SCHOOL OF PUBLIC HEALTH COLLEGE OF HEALTH SCIENCES UNIVERSITY OF GHANA PERCEPTIONS OF VOLUNTARY BLOOD DONATION AMONG THE YOUTH IN LA DADEKOTOPON BY TANYE, SHEILA (10212414) THIS DISSERTATION IS SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF SMASTER OF SCIENCE IN APPLIED HEALTH SOCIAL SCIENCE DEGREE JULY, 2015 University of Ghana http://ugspace.ug.edu.gh i DECLARATION I, Sheila Tanye, declare that I achieved this work independently under the supervision of Dr. Collins Stephen Ahorlu. I declare that except for other peoples works which have been duly acknowledged, this work is a result of my own original research, and that this dissertation, either in whole or in part has not been presented elsewhere for another degree. ……………………………………… ……………………………….. Sheila Tanye Date (Student) …………………………………… ……………………………… Dr. Collins Stephen Ahorlu Date (Supervisor) University of Ghana http://ugspace.ug.edu.gh ii DEDICATION I would like to dedicate this work to my husband, Peter Van-Dyck and my children, Ulrick and Gerald Van-Dyck, for affording me the time to concentrate on my studies, while that most needed motherly attention was temporally withdrawn. Thank you my Princes. University of Ghana http://ugspace.ug.edu.gh iii ACKNOWLEDGEMENT I thank God almighty for his unending love and mercies upon my life, and for guiding, protecting and strengthening me at all times of need. I would like to thank each and every one who helped me in one way or the other to complete this work. Your support has been very crucial to the production of this dissertation. I would start by thanking my academic supervisor, Dr. Collins Stephen Ahorlu, whose knowledge in research has enlightened me and given me direction to follow in completing this work. His critical reading, valued advice, intellectual guidance, suggestions and commitment to ensure that my dissertation turned out good was very helpful. I must say thank you for your support and advice. Support and prayers from my family are very much appreciated especially my brother John–Paul Tanye who took time off his busy schedule to edit my work whenever I approached him. To my mother in-law, Mrs. Matilda Van-Dyck, I say thank you for being there for me while I juggled between motherhood and schooling. You are the best. To all my friends especially Wilhelmina Cathline and Abibata Bavug who motivated and supported me throughout this course. Support from Dr. Kwabena Frimpong–Manso is very much appreciated. I am also grateful to Mr. George Addo for granting me time off work without which it could have been very difficult to attempt to study. All the participants of my research study for time they afforded me in responding positively to my invitation to partake in the study. I am very grateful to my lecturers Professor Philip Adongo, Dr. Mercy Ackumey, Dr. Phyllis Darko-Gyeke, Mr. Emmanuel Assampong and all the staff in the Department of Social and Behavioral Science, School of Public health, and all my colleagues. University of Ghana http://ugspace.ug.edu.gh iv ABSTRACT All over the world voluntary blood donation is hailed to be a safe source of blood supply and the window of hope for those who need blood transfusion. The main objective of this study was to examine the perceptions of voluntary blood donation among the youth in La Dadekotopon. The study also sought to determine the knowledge of the youth about voluntary blood donation, examine the attitude of the youth towards voluntary blood donation and to identify factors that influence the youth to engage in voluntary blood donation. A structured questionnaire was used to collect data from respondents. The data was analyzed using SPSS version 21. Descriptive statistics and Chi-square analysis were run to establish relationships between independent and the dependent variables. The study found that there was low level of knowledge on voluntary blood donation (46.4%) while respondents' attitude towards blood donation was good (72.31%). However, only a few (12%) respondents had actually donated blood voluntarily. Respondents reported factors such as; pro-social motivation, perceived need for blood, personal values and convenience to donation site as motivating factors to donate blood. On the other hand, factors such as; not having enough blood, lack of confidence in one’s self and fear of the unknown were the major deterrents reported. In conclusion, it was realized that even though blood donation was perceived by many of the respondents to be good, positive attitude alone without appropriate knowledge may not lead actual voluntary blood donation among our study participants. University of Ghana http://ugspace.ug.edu.gh v TABLE OF CONTENT Content Page DECLARATION ................................................................................................................. i DEDICATION .................................................................................................................... ii ACKNOWLEDGEMENT ................................................................................................. iii ABSTRACT ....................................................................................................................... iv TABLE OF CONTENT ...................................................................................................... v LIST OF TABLES ........................................................................................................... viii LIST OF FIGURES ........................................................................................................... ix LIST OF ABBREVIATIONS ............................................................................................. x CHAPTER ONE ................................................................................................................. 1 1.0 1NTRODUCTION ........................................................................................................ 1 1.1 Background ............................................................................................................... 1 1.2 Problem Statement .................................................................................................... 4 1.3 Justification ............................................................................................................... 6 1.4 Objectives .................................................................................................................. 6 1.4.1 General Objective ............................................................................................... 6 1.4.2 Specific Objectives ............................................................................................. 6 1.5 Research Questions ................................................................................................... 6 1.6 Conceptual Framework ............................................................................................. 7 CHAPTER TWO ................................................................................................................ 9 2.0 LITERATURE REVIEW ............................................................................................. 9 2.1 Introduction ............................................................................................................... 9 2.2 Worldwide and Regional African Disparities ........................................................... 9 2.3 Knowledge and Attitude about voluntary blood donations ..................................... 10 2.4 Factors influencing voluntary blood donation ........................................................ 16 University of Ghana http://ugspace.ug.edu.gh vi CHAPTER THREE .......................................................................................................... 20 3.0 METHODOLOGY ..................................................................................................... 20 3.1 Introduction ............................................................................................................. 20 3.2 Study Area ............................................................................................................... 20 3.3 Target Population .................................................................................................... 21 3.4 Sampling Technique ................................................................................................ 21 3.5 Sample Size Calculation.......................................................................................... 21 3.6 Variables.................................................................................................................. 22 3.6.1 Dependent variable. .......................................................................................... 22 3.6.2 Independent variables. ...................................................................................... 22 3.7 Sampling Procedure ................................................................................................ 22 3.8 Data Collection Techniques/Methods &Tools ........................................................ 22 3.9 Quality Control ........................................................................................................ 23 3.10 Pretesting ............................................................................................................... 23 3.11 Data Processing and Analysis ............................................................................... 23 3.12 Ethical Considerations........................................................................................... 24 CHAPTER FOUR ............................................................................................................. 25 4.0 RESEARCH FINDINGS ............................................................................................ 25 4.1 Introduction ............................................................................................................. 25 4.2 Background Characteristics of Respondents ........................................................... 25 4.3 Knowledge of respondents on blood donation ........................................................ 27 4.4 Attitude towards Voluntary Blood Donation .......................................................... 31 4.5 Factors influencing voluntary blood donation among the youth............................. 34 CHAPTER FIVE .............................................................................................................. 36 5.0 DISCUSSION ............................................................................................................. 36 5.1 Introduction ............................................................................................................. 