|Year : 2019 | Volume
| Issue : 1 | Page : 72-76
Prevalence of transfusion-transmissible infections among blood donors in Port Sudan
Bashir A.B Mohammed PhD 1, Maisa A Badneen2, Mohammed O Gibreel1, Suhair A Othman3
1 Department of Hematology, Medical Laboratory Sciences Division, Port Sudan Ahlia College, Port Sudan, Red Sea State, Sudan
2 Department of Clinical Chemistry, Laboratories Management and Researches, Ministry of Health, Port Sudan, Red Sea State, Sudan
3 Department of Pediatrics and Neonatology, Medical Pediatrics Division, Faculty of Medicine, Red Sea University, Port , Red Sea State, Sudan
|Date of Submission||18-Nov-2018|
|Date of Acceptance||10-Jan-2019|
|Date of Web Publication||27-Sep-2019|
Bashir A.B Mohammed
Department of Hematology, Medical Laboratory Sciences Division, Port Sudan Ahlia College, Port Sudan, Red Sea State
Source of Support: None, Conflict of Interest: None
Background Transfusion-transmissible infections (TTIs) are life-threatening for patients requiring blood transfusion. The prevalence of these blood-borne infections among blood donors may reflect the burden of these diseases among populations in developing countries. Unsafe blood transfusion remains a major global health problem; therefore, TTIs are an important issue in transfusion medicine.
Patients and methods A cross-sectional study was undertaken during March 2017 to June 2017 to focus on the magnitude of blood-borne infections among blood donors at Port Sudan Central Blood Bank and to assess the characteristics of reactive and nonreactive blood donors as well as association between coinfection and blood types. A total of 513 donors were encountered, and each blood donor was screened for HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis immunologically.
Results A total of 513 blood donors were enrolled in this study. Of these, 501 (97.7%) were males and 12 (2.3%) were females, with mean age of 32±9.7 years (range: 17–60 years); all of them are replacement blood donors. Overall, 103 (20.1%) blood donors were reactive, with 97 (18.9%) reactive for one blood-borne infection and six (1.1%) coinfected with two of the four TTIs. The prevalence of HBV, HCV, HIV, and syphilis accounts for 11.7, 0.4, 1.4, and 6.6%, respectively. Six (1.1%) of the study blood donors were coinfected: four (0.8%) with HBV–syphilis and two (0.4%) with HBV–HIV.
Conclusion TTIs is outstretched among the blood donors and have increased significantly over time. Stringent selection of blood donors is highly recommended to emphasize the safety of blood to the recipient. However, switch to central blood transfusion service rather than replacement donation may help to reduce the dangerous effect of TTIs.
Keywords: blood bank, donors, Port Sudan, transfusion-transmissible infections
|How to cite this article:|
Mohammed BA, Badneen MA, Gibreel MO, Othman SA. Prevalence of transfusion-transmissible infections among blood donors in Port Sudan. Egypt J Haematol 2019;44:72-6
|How to cite this URL:|
Mohammed BA, Badneen MA, Gibreel MO, Othman SA. Prevalence of transfusion-transmissible infections among blood donors in Port Sudan. Egypt J Haematol [serial online] 2019 [cited 2020 Oct 21];44:72-6. Available from: http://www.ehj.eg.net/text.asp?2019/44/1/72/268008
| Introduction|| |
Viruses, bacteria, and parasites can all be transmitted via blood or blood components . Blood donation saves lives of millions of people worldwide; however, the recipients are at a potential risk of exposure to transfusion-transmissible infections (TTIs) . Therefore, the likelihood of TTIs such as HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis still remains a sustainable threat from blood banks and transfusion facilities . TTIs were considered the greatest threats to blood transfusion safety for recipient and constitute serious public health problems . The highest risk groups that are exposed to these blood-borne pathogens are the anemic patients (children and adults), hemorrhagic pregnant women, and victims of major trauma . Morbidity and mortality from the transfusion of infected blood have influential consequences, not only for recipients themselves but also for their relative families and their communities . According to the WHO, safe blood transfusion is a global right. The ongoing improvement and application of donor selection criteria and sensitive or sophisticated tests in the blood bank can ensure the eradication, or at least lower the risks of acquiring TTIs . Monitoring of the magnitude of TTIs in blood donors is significant for measuring the risk of transfusion and enhancing donor recruitments, and administration to diminish infectious disease transmission . Most donors are replacement donors, mostly family members or a close friend of the patient with good intention to help for transfusion in emergency . There is a considerable need to provide safe blood components, and this requires improved quality transfusion services and modulated infrastructure along with properly trained and well-educated staff . The incidence value of these blood-borne diseases has boosted the problem of blood transfusion safety in Port Sudan, Sudan. However, this study was carried out to denote the occurrence of HIV, HBV, HCV, and syphilis infections in the blood donor populations and to assess the epidemiology of these blood-borne infections in Port Sudan city. To the best of knowledge, no such study was conducted before in Port Sudan.
