Assessment of Knowledge and Practice towards Blood Donation amongGedebano Secondary and Preparatory School Students, Mehal Amba,SNNPR, Ethiopia

Background: Blood transfusion is one of the most crucial needs of the society in multiple diseases and injuries. Unexpectedly, thirty-eight countries in Africa got below ten donations per one thousand populations. Shortage of blood is one of the reasons for the death of mothers in sub-Sahara, including Ethiopia. Although the need for blood is high in our country Ethiopia, the number of volunteer donors is still very low. Method: A descriptive cross-sectional study design was conducted on Gedebano secondary and preparatory students using pre-tested self-administered questionnaires. Multi-stage sampling technique was employed to select study participants. Result: Out of 392 participants, 182(46.43%) were knowledgeable whereas 210(53.57%) had poor knowledge about blood donation. The majority, 372(94.9%) of the study participants had never donated blood. Conclusion: the study showed that less than half of the study participants were knowledgeable and the majority had a poor practice of blood donation.


Introduction Background
Blood is a vital liquid flowing in the bodies of many types of animals that convey nutrients and oxygen.World Health Organization (WHO) estimates that blood donation by 1% of the population is generally the minimum needed to meet a nation's most basic requirements for blood.In addition, WHO also advocates for 100% non-remunerated voluntary blood donation (VBD), aimed at ensuring the safety of blood.According to its 2011 report, 107 million blood donations are collected globally; approximately half of these are collected in the high-income countries, home to 15% of the world's population [1].Unexpectedly, 38 African countries collected fewer than 10 donations per 1000 people [2].There has been gross inadequacy and in-equitability in access to blood safety in WHO's African region [3,4].At the same time, in Sub-Sahara, the demand of blood transfusion is significant due to maternal morbidity, under-nutrition and the heavy burden of communicable diseases like malaria [5].Shortage of blood is one of the reasons for the death of mothers in sub-Saharan countries [6].
Blood transfusion is an indispensable part of care delivery.Donating blood means saving thousands from dying around the world because blood is a fundamental component for people to live and nothing replaces it [7].
The blood and blood components for transfusion can be obtained from volunteer donors, direct donors, Paid donors, or through autologous donation.Volunteer donor is the one who donates a blood for an altruistic reason; intentionally to save the life of human beings who are being at critical situations [8].Adequate and safe supply of blood and blood components such as whole blood, plasma , blood clotting factor (platelet), and red cell is essential to enable a wide range of critical care procedures to be carried out in hospitals [9].

Journal of Blood Disorders and Medicine
Open Access Journal According to a research done on students in Nigeria, 61% of the students had good knowledge about blood donation, and eighty-five percent had no experience of donating blood.From the students who had an experience of donating blood, only 3% were volunteer donors [18].
According to a research done on 384 medical and health science students in Ethiopia at Addis Ababa University in 2014, 321(83.7%) of the students had good knowledge; but 63(16.4%)had poor knowledge about blood donation.1/3 of the students had a negative attitude and below 1/4 had an experience of donating blood [19].

Study design
Institution-based descriptive cross-sectional study design was conducted in Gedebano Secondary and Preparatory School, Mehal Amba, Ethiopia

Study area
Gedebano Gutazer Welene Woreda is one of the 13 woredas (districts) found in Guraghie Zone, Southern Nations, Nationalities and People Region (SNNPR), in Ethiopia.It is located in the south of Oromia, north of Muhur-Aklil, east of Qebena, and west of Mesqane.The administrative center of Gedebano Gutazer Welene Woreda is MehalAmba.
According to 2016 Census conducted by central statistics agency of Ethiopia (CSA), the number of its total population is 116,949, of whom 57,305 are men and 59,644 women.

Population
Source population: All students of Gedebano Secondary and preparatory school.
Study population: Students of Gedebano Secondary and preparatory school who were included in the sampling procedures.

