Knowledge, Attitudes, and Practices of Voluntary Blood Donation Among University Students in Nigeria: Ambrose Alli University as a Case Study

doi:10.21203/rs.3.rs-4862756/v1

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Research Article

Knowledge, Attitudes, and Practices of Voluntary Blood Donation Among University Students in Nigeria: Ambrose Alli University as a Case Study

https://doi.org/10.21203/rs.3.rs-4862756/v1

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Background

Adequate and safe blood supply has remained a challenge in developing countries, including Nigeria. Young students can play a fundamental role in blood donation, saving the lives of many people; hence, studying their knowledge, attitudes, and practices related to blood donation is essential.

Objective

The objectives of this study were to assess the knowledge, attitudes, and practices of voluntary blood donation among Ambrose Alli University students and the factors associated with the prevalence of blood donation.

Methodology:

This was a cross-sectional descriptive study carried out at Ambrose Alli University, Ekpoma. A total of 250 students were recruited. Pretested questionnaires were used to assess their knowledge, attitudes, and practices related to voluntary blood donation.

Statistical analysis

The responses were collated and analysed with the Statistical Package for Social Sciences (SPSS) v21. The associations between blood donation practices and the gender of the respondents and the age, year of study, department, and employment status of the parents were tested via chi-square tests where appropriate; p < 0.05 was considered statistically significant.

Result

The study revealed that the mean age of the respondents was 22.3 ± 9.049) years, with females accounting for 51.6% of the sample. A total of 34% (85) have good knowledge, and the respondents have a positive attitude (mean 3.23) toward donation; however, only 13.6% have donated blood with a male-to-female ratio of 2:1. The study revealed significant associations between knowledge of blood donation and several sociodemographic features, including age (p = 0.003), year of study (p = 0.025), faculty of the respondents (p < 0.001) and employment status of the father or male guardian (p = 0.035). Furthermore, blood donation practices were significantly associated with the year of study (p = 0.028) and faculty (p < 0.001). Logistic regression revealed that senior students were less likely to donate blood than first-year students were. Fourth-year students had an odds ratio (OR) of 0.20 (95% CI: 0.05–0.87, P = 0.032), and fifth-year students had an OR of 0.23 (95% CI: 0.06–0.93, P = 0.039).

Conclusion

Despite having a fair level of knowledge regarding blood donation as well as a positive attitude toward it, the respondents portray a poor practice culture with respect to blood donation.

Voluntary

Practice

University students

Blood donation

Nigeria

Blood is vital and important to all living organisms. Its importance is more apparent in hospitals for the treatment of sick people. Currently, there is no substitute for blood, and artificial blood is still used in research laboratories. Blood transfusion is important medically, as it plays a life-saving role in thousands of patients daily[1]. Blood transfusion is a vital therapeutic approach in modern health care that saves millions of lives, but overcoming insufficient voluntary blood donations in developing countries such as Nigeria, where there are increased rates of pregnancy and child-related health conditions, road accidents, and malaria-related deaths, is highly challenging.

According to the World Health Organization, the blood donation rate in a high-income country is 33.1 donations per 1000 people, 11.7 donations per 1000 people in middle-income countries, and as low as 4.6 donations per 1000 people in low-income countries[3]. This means that Nigeria, as a middle-income country, has limited numbers of donations each year, and many more blood donors are still needed to ensure the availability of blood in Nigeria. The reasons behind this limited number of donations are difficulty recruiting new blood donors, the decrease in eligible donors due to strict policies about blood donation, and the lack of altruism in society. [4]

Despite the WHO’s recommendation that 100% voluntary, nonremunerated donations of blood and blood components to every patient as needed should be available in each facility as needed for every patient[3], in Nigeria, family members are often pressured to donate or find a replacement donor in emergency cases. This causes emotional and financial stress and a significant delay in obtaining the suitable blood needed.

The myths about blood donation also impedes voluntary blood donation in Nigeria and other African countries. As many believe that they can contract HIV and other infections from blood donation, there is limited blood in the body, and they see no reason to donate; another myth is that one’s health deteriorates as one donates blood[18]. All these myths, coupled with cultural and religious beliefs, have greatly affected blood donation in our society. Finally, the level of knowledge, attitudes, and beliefs associated with blood donation may affect the disposition of potential donors.

Level of knowledge towards blood donation

According to a study conducted in Karachi among young students, more than half of the respondents (63.12%) indicated that they had heard about voluntary blood donation, 45% were male, and 55% were female. A total of 65.1% of the students had information about blood donations from family, friends, or relatives; 20.5% from schools, colleges, or universities; and 7.9% from television and other media. More than half (62.13%) of the respondents had correct knowledge about the utilization of donated blood, whereas 55.41% had a negative view of blood donation and the health of the donor[6].

A baseline study performed in Gondar town, Northwest Ethiopia, revealed that 436 (56.8%) had adequate knowledge of blood donation, 678 (88.3%) study participants thought that the importance of blood donation was to save life, and 24 (3.1%) believed that it was to receive health insurance[7].

A study performed among medical students in resource-limited countries revealed that 84% of the study participants had good knowledge of blood donation. Only 29.8% knew the age limit for donation, 28.5% were aware that the duration of donated blood volume replacement was within 48 hours in the body, and 31% knew the amount of blood that could be drawn for each donation cycle[8].