| Patients and methods|| |
This was a cross-sectional study aimed at assessing the prevalence of TTIs among blood donors visiting Port Sudan Central Blood Bank from March 2017 to June 2017. Blood donors were given a unique identification number, and their name, ages, sexes, date of births, professions, and contact numbers were registered. Before donation, each donor was subjected to fill a structured health history questionnaire, which encompassed data regarding their general health, current or past febrile illness, weight loss, chronic disease, unusual or excessive bleeding, drug history, tattoo piercing, previous blood transfusion, history of travel or immigration, sexual history, and risk behaviors followed by short interviews. Complete blood count was done to rule out any donors with anemia (hemoglobin<12.0 g/dl), thrombocytopenia, or infection. Furthermore, inspection was made for any signs of drug abuse or any skin lesion at the venipuncture site.
A total of 513 donors were prospectively enrolled in this study. The convenient sampling technique was used to recruit blood donors who were eligible for donation for serum screening of TTIs. Proper sterilization and other precautions were taken during blood collection, and blood units were stored using appropriate methods.
Study patients’ inclusion and exclusion criteria
All blood donors who appeared physically fit and were 17–65 years old and fulfilled the national blood bank criteria were included. Potential donors were ruled out if they were younger than 17 years; weighed less than 50 kg; were anemic or apparently unhealthy or malnourished; had a history of jaundice, malaria, or asthma; had a past history of HBV, HCV, HIV, or syphilis; or were unwilling to give informed consent.
A volume of 5 ml of venous blood was collected using a sterile test tube from each blood donor. Serum was extracted by centrifugation at a speed of 3500 rpm for 5 min, and 2 ml of serum was obtained from each sample using sterile plastic vials. Blood type for each blood donor was determined using antisera (Fortress Diagnostic Limited, Antrim, UK; 6/2019 expiry): anti-A, anti-B, and anti-D for Rhesus type. Each blood donor was screened for HIV, HBV, HCV, and syphilis using immunochromatographic test (Hangzhou AllTest Biotech Co. Ltd, Hangzhou, China; 9/2019 expiry). To emphasize the result, samples were retested using the fourth-generation enzyme-linked immunosorbent assay technique (enzyme linked immunosorbent assay kits for infectious diseases, 10/2019 expiry; Fortress Diagnostic Limited).
Standard operational procedures were strictly followed, and quality control materials were applied for all serological tests. Furthermore, laboratory quality was ensured by well-trained professionals and supervision during the sample process.
The collected data were analyzed using SPSS (IBN, Chicago, USA), version 24. Blood-borne infections among reactive and nonreactive blood donors were analyzed by using logistic regression. χ2-test was applied to assess the association between coinfections and blood type variables. P value less than 0.05 was considered significant in all analysis.
The study approval was set for the Ethical Clearance Committee of the Red Sea State, Ministry of Health and Administration of Port Sudan Central Blood Bank. Informed consent was taken from all donors only for study purpose.
| Results|| |
Approximately 513 blood donors visited Port Sudan Central Blood Bank for donating during the study period; among these, 501 (97.7%) were males and 12 (2.3%) were females, with a mean age of 32.0±9.7 years (range: 17–60 years); all of them were replacement blood donors.
With respect to donors’ ABO blood type distribution, 244 (47.6%) of donors were O+ blood type, 110 (21.4%) of the donors were A+ blood type, followed by 103 (20.1%) B+ blood type. The remaining 34 (6.6%), 10 (1.9%), nine (1.8%), two (0.4%), and one (0.2%) of the enrolled were O−, A−, AB+, B−, and AB− blood types, respectively. The overall characteristic variables among the reactive and nonreactive donors are listed in [Table 1].
