Seroprevalence of transfusion-transmissible infections (HBV, HCV, syphilis and HIV) among prospective blood donors in a tertiary health care facility in Calabar, Nigeria; an eleven years evaluation

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Abstract

 

Fig. 1

Algorithm for serological screening for blood donors

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Results

The overall number of prospective donors screened for donation within 2005–2016 period was 24,979 comprising of 24,654 (98.70%) males and 325 (1.30%) females. Of these, 1013 (4.1%) were reactive for HBsAg, 896 (3.6%) for HCV, 786 (3.6%) for syphilis and 1044 (4.2%) for HIV (Table 1). The total number of those infected with at least one agent was 3739. The percentage prevalence of transfusion transmissible infection in the study period was 14.96% while the percentage prevalence of HBV, HCV, Syphilis and HIV infected donors were 4.1, 3.6, 3.1 and 4.2%, respectively (Table ​(Table1).1). The year-to-year fluctuations in the overall prevalence of TTI in the prevalence of all the infections were all statistically significant (Table ​(Table11).

Table 1

Transfusion-transmissible infections in blood donors at University of Calabar Teaching Hospital during the period of 2005–2016

Year	No. of blood donors screened	Prevalence
		HBV		HCV		Syphilis		HIV
		N.	%	N.	%	N.	%	N.	%
2005	1410	79	5.6	58	4.1	54	3.8	81	5.7
2006	1871	82	4.4	108	5.8	80	4.2	103	5.5
2007	2110	94	4.5	48	2.3	76	3.6	121	5.7
2008	2118	98	4.6	52	2.5	44	2.1	80	3.7
2009	2225	115	5.1	25	1.1	83	3.7	152	6.8
2010	2327	77	3.3	61	2.6	83	3.6	124	5.3
2011	3234	121	3.7	272	8.4	183	5.7	118	3.6
2012	2008	81	4.0	67	3.3	78	3.9	59	2.9
2013	1611	60	3.7	30	1.9	15	0.9	96	6.0
2014	1883	77	4.1	79	4.2	43	2.3	57	3.0
2015	2178	60	2.8	39	1.8	9	0.4	18	0.8
2016	2004	69	3.4	57	2.8	38	19	35	1.7
Total	24,979	1013	4.1	896	3.6	786	3.6	1044	4.2
P value		X2(11) N = 32.153, P = 0.001		X2(11) = 316.068, P <  0.01		X2(11) N = 171.003, P <  0.01		X2(11) N = 182.261, P <  0.01
Gender
Male	24,654 (98.70)	1012	4.1	896	3.6	786	3.2	1044	4.2
Female	325 (1.30)	1	0.3	0	0	0	0	0	0

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N absolute number of positive blood donors, % percentage of positive blood donors, P significance of year-to-year fluctuations, determined by chi square test, HBV Hepatitis B virus, HCV Hepatitis C virus, HIV Human Immunodeficiency Virus

Within the study period, a declining trend in prevalence of TTI-positivity among donors was observed which was the result of decreasing number of HBV, HCV, syphilis and HIV positive donors (Table ​(Table11).

There were 137 (0.5%) voluntary, 9355 (37.5%) family replacement and 15,487 (62.0%) commercial donors in this study. There was no significant difference in the trend of donors over the years (Fig. 2). Transfusion transmissible infection was observed in 3 (2.2%) of the voluntary donors; consisting of 2 (1.5%), 1 (0.7%) and 0 (0%) HBsAg, HCV, Syphilis and HIV reactive cases, respectively. The family replacement donors had 1160 (12.4%) TTIs frequency consisting of 303 (3.2%), 253 (2.7%) and 387 (4.1%) reactive cases of HBsAg, HCV, Syphilis and HIV, respectively. More so, 15,487 (62.9%) cases of TTIs consisting of 708 (4.6%), 642 (4.1%), 569 (3.7%) and 657 (4.2%) cases of HBsAg, HCV, Syphilis and HIV, respectively were observed in the commercial donors (Table 2). There were 9267 (37.1%) first time and 15,712 (62.9%) repeat donors in this study (Table 3).

