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  • Gaurav Urs, Parikshit Gavhane, Ojaswi Desai, Japmehr Sandhu, Padmavathy KK, Vardhini Ganesh, Shreeya Pradhan, Parth Sharma, Siddesh Zadey

The Seven(+1) Sisters: Blood Banking in the Northeast

Updated: Jun 22



An ASAR Data Story


By ASAR Blogs Team

 

Calculations & Visualisations

Gaurav Urs, Parikshit Gavhane, Ojaswi Phal Desai, Japmehr Kaur Sandhu


Data Extraction

Gaurav Urs, Padmavathy KK


Ideation & Drafting 

Vardhini Ganesh, Shreeya Pradhan


Review & Editing 

Parth Sharma, Siddhesh Zadey 


“Blood donation is a vital act of human solidarity." 

- Nelson Mandela


Blood banks are essential for healthcare to provide a safe, reliable, and readily available supply of blood and blood products. In 2017, to treat various diseases and injuries, the world needed an estimated 304,711,244 blood product units. However, we only had a supply of 272,270,243 product units, leading to a shortage of 102,359,632 blood product units. This likely leads to millions of preventable deaths. In India, the shortage of blood was 40,964,075 units. In other words, India contributes to about 40% of the global shortage. Hence, India is among the blood deserts in the world. 


Blood is at the center of several healthcare issues — from one-time surgery to treat the injury after a road traffic crash to life-long support in the form of repeated blood donations in the case of people with thalassemia. The Association of Rural Surgeons of India notes that limited access to blood and blood products is among the top causes of the loss of patients, children, and young mothers in rural and remote areas. We have previously covered the blood drought in the northwestern state of Rajasthan. In this story, we will look at the Northeast. 


Northeast India includes the ‘seven sisters’ - Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland, and Tripura and the ‘brother’ state of Sikkim. This region shares international borders with five countries and thus holds a unique geopolitical significance. However, despite its geographical importance, it faces the challenge of isolation and neglect in terms of political attention and investments in critical social infrastructure including healthcare. The state of Assam, which is the most densely populated Northeastern state, has alarmingly high maternal and infant mortality rates. This statistic pushed us to investigate blood banking performance in the Northeastern Region.


In this data story, we report the availability of and accessibility to blood banks in the Northeastern states, using data from the state reports of India's National Blood Transfusion Council (NBTC), last published in 2016 – the most recent year for such a report.  


  1. How many blood banks per million people are present in the Northeastern states of India? 


Across states, Mizoram had the most blood banks available per million people - 9.1.  Manipur had the least number of blood banks - only 1.9 per million people (Figure 1). There is a disparity in the availability of blood storage services between and within the states. 




The district of Upper Siang in Arunachal Pradesh had the highest density of blood banks (28.3) where density stands for blood banks available per million people. Contrastingly, in Nagaland and Meghalaya, out of the 11 districts, only 3 had any blood banks. 


Figure 2 shows that most of the blood bank density was concentrated more toward the western parts of the Northeastern states. This could be due to higher altitudes and more difficult terrain towards the east. While the states of Tripura and the western part of Assam lie at a level of 100m above sea level, Arunachal Pradesh, Nagaland, Manipur, and the eastern parts of Assam lie at an altitude of over 1500m above sea level. Compared to the national blood bank density of 2.3, the Northeastern states and districts could do better, especially in the eastern regions. 




2. Who owns these blood banks? 


Whether the blood banks are owned and run by the public (government), non-profit/trust, or for-profit private players can often determine affordability for the patients in need. Figure 2, notes that all blood banks in Mizoram, Manipur, Meghalaya, and Nagaland are owned by the public or not-for-profit sectors. About 53% of the blood banks in Assam, the Northeastern state with the most number of blood banks, were public. While having more public and not-for-profit blood banks in the region improves the affordability of blood and blood products, it does not necessarily improve geographic accessibility, especially if their number is not proportional to the local population and their distribution is inequitable. 




