Don't Ask Don't Tell - The Status, Barriers, and Opportunities for Hospital Transfusion Committees (HTCs) in Rivers State, Nigeria: Mixed Methods Research on Hemovigilance.

Background: Blood and blood products are life-saving interventions, preventing millions of deaths annually. However, they present ethical and clinical risks from transfusing wrong blood, near misses, and infectious and immunologic risks, which effective hemovigilance systems are designed to prevent. As African countries have a scarcity of such robust surveillance systems, why do hospital transfusion committees (HTCs) that can enable effective hemovigilance remain a rarity?

Aim: We aimed to assess the status, barriers, and opportunities for functional HTCs in Nigeria to improve national hemovigilance systems and blood transfusion outcomes.

Methods: A mixed-methods research study was undertaken, with quantitative data collected using interviewer-administered questionnaires and in-depth group and individual interviews. These were audio-recorded, transcribed verbatim, and inductive thematic analysis was undertaken to identify key themes.

Results: Ninety-eight health facilities across all 23 local government areas in Rivers State were assessed quantitatively, and 128 blood transfusion practitioners were assessed qualitatively. Routine reporting of blood transfusion adverse events occurred in 56.7% of facilities, whereas only 33.3% conducted audits. Only 12.5% of facilities had functional HTCs. Practitioners' responses revealed poor management commitment, blame culture, inadequate training on documentation and recognizing adverse events, limited funding, and heavy staff workload.

Conclusion: Effective hemovigilance in Nigeria remains challenged, and findings underscore the need for national mandates standardizing HTC operations. Developing adequate reporting and auditing systems that enhance blood safety requires exploring hindrances to functional HTCs. Vital approaches include high-level government and management commitment, resource mobilization, staff training, blame avoidance, and technology-enabled systems that alleviate task burdens on transfusion personnel.