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Globally, more than half a million women die each year from complications of pregnancy and childbirth. The most common cause of maternal death is severe bleeding, which contributes to up to 44% of maternal deaths in sub-Saharan Africa.(Tapko.J.B. , 2014)
African Region frequently experiences man made natural disasters that considerably increase the demand for blood transfusion. Unfortunately, many countries in the Region do not collect enough blood for their populations. Blood donation rates in Africa are generally low(4.15 per 1000 population) in 2006 compared with over 30 per 1000 population on average in developed countries. Most of the African countries in the WHO African Region collect less than half of the blood needed to meet the transfusion requirements of their populations.(Tapko.J.B. , 2014)
Individuals lost their life’s due to lack to access to a safe blood supply during emergency health conditions resulted due to violence or injuries, road traffic accidents and complications related to pregnancy and child birth (like haemorrhage). With this instances for example,world wide, each year, more than 100 million people sustain injuries and most of them die from blood loss.Further more, Road traffic accidents are still the leading cause of deaths among people age 15–29 years;according to the latest WHO estimates, 1.25 million people died from road traffic injuries (over 90% of deaths occurred in low and middle income countries), almost 60% of road traffic deaths occur among people aged 15–44 years((Dalvi, 2004)).
Similarly, globally high number of maternal deaths are due to ineffective blood transfusion services, with this respect for example, every day around 830 women die from complications related to pregnancy and childbirth, where almost 90% of this death accounted by occurs in developing nation. Haemorrhage alone accounting for up to 27% of maternal deaths worldwide ((USAID, 2014))(11no ref. still).
The contribution of haemorrhage to maternal mortality in Africa was about 17.3% (mean; range 9.1–47.7%) of these deaths 26% preventable and happen due to lack of blood for transfusion. Reasons for lack of blood for transfusion had arisen from inability of the women to pay for blood in advance, lack of blood donors, unwillingness of relatives to donate blood(Bates et al., 2008). Sub-Saharan African accounts for 24·5% (16·9–34·1) maternal death due to haemorrhage (Say et al., 2014)
Since timely access to safe blood transfusion is a life-saving measure in many of these clinical conditions and can also prevent serious illness in these patients. Furthermore, blood transfusion also recognized as one of the eight essential component of comprehensive emergency obstetric care, which has been contribute its share to reduce maternal mortality(Say et al., 2014)).
In this respect for instance, literatures designates the existence,access to safe blood could help to prevent up to one quarter of maternal deaths each year (5).Similarly, finding from a systematic review to assess the contribution of ineffective blood transfusion services on maternal mortality in Sub-Saharan Africa, showed that overall 26% (16–72%) of maternal haemorrhage deaths were due to lack of blood transfusion (10(Bates et al., 2008)).
WHO estimates that blood donation by 1% of the population is generally the minimum needed to meet a nation?s most basic requirements for blood (6(WHO, 2010)).

Worldwide, a total collection of 112.5 million blood donations made.However, the level of blood collection varies between developed and developing regions(compared to the total population they have). With this, instance for example,about 47% of the global donations were from high-income countries, though low-income, and lower middle-income countries collected 2% and 22% of the global donations respectively(7(WHO, 2017b).
There were wide variations in whole blood donation rates among countries, which was 32.1 donations per 1000 population per year in high-income countries, 14.9 in upper middle-income countries, 7.8 in lower middle-income countries, and 4.6 in low-income countries. (WHO, 2017a)
Ensuring sufficient supplies of safe blood and blood products, and prevention of transfusion-transmissible infections are primary concern during selection of blood donors, where voluntary non-remunerated donations are safe compare to other sources.
There are variations in blood donation types also as explained by WHO in 2013. With this, instance for example, worldwide, of the total 88.2 million whole blood donations, 83.3% were reported as voluntary non-remunerated donations, 16.4% as family or replacement donations, and the rest 0.3% as paid blood donations; where as the proportion of voluntary non-remunerated donations in the African Region, was 74.8% , 24.7% family/relatives, 0.4% paid. The average annual blood donation rate was 4.3 units per 1000 population
In Ethiopia blood donation practice remains a challenge to many health facilities to ensure availability of adequate and safe blood products. With this instance,despite the fact that the country?s annual demand of blood was 250,000 units, only 88,000 units of blood collected(WHO, 2009b)from this all collected, voluntary non-remunerated donations were 53, 686(23.5%), Family/ replacement donations were 25,588 (WHO, 2017a)) and the donation rate in Ethiopia is 0.6%(Tapko.J.B. , 2014, WHO, 2017b)).
Different studies across the world shows ,socio-demographic and economic characteristics, knowledge, and attitude related variables identified as a predictor factors for blood donation practices (13–18(Mirutse, 2014).

