|Year : 2020 | Volume
| Issue : 2 | Page : 189-198
Demographic variations between blood donors and nondonors attending primary health care centers in Jeddah, Saudi Arabia, 2018–2019: a cross-sectional study
Iman M.W Salem1, Haifa Alshaikh2, Hanaa Abou Elyazid Abou Elhassan3
1 Department of Family and Community Medicine, Rabigh, King Abdulaziz University, Saudi Arabia; Department of Community Medicine, Al-Azhar University, Egypt
2 Department of Family Medicine, Ministry of Health, Jeddah, KSA
3 Department of Public Health and Community Medicine, Al-Azhar University, Egypt
|Date of Submission||26-Nov-2019|
|Date of Decision||14-Mar-2020|
|Date of Acceptance||04-May-2020|
|Date of Web Publication||24-Jul-2020|
PhD Iman M.W Salem
Associate Professor of Community Medicine, Al-Azhar University, 22338, Egypt
Source of Support: None, Conflict of Interest: None
Context Blood is a fundamental and vital component of the human circulatory system. Blood transfusion is essential to save lives or improve health in different parts of the world. Despite the increased number of voluntary blood donors worldwide, the demand for blood transfusion continues to rise.
Aims To assess the practice of blood donation and its demographic variations between donors and nondonors among primary health care’s (PHC) visitors of the Ministry of Health PHCs, in Jeddah city, Kingdom of Saudi Arabia, from December 2018 to February 2019.
Settings and design A multistage sampling technique was used to choose the selected five PHCs. The target sample size was calculated based on Raosoft software.
Patients and methods A cross-sectional analytic study was conducted from December 2018 to February 2019 at Ministry of Health PHCs in Jeddah on a total sample of 400 patients (200 males and 200 females) who were recruited by a multistage random sampling technique. Data were collected by using self-administered questionnaire about sociodemographic data and practices of blood donation among the study participants.
Results The participants were equally taken from both sexes (50% males and 50% females). Overall, 95% of the participants were from Jeddah, and 80% of the participants were Saudi nationals. There was a significant relation between donors and other independents variables such as PHC, age, and sex (P≤0.05).
Conclusion We concluded that the prevalence of blood donation among Saudi population is relatively low. Older married males with high educational level and low monthly income were the most common socio-demographic factors among the studied group.
Keywords: blood donor and nondonor, demographic factors, primary health care centers
|How to cite this article:|
Salem IM, Alshaikh H, Elhassan HA. Demographic variations between blood donors and nondonors attending primary health care centers in Jeddah, Saudi Arabia, 2018–2019: a cross-sectional study. Al-Azhar Assiut Med J 2020;18:189-98
|How to cite this URL:|
Salem IM, Alshaikh H, Elhassan HA. Demographic variations between blood donors and nondonors attending primary health care centers in Jeddah, Saudi Arabia, 2018–2019: a cross-sectional study. Al-Azhar Assiut Med J [serial online] 2020 [cited 2020 Oct 25];18:189-98. Available from: http://www.azmj.eg.net/text.asp?2020/18/2/189/290601
| Introduction|| |
Blood is a fundamental and vital component of the human circulatory system . Blood transfusion is essential to save lives or improve health in an emergency in different parts of the world . The WHO in June 2017  stated that ‘Blood transfusion saves lives and improves health.’
The need for blood transfusion is becoming universally a crucial component in the management of several critical conditions like accident injuries, surgical conditions, malignancies, pregnancy complications, and other medical conditions . In high-income countries, the major conditions include sophisticated medical and surgical procedures, malignancies, and trauma. On the contrary, pregnancy complications and childhood anemia are the conditions that largely need a blood transfusion in middle-income and low-income countries ,. A total of 5 00 000 women die each year in developing countries, and 99% of them die out of hemorrhage and inadequate blood transfusion .
Victims of motor vehicle accidents (MVAs) are at high risk of acute blood loss as well; up to 100 units of blood can be required to save the life of a MVA victim . In the Kingdom of Saudi Arabia (KSA), MVA results in four injuries every hour, making it one of the major risks for acute blood loss and subsequent 19 deaths daily . The high prevalence rate of hereditary hematological diseases also increases the demand for blood transfusion in KSA  with the prevalence of β-thalassemia of 0.05% and sickle cell disease of 4.5% .
