Blood Donation Pattern and Characteristics of Blood Donors in Saudi Arabia

Background: Blood donation rates in Saudi Arabia are relatively low compared to other countries. Understanding the patterns and characteristics of blood donors is crucial for improving donation rates and ensuring a sustainable blood supply. This Study utilizes data from the Wateen App to examine blood donation patterns in Saudi Arabia. Methods: A cross-sectional study was conducted using data from individuals who registered on the Wateen App. The Study analyzed demographic information, donation frequency, blood group distribution, regional variations, temporal trends, and user satisfaction with the App. Statistical analyses were performed to identify significant findings. Results: The Study found that the majority of registered donors were male, with a higher proportion in the 25-35 age group. Most donors had donated once, while a small percentage had multiple donations. O+ blood group donors constituted the most significant proportion, followed by A+ and B+. The Eastern province had the highest incidence of registered donors. Over the years, there has been a gradual increase in the number of donors. There was no significant correlation between donation numbers and different months, seasons, or Ramadan. Conclusion: This Study provides insights into blood donation patterns in Saudi Arabia. Efforts should be made to address gender disparities, engage a wider age range of donors, promote donations among individuals with less common blood types, and improve donation infrastructure in regions with lower donation rates. The Wateen App has shown positive outcomes in enhancing donor engagement. Further research and collaborative efforts are necessary to improve the blood donation system in Saudi Arabia.


Introduction
According to the Saudi Ministry of Health (SaudiMOH), One out of every ten patients admitted to hospitals requires blood products during their stay, and one unit of blood can save up to three lives, making blood donation an essential and moral action that saves thousands of lives.The blood supply needs to be regular to fulfill the continuous demands.For example, in the U.S., a patient needs a blood transfusion every two seconds.And despite this vast demand, globally only around 5% of those eligible to donate blood do so and around half of them never return to donate again [1].Generally, there are three types of blood donors (voluntary unpaid donors, family replacement donors, and paid donors).In order to achieve an adequate and reliable supply of safe blood, we need regular, voluntary, unpaid (voluntary non-remunerated) blood donors as these donors are considered the safest group of donors and they have the lowest bloodborne infection rate(according to WHO and [1,2].In high-income countries, the median blood donation rate is 31.5 donations per 1000 people, while in Saudi Arabia, it is only 13.8 per 1000 ‫؛‬globally 62 countries have more than 99% of their blood supply by voluntary non-remunerated donors, including 3 of the GCC countries, while in Saudi Arabia it is only 39.7%.The rest comes from family replacement donors (according to WHO 2017).globally, women's contribution to blood donation is 33%, while local studies showed a very low contribution rate [3].The majority of Saudi men and women show a positive attitude toward blood donation [4,5].The main reason for men not to donate blood is lack of time, while in women, the main reasons were inability to reach the blood donation centers and fear of anemia [5].These are personal reasons that negatively impact blood donations but on the other hand there are personal factors that positively affect blood donation for example being a college graduate, being employed, and other factors like being physically active and nonsmoking are all factors that positively associated with blood donation [4,6].Not only do individual factors affect blood donation, but other factors do too.For example, blood bank factors and collection site characteristics might positively or negatively impact blood donation [6,7].Wateen is an application that was launched by the Saudi Minister of Health in 2019 in order to reduce the gap between blood banks and donors in Saudi Arabia.With the objectives of improving the experience of voluntary blood donors by facilitating the blood donation process, promoting donation by raising awareness campaigns on voluntary blood donation to provide safe blood to all blood banks in the kingdom (As according SaudiMOH and [8]).Through the Wateen app, the users (blood donors or blood bank representatives) can request a blood donation from the Wateen community, know the list and locations of blood banks nearby and what blood group they have shortage at, have official donation records, and receive reminders about campaigns and donation dates.

Methods Study Settings and Participants
In this research, a cross-sectional survey is designed to investigate Blood donation pattern and characteristics of blood donors in Saudi Arabia based on MOH Wateen-App.The sample population constituted 1320900 participants from the Kingdom of Saudi Arabia.Ethical approval was provided by Prince Sultan Military Medical City, Saudi Arabia.

Inclusion and Exclusion Criteria
All adults who registered their donation in Watten-App before 1/oct/2022 were included in the Study, while all blood donors who did not register their donation in Wateen or registered it after that were excluded.

Data Collection
All data was gathered using the Watten-App database.

Statistical Analysis
Data were analyzed using Microsoft Power BI.Standard computation methods were used to calculate basic descriptive statistics.The data were expressed in percentages, and the mean (M), the standard deviation (SD), and the confidence interval (CI) of 95% were estimated and presented in the tables and figures of the Results section.