36 University of Ghana http://ugspace.ug.edu.gh vii 5.2 Background Characteristics..................................................................................... 36 5.3 Knowledge Level of Blood Donation ..................................................................... 37 5.4 Attitude and Practice towards voluntary blood donation ........................................ 39 5.5 Factors influencing voluntary blood donation ........................................................ 40 CHAPTER SIX ................................................................................................................. 43 CONCLUSION AND RECOMMENDATIONS ............................................................. 43 6.1 Conclusions ............................................................................................................. 43 6.2 Recommendations ................................................................................................... 43 REFERENCES ................................................................................................................. 45 APPENDICES .................................................................................................................. 51 A. CONSENT FORM ....................................................................................................... 51 B. Questionnaire ............................................................................................................... 54 University of Ghana http://ugspace.ug.edu.gh viii LIST OF TABLES Table 4.1: Demographic characteristics of respondents ................................................... 26 Table 4.2: Knowledge of participants on blood donation ................................................. 29 Table 4.3: Relationship between educational level and knowledge of participants on blood donation .................................................................................................................. 31 Table 4.4: Attitude of participants towards blood donation ............................................. 33 Table 4.5: Relationship between attitude towards blood donation and sex ...................... 34 Table 4.6: Factors influencing blood donation ................................................................. 35 University of Ghana http://ugspace.ug.edu.gh ix LIST OF FIGURES Fig 1.1: Conceptual Framework ......................................................................................... 8 University of Ghana http://ugspace.ug.edu.gh x LIST OF ABBREVIATIONS FRD- Family replacement donations GSS- Ghana Statistical Service HBM- Health Belief Model LADMA- La Dadekotopon Municipality MDGs- Millennium Development Goals NBSG- National blood service, Ghana SPSS- Statistical Package for Social Sciences VBD- Voluntary blood donation WHO- World Health organization University of Ghana http://ugspace.ug.edu.gh 1 CHAPTER ONE 1.0 1NTRODUCTION 1.1 Background Blood donation refers to giving blood to be used for transfusion in saving the lives of others. There is no artificial blood for sale, which means that blood must be donated freely by someone, out of the love for life. Any person who gives blood voluntarily is referred to as a voluntary non-remunerated blood donor. Voluntary non-remunerated blood donors give blood of their own free will and receive no money or other payment that could be considered a substitute for money. Their primary motivation is to help unknown recipients and not to obtain any personal benefit. Blood donation is a simple and safe process that takes approximately fifteen (15) minutes. Any healthy person, both male and female, between the ages of seventeen (17) to sixty (60) years and weighing 50 kg and above is eligible to donate blood in Ghana. Four hundred and fifty milliliters (450mls) of blood can safely be donated every four months which means that a voluntary blood donor can donate blood three times in a year without any health effects (NBS, 2013). The blood donor system in Ghana mostly depends on a combination of voluntary and replacement donors with an overwhelming majority of donors coming from family replacement donors. Though most blood donors feel no side effects, some may experience minor side effects such as bruising from the needle, feeling faint, or nausea which usually subside quickly. Voluntary blood donation (VBD) not only helps save the lives of others, but also comes with some health benefits. The first benefit is the self- satisfaction that comes from acts of benevolence that help to save lives. Blood donors University of Ghana http://ugspace.ug.edu.gh 2 also benefits from free periodic medical exams and counseling which ensure their good health and help detect diseases early. Donors also become aware of their blood group, which is very beneficial in medical emergencies, but most importantly, voluntary blood donation guarantees an adequate and regular source of safe blood for all (NBS, 2013). In Ghana ,when one engages in voluntary blood donation once, it gives the donor special preference of access to blood transfusion during emergencies or when need arises and access to transfusion for relatives if one engages in voluntary blood donation five or more times (NBS ,2014). The World Health Organization (WHO) has suggested that, countries should focus on voluntary non-remunerated blood donors for their blood supply. The principal reasons for promoting regular voluntary non-remunerated blood donation are that, voluntary non-remunerated donors have a lower incidence and prevalence of transfusion-transmissible infections than first-time or occasional donors or family/replacement donors or paid donors. Voluntary non-remunerated donors are also more likely to be willing to donate blood regularly, which is important in maintaining safe and adequate supplies of blood (WHO, 2011). Regular donors are also more likely to respond to an appeal for blood donors during an emergency because they have already expressed a commitment to voluntary blood donation (WHO, 2011). Apart from these reasons, family replacement donations does not ensure regular and constant supply of blood needed to save lives since these donors donate because someone they know needs a blood transfusion or has been transfused. This type of donation is not resilient for emergencies since donors give blood on request which does not necessarily replace quantity and types of blood administered. Another challenge with family replacement donation is that blood may not be readily available University of Ghana http://ugspace.ug.edu.gh 3 when it is urgently needed but also puts pressure on patients and their relatives to produce blood donors during emergency cases. Therefore, VBD is the basis for a secure and adequate blood supply. it contributes to saving millions of lives every year in both regular and emergency situations, it allows to a greater extent difficult medical and surgical interventions to be performed and considerably improves the life expectancy and quality of life of people with a range of acute and chronic conditions. Despite extensive efforts worldwide, the availability of blood still remains in short supply (Sharma, 2013). The blood donor system in Ghana mostly depends on a combination of voluntary and replacement donors (NBS, 2014). The WHO (2010) estimates that if only 1% of the world’s population donate blood, this would be sufficient to cover basic needs of safe blood on a global level. Media campaigns regularly call on the generosity of potential blood donors, but perhaps because of the specificity of the act of donating blood, the number of donors is not increasing in Ghana. The youth 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 own health, and could contribute to the development of a mature, responsible civic attitude (Zito, Alfieri, Marconi, Saturni & Cremonesi, 2012). The youth also consist of a large group of people who can provide an enormous number of blood donations, however, blood donation is uncommon among the youth (Safizadeh, Pourdamghan & Mohamadi, 2009; Rolseth & Stange, 2012). Several studies find that the most common barriers for donating blood are the inconvenience with time and the blood center location (Yuan, Hoffman, Lu, Goldfinger, & Ziman, 2011). Achievement of University of Ghana http://ugspace.ug.edu.gh 4 Millennium Development Goals 4, 5, 6 & 8, can be facilitated by efforts to attain universal access to safe and adequate blood (WHO, 2010). 1.2 Problem Statement Voluntary blood donation is the best source of blood for transfusion. It helps save lives when needed. WHO (2010) has advocated countries to incorporate 100% VBDs in their national blood policy and legislative framework, with a recommended target donation rate of 10/1000 population. Globally, out of 163 countries in the WHO data base, only seventy -three (73) countries collect more than 90% of their blood, that is 10/1000 unit of blood from voluntary blood donations. In Africa, an annual voluntary blood donation rate of 4.3/1000 was reported in 2010, with a total collection of 3,191,808 (40.7%) units of blood. with forty countries collecting 10/1000 units of their blood from voluntary blood donations (WHO, 2014). In Ghana, the national blood bank is confronted with a constant shortage of whole blood and blood products. In 2013, for instance, the national blood bank recorded a collection of 33% of voluntary blood donations indicating about 3.6/1000 units of blood collected, which was less than 50% of the blood needed in Ghana, for the year 2013 (Mamaye, 2014). Although the need for blood is worldwide, there is a major imbalance between developing and developed countries when it comes to the level of usage and access to safe blood. Also, the practice of voluntary blood donation, is higher in developed countries than in developing countries (Olubiyi, Babalola, Olubiyi, Jibril, & Ibraheem, 2014). There is a clear difference when it comes to access to blood between high-income and low -income countries, with women and children requiring the greatest need of blood transfusion in all countries. About 50% of blood transfusions are given to children with University of Ghana http://ugspace.ug.edu.gh 5 severe anemia resulting from malaria and malnutrition, and to women with 44% of maternal deaths due to pregnancy related bleeding in sub-Sahara Africa, and other causes prompting blood transfusion, including anemia from sickle-cell disease, malnutrition, road traffic accidents and other forms and causes of injury (WHO, 2014). Whole blood products, however, can only be stored for a maximum of 35 days (NBS, 2014) and because blood is needed at any time, it must be collected regularly. Although most of the youth are capable of donating blood and many awareness campaigns promoting the importance of voluntary blood donation, have been carried out, only a small number of youth, 41% of reported voluntary blood donation, are under the age of 25 years (WHO, 2014). WHO also insist that countries should focus on young people to achieve 100% non-remunerated voluntary blood donation (WHO, 2010). An adequate supply of safe blood is only assured through regular donations by voluntary unpaid blood donors (World Health Organization, 2013). According to the WHO, each sector of the population will have different beliefs and attitudes and so it is necessary to find out what the general public, blood donors, and potential donors themselves know, think, and do regarding blood donation to provide a basis for defining approaches and messages for different audiences and selecting the most effective means of reaching them (WHO, 2010). Therefore, understanding the perceptions of VBDs among the youth in La Dadekotopon (LaDMA) is important for the design of any intervention to promote VBD among the youth. University of Ghana http://ugspace.ug.edu.gh 6 1.3 Justification This study will help us identify some of the factors that influence the youth to engage in voluntary blood donation. It will also help us to understand the level of knowledge and attitude of the youth towards VBD. Findings of this study could inform policy makers about the design awareness programs and interventions that will motivate the youth to engage 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 community members and possibly increase the practice of VBD in the community. 