 

 

 

Fig. 2

Blood donation pattern over the period of 2005–2016 in University of Calabar Teaching Hospital, Nigeria

Table 2

Prevlence of Transfusion-transmissible infections in the three blood donor categories

Donor Category	Total Number of Samples (%)	Number of Positive Cases (%)				Total TTI (%)
		HBV (%)	HCV (%)	Syphilis (%)	HIV (%)
Voluntary Donors	137 (0.5)	2 (1.5)	1 (0.7)	0 (0.00)	0 (0.00)	3 (2.2)
Replacement Donors	9355 (37.5)	303 (3.2)	253 (2.7)	217 (2.3)	387 (4.1)	1160 (12.4)
Commercial Donors	15,487 (62.0)	708 (4.6)	642 (4.1)	569 (3.7)	657 (4.2)	15,487 (62.9)
P value		X2(2) =743.4	X2(2) =698.3	X2(2) =157.6	X2(2) =69.8	X2(2) = 26,808
		P<  0.01	P<  0.01	P<  0.01	P<  0.01	P<  0.01

Table 3

Categorization of blood donors based on frequency of blood donation

Donor Category	Frequency	%
First time	9267	37.1
Repeat	15,712	62.9

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Discussion

This study recorded the overall prevalence of various transfusion-transmissible infections in prospective blood donors at the blood bank of University of Calabar Teaching Hospital, Nigeria in the period from 2005 to 2016. Within the study period, we found that 14.96% (n = 3739) of the prospective donors were positive for transfusion-transmissible infections (TTIs). The decreasing trend in the prevalence of TTI observed in this study is in line with the global trend resulting from improved control of sexually transmitted infections [17], introduction of mandatory screening for TTI and launching of intervention programmes [18, 19]. Our finding is lower than another study in Nigeria [20] and Burkina Faso [21] that had 19.3 and 19.3%, respectively, but higher than earlier report from Ethiopia [22] with 11.5%. The difference in the prevalence may be due to differences in health care system in the different study settings as well as varying magnitude of risk factors for contracting transfusion transmissible infections [22] in the various settings.

In this study the prevalence of HBV was 4.1%. This value is lower than 14.3, 11.1, 26.0 and 20.3% reported in Jos [23], Kano [20], Taraba [24] and Ibadan [25], respectively in similar studies within Nigeria. However, lower value (1.67%) has been reported in Portharcourt [26], Nigeria. Similar findings have been reported in other Sub-Sahara African countries. The prevalence of HBV found in this study in Calabar Nigeria is similar to 4.7% reported in Ethiopia [22], while same is lower than 11.59, 7.51, 11.2 and 14.96% reported in Ghana [27], Benin [28], Cameroon [29] and Burkina Faso [30], respectively. Prevalence of hepatitis B observed in this study could be ranked low when compared with other Sub Sahara African countries and regions in Nigeria.

The prevalence of HCV in this study was 3.6%. This value is similar to 3.4 and 4.1% reported in Kano [30] and Benue [31], respectively. However, this finding is higher than 0.5 and 2.0% reported in Portharcourt [32] and Nnewi [33], respectively but lower than 6.1 and 6.0% reported in Jos [34] and Oshogbo [35] respectively, being studies within Nigeria. Comparatively with some Sub-Saharan regions, similar values; 3.2 and 4.4% have been reported in Kenya [36] and Ghana [37], respectively. However, lower value (0.4%) have been reported in Ethiopia [22] whereas higher value (8.6%) has been reported in Burkina Faso [21]. The reason for the relatively lower rate of seroprevalence of HBV and HCV in this study compared with other studies is unclear, but could be ascribed to differences in methodology, sensitivity and specificity of the various rapid test kits used in the different studies. The improvement in technology might make current screening reagents to be more specific and reliable, and could also be a pointer that there are geographical differences in prevalence.

