{
  "abstract": "Introduction Trauma, obstetric haemorrhage and severe anaemia lead to millions of deaths every year. Many of these deaths occur in regions known as ‘blood deserts’ where there is virtually no access to blood transfusions. A community or civilian walking blood bank (CWBB) is a low-resource strategy that can provide just-in-time, point-of-care tested blood transfusions in blood deserts when banked blood is not readily available and the alternative is almost-certain death. This protocol is designed to evaluate the effectiveness and implementation of a CWBB at Lodwar County Referral Hospital located in a blood desert in rural north-west Kenya.Methods and analysis We will use a mixed-methods approach relying on an implementation science design to evaluate effectiveness, acceptability, applicability and impact of a CWBB. The study will be conducted over 1 year in two parts: pre-emergency and post-emergency transfusion protocol (ETP) implementation. First, a previously developed ETP will be validated and finalised by key hospital stakeholders. Effectiveness will be assessed quantitatively and qualitatively. Prospective laboratory-based data collection will measure changes in blood ordering practices. We expect a sample size of approximately 140 (20/month) unmet blood transfusion requests, with 40 (5/month) of those being emergent (requiring blood in less than 2 hours). These cohorts will be compared pre-implementation and post implementation. Qualitatively, key informant interviews of hospital staff and the community will explore clinical blood demand and general understanding and perceptions about blood donation and transfusion. Lastly, we will determine the adaptability and scalability of a CWBB to other low-resource settings with in-depth interviews and a modified Delphi approach to achieve consensus regarding key components of a CWBB and its transferability to other settings.Ethics and dissemination Ethical approval was granted by the Strathmore University Institutional Scientific and Ethics Review Committee (SU-ISERC2234/24) and the Mass General Brigham (MGB) Hospital’s Institutional Review Board (#2024P001878; #2024P001879; #2024P001885; #2024P001887). The study team also secured a research licence from the National Commission for Science, Technology and Innovation (#168094) before initiating the study. Interviews will be voluntary and consent will be obtained prior to participation. Blood transfusion consent will be collected as per standard hospital process. The findings will be disseminated through academic publications, conference presentations and workshops, contributing valuable insights into emergency blood transfusion protocols. These findings will also be conveyed to Lodwar County Referral Hospital in order to facilitate quality improvement.",
  "authors": [
    {
      "affiliations": [
        "Department of Global Health and Social Medicine, Harvard Medical School Program in Global Surgery and Social Change, Boston, Massachusetts, USA",
        "University of California San Francisco East Bay Department of Surgery, Oakland, California, USA"
      ],
      "name": "Nikathan Kumar"
    },
    {
      "affiliations": [
        "Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"
      ],
      "name": "Fleming Mathew"
    },
    {
      "affiliations": [
        "Department of Global Health and Social Medicine, Harvard Medical School Program in Global Surgery and Social Change, Boston, Massachusetts, USA",
        "Blood DESERT Coalition, Boston, Massachusetts, USA"
      ],
      "name": "Riya Sawhney"
    },
    {
      "affiliations": [
        "Department of Global Health and Social Medicine, Harvard Medical School Program in Global Surgery and Social Change, Boston, Massachusetts, USA"
      ],
      "name": "Avery A Thompson"
    },
    {
      "affiliations": [
        "Institute of Healthcare Management, Strathmore University, Strathmore Business School, Nairobi, Kenya"
      ],
      "name": "Cindy Makanga"
    },
    {
      "affiliations": [
        "Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Wendy Williams"
    },
    {
      "affiliations": [
        "Blood DESERT Coalition, Boston, Massachusetts, USA"
      ],
      "name": "Caroline Wesonga"
    },
    {
      "affiliations": [
        "Department of Health and Sanitation, Turkana County Government, Lodwar, Kenya"
      ],
      "name": "Abdirahman Musa"
    },
    {
      "affiliations": [
        "Lorugum Subcounty Hospital, Lorugum, Kenya"
      ],
      "name": "Nicodemus OM Nyanamba"
    },
    {
      "affiliations": [
        "Lodwar County Referral Hospital, Lodwar, Kenya"
      ],
      "name": "Kristina Kuya Lokuruka"
    },
    {
      "affiliations": [
        "Ministry of Health, Nairobi, Kenya"
      ],
      "name": "Hillary Barmasai"
    },
    {
      "affiliations": [
        "Ministry of Health, Nairobi, Kenya",
        "University of Nairobi, Nairobi, Kenya"
      ],
      "name": "Maurice Wakwabubi"
    },
    {
      "affiliations": [
        "World Bank Group, Nairobi, Kenya"
      ],
      "name": "Elizabeth Wangia"
    },
    {
      "affiliations": [
        "Strathmore University, Strathmore Business School, Nairobi, Kenya"
      ],
      "name": "Cavin Otieno Opiyo"
    },
    {
      "affiliations": [
        "Turkana County Government, Lodwar, Kenya"
      ],
      "name": "Epem Esekon"
    },
    {
      "affiliations": [
        "Department of Livestock Development, Turkana County Government, Lodwar, Kenya"
      ],
      "name": "Lokoel Gilchrist"
    },
    {
      "affiliations": [
        "Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland",
        "University of Pittsburgh, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Juan Carlos Puyana"
    },
    {
      "affiliations": [
        "Institute of Healthcare Management, Strathmore University, Strathmore Business School, Nairobi, Kenya",
        "Global Business School for Health, University College London, London, UK"
      ],
      "name": "Pratap Kumar"
    },
    {
      "affiliations": [
        "Children’s National Hospital, Washington, District of Columbia, USA",
        "The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA"
      ],
      "name": "Meghan Delaney"
    },
    {
      "affiliations": [
        "Karolinska Institute, Stockholm, Sweden",
        "WHO Collaborating Centre for Emergency, Critical and Operative Care, New Delhi, India",
        "The George Institute for Global Health, New Delhi, India",
        "University of Global Health Equity, Kigali, Rwanda"
      ],
      "name": "Nobhojit Roy"
    },
    {
      "affiliations": [
        "Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA"
      ],
      "name": "Andrew P Cap"
    },
    {
      "affiliations": [
        "Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Tanujit Dey"
    },
    {
      "affiliations": [
        "Lodwar County Referral Hospital, Lodwar, Kenya"
      ],
      "name": "Stephen Omondi Onyango"
    },
    {
      "affiliations": [
        "Ministry of Health, Turkana County Government, Lodwar, Kenya"
      ],
      "name": "Edward Mutebi"
    },
    {
      "affiliations": [
        "Lodwar County Referral Hospital, Lodwar, Kenya"
      ],
      "name": "Kevin Hongo"
    },
    {
      "affiliations": [
        "Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA",
        "Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Nakul Raykar"
    },
    {
      "affiliations": [
        "Institute of Healthcare Management, Strathmore University, Nairobi, Kenya"
      ],
      "name": "Tecla Chelagat"
    },
    {
      "affiliations": [
        "Linda S Barnes Consulting, Seattle, Washington, USA"
      ],
      "name": "Linda Barnes"
    }
  ],
  "title": "Implementation and evaluation of a community walking blood bank for haemorrhagic shock when banked blood is unavailable: protocol for a mixed-methods, effectiveness-implementation study – phase 2 of the Local Initiative for emergency blood (LIFE-Blood) study",
  "uid": "6ed61766-2c9d-5d00-bbaf-05abf1120584"
}