Despite the increased number of voluntary blood donors worldwide, the demand for blood transfusion continues to rise . The growth of chronic diseases and the advancement in clinical and surgical procedures have led to increased blood transfusion demand, which continues to exceed supply, especially in developing countries ,.
Donation of blood is the main resource of blood availability. There are three main types of blood donors: volunteer donors, who donate without expecting a reward in return; replacement donors, who donate to their family or close people; and finally, paid donors. Collecting blood and blood products from voluntary, regular unpaid donors is recommended by the WHO to limit the transfusion-transmitted infections and to provide a constant resource for blood transfusion .
The WHO recommends blood donation by at least 1% of a country’s population and considered it as enough to meet a country’s basic requirements for safe blood .
Globally, 70 countries have a blood donation level less than the optimal level of 10/1000 population . WHO in its global report in 2013 estimated total collection of blood donation to be 112.5 million in the 180 countries during the reporting period. Overall, 178 of these countries collected 88.2 million whole blood donations and 11.0 million apheresis donations. Besides, 83.3% were reported as voluntary nonremunerated donations, 16.4% as family or replacement donations, and 0.3% as paid blood donations. Concerning the Eastern Mediterranean Region of WHO, 51% of whole blood donation was by voluntary nonremunerated whole blood donations. Based on the WHO global report, data of blood donation among the Saudi population in 2013 showed that whole blood donors were 10–19.9 per 1000 population, and of them, 25–49.9% were volunteer donors .
The way the blood donor reacts or behaves either as a single event or as a lifelong, dedicated practice to blood donation could be influenced by many individual characteristics as experiences, cultural, social, and sociodemographic complexes . Consequently, it is of interest in targeting first-time blood donors for recruitment and blood donor retention to zoom in on the characteristics of donors, more specifically into their demographic profile ,. Therefore, this research is to investigate the practice of blood donation and the demographic factors affecting it among the primary health care (PHC) center visitors in Jeddah, Saudi Arabia, from December 2018 to February 2019.
| Patients and methods|| |
Aim(s) of the study
The following were the aims of the study:
- To assess the practice of blood donation among the Ministry of Health (MOH), PHC’s visitors in Jeddah, from December 2018 to February 2019.
- To assess the demographic variations between nonblood donors and blood donors among the PHC center visitors in Jeddah, Saudi Arabia, from December 2018 to February 2019 .
Study design and setting
A cross-sectional analytic study was conducted from December 2018 to February 2019 at MOH PHCs in Jeddah, Kingdom of Saudi Arabia. The study was done in the MOH PHCs in Jeddah city, KSA.
Jeddah is the second largest city in KSA, and the largest city in Makkah province; it is located on the coast of the Red Sea with a population of four million people.
According to MOH, the total number of governmental PHCs in Jeddah was 45 PHCs which were divided into five areas; each area has one MOH secondary hospital. PHCs in Jeddah are classified according to the secondary hospitals, and each hospital covers 6–10 PHCs.
- All participants were adults (male and female) from 16 years and above, who attended PHCs in Jeddah, KSA, during the period of sample collection.
- They filled in the questionnaire (self-administered) after providing a written consent.
The target sample size was calculated based on Raosoft software to detect an expected 50% prevalence of blood donation with a 5% margin error and 95% confidence interval among a total population of 3 058 800 visitors in PHC according to the last statistic in 1437 H/2016 . The calculated sample size was N=377, which was increased to 400 to compensate for probable dropouts.
Data collection tool
A self-developed questionnaire was used for data collection and was validated to use by two epidemiologist experts and hematologist. Overall, two sections were included in the questionnaire: sociodemographic data  and practice of blood donation.
It was adopted from a previous study done in Riyadh after taking the approval to use the primary questionnaire from the author via e-mail . The self-structured questionnaire was in the Arabic language.
The questionnaire included two sections as follows:
- Part 1: it included the sociodemographic data such as age (Canadian classification of age subgroups) , sex, PHC center, residency, nationality, education, occupation, monthly income, and marital status.
- Part 2: it assessed the practice of participants and their previous donation state, times of donations, reasons, and places of previous donations, as well as their satisfaction after donation and recommendation to relatives and friends.
A multistage sampling technique was used in this study.