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Indeed a range of studies from Ethiopia aimed to assess blood donation practice and factors associated with it (17(Mende M 2016),(Shambel Wedajo 2016)shambel et, al.2016). However, most of them were facility based studies, which is difficult to asses the general population towards blood donation practice, since a very large proportion of the Blood donation is the process of collecting, testing, preparing, and storing blood and blood components.Blood is the most precious gift that anyone can give to another person, the gift of life. A decision to donate blood can save a life. ( )
Blood transfusion is one crucial part of health care systems which contributes to saving millions of lives each year in both routine and emergency situations. (WHO, 2008-2015, WHO, 2009a)
Most of donated blood is commonly used for the management of emergency health conditions, which resulted from due to pregnancy and childbirth ,trauma mainly from road traffic accidents, and the management of congenital blood disorder(WHO, 2004, Say et al., 2014)
With this instance for example, About 234 million major operations are performed worldwide every year, with 63 million people undergoing surgery for traumatic injuries, 31 million more for treating cancers and another 10 million for pregnancy-related complications.which are impossible without access to blood and blood products from donors (WHO, 2010).

Countries across the globe develop different strategies in order to ensure the availability and sustainability of blood and blood products by developing a national level blood policy. With this instance for example, worldwide, 122 countries (68%) developed a national blood policy and establish a total of 13,282 blood centers (WHO, 2017b).
Approximately 8 million blood are currently needed to meet transfusion demand for a population of nearly 800 million in Africa, according to the World Health Organization guidelines 10 per 1000 population. However, only 3 million of blood are collected annually, only 40% of estimate is satisfied. (Bloch et al., 2012)
Ethiopia has issued national blood transfusion services strategy as part of its health policy, and blood transfusion services were provided by the Ethiopian Red Cross Society (ERCS) starting from its establishment (1969 ). (ETHIOPIA and HEALTH, 2005).
Despite the benefit of blood transfusion service, there are also risks of acquiring of transfusion-transmissible infections (TTI)including HIV, hepatitis B, hepatitis C, Treponema pallidum (syphilis), malaria, unless care made during selection of blood donors(6,9(WHO, 2010, WHO, 2009d)).
Generally, blood donors categorized in to three major groups, voluntary non-remunerated donors,family, or replacement, and paid donors((ETHIOPIA and HEALTH, 2005). For the fact, the availability of blood and blood products alone does not ensure the survival and best health condition of the recipient unless it is from safe source; where the risk Transfusion-Transmissible Infections (TTI) are difficult to prevent voluntary blood donation practices are established. However mostBlood donation is the process of collecting, testing, preparing, and storing blood and blood components.Blood is the most precious gift that anyone can give to another person, the gift of life. A decision to donate blood can save a life. ( )
Blood transfusion is one crucial part of health care systems which contributes to saving millions of lives each year in both routine and emergency situations. (WHO, 2008-2015, WHO, 2009a)
Most of donated blood is commonly used for the management of emergency health conditions, which resulted from due to pregnancy and childbirth ,trauma mainly from road traffic accidents, and the management of congenital blood disorder(WHO, 2004, Say et al., 2014)
With this instance for example, About 234 million major operations are performed worldwide every year, with 63 million people undergoing surgery for traumatic injuries, 31 million more for treating cancers and another 10 million for pregnancy-related complications.which are impossible without access to blood and blood products from donors (WHO, 2010).

Countries across the globe develop different strategies in order to ensure the availability and sustainability of blood and blood products by developing a national level blood policy. With this instance for example, worldwide, 122 countries (68%) developed a national blood policy and establish a total of 13,282 blood centers (WHO, 2017b).
Approximately 8 million blood are currently needed to meet transfusion demand for a population of nearly 800 million in Africa, according to the World Health Organization guidelines 10 per 1000 population. However, only 3 million of blood are collected annually, only 40% of estimate is satisfied. (Bloch et al., 2012)
Ethiopia has issued national blood transfusion services strategy as part of its health policy, and blood transfusion services were provided by the Ethiopian Red Cross Society (ERCS) starting from its establishment (1969 ). (ETHIOPIA and HEALTH, 2005).
Despite the benefit of blood transfusion service, there are also risks of acquiring of transfusion-transmissible infections (TTI)including HIV, hepatitis B, hepatitis C, Treponema pallidum (syphilis), malaria, unless care made during selection of blood donors(6,9(WHO, 2010, WHO, 2009d)).
Generally, blood donors categorized in to three major groups, voluntary non-remunerated donors,family, or replacement, and paid donors((ETHIOPIA and HEALTH, 2005). For the fact, the availability of blood and blood products alone does not ensure the survival and best health condition of the recipient unless it is from safe source; where the risk Transfusion-Transmissible Infections (TTI) are difficult to prevent voluntary blood donation practices are established. However most countries especially Sub Saharan countries remained considerably dependent on family/ replacement and paid blood donors. Similarly in Ethiopia during a period of 2013, about 25,588 were from family/ replacement donors(WHO, 2009c).

