that health-care remains affordable and accessible.’
René van Hulst (Leeuwarden, 1972) studied Pharmacy in Groningen. He conducted his research at SHARE, the Graduate School for Health Research, Pharmacy department, Faculty of Mathematics and Natural Sciences at the University of Groningen. His supervisors were Prof. M.J. Postma and Prof. C. Th. Smit Sibinga. The research was funded by the Landsteiner foundation for blood transfusion research, the Ghanaian-Dutch cooperation programme for research into health care and development, the Ministry of Health, Welfare and Sport and the Bio-Rad and Baxter companies. Van Hulst also works as a researcher at the University of Groningen, as a hospital pharmacist in the Martini Hospital in Groningen and as a consultant at HECTA consultancy. His thesis is entitled Health economics of blood transfusion safety.
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