|Table 1 Characteristic variables of reactive and nonreactive blood donors|
Click here to view
Prevalence of blood-borne infections
In this assay, 103 (20.1%) of the donors showed reactive result for TTIs and 410 (79.9%) were nonreactive for the four TTIs. The prevalence of HIV, HBV, HCV, and syphilis in our study population was 1.4, 11.7, 0.4, and 6.6%, respectively ([Figure 1]). Among the donors who have the infection, 97 (18.9%) were positive for only one of the pathogens and six (1.1%) were coinfected with two of the four TTIs ([Figure 2]). Coinfection of more than two was not found. Six of the coinfected donors had HBV, and the common coinfection was HBV–syphilis [four (0.8%)], followed by HBV–HIV [two (0.4%)] ([Table 2]). All female donors in the present study were positive for at least one of the four TTIs. The prevalence of HBV infection was 58 (11.3%) among males and two (0.4%) among female donors. Seven (1.4%) of the male donors were positive for HIV. Donors who were positively reactive for Treponema pallidum were 31 (6.0%) males and three (0.6%) females. Sex has a significant association with syphilis prevalence (P<0.039).
|Figure 1 Frequency of blood-borne infections among blood donors at Port Sudan Central Blood Bank, 2017. HBV, hepatitis B virus; HCV, hepatitis C virus.|
Click here to view
|Figure 2 Infection status among blood donors at Port Sudan Central Blood Bank, 2017.|
Click here to view
|Table 2 Coinfection of hepatitis B virus, HIV, and syphilis correlations|
Click here to view
The major positive finding in this study was for HBV, where magnitude of 60 (11.7%), 22 (4.3%) were represented both among donors between 26 – 35 years’ age and greater than 35 years, respectively. HIV was present more in donors aged between 26 and 35 years. A total of 15 (2.9%) donors had evidence of syphilis at ages greater than 35 years. HBV, HIV, and syphilis were showed no association with age (P<0.880, 0.854, and 0.337, respectively).
Regarding the frequency of TTIs with blood group, among HBV reactive donors, 27 (5.3%) were O+ blood type, 16 (3.1%) were B+ blood type, 11 (2.1%) were A+ blood type, two (0.4%) were O− and A− blood type, and one (0.2%) was AB+ and B− blood types. Among O+ blood group donors, 15 (2.9%) were significantly positive for syphilis and four (0.8%) were reactive for HIV. There was no significant association between HBV, HCV, HIV, and syphilis with donor ABO blood groups (P<0.469, 0.469, 0.987, and 0.659, respectively).
| Discussion|| |
Blood transfusion is a life-saving measure in the modern medicine but still remains a potential risk factor for transmission of infections . Laboratory investigations of blood not only help to know about the incidence of the TTIs in an apparently healthy population but also secure the safe provision of blood and blood component . In this study, the overall prevalence of TTIs among blood donors in Port Sudan Central Blood Bank over 3 months of 2017 was 103/513 (20.1%), and this was much higher than the findings in Kosti, South Khartoum by Elsharif et al.  (9.6%), in Khartoum by Ali et al.  (5.6%), and in Kassala, Eastern Sudan by Abdallah and Ali  (3%) in comparison domestically. Universally, our findings were also higher when compared with studies conducted in Lahore by Manzoor et al.  (9.9%), northwest Ethiopia by Tessema et al.  (9.5%), in Ethiopia by Biadgo et al.  (6.6%), and in Islamabad by Waheed et al.  (14.3%). Moreover, these findings were also lower than other studies carried out in different countries, such as 43.2 and 29.5% in Ethiopia by Bisetegen et al.  and Azene et al. , respectively; 29.85% reported in Burkina Faso by Nagalo et al. ; and 21.6% in Cameroon of Noubiap et al. . These relative different rates could be owing to that most of the participants in the global previous studies were commercial blood donors, whereas in our study are replacement blood donors, and may be also owing to different screening methodologies used.
In this study, the prevalence of HCV was 0.4%, and this rate is lower when compared with Eastern Sudan report, which was 3.1%  and elsewhere in the world ,,. Conversely, our result is greater than Ali et al.  and Elfaki et al. ; their study demonstrated no cases of HCV infection at the Elobied Hospital, beside Diwan and Mathur , who reported in India no cases of HCV infection among their donors. The relative variation of HCV infection across the studies could be owing to multiple risk behavior and different cultural practices. Culture practice (tattoo and share needles) is commonly presented among uneducated people . Low HCV comparable with HBV may attribute to less infectivity of HCV, which is restricted transmitted through transfusion of blood or blood products.