Therefore, to ensure the availability, safety, and sustainability of blood transfusion services, it is mandatory to develop positive community attitudes to voluntary blood donation in order to motivate, recruit, and retain a sufficient number of safe blood donors.Additionally, public support must be fostered by confidence that the blood donation process is safe and that the blood transfusion service will respect and protect the health of blood donors accompanied with mobilizing young people as a new generation of blood donors((WHO, 2009a)). World Health Organization (WHO) encourages countries to foster on adult population to achieve 100% non-remunerated voluntary blood donation by 2020 Dhingra 2.(blood gondar pdf)(no ref.). This is why my research question focuses on adult population blood donation practice in Shashogo district.
1.2. Statement of the Problem
Globally, more than half a million women die each year from complications of pregnancy and childbirth. The most common cause of maternal death is severe bleeding, which contributes to up to 44% of maternal deaths in sub-Saharan Africa.(Tapko.J.B. , 2014)
African Region frequently experiences man made natural disasters that considerably increase the demand for blood transfusion. Unfortunately, many countries in the Region do not collect enough blood for their populations. Blood donation rates in Africa are generally low(4.15 per 1000 population) in 2006 compared with over 30 per 1000 population on average in developed countries. Most of the African countries in the WHO African Region collect less than half of the blood needed to meet the transfusion requirements of their populations.(Tapko.J.B. , 2014)
Individuals lost their life’s due to lack to access to a safe blood supply during emergency health conditions resulted due to violence or injuries, road traffic accidents and complications related to pregnancy and child birth (like haemorrhage). With this instances for example,world wide, each year, more than 100 million people sustain injuries and most of them die from blood loss.Further more, Road traffic accidents are still the leading cause of deaths among people age 15–29 years;according to the latest WHO estimates, 1.25 million people died from road traffic injuries (over 90% of deaths occurred in low and middle income countries), almost 60% of road traffic deaths occur among people aged 15–44 years((Dalvi, 2004)).
Similarly, globally high number of maternal deaths are due to ineffective blood transfusion services, with this respect for example, every day around 830 women die from complications related to pregnancy and childbirth, where almost 90% of this death accounted by occurs in developing nation. Haemorrhage alone accounting for up to 27% of maternal deaths worldwide ((USAID, 2014))(11no ref. still).
The contribution of haemorrhage to maternal mortality in Africa was about 17.3% (mean; range 9.1–47.7%) of these deaths 26% preventable and happen due to lack of blood for transfusion. Reasons for lack of blood for transfusion had arisen from inability of the women to pay for blood in advance, lack of blood donors, unwillingness of relatives to donate blood(Bates et al., 2008). Sub-Saharan African accounts for 24·5% (16·9–34·1) maternal death due to haemorrhage (Say et al., 2014)
Since timely access to safe blood transfusion is a life-saving measure in many of these clinical conditions and can also prevent serious illness in these patients. Furthermore, blood transfusion also recognized as one of the eight essential component of comprehensive emergency obstetric care, which has been contribute its share to reduce maternal mortality(Say et al., 2014)).
In this respect for instance, literatures designates the existence,access to safe blood could help to prevent up to one quarter of maternal deaths each year (5).Similarly, finding from a systematic review to assess the contribution of ineffective blood transfusion services on maternal mortality in Sub-Saharan Africa, showed that overall 26% (16–72%) of maternal haemorrhage deaths were due to lack of blood transfusion (10(Bates et al., 2008)).
WHO estimates that blood donation by 1% of the population is generally the minimum needed to meet a nation?s most basic requirements for blood (6(WHO, 2010)).