1.4 Objectives 1.4.1 General Objective The main objective of the study was to examine perceptions of VBD among the youth. 1.4.2 Specific Objectives 1. To determine the level of knowledge of the youth about VBD. 2. To examine the attitude of the youth towards VBD. 3. To identify factors that influence the youth in La to engage in voluntary blood donation. 1.5 Research Questions 1. What is the level of knowledge of the youth about VBD? 2. What is the attitude of the youth towards VBD? 3. What factors influence the youth in La to engage in VBD? University of Ghana http://ugspace.ug.edu.gh 7 1.6 Conceptual Framework This study adopted the health belief model (HBM) stipulated by Rosenstock, (1990) to understand the perception of VBD among the youth in La Dade Kotopong. The health belief model was formulated by social Psychologists, Hochbaum, Rosenstock and Kegels in the 1950s. The HBM was developed based on the understanding that a person will take a health related action if the person feels that a negative health condition can be avoided, has a positive expectation that by taking that action he or she will avoid a negative health condition and believes that he or she can successfully take a recommended health action. According to the HBM, any human behavior or action is guided by perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to the action and self –efficacy. As a general rule, the strength of a person’s intention to perform a particular behavior is based on the level of key concepts mentioned above, therefore the intent to engage in VBD will depend on the person’s knowledge, attitude and other factors. The conceptual framework assumes that behavior towards VBD in any population depends on how their demographic factors such as age, knowledge, ethnicity, religion and employment status, influence how susceptible they are to receiving blood transfusion, the perceived severity of not receiving blood transfusion, their perceived threat and benefits of VBD and the factors or cues to action that will influence them to engage in VBD. University of Ghana http://ugspace.ug.edu.gh 8 Fig 1.1: Conceptual Framework Adapted from (Rosenstock, 1990) Individual Perceptions Modifying Factors Likelihood of Action Perceived susceptibility Risk of need of blood transfusion Demographic variables  Sex  Age  Ethnicity  Level of education  Employment status  Religion Perceived benefits  VBD life saving  Self-satisfaction Perceived severity Consequences of not receiving blood transfusion are significant enough to try to avoid Perceived threat  Access to blood bank  Fear  Time commitment Likelihood of behavioral change  Likelihood of voluntarily blood donation Cues to action  Blood donation campaign.  Need of blood by family member  Knowledge about VBD University of Ghana http://ugspace.ug.edu.gh 9 CHAPTER TWO 2.0 LITERATURE REVIEW 2.1 Introduction This chapter presents the relevant literature on the concepts and the issues pertaining to voluntary blood donation. The chapter is organized into themes relevant to the problem of voluntary blood donation in literature worldwide, about regional African Disparities, about the level of knowledge about voluntary blood donation, attitudes towards voluntary blood donation and factors influencing voluntary blood donation. 2.2 Worldwide and Regional African Disparities According to the (WHO, 2014), out of one hundred and eight (108) million blood donations collected from one hundred and seventy–nine (179) countries globally, about half of them are collected in high-income countries, which is the home of 18% of the population in the world. Seventy-three countries collect more than 90% of their blood from VBDs; sixty of these countries collect 100% of their blood from VBDs. Thirty-eight of them from high income countries, twenty six from middle income countries and nine from low income countries (WHO, 2014). Seventy two countries collect 50% of their blood from VBD, eight of them are from high income countries, and forty-eight are from middle income countries and sixteen from low income countries. Twenty-five countries, however, were reported to be collecting remunerated blood donations. The literature also indicates that there is a clear variation among high income countries and low income countries with regards to level of access to blood. About 65% of blood University of Ghana http://ugspace.ug.edu.gh 10 transfusions are given to children under 5 years of age in low-income countries, while the most frequently transfused group of people in high-income countries is over 65 years of age, which accounts for up to 76% of all transfusions. The median rate of blood donation in high-income countries is 36.8 donations per 1000 population while that of middle-income and low-income countries are 11.7 donations and 3.9 donations respectively. 2.3 Knowledge and Attitude about voluntary blood donations Research conducted among college student in the US, Nigeria, India and Iran, indicates that the level of knowledge regarding blood donation was inadequate, incomplete or low. Their attitude towards blood donation was positive. However, the majority of students never donated blood and sited convenience, lack of opportunity and inadequate knowledge, lack of rewards such as souvenirs and the need for some form of motivation such as money as reasons for not doing so (Shaz et al., 2009; Salaudeen & Odeh, 2011; Arun et al., 2013; Allerson, 2012; Safizadeh, Pourdamghan & Mohamadi, 2009). Other studies conducted among medical and health professional students in Saudi Arabia, India, Kenya, Ethiopia, also indicate that the knowledge level about blood donation was inadequate and low (Mohammad, Ashfaq, Nanji, Anjum, & Lohar, 2011; Kowsalya et al., 2013; Misganaw et al., 2014; Kemboi, Maiyo, Mulw, 2014). Misganaw et al., (2014) and Kemboi et al., (2014) further found that the low level of knowledge increased with the years or the level of study, with the majority of respondents having an unfavorable attitude towards blood donation. University of Ghana http://ugspace.ug.edu.gh 11 Another study carried out by Ahmed, Zafar, Khan, Anjum & Siddique (2014), among undergraduate medical students in Pakistan, found that the majority of the participants had the appropriate knowledge of the various aspects of blood donation. Less than half of the participants, however, had a positive attitude about blood donation, with only half of participants indicating their willingness to engage in blood donation. They reported that males were found to have more appropriate knowledge, attitude and willingness to donate blood than the females. Another study conducted among medical students in south India, on the contrary, found an overall knowledge of blood donation among participants to be low, with the majority of participants never donating blood, with three quarters of participants having a negative attitude towards blood donation (Manikandan, Srikumar & Ruvanthika, 2013). Though, these studies were done among medical and health professional students, our study is among the youth, from various educational backgrounds and it will be interesting to see how the views of youths in our study with different educational backgrounds will differ from that expressed by medical students in the study discussed above. A research about blood donation among students in Malaysia found a high knowledge level about blood donation with a significant number of study participants having a poor attitude towards blood donation (Zainie, Hamid, Basiruddin, & Hassan, 2013). A study carried out by Ahmed et al., (2014), among undergraduate medical students in Pakistan, found that majority of the participants (92%) had the appropriate knowledge of the various aspects of blood donation. Less than 50% of the participants, however, had a positive attitude about blood donation, with 50% of participants indicating their University of Ghana http://ugspace.ug.edu.gh 12 willingness to engage in blood donation. They reported that males have a more appropriate knowledge, attitude and willingness to donate blood than females. Similar studies conducted in India regarding knowledge, attitude and practice on blood donation among health care medical students in Chennai, Tamil Nadu, Anand Gujarat and Puducherry, also found low levels of knowledge about blood donation among participants. But unlike the study in Saudi Arabia, this study found that the majority of the students had never donated blood. Majority of the non-donors however showed a positive attitude towards blood donation and expressed their willingness to donate blood in the future (Manikandan et al., 2013; Desai & Satapara, 2014; Kowsalya et al., 2013). Related studies carried out in Ethiopia and Kenya regarding factors associated with the level of knowledge, attitude and practice of blood donation among health science students of Addis Ababa University and University of Nairobi, found the overall level of knowledge among the students to be good with more than half of them having no previous blood donating record just like the studies in India and Saudi Arabia (Misganaw et al., 2014; Kemboi, et al., 2014). Another study carried out in India, about knowledge, attitude and practices on voluntary blood donation among college students also found that