- In the first stage, Jeddah PHC centers are clustered by MOH into five sectors allocated to nearest secondary care hospitals. One PHC center was chosen by a simple random method from each sector. So, five PHCs were included in this study, which were AL-Shate PHC, AL-Rugama PHC, AL-Quryat PHC, AL-Fyasaliah PHC, and Abdlmajeed PHC. The total calculated sample size (400) was divided equally (equal allocation) on the five chosen centers (80 participants from each PHC).
- The second stage was conducted by applying stratified random sampling, which divides the sample equally into males and females from the selected five PHCs by equal allocation also.
- Then the participants were chosen by simple random sampling from the patient’s list in the outpatient clinic of each center.
- Applied by selecting from the patients’ list of the five selected PHCs on different days of the week (twice weekly) until the required number from each PHC was achieved.
Inclusion and exclusion criteria
The following were the inclusion criteria:
- All adults of age 16 years and above.
- Both sexes attending the MOH PHC centers in Jeddah.
- Illiterate or non-Arabic readers who cannot read the questionnaire.
Data were computerized and analyzed using SPSS 20 program (IBM SPSS, Chicago, Illinois, USA). Descriptive analysis (univariate analysis) was done in the form of categorical data, which were presented as frequency (percentage), whereas continuous data were presented as mean±SD. Bivariate analysis was done in the form of c2, which was calculated to compare categorical variables, and level of significance was taken at P value less than or equal to 0.05. A stepwise regression analysis was further done as a multivariate analysis to determine factors contributing to blood donation.
A pilot study was done on a sample of 10% of the total sample size and was conducted in a PHC. Participants included in the pilot study were excluded from the result of the study. The pilot aimed for assessing the clarity, feasibility of the questionnaire and accessibility of the sample.
The study protocol and questionnaire were approved by the joint program of family medicine community and public health administration, represented by the Department of Medical Research and Studies, Directorate of Health Affairs, Jeddah, MOH.
Confidentiality was assured by anonymous data collection (numbers and initial of PHC) and coding of the collected data in the database. The written consent was obtained from all the participants’ prior participation.
| Results|| |
[Table 1] shows the sociodemographic data of the participants. The participants were equally taken from both sexes (50% males and 50% females). Overall, 95% of the participants were residents in Jeddah, and 80% of the participants were Saudi nationals. Regarding the visitors of PHCs, 52% of them were patients. Most of the participants were married, with 67%, and only 27% of them were single. Moreover, nearly half (47%) of the participants were university graduates. Regarding the job description, 11% were in the education sector and 36% of the participants were unemployed. The monthly income was less than Rs 10 000 of most of the study participants (64%) ([Figure 1] and [Figure 2]).
|Figure 1 Distribution of the participants according to their blood group.|
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|Figure 2 A: Age groups percent, 80% of the participants were from 25–64 age group. B: Percent of non-donors and donors, only 29.7 of the participants were blood donors.|
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[Table 2] demonstrates the demographic data concerning the state of donation. The data showed a significant relation between donors and PHC, with P value less than or equal to 0.05, where 26.1% of the participants were from Al-Shate PHC, whereas most of nondonors were from the Quriat PHC (21.7%). The data also showed a statistically significant relationship between age and donation, with P value less than or equal to 0.05, with a majority (87.4%) of the donation among 25–64 age group, and only 76.9% of nondonors were from the same age group. There was also a statistically significant relationship between sex and donation state (P≤0.05), where most of the donors (83%) were males, whereas most of the nondonors (64%) were females. Monthly income was statistically significantly associated with donation state (P≤0.05), where participants with monthly income less the Rs 10 000 were 58% of donors compared with 66.5% of nondonors. Type of participant, nationality, marital state, and level of education were not statistically significant (P≤0.05) about donation state, with a P value of 0.27, 0.50, 0.26, and 0.58, respectively.
|Table 2 Sociodemographic variations between nondonor and donor participants|
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Moreover, height and weight had a statistically significant (P≤0.05) association with blood donation (P=000 and 000, respectively). Mean height in donors was 169.29±16.0 cm compared with 162.91±10.23 among nondonors. Regarding the weight, the blood donors had a higher mean weight (28.68±16.63) than nondonors (25.93±13.53).