Approximately 85.3% of the study participants at a university in Kilimanjaro, Tanzania, had knowledge of blood donation, whereas 64% were aware of their blood group [9]. In contrast, a similar study done at Assoso University, Benishangul Gumuz, in Ethiopia revealed that 48.5% had adequate knowledge of blood donation [10]. Among the study participants, 255 (76.3%) knew about the common blood group; 143 (56.1%) of them received information from the classroom, followed by 119 (46.6%) from the internet. A total of 241 (72.2%) of the respondents knew the medical benefit of voluntary blood donation, and 223 (66.8%) of them said that no blood was manufactured artificially in the laboratory. However, only 127 (38%) of the respondents knew the minimum time interval between two donations, and 97 (29%) of them knew the volume of blood donated at a time[10].

In Nigeria, approximately half of the population in the country is medically fit for donation, and only four in one thousand are voluntary donors[3]. The low level of blood donation has been attributed to poor knowledge, myths, bias, misconceptions, poverty, ignorance, fear and malnutrition among the population. A study conducted in two selected states in North Central Nigeria reported that less than two-thirds (64.8%) of the respondents had good knowledge of blood donation. Approximately one quarter had poor knowledge of what actual blood donation entails. Fewer than half (47.5%) of the subjects had poor knowledge of health conditions that could warrant blood transfusion, whereas only 43% could correctly state some clinical conditions that would indicate blood transfusion[11]. A similar study was conducted in North-eastern, Nigeria; the baseline results revealed that three-quarters (77.5%) of the respondents knew that some diseases could be transmitted through blood transfusions. Among those who had knowledge about these diseases, 64% knew of HIV, whereas 25.9% and 9.6% knew of hepatitis and malaria, respectively[12].

A study conducted among health workers at the University of Benin Teaching Hospital (UBTH) in Nigeria revealed that 151 (92.6%) respondents expressed good knowledge of common blood group types and that 153 (93.9%) knew their own blood group. The respondents also demonstrated knowledge of the frequency of blood donation, as 27%, 21.5%, 8%, and 20.2% of the respondents said that donations should be made every six months, three months, monthly, and no knowledge, respectively [13]. A similar study conducted among residents of Ekpoma revealed that the respondents displayed good knowledge of voluntary blood donation, with 58.5% of the respondents being aware of their blood group [28].

Attitude toward blood donation

The attitude towards blood donation could be referred to as the intention of participants towards blood donation practices. The attitudes of 96 graduating health science students in Wolaita Soddo, Ethiopia [14], were assessed, and the study revealed that 58.33% of all the study participants strongly agreed that blood donation should be voluntary, whereas four disagreed. Sixty-four of them agreed that blood donation cannot affect donors, whereas 14 agreed that blood donation can affect donors[14]. A similar study was conducted among health science students at Addis Ababba University; this study revealed that participants are willing to donate blood in the future. However, more than one-third of the students, 76.6%, 34.6%, and 59.1%, believe that blood donation is weak, anaemia and reduced immunity, respectively. Like overall knowledge assessment, the cumulative level of knowledge was assessed by considering all the attitude questions; approximately one-third (123, 32%) of the respondents had unfavourable attitudes toward blood donation[15].

According to a study conducted at the University of Gondar, Gordar, Ethiopia, 86.7% of the respondents had a positive attitude toward blood donation. The survey revealed that 73.3% of the respondents agreed that voluntary donors are the major source of blood donations. A significant number of the participants do not donate blood either because they are not approached to donate or because they fear the results and consequences of donation. Sixty percent of the participants agreed that temporary weakness occurred during or after donation, and 80% of the respondents agreed that patient relatives should be asked to donate[16]. Another study performed in Tanzania among university students revealed that out of the 422 study participants, 89.3% were willing to donate to anyone, 94.5% were willing to donate to relatives in need of blood, and 84.4% did not expect a reward for donation[9].

In Nigeria, studies conducted in Calabar, Lagos, and Benin City showed impressive attitudes towards blood donation. A total of 542 blood donors from Lagos State University Teaching Hospital were interviewed, 52.4% of whom believed that they could contract HIV and other infections from blood donation, and 47% were afraid of what they regarded as side effects such as weight loss (28.8%), high blood pressure (5.2%), sexual failure (5.9%), sudden death (3.3%) and convulsion (1.47%) [17]. Approximately 41% preferred a certificate as an incentive, whereas 13.6% preferred money[17]. Another study conducted in a rural local government in Lagos revealed that the majority (51%) of the respondents agreed that blood donation can save lives, 48.5% disagreed that blood donation can cause health problems for the donor, approximately 36.8% disagreed that blood donors should be offered financial incentives, and 53.1% strongly agreed that voluntary blood donation should be encouraged. In this study, the prevalence of positive attitudes was 69.2%[18]. In a study from the University of Calabar Teaching Hospital, 79.7% of the respondents were willing to donate blood freely, whereas 20.3% would not donate their blood. The most common reason for nondonation was religious belief, and the results suggested that although most Nigerians are willing to donate blood freely, more positive steps should be taken to educate the population about blood donation[19]. In another study carried out at the University of Benin Teaching Hospital (UBTH), 81.6% of the respondents said that blood donation was good and that voluntary blood donation was accepted as the best source of blood by 72.2%, replacement donors by 6.7%, remuneration by 1.8% and self-donation by 1.8%. A total of 72% said that blood donation may have adverse effects, 12.3% said that the donor can contract infections, 60.7% said that the donor may experience temporary weakness, and 5.5% said that the donor may fall ill. However, 89.6% feel that patient relatives should be asked to donate[13]. Another study conducted in Nigeria among residents of Ekpoma revealed that attitudes toward voluntary blood donation were fair, with 51.7% of the respondents believing that blood donation is harmful [28].