the knowledge level of blood donation among all the students was either inadequate or incomplete. The study also established that though more than three quarters of the students stated their wish to donate blood, less than one quarter of them ever donated blood, with 14.5% of them being voluntary donors (Arun et al., 2013). The opposite was found in Nigeria in a study regarding knowledge and behavior towards voluntary blood donation among students of a tertiary institution, where more than half of the students had suitable knowledge of blood donation, however only a few of them, less than a University of Ghana http://ugspace.ug.edu.gh 13 quarter of the students ever donated blood out of which just 3% of them were voluntary donors (Salaudeen et al., 2011). Though these studies were done among medical and other health students, our study is among the youth from various educational backgrounds and it will be interesting to see how their views and attitudes will differ from those expressed by medical students in the various studies discussed above. A study investigating knowledge, attitude and barriers concerning blood donation in Jordan found fairly insufficient knowledge yet a positive attitude about blood donation among the majority of the participants although more than half of participants had never donated blood (Abderrahman & Saleh, 2014). Another study, conducted in Iran, also showed that less than half of the respondents had enough knowledge about blood donation. There was also a considerable relationship between location, age, education, occupation and social status when it came to knowledge of blood donation, but there was no correlation between gender and marital status (Shakeri et al., 2012). Another study of knowledge, attitudes, and motivations towards blood donation among King Abdulaziz Medical City population, Saudi Arabia, found that, a higher level of knowledge and positive attitudes towards blood donation could influence blood donation among people. The study also found that males in the military aged between thirty-one to fifty years and who have a higher educational level were more likely to engage in blood donation (Alfouzan, 2014). Similarly, a study regarding knowledge, attitudes and beliefs of Turkish women towards blood donation, found positive attitudes towards blood donation among participants, although none of the women in the sample had ever donated blood. This was because, all University of Ghana http://ugspace.ug.edu.gh 14 the participants thought that blood donation it not advantageous for the women due to the loss of blood during menstruation and that men were more suitable to donate blood (Dilsad, Tanriover, Hidiroglu, Gurbuz, & Karavus, 2013). Also, a study of knowledge, attitude and practice of women about blood donation in Iran, found that working women had more knowledge and practice about blood donation, while illiterate women and housewives had the least knowledge and practice of blood donation (Shahshahani, 2007). Though, this study was done among women, our study is among the youth, both male and female and it will be interesting to see how the views of the females in our study will differ from that expressed by older women in the studies referred to above. A Survey assessing the knowledge on blood donation among voluntary blood donors in India showed that overall knowledge and general knowledge on blood donation among respondents was good, with gender and education having a significant association with knowledge (Hiremath, 2012). In a related study conducted in Nigeria among students of a tertiary institution, more than half of the respondents had good knowledge about blood donation, though only one quarter of the respondents had ever donated blood out of which only 3% of them had donated voluntarily (Salaudeen et al., 2011). A study on knowledge, attitude, and practice of VBD among healthcare workers at the University of Benin Teaching Hospital, Benin City, Nigeria, found that the majority of these workers had both a good knowledge level and a positive attitude towards blood donation. But, good knowledge and a positive attitude is not reflected in actual practice, since only less than a quarter of these workers actually practice blood donation with a little less than half of them doing it voluntarily (Nwogoh, Aigberadion & Nwannadi, 2013). Another study on knowledge, attitude and practice of VBD among physicians in a University of Ghana http://ugspace.ug.edu.gh 15 tertiary health facility, also in Nigeria, found that physicians had good knowledge of VBD as well as positive attitude towards blood donation. In terms of practice of VBD, however, a little less than half of them had donated blood with majority of these donating on voluntary bases (Nwogoh et al., 2012). Another study carried out in South Africa indicates that almost all the participants had an incomplete knowledge about blood donation with the majority of participants showing negative attitudes towards blood donation (Mamabolo, 2012). In a study of perceptions about VBD among the supportive service employees of a multi-specialty rural tertiary care hospital, the majority of the respondents believed that blood donation was a noble and lifesaving act, but they also had several misapprehensions regarding blood donation (Dhara & Dinesh, 2012). A cross-sectional study designed to understand donors' attitudes toward blood donation incentives showed that the majority of the donors donated blood for altruistic reasons. One quarter of the donors believed that incentives should be offered to encourage people to donate blood. The majority of the donors, however, believed that the most effective incentive for them was to be offered some specific blood tests. Participants who had donated for non-selfless reasons were more concerned about getting incentives. The need to collect incentives was more common among younger, married, first-time donors, donors with a lower educational level and donors with a past of more than five donations. It was noted that most blood donors had no wish to accept incentives, especially not among those who donated for selfless reasons, even though non-financial motivations may influence younger, married, first-time donors, donors with a lower educational level and those who may have donated in excess of five donations (Kasraian & Maghsudlu, University of Ghana http://ugspace.ug.edu.gh 16 2012). A cross sectional study carried out in Jordan found that participants had relatively inadequate knowledge about blood donation. More than half of participants showed a positive attitude towards blood donation (Abderrahman & Saleh, 2014). 2.4 Factors influencing voluntary blood donation Studies have found different factors and reasons for why people do not donate blood. Inhibiting factors preventing people from donating blood include fear about pain or other possible health problems, such as fatigue due to donating blood and anxiety about the safety of the process. Less frequent reasons were, inconvenient hours for blood donation, negligence and previous bad experiences involving the bad attitude from the blood center personnel and for repeat donors, earlier traumatic experiences (Patiakas, Diamantidis, Kelesiadou, Megalou, 2013). A similar study in Greece also suggests bad treatment by personnel and health complications as inhibiting factors of blood donation (Kriebards, Giortsiou, Barbalias & Beloukas, 2012). A study in France, discovered medical reasons as the most important factor for which both lapsed donors and non-donors will not donate blood, but also lack of time, fear of donating blood, negligence, lack of information, lack of money, lack of opportunity and prior deferral as the main obstacles to blood donation. However lack of time and fear of donating blood were the factors mostly cited mostly by lapsed donors and non-donors respectively (Duboz & Cunéo, 2010). A study investigating individual and contextual determinant of multiple donations in Canada found that access to clinics was a major factor for repeat donation, while fear of needles and uncertainty about the blood system or lost time were factors which University of Ghana http://ugspace.ug.edu.gh 17 influenced their decision not to donate blood by first time donors (Cimaroli, Pa ́ez, Newbold & Heddle, 2012). In Nigeria, not being strong and the thought by respondents that they do not have sufficient blood, were the two main motives for refusing to donate blood. Other factors were misconceptions, misinformation and lack of awareness, such as loss of manhood/libido and the exposure of blood to witchcraft were other explanations given (Umeora, 2005). Studies among women in Turkey towards blood donation, discovered that the traditional role of women as care givers and managers of the home are the main obstacles preventing women from donating blood as well as a belief of the impurity of female blood, the suspicion of having unhealthy blood, rumors, misbelieves and undesirable experiences, anxiety about the procedure and a suspicion of blood banks, as other factors preventing women from donating blood (Dilsad et al., 2013). An earlier study carried out in Iran also discovered anemia, fear, lack of time and difficulty in accessing donation sites and false beliefs about blood donation, as the factors inhibiting women from donating blood (Shahshahani, 2007). Our study will be inferring attempt to find out if women in our study will have different or similar factors inhibiting their decision to donate blood. A similar study conducted among African American college students, found, convenience and support from their university as the major barrier and motivator for blood donation (Shaz et al., 2009) One major motivating factor found by Abderrahman & Saleh (2014) that influenced most participants to donate blood is altruism to help others and save their live even if they do not know them. In another study conducted in Turkey, altruism was not the only factor influencing blood donation, but also to a combination of some egotistic reasons (Karacan, University of Ghana http://ugspace.ug.edu.gh 18 Aktan, Seval, Palabiyikoglu & Ayli, 2012). A similar study conducted in Italy also found helping others, family influence and social or moral obligation being the main motivating factors which influence first time donors. Females were more likely to donate for altruism while males were more likely to be influenced by significant others and the chance to undertake free medical screening to donate blood (Bani & Strepparava, 2011). A survey carried out among medical students in Karachi found that several factors influence volunteers to donate blood. The most influential motivating factors were social responsibility, family, friends, altruism and screening for disease were other motivating factors. Fear of complications, not asked to donate, lack of time, and fear of being diagnosed with some diseases were the factors preventing blood donation (Mohammad et al, 2011). Another study among high school pupils in Italy suggests that factors that will influence female pupils to donate blood include:, if called upon to donate for significant others, testimonies of the importance and benefits of blood donation from a recipient of blood transfusion, if they feel they will be appreciated by society, relatives and friends, because it is life-saving and a feeling of fulfillment as well as a previous donor, parents and friends/classmates and experts. While the males will be motivated to donate if they know that they will obtain tangible compensations such as educational credits, blood tests, free meal, if they will feel useful because it is lifesaving, a feeling of satisfaction different from other people because it is a good deed and different from other people, also the influence of previous donors and teachers.