In this context, the prevalence of HIV is 1.4%, which is lower in comparison with 10.6% presented in Nigeria by Amadi and Mba , 5.5% found in Maiduguri by Baba et al. , 3.8% in Ghana by Ampofo et al. , 3% in Kassala, Eastern Sudan, by Abdallah and Ali . In another words, our findings were higher than the study done by Ali et al.  and Abu et al. , as shown in Nyala Hospital, Western Sudan, at 1%.A Treponema spp. positive prevalence of 6.6% in this report is lower than prevalence of 23% reported in southwestern Sudan by Atif and Magzoub , 15% seen by Elfaki et al. , and 13.5% showed in Ghana by Ampofo et al. . Our results are higher than 2.7% highlighted by a study done in eastern Sudan by Abdallah and Ali , 3.96% prevalence in Burkina Faso by Nagalo et al. , 3.6% presented by Chikwenet et al.  in Nigeria, and 0.89% in Islamabad by Waheed et al. . This might be explained by the association with the prevalence of HBV in this report where one could easily cross-over the other.
HBV is considered one of the most infectious disease around the world, but it is highly prevalent in sub-Saharan Africa and Asia . In this study, the prevalence rate of HBV among blood donors was 11.7%; this figure is lower compared with 25% in north Ethiopia by Tessema et al. , 18.6% in southwest Nigeria by Buser et al. , and 14.9% in Burkina Faso by Nagalo et al. . In contrast, the results of this study are higher than studies carried out in Ethiopia and elsewhere ,, as well as the prevalence is greater than studies performed in north and central Sudan, with 5.1 and 5.6%, respectively ,. These variations could be attributed to population risk exposure and effectiveness of donor screening methods. In this report, sex has a significant association with syphilis, and this could be owing to the higher seropositive of syphilis for patients aged older than 35 years. A limitation of our study was the blood donors encountered may not idealize the general population in the prevalence rate, and this is owing to different characteristics of underestimation or overestimation may be indicated.
| Conclusion|| |
TTIs are prevalent among blood donors in Port Sudan and may significantly increase over time. Prevention and control of TTIs should be the major issue right now. Stringent selection of blood donors is highly recommended to emphasize the safety of blood to the recipient. Further studies are necessary to evaluate the risk factors, attitude, knowledge, behavior, sensitivity and specificity of screening used, laboratory safety measures updating, and donor authentications.
B.A.B.M. had conceived the main idea of the study and contributed in manuscript writing; M.A.B. contributed to the blood bank work; B.A.B.M and M.O.G. contributed in statistical analysis and interpretation; and S.A.O. supervised the study and critically reviewed the manuscript. All authors read and approved the final draft of the manuscript.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Quinley ED. Transfusion transmitted disease. In: Quinley ED, editor. Immunohematology principles and practices
. 3rd ed. Shanghai, China: Wolters Kluwer, Lippincott Williams and Wilkins 2011. p. 252.
William EF, Jarreau PC, Zitzmann MB, Pictocco C. Transfusion-transmitted disease. In: Harmening DM, editor. Modern blood banking and transfusion practice
. 6th ed. Philadelphia: Davis Plus; 2012. p. 403.
Bisetegen FS, Bekele FB, Ageru TA, Wada FW. Transfusion-transmissible infections among voluntary blood donors at Wolaita Sodo University Teaching Referral Hospital, South Ethiopia. Can J Infect Dis Med Microbiol
Tessema B, Yismaw G, Kassu A, Amsalu A, Andargachew M, Emmrich F. Seroprevalence of HIV, HBV, HCV and syphilis infections among blood donors at Gondar University Teaching Hospital, Northwest Ethiopia: declining trends over a period of 5 years. BMC Infect Dis
Dessie A, Abera B, Wale F. Seroprevalence of major blood-borne infections among blood donors at Felege Hiwot Referral Hospital, Northwest Ethiopia. Ethiop J Health Dev
World Health Organization. Status of blood safety in the WHO African Region: report of the 2004 Survey WHO Regional Office for Africa
. Brazzaville, Congo: World Health Organization 2004.
Tiwari BR, Ghimire P, Karki S, Rajkarnika MR. Seroprevalence of human immunodeficiency virus in Nepalese blood donors: a study from three regional blood transfusion services. Asian J Transfus Sci
Manzoor I, Hashmi NO, Daud SE, Ajmal SA, Fatima HI, Rasheed ZA, Syed SA. Seroprevalence of transfusion transmissible infections (TTIS) in blood donors. Biomedica
Attaullah S, Khan S, Khan J. Trend of transfusion transmitted infections frequency in blood donors: provide a road map for its prevention and control. J Transl Med
Biadgo B, Shiferaw E, Woldu B, Alene KA, Melku M. Transfusion-transmissible viral infections among blood donors at the North Gondar district blood bank, northwest Ethiopia: a three-year retrospective study. PLoS ONE
Khan ZT, Asim S, Tariq Z, Ehsan MA, Malik RA, Ashfaq B, Hayat A. Prevalence of transfusion transmitted infectious in healthy blood donors in Rawalpindi District, Pakistan: a five-year survey. Int J Pathol.