Practice of blood donation

A Eurobarometer survey of 26,788 European citizens carried out in October 2009 in 27 European Union Member States revealed that 37% of European citizens have given blood. This percentage is significantly higher than the percentage recorded in 2002 (31%) when the European Union comprised 15 member states. An analysis of blood donation at the country level revealed some significant differences but no particular geographical skew. The countries with the highest levels of blood donation are Austria (66%), France (52%), Greece and the Republic of Cyprus (51%) [20]. Some of the newer Member States and Eastern European countries generally recorded blood donation levels over 40% (higher than the EU27 average of 37%), including Bulgaria, Estonia, Latvia, Lithuania, Hungary and Slovenia. In contrast, the lowest proportions of respondents who stated that they had already given blood were noted in Portugal (22%), Italy (23%), Poland (25%), Malta (29%) and Sweden (30%). The most significant increases in blood donation levels between 2002 and 2009 were recorded in Austria (51–66%), France (38–52%), Greece (40–51%), Spain (25–41%), and Germany (31–41%) [20].

Between 2008 and 2013, the WHO reported an increase of 37% in voluntary nonremunerated blood donation in Africa. A total of 2.13 million voluntary nonremunerated donations were recorded in 2008, and 2.92 million were recorded in 2013. The total number of blood donations in Africa was 2.95 million, which also increased to 4.34 million in 2013, an increase of approximately 47% [3].

According to WHO data for the United States of America, 13.63 million blood donations were reported in 2011. Most of the donations were voluntary nonremunerated donations. However, 6.12 million and 5.61 million donations were reported in 2012 and 2013, respectively[3].

A study carried out among health science students in South India revealed that the majority (62%) of the students never donated blood and that a mere 4.1% did not know their blood group. Among 156 donors, 59.6% have donated blood only once, and 15.6% donate blood whenever needed[2].

In Nigeria, 57,652 blood donations were reported in 2011. A total of 43,006 blood donations were reported in 2012, 40,442 of which were voluntary nonremunerated. A total of 125,101 blood donations were reported in 2013; 53,764 were voluntary nonremunerated blood donations, 40,540 of which were voluntary nonremunerated donations from first-time donors, whereas 13,224 were voluntary nonremunerated blood donations from repeated donors. There were 71,337 family and replacement donations [3]. The practice of blood donation among residents of Ekpoma was poor, and only 8.5% had previously donated blood to either friends/family members or the general public [28].

Factors associated with the practice of blood donation

According to a study conducted at the University of Gonar, the age of the respondent, knowledge about blood donations, attitude towards donation, and having any family member ever received blood were significantly associated with the practice of blood donation. Compared with those whose family members had not received blood, those whose family members had previously received blood are five times more likely to donate blood; those who are 25 years old and above are two times more likely to donate blood than those who are less than 25 years old. Respondents who score more than the mean of the knowledge questions about blood donation are two times more likely to donate blood than those who score less [15]. Another study performed at Ambo University associated family literacy with the practice of blood donation; those with literate families are two times more likely to donate blood than those with illiterate families are. This study also revealed that paid donors are three times more likely to donate blood than voluntary donors are[21]. There was an association between the gender of the participants and blood donation practices, whereby more than three-quarters of the males had donated at least once. Age, university education and ethnicity are not significantly associated with blood donation[8].

A study linked the use of television with blood donation; television users are more likely to be nondonors because psychological stress increases among television users than nonusers are, and television users are more concerned with game shows, soap operas, commercials, and action movies, but nontelevision users are blank monitors with no sound [22].

According to research conducted among undergraduate students at Ebonyi State University, Abakaliki, Southeast Nigeria, this study supported the findings of Donor’s Clinic of Delaware. The results revealed that male students were approximately four times more likely to be blood donors than female students were. Additionally, students who were willing to donate in the future were three times more likely to donate than those who were not willing. This study also linked socioeconomic groups with blood donation; students in low socioeconomic groups were approximately three times less likely to donate than were those in high socioeconomic groups[23]. A better education background and exposure to past donors were the predicators of the intention to donate blood. Both younger age groups and better educational status are significantly associated with the intention to donate blood[24]. The greater willingness of younger age groups may be attributed to the direct effect of a better educational background rather than age. Individuals who reported that they had donated blood in the past and who reported that they knew someone who had donated before were more likely to donate in the future[24].

University students are expected to be more aware than the general population of voluntary blood donation. They are the potential pool of eligible voluntary donors and motivators. The aim of this study is to assess the level of knowledge, attitudes and practices of Ambrose Alli University (AAU) students towards blood donation. It is essential to determine why students are not motivated and their misconceptions and myths toward blood donation. This knowledge is needed to eliminate myths and barriers and increase public awareness campaigns to promote the culture of ensuring an adequate supply of blood and its components for proper health care.