[Table 3] illustrates the variations between nondonor and donor participants according to their blood groups and history of chronic diseases.
|Table 3 Variations between nondonor and donor participants according to their blood groups and history of chronic diseases|
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As shown in [Table 3], there is a statistically significant relationship between the blood group of the participants and their donation state (P≤0.05). Overall, 47% of the donors were from blood group O, whereas 36% of nondonors did not know their blood group. Types of chronic diseases had also a statistically significant relation with donation state (P≤0.05), where 73% of nondonors had diabetes compared with only 44.7% among blood donors. In contrast, hypertension was more recorded among donors than nondonor (36.8 and 15.9%, respectively). Smoking was significantly associated (P≤0.05) with blood donation state, and according to the data, 31.1% of blood donors were smokers compared with only 12.1% of nondonors.
As shown in [Table 4], multivariate logistic regressions were performed to determine the factors independently associated with blood donation. Factors that highly affected the blood donation state were sex, in which male sex was recorded nearly six times among donors compared with nondonors [odds ratio (OR)=5.692, 95% CI=2.634–12.301]; marital status, where married participants were 1.4 times more likely to be among donors compared with nondonors (OR=1.473, 95% CI=0.753–2.884), followed by the type of participants, where the relatives were 1.086 times more likely to be among donors compared with nondonors (OR=1.086, 95% CI=0.629–1.875). Moreover, Saudi participants were 1.046 times more likely to be among donors compared with nondonors (OR=1.046, 95% CI=0.527–2.076). Height, BMI, and weight factors also affected the blood donation state as follows: height (OR=1.032, 95% CI=0.999–1.66), BMI (OR=1.027, 95% CI=1.001–1.053), and weight (OR=1.020, 95% CI=0.997–1.043).
|Table 4 Logistic regression of the sociodemographic factors affecting blood donation|
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| Discussion|| |
Demographic characteristics such as age, sex, marital status, education, income, and position might be thought to indicate potential donors and therefore to help identify potential donors. Research studies on blood donation and its association with sociodemographic factors in individuals who have never been in a blood bank are scarce but remain the best approach to understanding the low rates of blood donation and guide the future donor recruitment campaigns in this group of population ,,,,.
Based on the WHO global report, data of blood donation among the Saudi population in 2013 showed that whole blood donors were 10–19.9 per 1000 population, and of them, 25–49.9% were volunteer donors . Our study revealed the prevalence of blood donation among 29.75% of the study participants. Similar frequencies were found in the studies done by Al-Mutairi et al.  in Al-Ahsa, Al-Rahili et al.  in Madina, and by Al-Fouzan  in Riyadh; however, the prevalence of donation was less in the study done by Baig et al.  in KSA with a percentage of 19%. Internationally, the practice of donation was also variable, as similar findings of ∼30% were observed in Brazilian study among the general population in Pelotas . The general public of Pakistan was also studied on determinants of blood donation behavior, and 25% were found to be donors . Higher responses were recorded in studies done in Riyadh in 2016 by Al-Mutairi et al.  and Jordan , with a prevalence of 61.2 and 68.8%, respectively. These discrepant results may be related to the source of study participants. Different from other studies, our study focused on blood donation practice among PHC service users, which may have led to higher rates of self-responses on the inability to donate, and by consequence, lower rates of blood donation.
Research studies on the relation between age and patterns of blood donation have a mixed outcome. Data from the Healthy People 2010 study in the USA showed that individuals between 18 and 24 years of age had donation prevalence higher than that of individuals between 25 and 64 years of age . Moreover, in Germany , a study revealed that the percentage of donors in the general population was higher among the youngest age group (18–24 years), and Wooi Seong  in Malaysia showed the same finding. Another study done in India found maximum blood donors among young people . The same pattern was observed by Marantidou et al.  in Greece. On contrary, the current study found the older population of 25–64 years to be more willing to partake in voluntary blood donation (87.4% of donors vs. 76.9% of nondonors, with a mean age was 39.88±13.00 and 33.40±11.92 among both groups, respectively). Supporting our findings, the same manner was observed among the Saudi population in a study carried out by Al-Fouzan . Moreover, Kasraian  in Iran, Volken et al.  in Germany, and Ou et al.  in Hong Kong reported higher response rates among older donors. The older the participants, the greater the opportunities for blood donation they had throughout their life. Moreover, continuous community education on voluntary blood donation is scarce, especially in low-income countries, leading to a lack of knowledge and awareness on blood donation among young people  and that could explain our result.
