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Matters Arising: Blood Transfusion Services in Nigeria

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Blood Transfusion

By Saifullahi Attahir

I’m sure once in your life time have experienced or had one of your acquittances received a unit of blood. But have we ever gave a second thought about how this integral part of healthcare system in Nigeria is managed? In this article, I would give the reader a glimpse into this sector due to it’s importance, and some comparison of how it’s manage in other advanced countries.

Blood transfusion was a century old medical practice developed around 1900 by a scientist called Carl landstener, despite several attempts by contemporary scientists before him to devise a means to replace loss of blood encountered by patients either during surgical operations, accidents, or child birth.

Landstener was able to perpect the art of blood transfusion through discovery of major blood groups (ABO, and Rhesus) that played role in matching donor and recipients. Since then, there was continued effort toward safe blood transfusion services across the globe which massively lead to the decline in mortality rate associated with decrease blood supply in the body.

In Nigeria, blood transfusion services was practiced since the colonial-post colonial period mostly starting in Lagos and major urban centres. The major breakthrough was when the National blood transfusion services was established in 2005 during President Obasanjo. The National Health act of 2014 lead to the passage of National blood service Agency bill in 29th /July/ 2021.

According to the NBSA (www.nbsc.gov.ng) site, there was 17 voluntary blood donation centers across the 6 geopolitical zones of Nigeria including separate centers in Federal Capital Abuja, and other centers within the Arm Forces/ Military hospitals. National blood donation day is celebrated every 8th of December, and World safe donation day celebrated every 14th, June.

Nigeria has a population of over 200 million people, and without saying, our demand for blood donation was staggering looking at the number of road traffic accidents, obstetrics patients, major surgical procedures, under 5 years malarial and Schistosomial infections. This is apart from anaemic conditions due to malnutrition (Iron deficiency), other tropical diseases, Chronic Kidney Diseases, abnormal menstruation, and burns.

With all the above mention reasons, our data regarding blood transfusion services was reprehensible.

Several factors have lead to that including community neglect, lack of government intervention, lack of standard private practices, cultural influences, poor funding, and the Almighty mismanagement of resources.

About 1,230, 000 (one million, two hundred and thirty thousand) units/pints of blood are collected annually across Nigeria healthcare facilities, but unfortunately about 90% of this donations are paid commercials. Only 25,000 units are donated by volunteers that are made available to 3,400 hospitals urgent request! This simply shows that less than 5% of blood donation in Nigeria is voluntary.

Let me highlight four different forms of donations practiced worldwide;

* There was voluntary donation done by individuals just for the sake of humanity with no ulterior motive.

*There was direct/replacement donation usually done by relatives of a patients that are called in times of emergency. This one is hugely practice in Nigeria to about 75% in public hospitals.

* There was paid commercial donations in which donors give blood and collect money for it. This practice in Nigeria constitute about 25% in public hospitals and about 75% in some private clinics. This practice carried the major risk of transmitting transfusion-transmitted infections like HIV, Hepatitis B, and C.

* There was the autologous transfusion in which individual give his own blood prior to some surgical operations where the blood is stored, and later transfused back to him. This procedure has the least risk of transmitting infection and eliciting blood transfusion reactions.

Among the four blood transfusion methods, the two most widely practiced in Nigeria are the replacement and the paid commercial. People only care to donate blood when they knew their relatives are in need. This practice was commoner in our society from the villages to the urban. You could donate as soon as you know it’s your parents, wife, son, sister, brother or friend. Any other person can go to hell!

The worst form of practice is the commercial one, where people either out of ignorance or artificial poverty volunteer to donate only if they are going to be paid for it. This business triggers every form of atrocities where the donors sometimes donate multiple times within a short period of time ( The standard is at least an interval of 4-6 months, depending on age, gender, and social status).

The paid donors carries the highest risk of transmitting infections and other abnormalities either to themselves or to the recipients. So this practice need to be discourage by the healthcare personnels and the Government.
As an insider, and with my little period of practice, I have come to realized some of the difficulties blood transfusion services encountered in our health care facilities.

