Identifying blood deserts in Liberia: A geospatial analysis

Abstract

BACKGROUND: Understanding patterns in blood availability is key to identifying appropriate interventions to increase blood access, particularly interventions intended for use in blood deserts, defined as areas in which >75% of blood needs are unmet. Blood availability patterns are particularly difficult to understand in the decentralized systems made up primarily of hospital-based blood banks, which are common in low- and middle-income countries. In Liberia, >95% of blood is collected at decentralized hospital-based blood banks. STUDY DESIGN AND METHODS: A national cross-sectional geospatial analysis of blood bank accessibility in Liberia estimated the population residing within the cumulative travel-time thresholds of blood bank facilities and contextualized these findings using a static national estimate of blood supply. Geographic accessibility to blood banks was estimated in ArcGIS Pro 3.6 using a raster-based travel-time cost-distance approach. RESULTS: Only 0.22% of people in Liberia live within 30 min of a blood bank; 0.87% live within 60 min. DISCUSSION: Liberia is a blood desert, and blood-desert specific interventions (e.g., civilian walking blood banks), some of which may focus on hospital-based blood banks, should be considered. Interventions to enhance blood collection at the centralized national level, such as Club 25, are likely also appropriate. This analytic method effectively identified patters in blood availability in the absence of a countrywide blood inventory system. However, factors such as available road and population data, and specific geographic features, could lead the method to over- or underestimate blood availability and should be taken into account when choosing this approach.