Study Area

Ambrose Alli University (AAU) is a state-owned university located in Ekpoma, Edo state, Nigeria. It was established in 1981 by the governor of Bendel State (now Edo and Delta States), Professor Ambrose Folorunso Alli. The University was first known as Bendel State University and then Edo State University and finally changed to its present name to commemorate Professor Ambrose Folorunso Alli. The university is located in Ekpoma town, which is the administrative headquarters of the Esan West Local Government Area. Ekpoma lies on the geographical coordinate of latitude 6⁰45’N 6⁰08’E; the town has an official post office and is home to Ambrose Alli University.

Study design

A descriptive cross-sectional study involving students at Ambrose Alli University was carried out.

Study population

This study population included full-time undergraduate students at Ambrose Alli University.

Study duration

This study was carried out over five months, from January 2024 to July 2024.

Sample size estimation

The Cochran formula was used for sample size determination: [26]

ṉ=z²pq/d² [26]

where ṉ=minimum sample size

z = standard normal deviation (z score = 1.96 at 95% confidence interval)

P = Proportion of the target population with a desired characteristic

p = proportion of respondents who donate blood whenever there is a need (based on a study conducted in South India)[2] = 15.6%[3] = 0.156

q = 1 – p = 1–0.156 = 0.844

d = degree of precision at the confidence level of 95% = 0.05

Substituting the values for the formula above yields

ṉ = 1.96²\(\:\times\:\) 0.156 \(\:\times\:\) 0.844/0.05²

ṉ = 3.842 \(\:\times\:\) 0.156 \(\:\times\:\) 0.844/0.0025

ṉ =\(\:\frac{0.5059}{0.0025}\)

ṉ = 202

Minimum sample size = 202

Allowance for nonresponse rate = 202/0.9 = 224 (the calculated minimum sample size was rounded to 250)

Selection criteria

Inclusion criteria

Students who are available in school during the period of data collection

Students who are willing to participate, and

Students who are duly registered for the academic year.

Exclusion criteria

Students who refuse to participate

Data collection tools

Data were collected via structured interviewer-administered questionnaires focused on sociodemographic profiles (section A), knowledge of blood donation (section B), attitudes toward blood donation (section C) and the willingness to donate blood (section D). The questionnaires were designed after intensive literature review.

Sampling method

The major independent variable regarding students’ demography considered in this study was their level of study. To ensure appropriate representation of the majority of faculties of interest, only year 1 to year 5 students were considered for selection in this study. The total population of undergraduate students from the classes of interest is estimated to be 35,750 (Source: AAU Admission office. 2023)

Level of study	Sample size (Class size/population)	to be sampled	Approximated sample
Year 1	250(7800/35,750)	54.6	55
Year 2	250(5720/35,750)	40.0	40
Year 3	250(8160/35,750)	57.1	57
Year 4	250(10150/35,750)	71.0	71
Year 5	250(3860/35,750)	27.0	27
Total		249.7	250

There are 14 faculties in AAU, and systematic sampling was used to select the faculties in alphabetical order. For each faculty member, thirty-six (36) students were selected across the department in six (6) faculties, whereas thirty-four (34) students were selected randomly across the departments in the remaining faculty. In each department, nine (9) students were selected at each level until a sample size of 250 was achieved.

Pretesting

Fifty (50) questionnaires were pretested among 50 randomly selected students from the College of Education, Igueben.

Data analysis

The information collected from the respondents was entered into and analysed with the Statistical Package for Scientific Solutions (SPSS) version 21 [27]. Descriptive statistics were performed, and frequencies and proportions were used to summarize the variables of interest.

Ethical consideration

Ethical approval

was obtained from the ethics and research committee of Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria. Informed verbal consent was obtained from the students. The students were assured of confidentiality and were also given the leverage to opt out of the study anytime they felt like doing so.

A total of 250 respondents participated in this study, for a response rate of 100%.

3.1 Sociodemographic characteristics of the respondents

Table 1

Sociodemographic features of the study respondents
Variable	Frequency (n = 250)	Percent (%)
Age range (years)
15–20	106	42.4
21–25	119	47.6
> 25	25	10.0
Mean ± SD	22.3\(\:\pm\:\)0.45
Sex
Male	121	48.4
Female	129	51.6
Marital status
Single	243	97.2
Married	7	2.8
Ethnic group
Esan	121	48.4
Bini	18	7.2
Etsako	25	10.0
Others	86	34.4
Year of study
First year	55	22.0
Second year	40	16.0
Third year	57	22.8
Fourth year	71	28.4
Fifth year	27	10.8
Faculty
Law	34	13.6
Medical laboratory science	36	14.4
Clinical Science	36	14.4
Engineering	36	14.4
Agricultural science	36	14.4
Basic Medical Science	36	14.4
Education	36	14.4
Religion
Christianity	238	95.6
Islam	8	3.2
African traditional religion	4	1.2
Employment status of father or male guardian
Unemployed	45	18.0
Self employed	112	44.8
Salaried employment	82	32.8
Not applicable	11	4.4
Employment status of mother or female guardian
Unemployed	29	11.6
Self-employed	123	49.2
Salaried employment	92	36.8
Not applicable	6	2.4

As shown in Table 1, the majority of the respondents are aged 21–25 years (47.6%) and most are single (97.2%).