3. How many blood banks are accredited?


National AIDS Control Organisation (NACO) accreditation signifies that a blood bank meets specific standards for safety, quality, and availability of blood and blood products. All the blood banks in Mizoram, Meghalaya, and Nagaland are NACO accredited (100%). However, in the state of Assam, which boasts the highest number of blood banks in the Northeast region, only 46.4% of them have an accreditation (Figure 4). As many as 64% of the 120 districts in the Northeastern states completely lack the presence of a NACO-accredited blood bank.




4. How many blood units are collected in these blood banks?


In India, 1 in every 100 people donate blood, which meets the World Health Organization requirement. However, 6 of the 8 Northeastern states were below the national average. Mizoram had the highest blood unit collection per 100 individuals at 2.2, and Arunachal Pradesh had the lowest value at 0.4 (Figure 5). 




The Aizawl district in Mizoram collected 4.1 blood units per 100, while 5 districts in Manipur had 0 collection (Figure 6). States including Manipur, Assam, and Arunachal Pradesh with one or more than one district with zero blood collection are in desperate need of blood donation drives and appropriate storage to meet people’s needs in medical emergencies.




5.  How safe are these blood banks?


One way to mark the safety of blood banks is through the risk of transfusion-transmitted infections (TTIs). TTIs occur when infectious agents, such as viruses or bacteria, are transmitted through blood transfusions or blood products. The main TTIs include HIV, Hepatitis C, Hepatitis B, Syphilis, and Malaria. 


The seropositivity incidence of HIV amongst blood donors, that is, the percentage of donors whose blood sample tested positive for HIV, was higher than the national average (0.14%) for 4 states: Mizoram (0.30%), Nagaland (0.26%), Meghalaya (0.16%) and Manipur (0.15%). For Syphilis, Arunachal Pradesh (0.97%), Meghalaya (0.73%), Assam (0.30%) and Sikkim (0.19%) had an incidence higher than the national average (0.17%). Hepatitis C seropositivity incidence was greater in Mizoram (1.24%), Manipur (0.83%), and Meghalaya (0.47%)  above the national value of 0.34%. On a positive note, 7 out of the 8 states had a lower seropositivity incidence amongst blood donors than the national values for Hepatitis B (0.87%) and Malaria (0.36%). Figure 7 shows the relative patterns of TTIs. 




6. How well do the blood banks perform?


The National Blood Transfusion Council (NBTC) evaluated the blood banks in all states using a self-assessment questionnaire with a maximum score of 100. The questionnaire assessed various aspects such as ownership, collection practices, voluntary donation, human resources, training, and technical equipment, with the evaluation being carried out in collaboration with program administrators and experts in transfusion medicine, epidemiology, public health, and biostatistics. The final score, referred to as the Mean Assessment Score (MAS), was calculated by the Clinical Data Management Centre at the Department of Biostatistics, Christian Medical College, Vellore, India. 


Arunachal Pradesh had the lowest score (41.9), whereas Meghalaya had the highest score in the Northeast region (65), and was the only state with a score higher than the national average of 62. There is an urgent need to improve the quality of blood banking in the Northeast. 


Figure 8 compares NACO-accredited and non-NACO blood banks, using the MAS. We expected the NACO-accredited blood banks to have a better MAS (as seen in the previous Rajasthan ASAR Data Story). However, we do not see that pattern here. 




The lack of updated data, especially at a district level, should be tackled by conducting annual surveys at the level of individual states, and digitalization of the annual reports. All states should carry out accreditation and MAS evaluation exercises for their blood banks.


Establishing new blood banks in underserved areas within this region is a priority. Innovating and implementing alternatives to traditional blood banks such as the walking blood banks is also relevant. Addressing the disparities within the region is key to ensuring accessibility for all.


Cite this article as:

Urs G, Gavhane P, Desai O, Sandhu J, KK P, Ganesh V, Pradhan S, Sharma P, Zadey S.

The Seven(+1) Sisters: Blood Banking in the Northeast - An ASAR Data Story

2024 June 17; Available from:


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