Academy
Strengthening haemovigilance for safe blood transfusion at Muhimbili National Hospital in Tanzania
Elineema Meda
Muhimbili National Hospital in Dar es Salaam, Tanzania
Koga Luhulla
Muhimbili National Hospital in Dar es Salaam, Tanzania
Mbonea Yonazi
Muhimbili National Hospital in Dar es Salaam, Tanzania
Safe blood transfusion is a cornerstone of modern healthcare. However, ensuring transfusion safety requires more than screening blood for infections; it demands a robust haemovigilance system capable of detecting, reporting, and preventing adverse events. Muhimbili National Hospital (MNH), Tanzania’s largest tertiary referral hospital, has taken a significant step forward in this direction by implementing a comprehensive haemovigilance training program.
Muhimbili National Hospital: A tertiary hospital with high Blood Demand
Muhimbili National Hospital (MNH) serves patients from all 31 regions of Tanzania through its two campuses in Dar es Salaam. With a capacity of 1,500 inpatient beds and over 2,000 outpatient visits daily, it is one of the fullest healthcare facilities in the country (1,2). The hospital hosts a semi-autonomous Blood Transfusion Centre responsible for blood collection, component preparation, and transfusion-transmissible infection (TTI) screening. While most blood screening in Tanzania is centralized through the National Blood Transfusion Services (NBTS), MNH independently screens additional units to meet its exceptionally high demand, processing more than 100 new blood transfusion requests each day (3).
Like other hospital based blood transfusion centres in Sub Saharan Africa, Muhimbili National Hospital also strives economically to ensure availability of safe blood (4). To ensure the availability of safe blood, the hospital invests over 2 billion Tanzanian shillings annually, while, in accordance with national policy, blood transfusion services are provided free of charge to patients.
Despite the heavy reliance on transfusion services, there remains a significant gap in the reporting of adverse transfusion reactions. This challenge is not unique to MNH but reflects a nationwide issue, with limited documentation of transfusion-related events across Tanzania. Although published literature on transfusion reactions in Tanzania is lacking, one unpublished study identified febrile non-hemolytic transfusion reactions and allergic reactions as the most common acute events. For delayed transfusion reactions, there is a high likelihood of delayed hemolytic transfusion reactions, attributed to the high rate of red cell alloimmunization reported by Meda et al. and Tebuka et al (5,6)
Another major concern is on monitoring the appropriate use of blood products. Several studies have highlighted a high rate of inappropriate transfusions, which not only jeopardizes patient safety but also increases the financial burden on already constrained hospital resources (7,8).
Delila Kimambo,The Executive Director of Muhimbili National Hospital, delivered the opening remarks to officially commence the training
From left Elineema Meda , (facilitator and Director of Medical services at MNH Mloganzila), Mbonea Yonazi ( Facilitator and Director of Clinical Supportive services MNH Upanga) Ms Redempta Matindi (Director of Nursing services MNH Upanga) Dr Delila Kimambo (Executive Director), Koga Luhulla ( Facilitator), Don-Dolcetto Ngilisho (Facilitator) and Samira Mahfudh (Head of Clinical Pathology Laboratory)
Bridging the Gap Through Training
To address this, the Hospital Transfusion Committee, with support from the International Society of Blood Transfusion (ISBT), launched a large-scale haemovigilance training program. The goal was to strengthen knowledge and practice around transfusion safety and reporting. Over a five-day period, 298 healthcare professionals were trained in three batches. Participants represented a broad range of cadres, including members of the Hospital Transfusion Committee, nurses from every ward, doctors and specialists from various disciplines, and laboratory scientists/technologists (Figure 1).
The Executive Director’s Opening Speech
The training was officially opened by the Executive Director of Muhimbili National Hospital, who underscored the importance of vigilance and professionalism in the transfusion process. She further emphasized that adherence to both national and international guidelines is essential in ensuring patient’s safety.
The Executive Director also encouraged participants to embrace the training as an opportunity to expand their knowledge and translate it into daily practice. She concluded by expressing appreciation to the International Society of Blood Transfusion (ISBT) for supporting this training.