Knowledge of blood donation

Table 2

Knowledge of blood donation among Ambrose Alli University students
Variable	Frequency(n = 250)	Percent (%)
How did you know about your blood group?
Preadmission screening	58	23.2
Blood donation	50	20.0
Hospital visit	122	48.8
Requirement for travelling	6	2.4
Requirement for driving licence	5	2.0
I don’t know	9	3.6
Do you know about the rhesus system of blood grouping?
Yes	91	36.4
No	99	39.6
I don’t know	60	24.0
Is there artificial blood?
Yes	34	13.6
No	87	34.8
I don’t know	129	51.6
Can women donate blood while menstruating?
Yes	37	14.8
No	128	51.2
I don’t know	85	34.0
Blood donation cause anaemia
Yes	72	28.8
No	89	35.6
I don’t know	89	35.6
Person with history of drug abuse can donate blood
Yes	24	9.6
No	179	71.6
I don’t know	47	18.8
Pregnant women can donate blood
Yes	9	3.6
No	185	74.0
I don’t know	56	22.4
Can a person with any type of cancer donate blood?
Yes	8	3.2
No	192	76.8
I don’t know	50	20.0
A breastfeeding mother can donate blood
Yes	39	15.6
No	136	54.4
I don’t know	75	30.0
What is the minimum gap between two donations?
Less than 3 months	20	8.0
3–4 months	71	28.4
6 months	25	10.0
I don’t know	134	53.6
Which blood group is universal donor?
O	186	74.4
A	13	5.2
B	3	1.2
AB	9	3.6
I don’t know	39	15.6
Which of these can be transmitted through blood transfusion?
a) Malaria
Yes	75	30.0
No	95	38.0
I don’t know	80	32.0
b) HIV
Yes	185	74.0
No	31	12.4
I don’t know	34	13.6
c) Hepatitis B
Yes	96	38.4
No	54	21.6
I don’t know	100	40.0
d) Lassa fever
Yes	103	41.2
No	62	24.8
I don’t know	85	34.0
e) Yellow fever
Yes	72	28.8
No	76	30.4
I don’t know	103	40.8
f) Ebola
Yes	108	43.2
No	56	22.4
I don’t know	86	34.4
What is your blood group?
O	106	42.4
A	42	16.8
B	17	6.8
AB	11	4.4
I don’t know	74	29.6

As shown in Table 2, over half of the students (53.6) do not know the minimum gap between blood donations, and 51.6% are uncertain about the existence of artificial blood. While 76.8% know cancer patients cannot donate blood and 74.4% identify blood group O as universal donor, significant knowledge gaps exist about disease transmission through blood transfusion.

The Fig. 1 above shows the respondents’ knowledge of blood donation among Ambrose Alli University students. The majority of the respondents had fair knowledge (43.60%).

According to Fig. 2, Most of the respondents (122) became aware of blood groups during hospital visits.

Attitude towards blood donation

Table 3

Attitudes of Ambrose Alli University students towards blood donation
Variable	Strongly agree	Agree	Not sure	Disagree	Strongly disagree	Mean	Remark
I feel something harmful can happen during blood donation.	44 (17.6%)	94 (37.6%)	46 (18.4%)	44 (17.6%)	16 (6.4%)	2.50	Negative
Only patients relative should be asked to donate blood	24 (9.6%)	29 (11.6%)	25 (10.0%)	120 (48.0%)	46 (18.4%)	3.47	Positive
Blood donation is safe	32 (12.8%)	81 (32.4%)	81 (32.4%)	45 (18.0%)	7 (2.8%)	3.30	Positive
Blood donation makes one lose weight	24 (9.6%)	57 (22.8%)	77 (30.8%)	64 (25.6%)	22 (8.8%)	2.94	Negative
Best way to donate blood is voluntary nonremunerated	80 (32.0%)	87 (34.8%)	58 (23.2%)	10 (4.0%)	11 (4.54%)	3.81	Positive
People who donated blood may become infected because of needle insertion	34 (13.6%)	82 (32.8%)	71 (28.4%)	37 (14.8%)	22 (8.8%)	2.68	Negative
I believe that blood donated is always used for intended purposes	78 (31.2%)	97 (38.8%)	55 (22.0%)	12 (4.8%)	5 (2.0%)	3.89	Positive
Attitude						3.23	Positive

Regarding Table 3, to dichotomize the attitude score, means above 3 were classified as positive, 3 as neutral, and below 3 as negative. This shows that for most of the items, the respondents had a positive attitude toward voluntary blood donation. The overall mean attitude of 3.23, which is above the decision point of 3.0, shows that they have a positive attitude towards the practice.