Worldwide, a total collection of 112.5 million blood donations made.However, the level of blood collection varies between developed and developing regions(compared to the total population they have). With this, instance for example,about 47% of the global donations were from high-income countries, though low-income, and lower middle-income countries collected 2% and 22% of the global donations respectively(7(WHO, 2017b).
There were wide variations in whole blood donation rates among countries, which was 32.1 donations per 1000 population per year in high-income countries, 14.9 in upper middle-income countries, 7.8 in lower middle-income countries, and 4.6 in low-income countries. (WHO, 2017a)
Ensuring sufficient supplies of safe blood and blood products, and prevention of transfusion-transmissible infections are primary concern during selection of blood donors, where voluntary non-remunerated donations are safe compare to other sources.
There are variations in blood donation types also as explained by WHO in 2013. With this, instance for example, worldwide, of the total 88.2 million whole blood donations, 83.3% were reported as voluntary non-remunerated donations, 16.4% as family or replacement donations, and the rest 0.3% as paid blood donations; where as the proportion of voluntary non-remunerated donations in the African Region, was 74.8% , 24.7% family/relatives, 0.4% paid. The average annual blood donation rate was 4.3 units per 1000 population
In Ethiopia blood donation practice remains a challenge to many health facilities to ensure availability of adequate and safe blood products. With this instance,despite the fact that the country?s annual demand of blood was 250,000 units, only 88,000 units of blood collected(WHO, 2009b)from this all collected, voluntary non-remunerated donations were 53, 686(23.5%), Family/ replacement donations were 25,588 (WHO, 2017a)) and the donation rate in Ethiopia is 0.6%(Tapko.J.B. , 2014, WHO, 2017b)).
Different studies across the world shows ,socio-demographic and economic characteristics, knowledge, and attitude related variables identified as a predictor factors for blood donation practices (13–18(Mirutse, 2014).

Indeed a range of studies from Ethiopia aimed to assess blood donation practice and factors associated with it (17(Mende M 2016),(Shambel Wedajo 2016)shambel et, al.2016). However, most of them were facility based studies, which is difficult to asses the general population towards blood donation practice, since a very large proportion of the potentially eligible population does not actively donate blood. Therefore, in this study further exploration of knowledge at the community level were considered.
The rationale of the current study; for the fact that the current study area, (Shashogo district), many mothers referred due to pregnancy and child birth complications which either need surgical procedure or emergency obstetric interventions like blood transfusion. Therefore, understanding community practice and factors related to blood donation will help to come up with strategies and alternative strategies that possibly improve community awareness towards blood donation practice and ensure the availability as well as sustanablity of blood collection activities.
1.3.Rationale of the Study
As evident from reports across the globe, the level of blood collection varies between developed and developing regions, which also true in blood donation sources(7(WHO, 2017b)). Which subsequently affect the quality of health care services and contribute for unacceptable 5 deaths due to insufficient supplies of safe blood and blood products, and increases risk of transfusion-transmissible infections. This problem is still a burden to many Sub-Saharan Africa countries including Ethiopia. Based on the 2013 reports, in Ethiopia of total 79,274 blood donors, 53, 686 were voluntary non-remunerated donations; Family/ replacement donations were 25,588. Moreover, the current study area known by high road traffic accidents and cause increase demand of blood transfusion. Moreover,as of the investigator knowledge,voluntary blood donation status and related factors,in the current study area are not well studied.

Therefore, this study try to assess community blood donation practice and identify independent predictors of voluntary blood donation practice, in the current study area to be use by policy makers, health care providers, and researchers to improve or strengthen strategies related to community practice and awareness on blood donation. Moreover, the information obtained from this study will add to the existing body of knowledge toward of blood donation service to implement alternative intervention strategies. 6
2. Literature Review
2.1 Global blood donation practice
As the reviewed literatures showed difference in blood donation practice and blood donors worldwide.
According to the a national wide survey done in Pakistan, the over all blood donation practice were 51% ,from this 29% had donated blood voluntarily and 22% had donated blood for friends and family. (Waheed. U. , 2015) Similarly, a study in Pelotas, Southern Brazil done and it shows,blood donation prevalence for ever donated respondents were 32%,(Zago et al., 2010)
Another study findings from Africa shows, blood donation practice is still poor, for example in Democratic Republic of Congo (54.9%) (Kabinda et al., 2014), as study in Nigeria, University of Benin Teaching Hospital, Benin City,among Health care Workers Practice of Blood Donation. 22.1% have donated in the past. 13.9% were regular donors. 41.7% are voluntary, and 52.8% donated to a friend or relative in need of blood (Nwogoh Benedict 2013,)and in Botswana, only 27.1 donate blood previously (Pule et al., 2014). In Sub-Saharan Africa all blood donors should be voluntary and non remunerated, replacement donors are common throughout Sub-Saharan Africa.(Osaro and Charles, 2011)
In Ethiopia, as evident from different study findings and reports, only 22% of blood is being donated by VBD; which put the country among countries that have least number of VBD (Group C, countries with

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