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      Collaborations on blood transfusion research in sub‐Saharan Africa: who, what and where

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          Abstract

          Background and objectives

          Children and pregnant women use 75% of the blood supply in sub‐Saharan Africa (SSA) but face widespread blood shortages. To increase safe blood supply, Africa‐specific evidence and strengthened capacity for transfusion research are needed. Our study analysed seven years of SSA transfusion publications, compared researched topics against priorities and enumerated SSA transfusion research collaborations.

          Materials and methods

          Data on research topic, journal type, authors’ institutions and country were extracted from transfusion‐related SSA articles published between 2008 and 14 and used to construct a quantitative, graphic visualization of collaborations. Research topics were compared to those identified as priorities for SSA blood services in 2008 and 2015.

          Results

          Of the 2176, 267 articles (average 38/year) met criteria for analysis. They involved 1245 authors, 673 institutions, 59 countries (35 SSA) and 1375 collaborations. About 41% were on transfusion‐transmitted infections. About 34% were published in specialist transfusion journals. Only 7% involved exclusively collaborations within SSA. Two of the top fifteen institutions by publication quantity were from outside SSA.

          Conclusion

          Despite a general paucity of SSA‐relevant transfusion research, Francophone SSA was well‐represented. Published research topics are not well matched to SSA research priorities; research on supply, distribution, financing and systems is particularly neglected. The study provides a baseline against which to track any refocusing of research activity to better meet SSA’s needs. Transfusion research hubs within and beyond SSA have been identified as a springboard network for expanding SSA transfusion research capacity.

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          Most cited references19

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          Good and Bad Research Collaborations: Researchers’ Views on Science and Ethics in Global Health Research

          There has been a dramatic rise in the scale and scope of collaborative global health research. A number of structural and scientific factors explain this growth and there has been much discussion of these in the literature. Little, if any, attention has been paid, however, to the factors identified by scientists and other research actors as important to successful research collaboration. This is surprising given that their decisions are likely to play a key role in the sustainability and effectiveness of global health research initiatives. In this paper, we report on qualitative research with leading scientists involved in major international research collaborations about their views on good and bad collaborations and the factors that inform their decision-making about joining and participating actively in research networks. We identify and discuss eight factors that researchers see as essential in judging the merits of active participation in global health research collaborations: opportunities for active involvement in cutting-edge, interesting science; effective leadership; competence of potential partners in and commitment to good scientific practice; capacity building; respect for the needs, interests and agendas of partners; opportunities for discussion and disagreement; trust and confidence; and, justice and fairness in collaboration. Our findings suggest that the sustainability and effectiveness of global health research collaborations has an important ethical or moral dimension for the research actors involved.
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            Maternal mortality in sub-Saharan Africa: the contribution of ineffective blood transfusion services.

            In sub-Saharan Africa, where blood supply is critically inadequate, severe haemorrhage is a leading cause of maternal deaths. The aim of this review was to estimate the impact of lack of blood on maternal deaths and identify reasons and potential solutions. Databases and websites from 1970 to 2007 were searched for information concerning maternal deaths and near misses due to haemorrhage in sub-Saharan Africa. Original studies that provided qualitative or quantitative information about blood transfusion services in relation to obstetric deaths or near misses were included. Data about maternal haemorrhage deaths associated with lack of blood for transfusion and reasons for blood shortages were extracted from the full text of articles by two independent reviewers using predesigned, piloted forms. Twenty of 37 selected studies described a direct association between maternal deaths and lack of blood transfusions. Five of 37 provided quantitative information which showed that overall 26% (16-72%) of maternal haemorrhage deaths were due to lack of blood. Reasons included nonaffordability of blood, lack of blood donors, unwillingness of relatives to donate and inadequate supplies and transport. Lack of blood for emergency transfusions is a major, but poorly quantified and under-researched cause of maternal deaths in sub-Saharan Africa. Potential solutions include more blood donations, better financing mechanisms and more efficient management systems. Complementary approaches to prevent severe anaemia and treat hypovolaemia are important to reduce use of transfusions.
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              How do external donors influence national health policy processes? Experiences of domestic policy actors in Cambodia and Pakistan

              Abstract Although concerns have historically been raised about the influence of external donors on health policy process in recipient countries, remarkably few studies have investigated perspectives and experiences of domestic policymakers and advisers. This study examines donor influence at different stages of the health policy process (priority setting, policy formulation, policy implementation and monitoring and evaluation) in two aid-dependent LMICs, Cambodia and Pakistan. It identifies mechanisms through which asymmetries in influence between donors and domestic policy actors emerge. We conducted 24 key informant interviews—14 in Pakistan and 10 in Cambodia—with high-level decision-makers who inform or authorize health priority setting, allocate resources and/or are responsible for policy implementation, identifying three routes of influence: financial resources, technical expertise and indirect financial and political incentives. We used both inductive and deductive approaches to analyse the data. Our findings indicate that different routes of influence emerged depending on the stage of the policy process. Control of financial resources was the most commonly identified route by which donors influenced priority setting and policy implementation. Greater (perceived) technical expertise played an important role in donor influence at the policy formulation stage. Donors’ power in influencing decisions, particularly during the final (monitoring and evaluation) stage of the policy process, was mediated by their ability to control indirect financial and political incentives as well as direct control of financial resources. This study thus helps unpack the nuances of donor influence over health policymaking in these settings, and can potentially indicate areas that require attention to increase the ownership of domestic actors of their countries’ health policy processes.
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                Author and article information

                Contributors
                Imelda.bates@lstmed.ac.uk
                Journal
                Vox Sang
                Vox Sang
                10.1111/(ISSN)1423-0410
                VOX
                Vox Sanguinis
                John Wiley and Sons Inc. (Hoboken )
                0042-9007
                1423-0410
                05 February 2020
                April 2020
                : 115
                : 3 ( doiID: 10.1111/vox.v115.3 )
                : 221-232
                Affiliations
                [ 1 ] St James’s University Hospital University of Leeds Leeds UK
                [ 2 ] University of Liverpool Liverpool UK
                [ 3 ] Liverpool School of Tropical Medicine Liverpool UK
                [ 4 ] Department of Computer Science University of Liverpool and The Data Incubator Washington DC
                Author notes
                [*] [* ] Correspondence: Imelda Bates, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK

                E‐mail: Imelda.bates@ 123456lstmed.ac.uk

                Author information
                https://orcid.org/0000-0002-0862-8199
                Article
                VOX12884
                10.1111/vox.12884
                7187137
                32026497
                007731b9-3971-4aa6-ad73-e66347f1e23b
                2020 The Authors. Vox Sanguinis published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 June 2019
                : 10 December 2019
                : 15 December 2019
                Page count
                Figures: 2, Tables: 4, Pages: 12, Words: 7228
                Funding
                Funded by: Seventh Framework Programme , open-funder-registry 10.13039/100011102;
                Award ID: 98388
                Categories
                Original Paper
                Transfusion Medicine and New Therapies
                Custom metadata
                2.0
                April 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.1 mode:remove_FC converted:28.04.2020

                Hematology
                sub‐saharan africa,blood transfusion,research,collaborations
                Hematology
                sub‐saharan africa, blood transfusion, research, collaborations

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