Willingness to donate blood

Table 4

Willingness to donate blood among Ambrose Alli University students
Variable	Frequency (n = 250)	Percent (%)
Have donated blood before
Yes	34	13.6
No	216	86.4
Reasons for respondents’ previous donation (n = 34)
It is my moral responsibility to humanity	2	5.9
To save lives	23	67.6
To know my HIV status	2	5.9
To get money	1	2.9
No particular reason	6	17.7
*Why haven’t you donated blood?
I am afraid of needle	25	10.0
My blood type not in demand	16	6.4
I am afraid of contracting disease	28	11.2
I haven’t had the opportunity to donate	133	53.2
Willingness to donate blood to someone you do not know if called upon to do so
Yes	149	59.6
No	101	40.4
Willingness to donate blood if given incentive in cash or kind
Yes	47	18.8
No	203	81.2
Willingness to donate blood to family members or friends
Yes	205	82.0
No	45	18.0
Willingness to accept blood donation if need be
Yes	176	70.4
No	74	29.6
Have you ever donated during a blood donation campaign?
Yes	16	6.4
No	234	93.6
Have you ever encouraged someone to donate blood?
Yes	64	25.6
No	186	74.4
Have you ever refused to donate blood when asked?
Yes	35	14.0
No	215	86.0
Reasons for refusal of blood donation when called upon (n = 35)
Out of fear	6	17.1
It is against my culture and religion	6	17.1
No interest to donate	5	14.3
No time to go for donation	5	14.3
Insufficient information about blood donation	7	20.0
No reason	6	17.1
*multiple responses

As shown in Table 4, only 13.6% of the students have donated blood before, with 67.6% of these donations made to save lives. Fear of needles (10.0%) and contracting diseases (11.2%) are common reasons for not donating.. Despite this, 59.6% are willing to donate to strangers, 82.0% to family or friends, and 70.4% would accept blood donation if needed.

Table 5

Association between respondents’ sociodemographics and their practice of blood donation
Variables	Have you donated before		\(\:{x}^{2}\)	P value
Variables	Yes n(%)	No n(%)
1) Age
15–20	10 (29.4)	96 (44.4)	8.771	0.120
21–25	16 (47.1)	103 (47.7)
> 25	8 (23.5)	17 (7.9)
2) Sex
Male	24 (70.6)	97 (44.9)	7.757	0.050
Female	10 (29.4)	119 (55.1)
3) Marital status
Single	32 (94.1)	211 (97.7)	1.374	0.241
Married	2 (5.9)	5 (2.1)
4) Ethnic group
Esan	13 (38.2)	108 (50.0)	4.142	0.247
Bini	5 (14.7)	13 (6.0)
Etsako	3 (8.8)	22 (10.2)
Others	13 (38.2)	73 (33.8)
5) Year of study
First year	5 (14.7)	50 (23.1)	10.843	0.028*
Second year	10 (29.4)	30 (13.9)
Third year	5 (14.7)	52 (24.1)
Fourth year	7 (20.6)	64 (29.6)
Fifth year	7 (20.6)	20 (9.3)
6) faculty
Law	1 (2.9)	33 (15.3)	28.272	< 0.001*
Medical laboratory science	1 (2.9)	35 (16.2)
Clinical science	13 (38.2)	23 (10.6)
Engineering	1 (2.9)	35 (16.2)
Agricultural science	7 (20.6)	29 (13.4)
Basic medical science	7 (20.6)	29 (13.4)
Education	4 (11.8)	32 (14.8)
7) Religion
Christianity	34 (100)	204 (94.4)	1.984	0.371
Islam	0 (0.0)	8 (3.7)
African Traditional religion	0 (0.0)	4 (1.9)
8) Employment status of mother or female guardian
Unemployed	4 (11.8)	25 (11.6)	9.761	0.370
Self-employed	16 (47.1)	107 (49.5)
Salaried employment	13 (38.2)	79 (36.6)
Not applicable	1 (2.9)	5 (2.3)
9) Employment status of father or male guardian
Unemployed	4 (11.8)	41 (19.0)	5.957	0.114
Self-employed	11 (32.4)	101 (46.8)
Salaried employment	17 (50.0)	65 (30.1)
Not applicable	2 (5.9)	9 (4.2)

According to Table 5 above, the year of study and faculty of respondents are factors associated with the practice of blood donation among Ambrose Alli University students.

Table 6

Association between sociodemographic features and knowledge scores of the participants
Variables	Knowledge score of respondents			\(\:{x}^{2}\)	P value
Variables	Poor n(%)	Fair n(%)	Good n(%)
1) Age
15–20	25 (44.6)	58 (53.2)	23 (27.1)	15.808	0.003*
21–25	27 (48.2)	44 (40.4)	48 (56.5)
> 25	4 (7.1)	7 (6.4)	14 (16.5)
2) Sex
Male	35 (62.5)	48 (44.0)	38 (44.7)	5.753	0.056
Female	21 (37.5)	61 (56.0)	47 (55.3)
3) Marital status
Single	54 (96.4)	106 (97.2)	83 (97.6)	0.186	0.911
Married	2 (3.6)	3 (2.8)	2 (2.4)
4) Ethnic group
Esan	27 (48.2)	55(50.5)	39 (45.9)	1.947	0.924
Bini	3 (5.4)	8 (7.3)	7 (8.2)
Etsako	5 (8.9)	9 (8.3)	11(12.9)
Others	21 (37.5)	37 (33.9)	28 (32.9)
5) Year of study
First year	15 (26.8)	30 (27.5)	10 (11.8)	17.481	0.025*
Second year	10 (17.9)	17 (15.6)	13 (15.3)
Third year	15 (26.8)	27 (24.8)	15 (17.6)
Fourth year	12 (21.4)	27 (24.8)	32 (37.6)
Fifth year	4 (7.1)	8 (7.3)	15 (17.6)
6) faculty
Law	12 (21.4)	16 (14.7)	6 (7.1)	57.977	< 0.001*
Medical laboratory science	8 (14.3)	14 (12.8)	14 (16.5)
Clinical science	3 (5.4)	7 (6.4)	26 (30.6)
Engineering	9 (16.1)	19 (17.4)	8 (9.4)
Agricultural science	18 (32.1)	14 (12.8)	4 (4.7)
Basic medical science	3 (5.4)	20 (18.3)	13 (15.3)
Education	3 (5.4)	19 (17.4)	14 (16.5)
7) Religion
Christianity	54 (96.4)	102 (93.6)	82 (96.5)	3.055	0.549
Islam	2 (3.6)	5 (4.6)	1 (1.2)
African Traditional religion	0 (0.0)	2 (1.8)	2 (2.4)
8) Employment status of mother or female guardian
Unemployed	10 (17.9)	14 (12.8)	5 (5.9)	9.097	0.168
Self employed	22 (39.3)	55 (50.5)	46 (54.1)
Salaried employment	21 (37.5)	39 (35.8)	32 (37.6)
Not applicable	3 (5.4)	1 (0.9)	2 (2.4)
9) Employment status of father or male guardian
Unemployed	15 (26.8)	20 (18.3)	10 (11.8)	13.541	0.035*
Self employment	19 (33.9)	51(46.8)	42 (49.4)
Salaried employment	16 (28.6)	36 (33.0)	30 (35.3)
Not applicable	6 (10.7)	2 (1.8)	3 (3.5)