Results
The total number of individuals who downloaded the Wateen App is 1298809.Out of those, 462331 (35.60%) have never registered any donation, 630338 (48.53%) have donated once, 182887 (14.08%) have donated 2-5 times, 15822 (1.22%) have 6-9 registered donations, and 7431 individuals have ten or more registered donations in the App.The demographics of the 1320900 donations included in the Study are shown in (Table 1).This table indicates that most donations come from male donors (97.39%) and that the age group 25-35 accounts for 81.93% of the donors, with a mean age of 31 years and a standard deviation of 5.58 years.Regarding the blood group of donors (Figure 1), it shows that 641111 of the donations are from O+ blood group donors, accounting for 48.53% of the total donations.The total number of donations per region is divided into 20 cities as per the Wateen-App algorithm, and some donation locations are not registered because the older version of the App was not well connected to all the blood banks.(Table 2) showed that the highest donation per region is in the Eastern province, with a total of 18.59%, but when we combined the cities in Makkah region (Makkah, Jeddah, and Ta'if), the total will be 24.36%.

Donations based on Blood Groups
The total number of monthly donations is shown in (Figure 2), and we can see a continuous increase in donations with time.For example, if we take the average donations per month of the year 2019,2020,2021 and the first three quarters of 2022, they will be 16932.92,19658.58,21690, and 23457.67,respectively.Although there was quarantine due to COVID-19 in Saudi Arabia for around eight months in 2020 (Apr to Dec), the total of donations is still higher than in 2019, and this is because the Saudi MOH used the Wateen App to issue permits for donors to go to the blood banks for donation.
The minimum overall number of donations was 8508 in (2019-Rabi Al-Awal), while the max overall number of donations was 29523 in (2022-Jumada Al-Akhirah).
When comparing the donations in Ramadan, it was notices that the minimum number of donations was 12714, 2019 while the max number of donations was 21383, 2021.As shown in Figure 2.There was no notable difference between donations in Ramadan and other months of the year (P-value more than 0.1), as shown in Table 3.

Findings Summary
This Study assessed the Wateen app's importance; the majority of registered individuals are male, with ages ranging from 25 to 35 years old.The number of donations per individual varied from one time (48.53%) up to 6-9 times (1.22%), while only 7431 individuals have ten or more times of donations.The majority (48.53%) of blood group of the donners was O+ blood group, followed by A+, and B+.Other blood groups are minor.The eastern province has a high incidence of registered donors.However, as to the other areas, we cannot assume low numbers of donations due to the lousy connection to all the blood banks with the older app version.The total number of dinners increased gradually per year.There was no strong correlation between the number of donners in different months, seasons, or Ramadan and other months.The findings in this research demonstrate that participants had good usability outcomes and high degrees of satisfaction with the App's utility.Although these results point to satisfactory Wateen app experiences, they should be considered within the particular Saudi context.Our results in the context of literature In a study by Ould Setti et al 2022 [9], found that the donation was frequent (not once or even 10 times) specially in Ramadan.Like our results, the majority of the doners were males.However, the females were more frequent doners.Unexpectantly, the maximum numbers of donations wasn't in Ramadan [9].In another study by Alsughayyir et al. 2022 [10], blood demand increased every year despite the gradual marked increase in the donners.Also, and in line with our findings, the majority of donners were males; females comprised only 2.5%.Eastern directory and Madinah had the highest donation rate, comprising 53% and 50% total yearly donations, respectively [10].
A study by Sari Bäckman et al. ( 2016) illustrated that the mean capillary blood hemoglobin level is higher in the winter than in summer.Compared to our sturdy, there was no statistically significant difference between the number of donors between winter and summer [11].Guglielmetti et-al.found that potential donors' participation is particularly influenced by the caliber of blood donation services.In this aspect, the Wateen app progressed well; blood donors and medical professionals recognized the advantages it might offer to both users and the blood donation procedure.
Results from both study groups show that, in comparison to earlier donation techniques, the App provides a more efficient way for users to give blood and may shorten the time between the need for blood and blood donation-a conclusion that is consistent with earlier studies [12].
Participants felt that the App increases awareness and understanding by providing information, that it facilitates better communication between donation centers and donors, and that it increases efficiency by making it simpler to recruit donors and by pointing them in the direction of the donation centers that are most convenient for them.The benefits mentioned here are consistent with those found in earlier studies [13].
Regarding the advantages of using the App to share blood test results with donors, respondents couldn't agree on anything.According to some respondents, this would be a useful feature that would motivate potential donors to interact with the App and donate.
Other medical professionals, however, voiced concerns about these procedures, citing increased user stress and confidentiality issues, especially when test findings are concerning [14].

Conclusion
In conclusion, this Study provides insights into blood donation patterns in Saudi Arabia.Efforts should be made to address gender disparities, engage a wider age range of donors, promote donations among individuals with less common blood types, and improve donation infrastructure in regions with lower donation rates.The Wateen App has shown positive outcomes in enhancing donor engagement.Further research and collaborative efforts are necessary to improve the blood donation system in Saudi Arabia.

Figure 1 :
Figure 1: Donation Based on Blood Group

Figure 2 :
Figure 2: Number of Donations per Month