Shortage of blood units

There was the problem of blood supply shortage, this is evident from how Doctors/Lab personnel always advised patient relatives to go home and mobilized their kinsmen when a patient was in need of blood. This happens as if it were the standard thing to do. The ideal is for a patient to be transfused blood from the pool of blood bank regardless of bringing replacement or not. But this can only happens if their was enough units stored in the blood bank, and in most cases their was non.

I have personally witnesses several cases where a patient can almost loose his/her life their donors travelling many kilometers only to be rejected due to mismatch. Imagine the money and time wasted! The blame is not on the healthcare personnel, nor on the government alone, the blame is on the system and our society at large. We are lacking altruism.

This problem can be attributed to the lack of decentralised system of blood banking we operate in Nigeria.
Nigeria has a single National blood donation system. While in places like US, procurement of blood is majorly met by volunteers, they have a pluralistic blood collection programs by ( Red cross, independent community blood centres,and hospitals).

In the US, 15 million units of blood are collected from 10 million donors annually, and only 7% are collected in hospitals, and 93% in regional centres, unlike Nigeria where most of the collection are done in hospitals.

In the US, the blood collection, processing, testing,and preservation are regulated by the FDA. They operated a sharing system where by blood units can be transferred from a region with less demand and higher collection to a region with more demand.

Blood transfusion data

Nigeria has a blood collection data problem, many hospitals especially in the rural areas can not keep the record consistently for a year. This problem can be attributed to the manual (pen and paper) system of health records we are still operating in Nigeria, which is subject to error, missing, or manipulation. Without proper blood collection data it would be difficult to alleviate problem of shortage, and implementation.

Lack of Awareness

A recent data has shown how blood donation is directly proportional to development; in developed countries, 50 units of blood are donated in every 1000 population. In developing countries, 15 units of blood are donated in every 1000 population. While in under developed countries, only 5 units of blood are donated in every 1000 population.

In under developed and developing countries, limited storage facilities, lack of incentives, malnutrition, personal wellbeing,and lack of knowledge can be a contributing factor to low turnout of voluntary blood donation. It’s more likely for a high income University graduate to donate blood voluntarily than a less educated poor labourer. The former might be healthier, more mentally stable, and more aware on the need to donate.

Expertise and Procurement Facilities

The current improvement in blood donation service especially in the tropics can be attributed to the benevolent funding by the US through USAID and President Emergency Plan For AIDS Relief (PEPFAR). Since 2000, there was continued efficiency in transfusion services in Nigeria, thanks to the aforementioned Agencies.

Despite this improvement, there was still problems of procedures, staff proficiency, specific testing,and preparation of separate blood components ( like plasma derivatives, platelets, and white blood cells).

Our screening methods are still qualitative immuno-phenotyping, we are using 4th generation ELISA ( Enzyme linked immunosorbent Assay), and no Nuclear Amplification Technique (NAT ) testing yet.

In 2018, I attended a two weeks training in Abuja organized by the University of Maryland experts under the supervision of Federal Ministry of Health (FMoH). We were trained on the standard serological techniques of Retro viral screening (RVS), Hepatitis, and VDRL. It was in preparation for a six month extensive survey we conducted across Nigeria based on the impact of HIV screening and therapy over the last three decades called Nigeria AIDS INDICATOR AND IMPACT SURVEY (NAIIS 2018). The training was an eye opener for me on the need to standardized our screening methods.

On a way forward, in order to attain the blood transfusion safety target, there is need for more voluntary donations campaign through mass media, schools, Churches, and Mosques.

Factors that prevent people from voluntary donations should be address like establishment of more independent blood donation centres, incentives, availability of storage facilities, and free donation services.
Nigeria should have a centralised registry of people with blood group O rhesus D negative, and such rare blood units should be made available across the country through a systematic sharing arrangement.

There is need for the communities and philanthropies to create more Non governmental organizations (NGOs) to address shortage of blood and to complement government efforts, as the government can not carryout the duty alone.

Saifullahi Attahir is the President of National Association of Jigawa State Medical Students (NAJIMS) National body. He wrote this piece from Federal University Dutse

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Oyo Seals Ar-Rahmon Khabul Herbal Over Health Concerns

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OYRLEA

By Modupe Gbadeyanka

An Ibadan-based herbal company, Ar-Rahmon Khabul Herbal Nigeria Limited, has been sealed by the Oyo State Rule of Law Enforcement Authority (OYRLEA).