Eligibility criteria
Inclusion criteria: All students of Gedebano Secondary and preparatory school who were volunteers were included in the study.
Exclusion criteria: Students who were not able to fill the questionnaire by any reason

Sample size determination and sampling procedures
Sample size determination: The sample size was estimated by using single population proportion formula, [n=(Zα/2) 2 p (1p)/w 2 ].Considering a similar study conducted at Addis Ababa University about knowledge, attitude and practice towards blood donation among health science students, 83.7% (p=0.837) was used in this study by considering 95% confidence interval and Marginal error of 5%.So, ni=(Zα/2) 2 (P) (q)/w 2 =(1.96) 2 (0.837) (0.163)/(0.05) 2 =210.Since the Source population during the study period was less Donated blood can be lifesaving for individuals who have lost large volumes of blood from serious condition such as road traffic accidents, obstetric and gynecological hemorrhages, or surgery and stem cell transplant patients, trauma, chemotherapy, patient in need of long term-therapies as well as for individuals who have symptomatic anemia from medical or hematologic conditions or cancer.Besides, blood transfusion is one part of complex medical and surgical interventions which improves the life expectancy and life quality in patients with a variety of acute and chronic conditions.Therefore, blood transfusion is now considered as an indispensable component of the medical management of many diseases [10][11][12].
The use of these lifesaving products may be complicated by infectious and immunological diseases some of which could be life-threatening [11,12].The quality and the safety of blood transfusion is still a concern, particularly in the developing countries.Blood collection from unsafe donors, poor laboratory procedures and the inadequate testing of blood are the main reasons for these safety problems.Blood will be safe if there is a nationally coordinated blood transfusion service, a collection of blood only from voluntary non-remunerated donors, testing of blood for transfusion-transmissible infections and if there is transfusion of the right blood to the right patient through the appropriate clinical use of blood [13].Providing sufficient and qualified blood for the society is an obligation on blood banks [14].
Blood donation may save thousands of people globally from dying.Based on WHO's 2011 report, 107 million donors donate blood around the world: nearly 50% collections occur in developed nations, composed of fifteen percent of the globe's population.Donation rates among rich, medium and poor nations were around thirty-nine, twelve and four donations per one thousand populations respectively.In developing countries, about sixty-five percent of blood transfusion is transfused to children less than 5 years old; however, in developed nations, clients above sixty-five years old are the commonest ones that receive blood which accounts seventy-six percent of the total transfusions.
The need for blood in care of patients is increasing because of sophisticated as well as advanced clinical medicine.But, the need and provision are never being in a balance; the need is increasing.Blood donation through payment is frequent in every part of Sub-Sahara even though all the donors are recommended to be volunteer and non-remunerated [15].
Presence of blood transmissible disease, complicacy of transfusion services, expensiveness of provision of transfusion services, increased demand of blood as a result of injury, acute and chronic medical illness, low donation rate, high deferral rate and organizational deficits are the major challenges in providing quality and adequate blood in less developed countries, particularly in African countries [16,17].
WHO recommends every country on focusing on the youth in order to fulfill hundred percent non-numerated and voluntarily obtained blood [13].
Poor practice: study participants who respond to the practice questions <50% was said to have poor practice.

Ethical consideration
The study was conducted after the ethical letter was given to Gedebano Secondary and Preparatory School administrators.Then data was collected after informed and written consent was taken.To keep confidentiality, the participants' name was not written.

Socio-demographic characteristics
A total of 392 students from four grades and 15 sections were approached for the study and all of them were participated with a response rate of 100%.The majority, 350(89.29%) of the students were from the age group 18-25 years and 233(59.44%) of the respondents were males.All the study participants were single in marital status.Religiously and ethnically, 375(95.66%)were Muslims and 381(97.19%)were Guragie respectively (Table 1).

