Timeliness of blood transfusion among children admitted with severe anaemia in a tertiary hospital in Eastern Uganda: a prospective cohort study

Anaemia remains a major global public health problem especially in low- and middle-income countries (LMICs). Timely blood transfusion among children with severe anaemia can be life-saving. However, many countries still suffer from acute blood shortages leading to adverse clinical outcomes. The study aimed to determine the timeliness of blood transfusion in a regional referral hospital in Eastern Uganda. This was a cohort study that recruited 323 children up to 12 years of age who were admitted to a regional referral hospital in Eastern Uganda. Using a structured questionnaire, we captured the sociodemographic and clinical characteristics of the children and their caregivers. We also captured the time of arrival at the hospital, the time when the decision to transfuse was made, and the time spent in the laboratory before blood was issued. Data were analysed using Stata version 18. Categorical variables were reported as proportions and the factors associated with delayed transfusion were determined using a generalised linear model with a gamma distribution and a log link. The median door-to-transfusion time was 3.6 h (interquartile range [IQR] 1.7–7.7). Delays in blood transfusion occurred across different health system service points mainly from blood stockouts (73%, n = 233/319), inadequate supplies (21.6%, n = 69/319), and healthcare worker shortages (19.4%, n = 62/319). Children whose caregiver was the father experienced 26% shorter expected time to transfusion compared with those accompanied by other caregivers (exp(β) = 0.74; 95% confidence interval [CI] 0.56–0.99). High out-of-pocket expenditure above 5.6 United States Dollars was associated with 42% longer expected time to transfusion (exp(β) = 1.42; 95% CI: 1.08–1.87) compared to lower expenditures. Delayed blood transfusion is common in Eastern Uganda. Health system factors such as blood stockouts and lack of essential transfusion supplies were the main contributors to delayed transfusion. Efforts should be directed at improving the availability of blood and the quality of healthcare services to improve patient outcomes.