The trainees attentively followed the training session
The trainees engaged in an interactive group case discussion session
Building Knowledge Step by Step
Before the training, a baseline assessment revealed that many healthcare workers had limited knowledge of haemovigilance systems and concepts such as near-miss reporting (Figure 2). The training itself was structured into two-day sessions for each batch:
• Day 1: Participants were introduced to the principles and importance of haemovigilance, learned about the recognition and management of adverse transfusion reactions, and explored alternatives to blood transfusion. Case-based group discussions allowed participants to apply their learning in practical scenarios. • Day 2: Sessions focused on transfusion indications in special populations, transfusion errors, and the look-back process. Participants also reviewed hospital SOPs for blood administration, learned to use the adverse event notification form, and identified challenges in the transfusion chain. Each session concluded with an action-planning discussion to promote continuous improvement.
Impact and Way Forward The post-training assessment showed a marked improvement in haemovigilance knowledge across all professional groups. Participants reported increased confidence in recognizing and managing transfusion reactions, as well as a clearer understanding of reporting mechanisms (Figure 2).
Training materials and national haemovigilance guideline as well as guideline for appropriate use of blood products were made available through a shared digital platform, and the Hospital Transfusion Committee has committed to coordinating ongoing training within specialized units. This ensures that the culture of haemovigilance will continue to grow and be sustained across the hospital.
Case presentation session
Conclusion
The haemovigilance training program at MNH represents a critical step in improving transfusion safety in Tanzania. By equipping healthcare professionals with the knowledge and tools to detect and report transfusion-related events, MNH is not only strengthening its own systems but also setting an example for hospitals nationwide. Safe blood is not just about availability, it is about vigilance, accountability, and continuous learning. Special appreciation goes to the International Society of Blood Transfusion (ISBT) for their support in this transformative program.
References
1. About Us [Internet]. [cited 2025 Mar 29]. Available from: https://www.mnh.or.tz/index.php/about-us
2. Muhimbili National Hospital - Mloganzila [Internet]. [cited 2025 Mar 29]. Home. Available from: https://www.mloganzila.or.tz/
3. Mohamed Z, Kim JU, Magesa A, Kasubi M, Feldman SF, Chevaliez S, et al. High prevalence and poor linkage to care of transfusion‐transmitted infections among blood donors in Dar‐es‐Salaam, Tanzania. J Viral Hepat [Internet]. 2019 Jun [cited 2023 Aug 8];26(6):750–6. Available from: https://onlinelibrary.wiley.com/doi/10.1111/jvh.13073
4. Barnes LS, Stanley J, Bloch EM, Pagano MB, Ipe TS, Eichbaum Q, et al. Status of hospital-based blood transfusion services in low-income and middle-income countries: a cross-sectional international survey. BMJ Open [Internet]. 2022 Feb [cited 2023 Aug 8];12(2):e055017. Available from: https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2021-055017
5. Tebuka E, Charles M, Bhuko JO. Prevalence and risk factors for red blood cell alloimmunisation among sickle cell patients in Mwanza City, Tanzania. African Journal of Laboratory Medicine [Internet]. 2020 Sep 10 [cited 2025 Aug 27];9(1). Available from: http://www.ajlmonline.org/index.php/AJLM/article/view/823
6. Meda E, Magesa P, Marlow T, Reid C, Roberts D, Makani J. Red Blood Cell Alloimmunization in Sickle Cell Disease Patients in Tanzania. 2017;
7. Bhombo A, Mwashiuya O, Mauka W, Mgasa A, Ngerageza I, Mogella D, et al. Appropriateness of transfusions of red cells, platelets and fresh frozen plasma: An audit in referral hospitals in Tanzania: Pertinence des transfusions de globules rouges, de plaquettes et de plasma frais congelé : un audit dans les hôpitaux de référence en Tanz. Afri Sang [Internet]. 2022 Dec 22 [cited 2024 Nov 28];24(1):10–8. Available from: https://www.ajol.info/index.php/asan/article/view/238812
8. Akoko LO, Joseph AB. Blood utilization in elective surgery in a tertiary hospital in Dar es Salaam, Tanzania. Tanzania J Hlth Res [Internet]. 2015 Sep 21 [cited 2023 Aug 8];17(4). Available from: https://www.ajol.info/index.php/thrb/article/view/114510