(Zito et al., 2012) University of Ghana http://ugspace.ug.edu.gh 19 With regards to factors preventing them from blood donation, the study discovered fear of falling ill or fainting after donation, fear of needles and of the unknown, and of being diagnosed with some disease, or contracting a disease/infection, fear of seeing blood. The study also found that, laziness was a major factor that will prevent most of the males from donating blood, while poor information, not feeling old enough, ignorance about the blood donation procedure, lack of time and unsuitable lifestyle/characteristics were more prominent among females (Zito et al., 2012). A similar study conducted among African American college students found convenience and support from their university as the major barrier and motivator for blood donation (Shaz et al., 2009). Another study among college students in India, discovered that a significant proportion of them believed monetary rewards and some form of motivation were going to influence them to donate blood (Arun et al., 2013). In our study, we will seek determine factors which are influencing the youth participate in voluntary blood donation in Accra. University of Ghana http://ugspace.ug.edu.gh 20 CHAPTER THREE 3.0 METHODOLOGY 3.1 Introduction This chapter presents the methodology that guided the study. The study employed a cross- sectional quantitative survey research design. The cross-sectional survey was used because there was limited time for the research; it also helped provide a quick outcome at a specific point in time. Also, it could estimate the perceptions of voluntary blood donations among the youth because the sample was taken from a whole population. 3.2 Study Area La Dadekotopon Municipality is in the Greater Accra Region of Ghana with an estimated population of 231,166 people (GSS, 2012). It shares boundaries to the south with the Atlantic Ocean, to the west with Osu Klottey Sub Metro, to the North with Ayawaso East Sub Metro and Ayawaso West -Sub Metro and to the East with Ledzokuku Krowor Municipality. It also has ten (10) electoral areas (Labone Express, 2013). Unpublished reports from the La Dadekotopon Municipal health directorate indicate that, the Municipality is divided into three (3) zones, namely the La South, La North and Tenashie. It has on record, four (4) public hospitals, nine (9) private clinics, three (3) private maternity homes and three (3) urban CHPS zones. Unpublished records at the La Dadekotopon Municipal Assembly also indicates that, the Municipality is a predominantly Ga community, but also with people from varying socio-economic and ethnic backgrounds. Land marks found within the municipality include the Kpeshie lagoon, Kotoka International Airport, the Ghana International Trade fair center and the La Pleasure Beach. University of Ghana http://ugspace.ug.edu.gh 21 3.3 Target Population The population of interest consisted of youth between the ages of eighteen (18) to thirty- four (34) years. This age bracket was chosen because the researcher wanted responses from adult youth who are within the age range considered as youth in the National Youth Policy of Ghana (2010). The La Dade Kotopon was chosen because it is one of the metropolis in the Greater Accra Region which contains the higher number of youth in Accra (Ghana Statistical Service, 2012). 3.4 Sampling Technique The sampling technique used to select the area within the LaDMA was cluster sampling and random sampling for respondents. Cluster sampling is a survey method in which the population is divided into groups (clusters) that have similar characteristics and then samples are drawn from each group and these groups are natural groupings of the population. La south was selected from the three zones within the La Dadekotopon Municipal Assembly using simple random sampling. The investigator started by making a random entry into the first household and interviewed the highest educated youth within the ages of 18-34 years and continued to interview any youth found in every other household until the sample size was achieved. Those who did not fall in the eligibility criteria were exempted from filling the questionnaire. 3.5 Sample Size Calculation A Sample size of two hundred and seventeen (217) respondents was used in the study. The sample size was calculated using Epi info 7 with confidence level of 95%, confidence limits of 5%), design effect of 1.0, expected frequency of 15% arrived at University of Ghana http://ugspace.ug.edu.gh 22 using previous studies, one cluster and an expected loss ratio of 10% and an estimated population of 122,295 people aged 15-49 years. 3.6 Variables 3.6.1 Dependent variable. The dependent variable for this study is Voluntary Blood Donation. 3.6.2 Independent variables. The independent variables for this study are; Age, Sex, Level of education, Ethnicity, Religion, Level of knowledge VBD, Attitude towards VBD, and factors influencing VBD. 3.7 Sampling Procedure The municipality was grouped into three Clusters, out of which one, the La South zonal area was randomly selected for the study. The researcher then made a random entry into the first household and interviewed any youth willing to be interviewed after administering informed consent to them. The researcher then continued interviewing every youth in every other household until the sample size was achieved. 3.8 Data Collection Techniques/Methods &Tools Questionnaire method was used for data collection among the youth aged 18 -34 years. Structured survey questionnaire on the research topic was designed and administered to respondents from La south. A semi-structured questionnaire comprising both open and close ended questions was used to collect specific and general responses from University of Ghana http://ugspace.ug.edu.gh 23 respondents. Investigator administered questionnaire method was employed in filling questionnaire to ensure consistency in asking the questions. 3.9 Quality Control The semi-structured questionnaire was created and revised based on reference materials and recommendations from supervisor. There were no research assistants so the researcher made sure the data was collected properly. All questionnaires were checked for mistakes and completeness. Any questionnaire that had unclear responses or missing information that could not be clarified was excluded. Double entry of data was done to reduce data entry errors and validate authenticity. 3.10 Pretesting Questionnaire was pretested on youth at Lashibi to test for feasibility and observe the reactions of respondents to specific questions asked. The pretesting was also done to verify acceptability of the questions and willingness of respondents to answer the questions as well as determine the average length of an interview session. 3.11 Data Processing and Analysis Descriptive statistics involving percentages and frequencies were used to analyze demographic characteristics, knowledge and attitude of respondents. Computer assisted generation was used to clean data to manage outliers and missing data. The results were presented in frequencies and percentages shown in tables. Spearman Chi-Square analysis was used to test for relationship between knowledge and Educational level and attitude towards blood donation and sex. A significant level of 5% was considered, hence all relationships that had corresponding p-values less than 0.05 was considered significant. University of Ghana http://ugspace.ug.edu.gh 24 The tests were analyzed using Statistical Package for Social Scientist IBM SPSS version 21. 3.12 Ethical Considerations Permission was sought from the Ghana Health Service Ethical Review Board. An official letter was also submitted to the La Dadekotopon Municipal Assembly for approval before the start of data collection. Individual consent was taken from respondents before questionnaire administration. The rights of respondents were protected by informing them about the purpose of the study and not coercing them to participate. Respondents were also informed that their involvement in the study is voluntary and they have an option of withdrawing at any time. Furthermore, respondents were provided with contact numbers for explanation and measures put in place to ensure confidentiality of the survey data. The general and specific objectives of the study, as well as the benefits of the research were explained to participants. All consenting participants were made to sign/ thumbprint an informed consent form. University of Ghana http://ugspace.ug.edu.gh 25 CHAPTER FOUR 4.0 RESEARCH FINDINGS 4.1 Introduction This chapter presents the findings of the study on knowledge and attitude towards voluntary blood donation as well as factors which influence the youth to engage in voluntary blood donation. It begins with a presentation on demographic characteristics of respondents, followed by the level of knowledge of voluntary blood donation, the attitude and practice towards voluntary blood donation and the factors which influences the youth to engage in voluntary blood donation. There was also a presentation on chi-square, testing the relationship between educational level and knowledge, and sex and attitude towards blood donation. 