The state government, in a statement signed on Friday by the Commissioner for Information, Mr Dotun Oyelade, revealed that the herbal firm was shut down due to environmental violations and public health concerns.

The leader of OYRLEA, Mrs Aderonke Aderemi, explained that the action was taken after multiple petitions from residents alleging persistent offensive odour and health challenges linked to the company’s operations.

She noted that the state government swung into action “to protect public health, preserve environmental standards, and enforce regulatory compliance across the state.”

It was gathered that investigations identified tobacco leaf as a major component in its production process, generating a strong, putrid odour deemed hazardous to residents and capable of posing serious health risks to the surrounding community.

“Joint inspections by officials revealed that the company operates a herbal production facility within a densely populated residential area, in clear violation of environmental and public health standards,” the statement said, adding that further findings from the inspection include the emission of harmful and toxic gaseous substances into the atmosphere, the discharge of wastewater into a nearby community water body, the installation of a chimney deemed too short and directly facing residential buildings, and the accumulation of solid waste within the premises despite claims of engaging a waste contractor, among others.

Prior to the enforcement action, the agency had issued an abatement notice directing the company to cease operations and relocate within 21 days in accordance with the Oyo State Environmental, Sanitation and Waste Control Regulations.

OYRLEA, along with the agencies that carried out the enforcement, reiterates that air pollution, hazardous waste discharge, and improper waste management are violations of environmental laws.

Mrs Aderemi reaffirmed OYRLEA’s commitment to sustained monitoring and enforcement to ensure a safe and healthy environment for all residents.

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NAFDAC Receives Seized Pharmaceutical Products from Rivers Customs

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Rivers customs NAFDAC

By Bon Peters

The Port Harcourt Area I Command of the Nigeria Customs Service (NCS) has handed over pharmaceutical products intercepted at the Omagwa International Airport recently to the National Agency for Food and Drug Administration and Control (NAFDAC).

The spokesman for the command, Mr Barilule Aanee, an Assistant Superintendent of Customs 1, said in a statement that the items were given to NAFDAC on February 12, 2026, at the NAHCO Shed of the airport, where the seizure occurred.

The Customs Area Controller of the command, Comptroller Salamatu Atuluku, disclosed that the interception was made during routine examination and intelligence-driven scrutiny at the NAHCO Shed by officers of the Command in collaboration with relevant agencies.

She disclosed that six packages of pharmaceutical products, including Menotrophin 150 IU injections, Progesterone, and Isifrane, as well as three packages of medicaments containing Tramadol Ratiopharm injections, were discovered in two separate consignments.

The products, according to the statement, were neither properly declared nor accompanied by the mandatory NAFDAC certification required for lawful importation into Nigeria.

The Customs Area 1 chief further revealed that one shipment, originating under the name Zecho Oil and Gas Nigeria Limited for Elite Health Pharmacy Ltd, with Airway Bill No. 020 34858250, weighing 135 kilograms and amounting to 4,300 units, transported by Lufthansa Cargo Airline, was among the seized products.

More so, another consignment on Allied Airway Bill No. 574 34543283 from Amsterdam was falsely declared as spare parts.

She emphasised that regardless of the importer or volume involved, “no pharmaceutical product is permitted entry into Nigeria without proper declaration and regulatory clearance from NAFDAC.”

Comptroller Atuluku commended the diligence of the Customs Intelligence Unit and all officers involved, stressing that sustained interagency cooperation remained vital to strengthening enforcement and preserving the integrity of the nation’s supply chain.

While receiving the items, the Deputy Director of the NAFDAC Port Inspection Directorate, Pharm. Adepoju Bayo Raufu, thanked the customs for its vigilance and prompt handover of the intercepted items.

He assured that the agency would subject the items to appropriate regulatory procedures in line with its mandate to safeguard public health.

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Accurate Multi-Panel Drug Test Cups For Professionals

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drug test cups

In safety-sensitive workplaces, clinical settings, and staffing operations, reliable on-site drug screening is a practical first line of defense. Accurate multi-panel drug test cups for professionals combine speed with portability, allowing organizations to screen for multiple substances quickly while preserving chain-of-custody and sample integrity. This guide explains how these cups work, how to choose the right product for a professional setting, and how to manage administration, interpretation, and compliance to reduce legal risk and costly false positives.