According to Table 6 above, age, year of study, faculty and employment status of the father or male guardian were associated with knowledge of blood donation among the students.

Table 7

Binary logistic regression of the determinants of voluntary blood donation
Variable	OR	95% CI		P value
		Lower	Upper
Year of Study
First year	1
Second year	0.23	0.05	1.08	0.062
Third year	1.14	0.27	4.81	0.861
Fourth year	0.20	0.05	0.87	0.032*
Fifth year	0.23	0.06	0.93	0.039*
Faculty
Law	1
Medical laboratory science	0.14	0.01	1.56	0.106
Clinical science	0.11	0.01	1.13	0.063
Engineering	3.08	0.80	11.91	0.103
Agricultural science	0.13	0.01	1.34	0.087
Basic medical science	1.47	0.36	6.06	0.597
Education	1.68	0.41	6.89	0.472

As shown in Table 7, the binary logistic regression analysis of the determinants of voluntary blood donation revealed significant findings related to the year of study of the participants. Specifically, students in their fourth and fifth years are significantly less likely to donate blood than first-year students are. No significant associations were found between faculty and blood donation compared with law students.

The current study assessed the knowledge, attitudes and practices of Ambrose Alli University students towards blood donations. The main purpose of this study was to identify approaches and issues that influence the recruitment and retention of voluntary nonremunerated blood donors to achieve 100% voluntary blood donation.

Knowledge of blood donation among students was measured by using questions that included respondents’ understanding of the risk of blood donation to donors, how they learn about blood donation and the conditions that can be transmitted through blood donation. The majority of the respondents (43.6%) had fair knowledge about blood donation; 48.8% (122) knew about their blood group during hospital visits, and only 28.4% (71) knew the minimum gap between two donations, which is contrary to the findings of a study conducted in Gondar town, Northwest Ethiopia, where 56.8% had adequate knowledge about blood donation, probably due to different geographical locations. However, a similar study conducted in 2016 among residents of Ekpoma revealed that the residents had good knowledge of blood donation [28]. A study conducted among university students in Kilimanjaro, Tanzania, revealed that 85.3% of the respondents had adequate knowledge about blood donation[9]. Another study conducted among university workers in Benin teaching hospitals reported that 92.6% of the respondents expressed good knowledge [13]. This percentage is contrary to the percentage that showed good knowledge in this study; the disparity may be because it was conducted among hospital workers.

In this study, the majority of the respondents had positive attitudes towards blood donation. This study agrees with a study performed at the University of Gordar, Ethiopia, where 86.7% of the respondents had positive attitudes towards blood donation [7]. This also agreed with studies conducted in Calabar and Benin [13, 19]. According to a study conducted at the University of Benin Teaching Hospital among workers, 72.2% of the respondents agreed that voluntary blood donation is the best source of blood, whereas 66.8% of the participants in this study indicated the same [13]. However, more than half of the respondents (55.2%) felt that something harmful can happen during blood donation. Although the majority of the respondents had positive attitudes, more positive steps should be taken to educate the population about blood donation [13].

With respect to the sharing of the blood donation experience, only approximately 13.6% of the respondents are blood donors at the moment, which is far less than expected in a student environment. A similar study conducted in 2016 in the same community revealed that only 8.5% were donors [28]. This result agrees with a study carried out among health science students in South India, where the majority of the respondents (62%) never donated blood before despite schooling in a teaching hospital where blood is needed to save lives [2]. In this research, 53.2% (133) of the respondents who had not donated blood previously indicated that they did not donate because they had no opportunity to do so. When asked if they would donate when called upon, 59.6% (149) indicated that they would donate. However, 18.8% (47) agreed that they would donate if given incentives in cash or kind. Eighty-two percent (205) agreed that they would donate blood to family members, whereas 70.4% (176) agreed that they would accept blood transfusions if needed. With respect to donations during campaigns, 86% (215) indicated that they never donated during a campaign, which shows that more positive steps must be taken to create awareness among the population about blood donation. Fourteen percent (35) refused to donate blood before, for several reasons, including fear, cultural and religious background and insufficient information during blood donation. The 13.6% prevalence of blood donation is lower than expected, but this indicates the prevalence of blood donation in Nigeria. In 2011, only 57,652 donations were reported; 43,006 donations were reported in 2012; 125,101 blood donations were reported in 2013; and only 53,764 were voluntary nonremunerated donors. A total of 40,540 were voluntary nonremunerated donations from first-time donors[3]. Only 13,224 were voluntary nonremunerated blood donations from repeated donors[3]. This finding shows that much work needs to be done to obtain more donors into the donor pool, which can be accomplished by creating awareness, especially among tertiary institution students, and mitigating their fears and myths about blood donation.

