This cross sectional study was conducted at conveniently selected eight tertiary care hospitals in Pakistan. Four hospitals were public while, four were in private sector. Two hospitals were selected from each province of Pakistan (Punjab, Sindh, Khyber Pakhtunkhwa and Baluchistan).

The time period of the study was 8 months, starting from January 2014 to August 2014.

Inclusion criteria: Attendants of patients admitted in a surgical ward, more than 16 years of age. No gender restrictions were applied.

Self-administered questionnaire was developed and targeted towards attendant’s information regarding blood donation and their practices. A few questions were derived from International blood fear index questionnaire. The questionnaire was translated from English to the Urdu language (the national language of Pakistan), to maximize response by answering in either language. Participant who did not know how to read or write (non-educated) were assigned a non-medical facilitator to guide them through the procedure.

Oral and written consent was obtained from all the participants prior to the start of the study. Ethical approval was obtained from all the institutions/hospitals where data was collected.

The participants were briefed regarding the nature of the study and were provided information about blood donations after filling up the questionnaire by a specialist. They were also provided the opportunity to ask any questions regarding the issue.

The data was analyzed using Statistical Package for Social Software (SPSS) version 17.

Response rate was 84%. 800 out of 950 initially enlisted respondents participated in the study. Overall 55% male and 45 % female participated with 15.5% of the total population was below the age of 20 years. The age group with the maximum number of participant was between 20 to 39 years of age (47.5%).

Overall 26% and 22.5% of the males and female participants respectively had knowledge about blood donation however 21% and 16.8% of these respondents were in the age group of 40-59 years and 30-49 years respectively. Lesser percentage of attendants, 7.2% of the males and 4.6% asserted that they had donated blood in the past, and it was highest among graduates (3.5%) and less in primary educated respondents (2.2%) and uneducated respondents was 0.7%

Greater percentage of the attendants thought that Hepatitis B can be acquired by donating blood males 10.5%, females 12.2%. whereas,7.6% of the males while 4.8% of the females believed that HIV can be contacted by donating blood.

On inquiring regarding fear, 18% of the males and 17% females admitted that they have some kind of fear of blood donation. The percentage of respondents, who knew regarding blood donation and feared donation, was highest in secondary level educated respondents as compared to other respondents based on education level. Significant p values are shown in the table (Table 1)

Our study showed that 48.5% of the attendants had knowledge about blood donations. Out of 360 females, 50% of them knew about blood donation as compared to 208 males out of 440 (47%). These results are alarming as it showed that in this era of medical advancement, a large proportion of population have very limited information about blood donation. Rather, at least half of the population is unaware of the procedure which is one reason why there are very few voluntary donors in Pakistan.

In a study carried out at King Abdul-Aziz University, Jeddah, KSA in 2013, 10 19% students were donors; with a mean age of around 22 years. The survey carried out in Pakistan however revealed that only 11.9% of the participants reported that they had donated blood at least once. The percentage was less than that found in the study that took place in KSA but it is important to note that the respondents in Pakistan have major contrast in social backgrounds, socioeconomic status and levels of education. Interestingly, only 24.5% of total respondents who knew about blood donation had actually donated blood before.

Another significant fact that we came across was that the least number of donors came from the 20-39 age group (3.4%). Studies carried out in Netherlands 11 and Bangladesh) 12 showed comparable results, with the young donor population being 7% and 16% respectively.

This scant percentage of donor population shows lack of knowledge about the importance of blood donation. As already discussed majority are replacement donors and they do not feel the need to donate blood in the first place. They only donate blood when a family member or a friend is in need. According to the above mentioned research carried out in KSA, students claimed they had never been asked to donate blood and so never did. This shows there is a need for campaigning to be done at national and international level by government and/or NGOs to encourage people to donate blood voluntarily 10.

Another reason why people refrain from donating blood is fear. This study demonstrated that 35% of the respondents had some form of fear associated with donation of blood. Fear seemed to show a trend, being the highest among among the graduates and post graduates and lowest amongst uneducated and primary educated. The results are contradicting the fact that the higher the education, the greater the awareness and hence should be less fear. People usually fear fainting, getting weak or anemic after giving blood. In a study carried out in 2001 regarding the frequency of vasovagal syncope reactions, it was revealed around 178 out of 194,000 blood donors had experienced it (0.1%) and as a result some had also suffered trauma 13. Another study suggested syncope reaction percentage of 1.43% 14. Fear of fainting is common in general population even though the chances of it happening are comparatively very low.

Some people report to have fear of needles due to which they prefer not to donate blood. However another misconception which was encountered by the respondents was the concern of acquiring HIV and Hepatitis B infections. Overall 12.4% and 22.7% thought HIV and Hepatitis B respectively can be acquired through blood donation. Similar was the case seen in the study carried out in KSA 10 with 26% respondents having the same fear. These studies clearly show lack of knowledge among the general population due to which such misconceptions are quite widespread.

According to a survey carried out in Pakistan in 2009 15, an important factor why people from rural areas do not encourage blood donation or even transfusion, is the fact that blood is a symbol and source of one’s lineage. Giving or taking blood is considered a stigma in such people even if it would mean life or death. This shows that this is another social aspect to why people do not donate blood.

Blood drives are carried out throughout Pakistan each year in colleges, universities and various other institutions but not enough campaigning is done to remove the prevalent misconceptions, which keep people away from volunteering to donate blood. The government should launch programs that should include the digital and social media to target and involve the youth who are more enthusiastic when it comes to various causes. As discussed earlier they are also the safest group of blood donors and so should be targeted as possible registered voluntary blood donors.

A lot of work needs to be done to raise awareness among the common population to increase the number of voluntary blood donors. This can be accomplished by involving the youth by carrying out regular blood drives in colleges and universities with the aim to not only increase the number of voluntary blood donors but also to remove prevalent misconceptions which generally discourage people from donating blood. Electronic and social media can be used to do the same and might just be the impetus needed to encourage more people for this good cause. Government organizations should also be established with the aim to increase awareness in rural and urban areas. Incentives like free blood screening can be advertised to encourage more people.