What Multi-Panel Drug Test Cups Are And Who Should Use Them

Multi-panel drug test cups are self-contained immunoassay devices that screen a urine sample for multiple drug classes simultaneously, typically including amphetamines, cocaine metabolites, opioids, cannabinoids (THC), benzodiazepines, and others depending on the panel. They are designed for point-of-care use: a donor provides a urine specimen directly into the cup, and the integrated test strips produce rapid visual results within minutes.

Who should use them? Professionals that benefit most include:

  • Occupational health and human resources teams conducting pre-employment, post-incident, or random testing programs.
  • Substance use clinicians and treatment centers performing routine monitoring.
  • Staffing firms and temp agencies that need quick screening before placement.
  • Corrections and probation officers performing supervision checks.
  • Employers in transportation, construction, healthcare, and manufacturing where safety is critical.

For organizations prioritizing both speed and defensibility, multi-panel cups offer a pragmatic balance: they provide immediate screening to inform next steps while still allowing for confirmatory laboratory testing when required.

How Multi-Panel Test Cups Work: Technology And Accuracy Factors

At their core, most multi-panel cups use lateral flow immunoassay technology. Antibodies embedded on test strips bind to drug metabolites in the specimen: a visible line forms (or disappears) according to the assay design, indicating a negative or presumptive positive.

Key accuracy factors to understand:

  • Antibody specificity and cross-reactivity: High-quality assays use antibodies selected to minimize cross-reactivity with over-the-counter medications or endogenous compounds. Lower-grade tests may yield false positives when donors take legal medications that share similar metabolites.
  • Cutoff concentrations: Each assay has a cutoff (measured in ng/mL) that determines whether a result is reported as positive. Most professional cups follow SAMHSA or DOT cutoffs for workplace testing: knowing these thresholds reduces misinterpretation.
  • Temperature and matrix checks: Modern cups often integrate temperature strips and creatinine/oxidant checks to detect dilution or tampering. These integrity features improve the reliability of on-site results.
  • Operator influence: Proper collection, timing, and result reading windows directly affect accuracy. Even the best cup can produce incorrect readings if the test is read too early or too late.

Real-world accuracy is often expressed in sensitivity (ability to detect positives) and specificity (ability to rule out negatives). Professional cups from reputable manufacturers typically report >95% agreement with laboratory immunoassays at the stated cutoffs, though confirmatory GC-MS or LC-MS/MS remains the gold standard for legal or employment consequences.

Choosing The Right Cup For Professional Settings

Selecting the appropriate multi-panel drug test cup requires more than picking a high panel count. It’s about matching features to use case, workflow, and legal requirements.

Key Selection Criteria

  • Regulatory alignment: Choose cups that adhere to SAMHSA/DOT cutoffs if testing falls under federal guidelines.
  • Built-in integrity checks: Temperature, adulteration, and creatinine tests help detect tampering or dilution at collection.
  • Ease of use: Simple, unambiguous results and clear timing windows reduce operator error and training burden.
  • Documentation options: Cups that help clear labeling, lot tracking, and photo documentation streamline chain-of-custody.
  • Shelf life and storage needs: Longer shelf life and uncomplicated storage conditions simplify inventory management.

Panel Selection: Which Drugs To Include

Common professional panels are 5-, 8-, or 12-panel cups. Decisions should be risk-based:

  • 5-panel: Standard workplace screens (AMP, COC, OPI, THC, BZO).
  • 8–12 panel: Add methamphetamine, oxycodone, fentanyl, barbiturates, PCP, and others where clinical or workplace exposure warrants it.

Staffing and healthcare employers often opt for expanded panels that include fentanyl and synthetic opioids given their prevalence.

Sensitivity, Cutoffs, And False Positives

Higher sensitivity isn’t always better: it may detect clinically irrelevant low levels or passive exposure. Professional programs typically use established cutoffs to balance sensitivity and specificity. When a presumptive positive appears, organizations must have a policy for confirmatory testing rather than making employment decisions on a single cup result.