Knowledge of study participants towards of blood donation
Knowledge about blood donation was assessed by using 14 questions.Respondents who answered less than 7(<50%) were considered as not knowledgeable whereas those who answered 7 and above (≥ 50%) were considered as knowledgeable about blood donation.Knowledge scores for each individual were calculated and summed up to give the total knowledge score.Out of 392 participants, 182(46.43%)were knowledgeable whereas 210(53.57%)had poor knowledge about blood donation.Majority; 276(70.41%),271(69.13%),274(69.9%),257(65.56%)and 237(60.46%) of the study participants did not know the maximum volume of blood to be donated once, the minimum interval at which a person can donate blood, cigarette smokers cannot donate a blood, pregnant women can't donate blood and a person with high blood pressure can't donate blood respectively.However, above half, 243(61.99%)were knowledgeable about the minimum age to donate blood.Surprisingly, all 392 study participants were knowledgeable about an HIV-infected person can't donate blood (Table 2).

Practice towards blood donation
About 20(5.1%) of the study participants had an experience of blood donation before; of whom more than half, 11(55%) had ever donated once and 17(85%) were volunteer donors.About 6(30%) of the donors said that they had experienced some tiredness/fatigue whereas 8(40%) had satisfied after donation.
The majority, 372(94.9%) of the study participants had never donated blood.Among these, 113(30.38%)gave lack of adequate information, 107(28.76%)gave fear of pain, 68(18.28%)gave a feeling of medically unfit and 84(22.58%)had not been asked to donate blood, as a reason (Table 3).than ten thousand (N<10, 000) which is 1172, the sample size was determined by correction formula as follows: NF=ni/(1+(ni/N))=210/1+(210/1172)=178, But due to design effect the sample size was multiplied by 2, which was 356 Considering a 10% non-respondent rate, the final sample size of the study was 392.
Sampling technique and procedure: The proportional multistage sampling method was employed for this study.Grades 9 th , 10 th and 12 th were selected from the school randomly, and then the selected grades were divided into different sections based on the school's designation (grade-9 consisted 6 sections, grade-10 consisted 4 sections and grade-12 consisted 2 sections).The sections to be studied from the three grades (sections A, C, D & E from grade-9, sections A, B & D from grade-10 and section A from grade-12) were selected by simple random sampling technique.The number of samples to be studied was determined by proportional allocation method using the sampling frame obtained from the Director's office.Finally, the data were collected by the study samples that were selected by lottery method.

Discussion
This study tried to assess the knowledge and practice towards blood donation among Gedebano Secondary School students in Mehal Amba.
In the current study, 182(46.43%) of students were knowledgeable about blood donation.This is lower than the result of a study conducted in central India (52.5%) [12].Again, it is much lower than studies done in Nigeria (85%) [19], Addis Ababa (83.7%) [20], Thailand (80%) [21] and higher than studies done in Nepal (32.4%) [10] and South India (35.65%) [1].The possible reason for variation might be due to the differences in access to learning opportunities about the importance of blood donation.
The study shows that minority of the participants (5.1%) had ever donated blood.This is lower than the results of studies done in Thailand (11%) [21], South India (10.75%) [1], Nigeria (15%) [19], central India (47.5%) [12].This difference might be due to the promotional effect of the blood bank and other social institutions about the necessity of blood donation.
In this study, below half of them were the knowledgeable and small proportion of them had ever donated (practiced) (5.1%).This is lower than other studies conducted in Thailand where 80% of the study participants had good knowledge but only 11% of the study population had donated before [21].
The main reasons that participants replied for donating blood were fear of pain (28.76%), lack of adequate information (30.38%) and had not been asked to donate (22.58%).

Conclusion
From this study we may conclude that: the students have poor knowledge and practice towards blood donation.
The knowledge of students about blood donation was low as compared to the expected knowledge since they are close to education.

Recommendation
Based on the study finding the following recommendations are forwarded.The Government should design promotion and sanitization strategies to enhance knowledge, attitude and practice of students towards blood donation.Gedebano Secondary and Preparatory School administration and blood bank should prepare discussions, seminars, and other means of awareness creation strategies to improve knowledge, attitude and practice of students further in-depth.

Table 1 :
Socio-demographic characteristics of Gedebano Preparatory and Secondary School

Table 2 :
Knowledge of study participants towards blood donation

Table 3 :
Practice towards blood donation, Feeling after donation and reasons for not-donating blood