[Transfusion risk in sub-Saharan Africa: current situation and challenges specific to the Democratic Republic of...

Ensuring the safety of blood transfusions remains a significant health challenge in sub-Saharan Africa (SSA), especially in the Democratic Republic of Congo (DRC). Political instability, inadequate infrastructure, and the absence of comprehensive hemovigilance systems exacerbate the risks. This situation exposes blood transfusion recipients to post-transfusion complications, especially infectious ones, that could be avoided. Additionally, sociocultural mistrust of blood donation contributes to the shortage of safe blood products. This narrative review aims to address the current issues related to transfusion safety in SSA, particularly in the DRC.

An integrative narrative review was conducted from January to April 2025 using the following English and French keywords: "transfusion safety," "sub-Saharan Africa," "blood transfusion risks," "post-transfusion surveillance," "transfusion-transmitted infections," "hemovigilance," and "Democratic Republic of the Congo," either alone or in combination using Boolean operators. Original articles, systematic reviews, institutional reports, and recommendations from public health organizations published between 2000 and 2025 were included. The selection focused on sources relevant to transfusion safety systems, clinical practices in settings with limited resources, and surveillance models in low-and middle-income countries.

The DRC still lacks an operational national hemovigilance system. Transfusion management remains decentralized, fragmented, and insufficiently standardized, which compromises the quality and safety of care.The lack of traceability and incomplete screening sometimes expose recipients to avoidable risks. However, several local initiatives supported by non-governmental organizations (NGOs), academic institutions, or international programs are emerging. Identified levers include developing digital surveillance tools, networking sentinel laboratories, improving access to safe blood in peripheral areas, and creating regional centers for continuing education and applied research in transfusion safety.

Ensuring the long-term safety of blood transfusions in the DRC requires a systemic, integrated, multisectoral approach based on contextual innovation, institutional support, and strengthening local research capacities. Political mobilization and strengthening partnerships are essential to establishing an effective hemovigilance system.