Adulteration Detection And Integrity Features

Buy cups with built-in tamper indicators: temperature strips (correct collection window), creatinine or pH checks, and oxidant detection. These features lower the likelihood of undetected sample manipulation and strengthen the defensibility of the screening process.

Best Practices For Collection And Administration

Accurate results start with consistent collection procedures and well-trained staff.

Chain Of Custody And Documentation

Maintain an unbroken chain of custody: donor identification, time-stamped collection, witness signatures, and secure transport for confirmatory samples. Use standardized forms and consider photo documentation or barcode systems that tie cups to donor records. This reduces disputes and protects both employer and donor.

Proper Sample Collection And Handling Steps

  • Verify donor identity and inspect the collection area for prohibited items.
  • Instruct the donor to provide an adequate volume into the cup: record temperature immediately.
  • Observe, where policy and law permit, to prevent substitution.
  • Seal and label samples promptly if they will be sent for confirmatory testing.
  • Adhere to manufacturers’ timing for reading results: most cups specify a 5–10 minute window.

Training Staff And Reducing Human Error

Regular staff training on procedure, result interpretation, and documentation reduces mistakes. Provide quick-reference guides, role-play common scenarios, and audit collections periodically to ensure compliance.

Interpreting Results And When To Confirm

On-site cups deliver presumptive results, actionable only within a clear policy framework.

Reading Immunoassay Results Correctly

Most cups use a two-line format: a control line indicating the test is valid, and a test line indicating a negative or positive depending on the device. A faint test line usually indicates a negative result at or above the cutoff: no test line indicates a presumptive positive. Staff should follow the manufacturer’s visual guide and timing strictly. Photographing results can help document ambiguous cases.

Confirmatory Testing: When And How To Send Samples

Any presumptive positive that could have employment consequences should be sent to a certified laboratory for confirmatory testing using gas chromatography–mass spectrometry (GC-MS) or liquid chromatography–tandem mass spectrometry (LC-MS/MS). It’s best practice to split or retain an aliquot during collection for immediate confirmatory shipment if required. Establish relationships with accredited labs and clarify reporting timeframes, cutoff standards, and evidence handling procedures.

Legal, Regulatory, And Privacy Considerations

Testing programs operate in a regulated and privacy-sensitive environment: mishandling can result in litigation or regulatory penalties.

Compliance With Workplace Testing Regulations

Understand federal, state, and industry-specific regulations that apply to the organization. Transportation and DOT-regulated employees face stricter protocols, specific cutoffs, and certified collector requirements. Non-DOT employers still should align policies with best practices to maintain defensibility.

Recordkeeping, Privacy, And Liability Best Practices

Limit access to test results to authorized personnel, store records securely, and retain documentation according to legal retention requirements. Clear written policies that explain testing rationale, disciplinary procedures, and the appeals process help mitigate liability. Include provisions for reasonable accommodations and medical review officers (MROs) who assess legitimate medical explanations for positive results.

Storage, Shelf Life, And Vendor Reliability

Purchasing decisions affect accuracy and supply-chain resilience.

Storage Conditions, Expiry, And Inventory Management

Store cups per manufacturer recommendations, usually at controlled room temperature away from direct sunlight. Track lot numbers and expiration dates in inventory systems and rotate stock using FIFO principles. Expired tests can degrade antibody performance and increase error rates.

Evaluating Suppliers And Quality Assurance Practices

Work with suppliers that provide lot-level COAs (Certificates of Analysis), recall notifications, and prompt customer support. Vet vendors for ISO or other quality certifications, clear warranty policies, and responsiveness to post-sale technical questions. For agencies that manage testing programs for clients, documented supplier reliability reduces operational risk and preserves client trust.

Conclusion

Accurate multi-panel drug test cups for professionals are a practical tool when used within a rigorously designed program: choose products that match regulatory requirements, incorporate integrity checks, and come from reliable vendors. Combine those choices with standardized collection procedures, trained staff, and clear confirmatory pathways to reduce false positives and legal exposure.

For agencies and businesses that support client organizations, whether staffing firms or occupational health providers, investing in the right cups and operational controls pays off in defensible screening results and smoother downstream workflows. When testing has real consequences, a presumptive result from a quality cup should be the beginning of a controlled process, not the final word.

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