4.2 Background Characteristics of Respondents Table 1 shows the background characteristics of the respondents to this study University of Ghana http://ugspace.ug.edu.gh 26 Table 4.1: Demographic characteristics of respondents Background characteristics Frequency (N=217) Percentage (%) Age 18-23, 24-29, 30-34 98 75 44 45.2 34.6 20.3 Educational level Primary JHS SHS Tertiary 4 19 84 110 1.8 8.8 38.7 50.7 Religion Muslim Christian Traditional Other, 21 190 5 1 9.7 87.6 2.3 0.5 Sex Male Female 90 127 41.5 58.5 Ethnicity Akan Ga/Adangme Ewe Mole Dagbani Kasena Dagao Other 70 78 43 10 1 1 14 32.3 35.9 19.8 4.6 0.5 0.5 6.5 Occupation Trade/Business Farming Fishing 43 6 2 19.8 2.8 0.9 University of Ghana http://ugspace.ug.edu.gh 27 Official employee Casual labor Student 49 9 108 22.6 4.1 49.8 Marital Status Never married Consensual union Married 168 10 39 77.4 4.6 18.0 The study sample comprised 58.5% of women and 41.5% of men. Out of 217 respondents, the highest age group, which took part in the study, was 18 to 23 years (45.2%). Most of the respondents were students (49.8%), and 77.4% were never married. A little over half (50.7%) of the respondents were tertiary level students. Christians (87.6) were the highest religious group in the study. As expected, majority of the respondents was Ga /Adangme ethnic group (Table 4.1). 4.3 Knowledge of respondents on blood donation Majority (94.5%) of respondents has heard of blood donation. A little over half (63.1) of respondents know the common blood groups and their blood groups (52.1%). Majority of the respondents (85.3%) knew that HIV/AIDS is tested for when one donates blood. Only (36.4%), of respondents knew how often an individual can safely donate blood but majority (82.9%) of them knew that healthy men & women could donate blood while children below 18 years, adults above 60 years and the vulnerable could not donate blood (70%). Majority (76%) of respondents suggested that a person must be 18 years to be eligible to donate blood. Only 3.2% of respondents knew the number of lives one pint of blood can save. However, 57.1% of the respondents did not know the minimum weight University of Ghana http://ugspace.ug.edu.gh 28 required for one to be eligible to donate blood. All (100%) respondents know that blood cannot be manufactured artificially. Less than a quarter (12%) of respondents knew how long the blood collection phase lasts. It was encouraging to find that, majority (99.5%) of the study participants intend to donate blood voluntarily if called upon. However, more than half (60%) of them reported that they do not have enough knowledge regarding blood donation in Ghana. The table below shows participants level of knowledge on blood donation. University of Ghana http://ugspace.ug.edu.gh 29 Table 4.2: Knowledge of participants on blood donation Knowledge Characteristics Frequency N=217 Percentage (%) Diseases tested during blood donation HIV HBV HCV Syphilis Malaria Don’t know 185 44 44 26 63 22 85.3 20.3 20.3 12.0 29.0 10.1 Number of times to donate blood Correct response Incorrect No idea 79 56 82 36.4 25.8 37.8 Persons who can donate blood Correct response Incorrect response No idea 152 3 61 70.0 1.4 28.1 Persons who cannot donate blood Correct response Incorrect response No idea 180 2 35 82.9 0.9 16.1 Minimum age required to donate blood in Ghana Correct response Incorrect response No idea 4 173 40 1.8 79.7 18.4 Number of lives one pint of blood can save Correct response Incorrect response No idea 7 112 98 3.2 51.6 45.2 Average duration of blood collection phase Correct response 26 11.9 University of Ghana http://ugspace.ug.edu.gh 30 Incorrect response No idea 134 57 61.8 26.3 Minimum weight required to donate Correct response Incorrect response No idea 46 47 124 21.2 21.7 57.1 From the table (4.3) below, the educational level of the youth is significantly associated with participants awareness of blood donation, knowledge about the common blood groups, diseases tested for during blood donation, how often one can donate blood, who is eligible to donate, who is not eligible to donate, minimum age and weight required for donation, numbered of lives a pint of blood can save and average length of time for collection but is not significant to whether participants have heard of blood donation (P>0.05). University of Ghana http://ugspace.ug.edu.gh 31 Table 4.3: Relationship between educational level and knowledge of participants on blood donation Knowledge related questions chi-square value p -value Heard of blood donation 0.966 0.966 Do you know the common blood groups 63.157 0.000 What diseases are tested for during blood donation 16.224 0.001 How often can one donate blood 40.614 0.000 Who can donate blood 64.397 0.000 Who cannot donate blood 45.950 0.000 Minimum age for blood donation 27.315 0.001 Number of lives a pint of blood can save 28.111 0.005 On average how long would you expect the blood collection phase to last 38.536 0.001 What is the minimum weight required for donation 48.117 0.000 4.4 Attitude towards Voluntary Blood Donation Of the 217 respondents who participated, majority thought that blood donation was good (85.3%), a positive behavior (86.6%), and necessary (86.2%). Majority (94.5%) also thought that blood donation really saves lives and not a painful thing (69.6%). More than half (68.7%) of the respondents also thought, VBDs were the best source of donor blood, 68.2% were willing to donate voluntarily, 78.9% identified temporally weakness as the worst that can happen to a donor during or after blood donation, and 80.2% were confident they will donate blood if they were asked to donate. More than half (53%), University of Ghana http://ugspace.ug.edu.gh 32 indicated they did not know any known benefits of voluntary blood donation even though many of them also thought self-satisfaction was a benefit. Out of the 217 participants, only a few (29.6%) have donated blood in the past and only 12% of the donors were voluntary donors. Among the 64 study respondents who had donated blood, 34 were males and 24 females. This difference was found to be statistically significant (p<0.05) (Table 4.6). Majority of respondents also cited low awareness and education (57.6%) and fear (35.9%) as the main reasons for non-donation, with 47.9% indicating they will voluntarily donate if it is about saving the life of a relation and 84.3% will encourage their relatives to donate blood. The table below shows the attitude and practice of VBD among respondents. University of Ghana http://ugspace.ug.edu.gh 33 Table 4.4: Attitude of participants towards blood donation Attitude characteristics Frequency N=217 Percentage (%) Thought about blood donation Good Bad Neutral 185 13 19 85.3 6 8.8 Best source of donor blood  Voluntary donor Replacement donor Remunerated donor Self-donor Don’t know 149 16 5 18 29 68.7 7.4 2.3 8.3 13.4 Effect during or after donation Correct response Incorrect response No idea 25 156 36 11.5 71.9 16.6 Reason for donation  VBD FRD 26 38 12 17.5 Reason for non-donation by non-donors  Fear low awareness & education Others No reason 78 125 77 84 35.9 57.6 35.4 38.7 Motivation to donate blood voluntarily To save an unknown person’s life To save a relatives life 58 104 26.7 84.3 Table 4.5 indicates the Chi-Square test of the relationship between sex and attitude towards blood donation. Apart from the question have you ever donated blood and why participants donated blood which were statistically significantly related to sex with values University of Ghana http://ugspace.ug.edu.gh 34 p<0.011 & P< 0.037 respectively, there was no statistically significant difference observed between males and females attitude towards voluntary blood donation (Table 4.5) Table 4.5: Relationship between attitude towards blood donation and sex Question Male Female Total P-value Opinion about blood donation in general (Good) 72 113 185 0.180 Best source of donor blood (VBD) 64 87 149 0.678 Voluntarily donate (Yes) 62 86 148 0.855 Effect during or after donation 67 87 156 0.397 VBD a positive behavior (Yes) 76 112 188 0.424 Blood donation painful (No) 62 89 151 0.851 Will donate if you had more knowledge about VBD (Yes) 75 109 184 0.614 Confident can donate to an unknown person if asked (Yes) 72 102 174 0.954 Past donor (Yes) 34 28 62 0.011 Reason for donation (VBD) 17 15 32 0.037 Will donate voluntarily if called upon (yes) 72 92 164 0.202 4.5 Factors influencing voluntary blood donation among the youth The factors attributed by participants as motivating factors that could influence them to engage in voluntary blood donation were, helping others 98 (41%), perceived need for blood 78 (35.9%), personal values 70 (32.3%) and convenience to donation site 67 (30.9%). Marketing communication, social norms and indirect reciprocity, were also mentioned as motivating factors. While not having enough blood 83 (38.2%), lack of University of Ghana http://ugspace.ug.edu.gh 35 confidence in one’s self, 80 (37.3%) and fear of the unknown 64 (29.5) were the major deterring factors that could prevent respondents from engaging in voluntary blood donation. The table below indicates the motivating and deterring factors which could influence participants to donate blood. Table 4.6: Factors influencing blood donation Question(multiple response) Frequency Percentage (%) Motivating factors of blood donation Convenience of collection site 67 30.9 Helping others 89 41.0 Personal values 70 32.3 Perceived need for blood 78 35.9 Indirect reciprocity/gain reputation 29 13.4 Incentives 57 26.3 Social norms 50 23.0 Marketing communications 54 24.9 No idea 3 1.4 Deterring factors of blood donation Lifestyle barriers 40 18.4 Not having enough blood 83 38.2 T &T to donation site 37 17.1 Low involvement 31 14.3 Inconvenience 28 12.9 Ineffective/unwanted/inadequate incentives 37 17.1 Lack of knowledge of donation site 50 23 Negative services experience 43 19.8 Fear of the unknown 64 29.5 University of Ghana http://ugspace.ug.edu.gh 36 CHAPTER FIVE 5.0 DISCUSSION 5.1 Introduction This cross sectional study was conducted to determine the perceptions of voluntary blood donation among the youth. The study involved youth of La Dadekotopon within the ages 18 to 34 years old who were randomly selected. This chapter discusses findings of the research, how it connects with the conceptual framework developed for the study and also how the results correspond with other literature. 