Sex is a considerable sociodemographic characteristic that could influence blood donation. Lower rates of female donors were expected, as on the global population, only 30% of blood donation is from females, and in some countries, this rate is even lower, reaching only 10% . The study result demonstrated that females were less frequent to donate blood than males (16.8 vs. 83.2%), which was in agreement with a study conducted by Al-Fouzan , which found lower frequency of females donating blood in comparison with males (18.6 vs.77.6%). One more study was done in Saudi Arabia, which also showed that of 250 donors, 6% were females and 94% were males . The current finding also agrees with the study conducted in Kuwait by Al-Haqqan et al.  and in Pakistan , India , Brazil , and Denmark, in which females had less tendency to donate blood than males .
The main barriers to blood donation among women are health-related factors such as low weight, the greater propensity for anemia, and iron deficiencies ,. Although many of these health issues are temporary deferral factors, many women mistakenly consider themselves permanently unable to donate ,. Moreover, other factors include lack of time, fear of needles, fear of blood, vasovagal reaction, lack of information related to the donation process, and misconceptions contribute to this low prevalence . In contrary to our study, Al-Rahili et al.  demonstrated that among medical students, females were more likely to be donors (77.9%) than males (22.1%). This was also shown in a study among African American college students . They stated that female students were more willing to donate because of their enthusiasm to participate in extracurricular activities and their willingness to help others. Being university students, the response of their participants was different, which may explain the discrepancy in the results.
Regarding the role of marital status on blood donation, the current study revealed that blood donors more commonly married. Our results supported the study of Al-Fouzan  in Riyadh who found a higher rate of blood donation among married individuals compared with single ones (53.3 vs. 29.4%). Moreover, Gillespie and Hillyer  in USA and Veldhuizen et al.  in Netherland concluded that blood donation is most common among married people. Mesch et al.  attributed this finding to the better social network connectivity enjoyed by married persons, which motivates them to donate blood to do good to others, especially to their children, which is demonstrated in the current study, where donors had more average number of children than nondonors (3.71±2.59 and 3.30±1.77, respectively).Socioeconomic status (as measured by education level or individual income) could affect blood donation behavior as well, although the exact relationships are unclear. Our results demonstrated that university or higher educational level was more frequent among donors (55.5%), but surprisingly 58.0% of blood donors had low monthly income rate. In the same line, in his study, Al-Fouzan  found that the history of blood donation was steadily increasing with the increase in the educational level of the participants, as 57.1% of individuals with postgraduate education compared with 20% of illiterates have donated blood previously. Likewise, one study in the USA found that individuals with at least some college education donated at a prevalence of higher rate than the other educational levels , and Saberton et al.  in Canada pointed to the inverse relationship between average household income and donor numbers in large cities. However, Roopadevi et al.  in India concluded that, as the level of education or per-capita income increases, the percent of blood donors increases as well. Moreover, in Netherland, Veldhuizen et al.  found that blood donors had a better than average education and a higher socioeconomic status. We referred the reason for the decrease in blood donation among the highest income group to the challenges of a busy working schedule they had. On the contrary, education may influence donation behavior directly by providing knowledge about the necessity of blood donation.
Concerning blood group, like the pattern in general population, group O was the most prevalent one followed by group A. Veldhuizen et al.  also found the same pattern among Dutch population, where most donors having either O positive or A positive blood, and few donors having AB negative blood. Moreover, in Nigeria  the commonest blood group observed among the donors was O positive. In addition, observations by Arshad et al.  in Pakistan and Song et al.  in Western China showed the same findings. Nevertheless, some studies have observed B-positive blood group as the most frequent one ,. The differences may be attributed to the genetic variations in blood group antigens among the different study populations. As low weight could be one of the main barriers to blood donation especially among women  similarly and in other words, our results demonstrated increased body weight among blood donors than nondonors (average BMI was 28.68±16.63 and 25.93±13.53, respectively). In agreement, Getta et al.  in Iraq found most of the blood donors were at least overweight if not obese. Obesity is also generally associated with middle age, and this is also true for blood donors .
To the spirit of my father and mother who taught me a lot and they were credited with all my work.
Presentation at a meeting: Al-Azhar University in Egypt, King Abdulaziz University (Rabigh), Saudi Arabia.
Date: 26 November 2019.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]