1.1.            Background

The demand for whole blood transfusion and derivatives is rising worldwide. This is in relation to increasing life expectancy, accidents, severe anaemia, cancer, chronic diseases, obstetric and gynaecologic anaemic-related complication management, and technological advancements in the healthcare delivery system demanding blood transfusion [1,2]. Voluntary blood donation is the only means by which blood can be stored and made available for the population [3], since blood cannot be manufactured. However, blood collection agencies worldwide are increasingly facing the problem of recruitment and retention of adequate numbers of blood donors [4]. The World Health Organization (WHO) advocates an annual blood donation rate of 1% to 3% of the population, as the minimum needed to meet a country’s most basic requirements for blood [5], and by 3% to 5% of a country’s healthy population to maintain an ideal stock of blood and blood products to keep up with its consumption [3]. The WHO also insists that countries should focus on young people to achieve 100% regular voluntary non-numerated blood donation since an estimated 38% of  VBDs are youths under the age of 25 [5].

In Africa, an annual blood donation rate of 5.6/1000 population was reported [6]. In sub-Saharan Africa, 1,494,263 units of blood were collected in 45 countries in 2020, compared to 1,794,211 units of blood in 2019. resulting in an average decreased proportion of 16.7% [7]. This proportion was lower in Central Africa (34.4%) [6]. The lack of blood donors in Sub-Saharan African (SSA) countries, on the other hand, is due to factors, such as the lack of well-established units for the provision of blood services; poor infrastructure and logistics for blood donor recruitment and retention; geographically widespread population, many of whom live in rural areas with poor access to blood centres and poor communication networks; high prevalence of transfusion transmissible infections (TTIs); misperceptions about blood and blood donation due to lack of knowledge, cultural influences, and resource constraints [4]. Consequently, the blood donation rate is  6.8/1000 persons and 5/1000 persons donations in middle and low-income countries respectively [8].

The blood donor system in Cameroon mostly depends on a combination of voluntary and replacement donors with an overwhelming majority of donors coming from family replacement donors. According to the National Blood Transfusion Programme (NBTP), Cameroon needs 400.000 units of blood annually [9]. However, in 2018, 94,873 units of safe blood were collected [9], in 2019, 47,275 units [7], and in 2020, only 32,328 units. This represents just 8% of the annual need. Meanwhile, the national prevalence of anaemia stands at 60.3% in children, 39.5% in women [10].  Donor eligibility, negative attitudes, and the lack of education explain this shortage in various facilities as people assume that they may develop a complication from donating [1].  There are major misperceptions underlying this practice. Studies on knowledge, attitude, and practice (KAP) have been done in many countries to understand factors that influence blood donation and are the basis for communication and donor mobilization strategies. In Cameroon, not much has been done.

Willingness to donate blood without expecting a financial reward is one major factor that influences blood donation practice. Youths (students) are a potential source of great interest, not only for the blood they could supply, but also because information on blood donation could promote the spread of healthy lifestyles, the acquisition of greater awareness about one’s health, and could contribute to the development of a mature, responsible civic attitude [11]. Students are nevertheless highly accessible, healthy, active, dynamic, resourceful, receptive, and are majoritily youths.

1.2.            Problem statement

In Cameroon, there is a constant need for blood transfusion. The national prevalence of anaemia stands at 60.3% in children, 39.5% in women, yet in 2020 only 8% of the annual needs of blood was met. Most blood banks are insufficiently stocked, and are constantly waiting for potential donors who are the students found in tertiary institutions. The blood donation system in Cameroon solely depends on family replacement donation making it difficult to retain and follow up donors. Some of these persons who nevertheless engage in this mode of blood donation still have myths and limited awareness about blood donation. Little or no studies have been carried out so far to understand the factors behind the relent in blood donation among youths especially students.

1.3. Justification

This study targets undergraduate students because they are: educated, confine in a defined community, in good health and/or physically fit, and easily accessible. The study will help us identify some of the factors that motivate University students to engage in voluntary blood donation. It will also help us to understand the level of knowledge and the perception of undergraduate students towards voluntary blood donation (VBD), in other to identify various barrier levels to blood donation. The findings of this study could inform policymakers on how to design awareness programmes and intervention that will motivate studentsengage in VBD. Findings could also serve as a source of reference and literature for other researchers in the future. Also, findings, when disseminated, could help change the perceptions of VBD among students and the community at large and possibly increase the practice of VBD in the student community.

1.4. Research questions

1. What is the level of knowledge of blood donation among students of the University of Buea?
2. What are their perceptions towards blood donation,?
3. What are their practices regarding blood donation?
4. What factors influence the levels of knowledge, perceptions, and practices of blood donation among these students?

1.5.  Research hypotheses

1. Undergraduate students have poor knowledge about blood donations.
2. They have a negative perception of blood donation
3. They have poor (unfavorable) practices towards blood donation
4. There are several factors that can influence the levels of knowledge, perception, and practice towards blood donation.

1.6.  Research goal and objectives

• Goal

Provide data to help improve the policy to encourage voluntary blood donation.

• General objective

The main objective of the study is to examine the knowledge, perceptions, and practices of voluntary blood donation among undergraduate students of the University of Buea and identify their associations.

• Specific objectives

1. To determine the level of knowledge of undergraduate students of the University of Buea on voluntary blood donation
2. To identify the perceptions of these students towards voluntary blood donation
3. To identify their practices regarding voluntary blood donation
4. To identify the factors associated with the knowledge, perceptions and the practices of blood donation among these students