5.2 Background Characteristics According to the world health organization, it is important to record analyses of demographic information about blood donors for monitoring and formulating strategies for recruitment of voluntary blood donation (WHO, 2014). On analyzing the demographic data, it was found that almost half (45.9.2%) of the respondents were within the age groups of 18-23 which was similar to the findings of a study done by Shidam, Lakshminarayanan, Saurabh & Roy (2015). This young population structure in Ghana could provide a window of opportunity as the youth can serve as change agents in the voluntary blood donation drive. Our study also found that more females (58.5%) participated in the study than males (41.5%). This study also shows direct association between age group and educational level. Usually by the age of 23 years, youth in Ghana may have attained higher education. This accounts for the statistics got from the results which revealed 50.7% of the youth having tertiary level of education and 49.8% being students and not married (77.4%) The results also show Ga/Dangme as the highest ethnic group and Christians as the highest religious group among the respondents. This could be University of Ghana http://ugspace.ug.edu.gh 37 as a result of the study area being predominantly Ga community and over 70% of Ghanaians being Christians (GSS, 2012). From the Health belief model, demographic variables forms a part of the control variables that informs and modifies ones intention to engage in voluntary blood donation. In other studies, variables such as sex, age, race, and marital status have a significant influence on blood donation ((Duboz, Macia & Cunéo, 2010; Boulware et al., 2002). Our study, also found a significant relationship between sex and blood donation (Table 4.5). We also found a significant relationship between level of education and knowledge, which could be an indication that educational status of the youth could affect the actual practice of blood donation. 5.3 Knowledge Level of Blood Donation In our study a significant proportion of the study participants (94.5%) said they have heard of blood donation. A study by Olubiyi et al., 2014 recorded a similar response (96.9%) in Nigeria. This finding indicates that hearing alone without inspiration may not increase the group of voluntary donors in Ghana. Not all, our study found that less than half (36.9%) of the respondents had knowledge of the common blood groups. A study in Nigeria on the other hand observed a high knowledge (98.6%) of common blood groups (Nwogoh, Aigberadion, Nwannadi & Aigbe, 2012). This high record of knowledge of the common blood groups could be attributed to the fact that this particular study was conducted among medical students. It is important for every individual to know their blood group so that they can donate blood whenever emergency situations arise. Majority of our study (85.3%) of respondents were aware that HIV was tested for when one donates blood, (29%) for malaria, 20.3% knew about Hepatitis B and C viruses and whilst 12% knew about syphilis. Similar findings were observed by Goni et al., (2013) in University of Ghana http://ugspace.ug.edu.gh 38 Nigeria excluding the HIV test with a (25.9%) response rate. This could be as a result of the intensive HIV campaigns that have been going on in Ghana. Again, our study found that less than half (36.4%) of the study respondents had knowledge about the intervals or how often an individual can safely donate blood in Ghana, Shidam et al., (2015) recorded a similar finding (14.8%). This lack of knowledge about blood donation interval is not just among ordinary people but also among health professional as Nwogoh et al., (2012) also noted similar findings even though their study was conducted among physicians in Nigeria. Uma et al., (2013), however found a higher knowledge (51.2%) about the intervals between safe donations. Our study also found that majority (82.9%) of the study respondents had adequate knowledge about the people who can donate blood. Sharma & Pranjali (2013) and Samar, Ahmad, Mansour, Yahiya & Musa (2012), in their findings observed similar results, where 56% and 74.3% respectively were considered to have had high knowledge about blood donation, though these were little less than what we found. With regards to participants knowledge about the minimum age a healthy individual can donate blood in Ghana, our study found that only a few (1.8%) of respondents had adequate knowledge, that is, seventeen years. Alfouzan (2014), and Safizadeh, Pourdamghan & Mohamadi (2009), recorded a little higher findings with regards to participants knowledge of the minimum age required for blood donations in Saudi Arabia and Iran respectively. Our study further found that a small number (21.2%) of the study respondents knew the minimum weight required to donate blood. Alfouzan (2014), and Safizadeh, Pourdamghan & Mohamadi1 (2009) recorded 40.1% and 51.2% in their findings in Saudi Arabia and Iran respectively. Our study found that only 12% of respondents know that duration of the actual donation process. Uma et al., (2013), University of Ghana http://ugspace.ug.edu.gh 39 Sharma & Pranjali (2013) and Nwogoh, Aigberadion & Nwannadi (2013), documented similar findings of less than 40%. Elsafi et al., (2015), on the other hand recorded a response rate of 66.3%. This observed gap on knowledge of donor requirements is an important factor affecting blood donation practices in Ghana. Improved sensitization and provision of appropriate information on blood donation requirements may provide opportunity for informed decision on voluntary blood donation among the youth. Not all, our study also found that more than half (59%) of the respondents knew if they are eligible to donate blood, who cannot donate blood (70%). Interestingly however, 68.7% of respondents thought voluntary blood donors were the best sources of donor blood. An over whelming majority (99.5%) of the study participants also intend to donate voluntarily if called upon but few (38.7%) of them felt they have adequate knowledge regarding blood donation in Ghana? This low level of knowledge about blood donation may be due to ineffective programs towards promoting voluntary blood donation. Ordinarily, Ghanaians are sympathetic in nature and so with adequate education and sensitization clarifying the misconceptions and most importantly the benefits of VBD and of course community involvement in VBD campaigns, people and most especially the youth, VBD can be improved. Knowledge about VBD also serves as a cue to action to engage in voluntary blood donation from the Health belief model. 5.4 Attitude and Practice towards voluntary blood donation It is important to note that majority of the study respondents showed positive attitude towards VBD. A positive attitude towards blood donation was also detected in majority of the respondents since almost all of them agreed that blood donation was a good (85.3%) and a positive behavior (86.6%). These findings are in agreement with other University of Ghana http://ugspace.ug.edu.gh 40 studies carried out on students with similar level of educational and age group (Elsafi et al., 2015). Rathod & Parmar (2012) has reported similar result (74.67%) in their study. With regards to whether study participants will donate blood voluntarily in our study, majority (68.2%) of respondents confirmed they will donate blood voluntarily while 80.2% of the participants were confident they could donate to an unknown person if asked to do so. Shidam et al., (2015), noted similar findings (77%) in their study as well. This study also found that 46.7% of the study respondents thought that Self-satisfaction which comes up from acts of kindness that help to save lives a benefit of VBD. From the health belief model again, saving some one’s life and self-satisfaction are the perceived benefit that could come from VBD. Our findings further suggests that even though the respondents had a positive attitude towards VBD, a very poor blood donation practice was observed in this study as 29.5% of respondents have ever donated blood in the past in which 54.85% of respondents were males while 45.2% were females with only 12% of respondents being voluntary blood donors. Similar findings were recorded in Nigeria by Salaudeen, Musa, Bolarinwa, Adegboye & Samuel (2011) and in India when Rathod & Parmar (2012), did a comparative study between health professional (doctors, nurses, and technicians) and the general population where only a few participants had ever donated blood with majority of them being males. This shows that there is a need to take sufficient steps to involve the youth and to create opportunities for the youth to donate blood voluntarily. 5.5 Factors influencing voluntary blood donation When our study participants were asked to identify the factors that could influence them when it comes to blood donation, it was found that, participants own imagination that, University of Ghana http://ugspace.ug.edu.gh 41 they do not have sufficient blood (38.2%) was the leading factor that could deter them from volunteering to donate blood in the first place. Further, lack of confidence in one’s self (37.3%) was also identified as a factor which could deter them. Here, respondents believed they needed the approval of their significant others before they could decide to donate blood voluntarily. This could be because majority of our respondents are still students and dependent on others for their upkeep. Another factor that participants thought could deter them from donating blood is fear (26.5%) of needles, physical injury due to bruising, general nervousness, and fear of falling ill after donation, fear of the risk of contracting an infection, and fear of seeing of blood. Respondents also thought their Personal values (25.8%) such as their religious beliefs and their own personal morals could deter them from donating blood. Other minor factors also identified by participants as deterrent includes lifestyle barriers, transportation to donation site, low education, inconvenience, the lack of knowledge of the donation site, ineffective/unwanted/inadequate incentives and negative services experience from the staff of the blood service could deter them from donating blood. This means that minor as they may seem, improved educational campaigns to reassure the youth about these factors. The staff of the blood service must adopt the marketing orientation where the customer is always right in order to not to deter donors and potential donors away due to their attitude towards them. Similar findings were observed by Bednall and Bove (2011) in their Meta analytic review in Australia. Kamari & Raina (2015) and Agus, Yilmaz & Agus (2015) also recorded fear as a deterrent in their study in Turkey. Fear seems to be a major factor preventing a lot of people from voluntarily donating blood. These factors are also seen as perceived threats to voluntary blood donation from the health belief model. University of Ghana http://ugspace.ug.edu.gh 42 The above factors therefore should be taken into consideration when developing donor recruitment programs. This could be an indication that enough sensitization and education is not being done to demystify any doubts the youth may have about voluntary blood donation. Respondents of our study identified helping others/altruism as the main factor that will motivate them to donate blood. Our study participants also identified perceived need of blood (35.9%), personal values (32.3%), as well as convenience to the blood donation site (30.9%) as equally important factors that could motivate them to donate blood. Kamari & Raina (2015) in their findings also discovered similar thing as