Elsharif AB, Moataz MA, Hamza BH, Omer SM, Mutasim MS, Bader EH. Sero-prevalence of viral transfusion-transmissible infections among blood donors at Kosti Teaching Hospital, White Nile State/Sudan. Int J Curr Microbiol Appl Sci
Ali NO, Omer ED, Ali MA. Sero-prevalence of transfusion transmissible infections among blood donors in Khartoum Central Sudan. Eur Acad Res
Abdallah TM, Ali AAA. Sero-prevalence of transfusion-transmissible infectious diseases among blood donors in Kassala, eastern Sudan. J Med Med Sci
Waheed U, Khan H, Satti HS, Ansari MA, Malik MA, Zaheer HA. Prevalence of transfusion transmitted infections among blood donors of a teaching hospital in Islamabad. Ann Pak Inst Med Sci
Nagalo MB, Sanou M, Bisseye C, Kabore MI, Nebie YK, Kienou K et al.
Seroprevalence of human immunodeficiency virus, hepatitis B and C viruses and syphilis among blood donors in Koudougou (Burkina Faso) in 2009. Blood Transfus
Noubiap JJ, Joko WY, Nansseu JR, Tene UG, Siaka C. Sero-epidemiology of human immunodeficiency virus, hepatitis B and C viruses, and syphilis infections among first-time blood donors in Edea, Cameroon. Int J Infect Dis
Oner S, Yapici G, Sasmaz C, Kurt A, Bugdayci R, Hepatitis B. Hepatitis C, HIV, and VDRL Seroprevalence of blood donors in Mersin, Turkey. Turk J Med Sci
Walana W, Ahiaba S, Hokey P, Vicar EK, Acquah SEK, Der EM et al.
Sero-prevalence of HIV, HBV and HCV among blood donors in the Kintampo Municipal Hospital, Ghana. Br Microbiol Res J
Elfaki AMH, Eldour AAA, Elsheikh NMH. Sero-prevalence of immunodeficiency virus, hepatitis B and C and syphilis among blood donors at Elobeid Teaching Hospital, West Sudan. Sudan J Med Sci
Diwan R, Mathur M. Incidence and pattern of transfusion transmitted infection in voluntary donors in a teaching hospital − a four-year retrospective study. J Pharm Biomed Sci
Halile Meskal F, Kefene H, Haile Selassie A, Khodakevich L. A survey of harmful traditional practices in Ethiopia
. Available at: http://www.popline.org/node/381405
. [Accessed 27 March 2017].
Amadi AN, Mba LE. Distribution of HIV infection in Abia State, Nigeria. Niger. J Med Investig Pract
Baba MM, Hassan AW, Gashau W. Prevalence of hepatitis B antigenaemia and human immunodeficiency virus in blood donors in Maiduguri, Nigeria. Niger J Med
Ampofo W, Nii-Trebi N, Ansah J, Abe K, Naito H, Aidoo S et al.
Prevalence of blood borne infectious diseases in blood donors in Ghana. J Clin Microbiol
Abu M, Eltahir Y, Ali A. Seroprevalence of hepatitis B virus and hepatitis C virus among blood donors in Nyala, South Darfur, Sudan. Virol J
Atif EA, Magzoub AA. Seroprevalence of syphilis among blood donors in South Western Sudan. Niger J Surg Res
Chikwemet JO, Mohammed I, Okara GC, Ukwandu NC, Ola TO. Prevalence of transmissible blood infections among blood donors at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. East Afr Med J
Fessehaye N, Naik D, Fessehaye T. Transfusion transmitted infections − a retrospective analysis from the National Blood Transfusion Service in Eritrea. Pan Afr Med J
Buser FI, Muhibi MA, Jeremiah ZA. Sero-epidemiology of transfusion-transmissible infectious diseases among blood donors in Osogbo, south-west Nigeria. Blood Transfus
Nagi AM, Altyeb HA, Ahmed AM. Seroprevalence of hepatitis B and C viral infections among blood donors in Shendi, River Nile State, Sudan. Res J Med Med Sci
Elsheikh RM, Daak AA, Elsheikh MA, Karsany MS, Adam I. Hepatitis B virus and hepatitis C virus in pregnant Sudanese women. Virol J
[Figure 1], [Figure 2]
[Table 1], [Table 2]