Factors associated with the practice of blood donation

The relationship between the year of study of the respondents and their willingness to donate blood was statistically significant (p < 0.028). Other factors affecting blood donation are the faculty of the respondents (p < 0.001), whereas age, year of study, faculty of the respondents and employment status of the father or male guardian are associated with knowledge of blood donation among the students because the p values are less than 0.05. Specifically, students in their fourth and fifth years are significantly less likely to donate blood than first-year students are. Fourth-year students had an odds ratio (OR) of 0.20 (95% CI: 0.05–0.87, P = 0.032), and fifth-year students had an OR of 0.23 (95% CI: 0.06–0.93, P = 0.039). These findings indicate a significant decline in the likelihood of blood donation among senior students compared with those in their first year. No significant associations were found between faculty and blood donation compared with law students. A study conducted among undergraduate students at Ebonyi State University linked socioeconomic group and educational status of the students to blood donation; students in the low socioeconomic group were three times less likely to donate blood than those in the high socioeconomic group were [23].

The general knowledge of blood donation among the respondents was satisfactory but not significantly good and above 50%. The present study revealed that a lack of awareness of blood donation was present even among university students. Hence, an intermittent awareness program on blood donation must be started in various educational institutions to achieve 100% voluntary nonremunerated blood donation. The current study revealed that the majority of the participants never donated blood despite their perceived positive attitudes. The reasons for nondonation were a lack of information on blood donation, cultural and religious background, and negative attitudes, such as blood donation, resulting in weight loss, fear, and other multiple reasons. Nondonors with positive attitudes should be motivated, and awareness of voluntary blood donation should be provided to promote blood donation on a voluntary basis, whereas nondonors with negative attitudes need to be educated about the importance and health benefits of blood donation. Their doubts regarding blood donation should be clarified, and they should be motivated to donate blood on a regular basis. Delivery of adequate knowledge, awareness, communication materials and advertisements to address the fear factor may strengthen the recruitment and retention of voluntary blood donors to donate blood on a regular basis to achieve 100% blood donation only on a voluntary basis. The necessary steps to involve students and create opportunities for them to donate blood are vital if we need to improve the voluntary collection of blood from them. Studies need to be carried out in all states across the country to walk towards 100% voluntary nonremunerated blood donation in Nigeria.

Recommendations

To promote voluntary nonremunerated blood donation, it is crucial to build a positive and progressive image of the donor in the public and develop blood donation as an act of charity. Therefore, good public relations, which involves the use of different media, is crucial for promoting blood donor retention and recruitment by providing information on blood donation and its positive effects on human health. Community participation and involvement, especially in blood donation, can be encouraged with different methods and techniques by the government and private sector, with different awareness programmes, public honour to active donors and genuine thanks to and offerings by society and the government.

Making donors feel that their blood donations are useful for saving lives is important. Not all first-time donors are repeated donors, so it is certainly essential to focus donor retention policies on the conversion of the first timer donor into repeated ones.

Each population has different knowledge, beliefs and practices, so it is necessary to determine what the general population and donors know. Further research should focus on the knowledge, attitudes and practices of blood donation among the general population, which would enable the identification of proper knowledge, attitudes and practices of blood donation in society. The current study provides important information regarding proper knowledge, attitudes and practices related to blood donation and the aim of 100% voluntary nonremunerated blood donation as soon as possible.

Acknowledgements

The authors acknowledge support from experts who reviewed the survey questionnaires. We would like to thank the respondents who participated in this study.

Authors’ contributions

SAS contributed to the study design and data collection and performed the data analysis. E.E.M, N.M,M, A.A.I, C.O.A, P.I.O, M.E.A, N.C.D and O.N.E contributed equally to data collection, data analysis and approved the manuscript for publication.

Funding

Not applicable

Availability of data and materials

The data presented in this study are available upon request from the corresponding author.

Ethical approval and consent to participate

This study was performed in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethical Review Board at Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

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No competing interests reported.

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Knowledge, Attitudes, and Practices of Voluntary Blood Donation Among University Students in Nigeria: Ambrose Alli University as a Case Study

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Abstract

Figures

Background

Level of knowledge towards blood donation

Attitude toward blood donation

Practice of blood donation

Factors associated with the practice of blood donation

Methods

Study design

Study population

Study duration

Sample size estimation

Selection criteria

Data collection tools

Sampling method

Pretesting

Data analysis

Ethical consideration

Results

3.1 Sociodemographic characteristics of the respondents

Knowledge of blood donation

Attitude towards blood donation

Willingness to donate blood

Discussion

Factors associated with the practice of blood donation

Conclusion

Recommendations

Declarations

References

Additional Declarations

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