motivator of blood donation in India. Comparative factors were also noted in Australia (Alessandrini, 2007). A small number of our respondents also thought that incentive (26.3%) and other factors such as gaining reputation, their social norms, and marketing communications. A similar study conducted in India among blood donors however recorded different motivational factors (Roy, Singh & Banerje, 2005). From our study it is obvious that advertisements both in the print and mass media could motivate them to donate blood. Social media could also be used as an avenue to educate and sensitize the youth about voluntary blood donation in Ghana since that is what is trending and in vogue among the youth recently. University of Ghana http://ugspace.ug.edu.gh 43 CHAPTER SIX CONCLUSION AND RECOMMENDATIONS 6.1 Conclusions Findings showed that the level of knowledge in relation to blood donation was high and attitude towards blood donation was also good even though respondents had poor blood donation record. There was no statistically significant difference between males and females’ attitude towards voluntary blood donation. Whether respondents ever donated blood and why participants donated blood on the other hand, were significantly related to sex. There was also a significant associated between educational level of respondents and their level of knowledge on blood donation. Factors that are likely to deter the youth of La Dadekotopon from donating blood included; perceived lack of blood/not having enough/ sufficient blood, low self-efficacy, fear and the satisfaction of helping others/altruism, perceived need of blood and convenience of the blood donation site. The findings of this study provide insight that can be used to formulate strategies to encourage and motivate the youth to participate in voluntary blood donation drives in the country. 6.2 Recommendations We observed that educational level of an individual affects the knowledge level of that individual about blood donation which may translate into actual practice. Therefore, the national blood service should intensify education on VBD especially eligibility criteria for VBD among the youth using audience segmentation where the youth with varying educational levels are equipped with the appropriate knowledge about blood donation. University of Ghana http://ugspace.ug.edu.gh 44 The national blood service should organize periodic promotional education and interactive awareness sessions using the mass media - print and electronic media including social media to help eliminate misconceptions among the youth regarding blood donation and blood safety as well as to reinforce positive attitudes towards blood donation, emphasizing the many benefits of blood donation. Furthermore, this study was a quantitative study which brought out levels and percentages of the respondents. It will be crucial to conduct a qualitative study to find out reasons why the youth have high knowledge and attitudes toward VBD but poor donation practices. The qualitative data will also help to assess the social, cultural and economic factors informing the decision of the youth to donate or not to donate blood. Since there is little literature on voluntary blood donations in Ghana, it is recommended that Ghanaian more studies are done on VBD to inform appropriate interventions to improve voluntary blood donations in Ghana, especially among the youth. We recommend that quizzes and assays competitions are organized among schools at the various levels to encourage the youth to develop interest in reading and learning about voluntary blood donation. University of Ghana http://ugspace.ug.edu.gh 45 REFERENCES                        ́     University of Ghana http://ugspace.ug.edu.gh 46                              University of Ghana http://ugspace.ug.edu.gh 47                              University of Ghana http://ugspace.ug.edu.gh 48                              University of Ghana http://ugspace.ug.edu.gh 49                                University of Ghana http://ugspace.ug.edu.gh 50                           University of Ghana http://ugspace.ug.edu.gh 51 APPENDICES A. CONSENT FORM                                 University of Ghana http://ugspace.ug.edu.gh 52              University of Ghana http://ugspace.ug.edu.gh 53           University of Ghana http://ugspace.ug.edu.gh 54 B. Questionnaire SCHOOL OF PUBLIC HEALTH UNIVERSITY OF GHANA, LEGON PERCEPTIONS OF VOLUNTARY BLOOD DONATIONS AMONG THE YOUTH IN LADAKOTOPON My name is Sheila Tanye. This research is being carried out for academic purposes as part of requirements for the award of Master of Science (MSc.) Degree at the University of Ghana, Legon. The purpose of the research is to understand the perceptions of voluntary blood donation among the youth in La. Participation in this study is absolutely voluntary. Please feel free to express yourself as accurately as possible in your answers to the questions that I will be asking you. We are interested in your personal viewpoints. Responses will be confidential and will not be disseminated to outside parties. Thanks very much for accepting to participate in the study. Sheila Tanye (B.A. Social Work with Psychology) Mobile Phone Contact+233 202843139 Email: sheilatanye@yahoo.com Date: ___ /__ _/___ (dd/mm/yy) House No.: SECTION A: Background Information NO. Question Response Code 1. Age 18-23, 24-29, 30-34 Don’t know 1 2 3 96 2. Education Primary JHS SHS Tertiary No formal training/schooling Other, specify……………………………………………… 1 2 3 4 5 99 3. Religion Muslim Christian Traditional No religion Other, specify……………………………………………… 1 2 3 4 99 University of Ghana http://ugspace.ug.edu.gh 55 4. Sex Male Females 0 1 5. Ethnic Background Akan Ga/Adangme Ewe Mole Dagbani Kasena Dagao Other specify…………………………………………….. 1 2 3 4 5 6 99 6. Source of livelihood Trade/Business Farming Fishing Official employee Casual labor Other, specify................................................. 1 2 3 4 5 99 7. Marital Status Never married Consensual union Married Separated Divorced Widowed 1 2 3 4 5 6 SECTION B: Knowledge Assessment 8. Have you heard of blood donation? Yes No 1 0 9. Are you aware of blood donation? Yes No 1 0 10. Do you know the common blood groups? Yes No 1 0 11. Do you know your blood group? Yes No 1 0 12. What is your blood group? A+ A- AB B+ B- O+ O- Don’t know 1 2 3 4 5 6 7 96 13. Can a person be infected by receiving blood transfusion? Yes No 1 0 14. What diseases are transmissible by blood transfusion? HIV HBV HCV Syphilis 1 2 3 4 University of Ghana http://ugspace.ug.edu.gh 56 Malaria Don’t know Other specify…………………………….…………… 5 96 99 15. How often can an individual donate? Weekly Monthly 3monthly 6monthly Annually Don’t know Other specify…………………………….…………… 1 2 3 4 5 96 99 16. Who should donate blood? Healthy Men Women Young <18yrs Old >60yrs Don’t know Other specify…………………………….…………… 1 2 3 4 5 96 99 17. Who should not donate blood? Healthy Men Women Young <18yrs Old >60yrs Vulnerable Don’t know Other specify ……………………………………………. 1 2 3 4 5 6 96 99 18. How often does someone in Ghana need a blood transfusion? Once every day Once every six hours Once every minute Once every two seconds Don’t know Other specify.............................................. 1 2 3 4 96 99 19. How old must you be in order to donate blood in Ghana 17 18 21 Don’t know Other specify............................................. 1 2 3 96 99 20. How many lives can one pint of blood save? 1 3 5 10 Don’t know Other specify………………………………………….. 1 2 3 4 96 99 21. Can blood be artificially manufactured? Yes No 1 2 22. On average, how long would you expect the blood collection phase to last? 10 minutes 20 minutes 30 minutes 1 2 3 University of Ghana http://ugspace.ug.edu.gh 57 40 minutes Other specify................................................... 4 99 23. What is the minimum weight requirement for a donor to be eligible to donate blood in Ghana? 50kg 60kg 70kg 80kg Don’t know Other specify................................................... 1 2 3 4 96 99 24. Do you know the different types if blood donors we have? Yes No 1 0 25. Do you know if you are eligible to donate blood? Yes No 1 0 26. Do you feel like you have adequate knowledge regarding blood donation in Ghana? Yes No 1 2 27. Do you know your own blood type? Yes No 1 0 SECTION C: Attitude towards Blood Donation 28. What do you think about blood donation Good Bad Neutral Other specify................................................... 1 2 3 99 29. What do you think is the best source of donor blood?  Voluntary donor Replacement donor Remunerated donor Self-donor Other specify.................................................. 1 2 3 4 99 30. What can happen to a blood donor during or after donation? Contract infection Temporary weakness Fall sick Don’t know Other specify…………………………….…………… 1 2 3 96 99 31. What are the benefits of blood donation? 32. Do you think donating blood is a positive behaviour Yes No 1 0 33. Do you think donating blood is unnecessary Yes No 1 0 34. Will you be saving lives If you donate blood? Yes No 1 0 35. Will you feel pain If you donate blood? Yes No 1 0 36. Is it desirable to perform an act that can save lives? Yes No 1 0 University of Ghana http://ugspace.ug.edu.gh 58 37. If you knew more about blood donation in Ghana, will you be more likely to donate blood voluntarily? Yes No 1 0 38. Are you confident that you could donate blood if you were asked to do so? Yes No 1 0 Section D: Practice of blood donation   39. Have you donated blood in the past?  Yes No 1 0 40. Why did you donate?  41. Will you donate if called upon or reminded to do so?  Yes No 1 0 42. What are some of the reasons for non-donation by non-donors  …………………………………………………………………… …………………………………………………………………… …………………………………………………………………… 43. What will make you donate blood voluntarily? …………………………………………………………………… …………………………………………………………………… 44. Will you encourage relatives to donate blood? Yes No 1 0 SECTION E: FACTORS INFLUENCING BLOOD DONATION 45. What factors do you think will motivate or influence people to donate blood Convenience of collection site Helping others Personal values Perceived need for donation Indirect reciprocity/gain reputation Incentives Social norms Marketing communications Other Specify…………………………………………….. 1 2 3 4 5 6 7 8 99 46. What factors could serve as deterrents of blood donations lack of confidence in one’s self Lifestyle barriers Not having enough blood T &T to donation site Low involvement Inconvenience Ineffective/unwanted/inadequate incentives Lack of knowledge of donation site Negative services experience Fear Personal values Others Specify……………………………………… 1 2 3 4 5 6 7 8 9 10 11 99 Adapted from : (Nwogoh B, Aigberadion U, Nwannadi I. A, 2012)&(Bednall & Bove, 2010) University of Ghana http://ugspace.ug.edu.gh