The overall prevalence of syphilis in this study was 3.1%. The value obtained from this study is similar to 3.6 and 2.61% reported in Maiduguri [38] and Ile Ife [39], respectively within Nigeria. However, lower value of 0.1% has been reported in Portharcourt [26]. Similar result has been reported from Sub-Saharan region such as Burkina Faso [21] (3.96%). However, lower values have been reported in Ethiopia [22] (0.1%) and Kenya [36] (1.2%) whereas a higher value of 7.5% has been reported in Ghana [40]. The reason for the disparity in the prevalence of syphilis observed in this study when compared to other studies may be due to geographical differences in the prevalence of syphilis as well as methodological differences. It has been earlier reported that T. pallidum particle agglutination assay are more sensitive than rapid plasma reagin and T. pallidum hemagglutination assay [3].

Seroprevalence of HIV in this study was 4.2%. This prevalence is similar to 4.6 and 3.8% reported in similar Nigerian studies in Sokoto [41] and Kano [42]. However, lower values of 1 and 2.8% have been reported in Portharcourt [26] and Kaduna [43]. Data from some other Sub-Saharan region has reported similar result in Ghana [37] (4.9%). However, lower values of 0.1 and 2.21% have been reported in Ethiopia [22] and Burkina faso [21], respectively. Though the overall HIV prevalence in this study is high, there was a sharp decline in the prevalence across the years from a score of 5.7% in the starting year to 1.7% in the ending year. The earlier rise in HIV seroprevalence observed in this study corresponds to the peak of HIV epidemic at the era when HIV was not recognized as public health concern. This was also when people were in denial of the disease. The subsequent decline that ensued could be interpreted as the outcome of the various intervention programmes that have been implemented over the years.

This study observed significantly declining trend of transfusion-transmissible infections within the period under study. This observation is in consonance with reported decline in HIV seroprevalence in Nigeria [26, 42]. This trend gives credence to much of the HIV/AIDS intervention programmes launched over the years.

There was a male dominated donor pool (98.70%) in this study. This demographic pattern have been replicated in earlier studies from other parts of Nigeria [44, 45]. Similar trend has been reported in India (95.20%) [46], Pakistan (99.62%) [47], Cameroon (82.0%) [48], Ethiopia (86.8%) [49] and Mexico (81.86%) [50]. This observation could be attributed to the cultural dogma that women should abstain from blood donation as they do lose blood monthly via menstruation. More so, the present study and the studies with similar trends were comprised mostly of replacement and remunerated donors. Male donors have been reported to be motivated by altruism and remuneration benefits [51]. However, this observation was at variance with reports from United States of America (51.7%) [52], Spain (54.0%), Portugal (57.0%), Belgium (54.6%), Netherlands (50.0%,), Denmark (50.0%), France (50.0%), United Kingdom (47.0%) and Finland (45.0%) [51] where the values were almost at par in both sexes. This non gender difference may be attributed to the fact that majority of the blood donations in these developed countries were voluntary donations which is mainly driven by altruism which is shared by both sexes [51]. Females have been reported to be motivated to donate mainly by altruism rather than males who do for both altruism and remuneration benefits [51]. Male donors recorded the highest prevalence of TTIs. This finding is similar to the report of Okocha et al. [44]. Zaheer et al. [47] attributed this to the view that women are confined to home settings, and therefore, are comparatively less exposed to the risks factors associated with transfusion transmissible infections as compared to males.

This study identified commercial donors as the predominant donor type, followed by the family replacement donors, while the voluntary donors were the least in number. The amount of voluntarily donated blood has continued to fall over the years in Nigeria due to logistics and organizational problems associated with the national blood transfusion service. The net result is that commercial blood donation becomes the order of the day. This finding is in consonance with previous reports [35, 44]. However, the finding is at variance with previous report by Damulak et al. [53] in Jos. This disparity could be attributed to the fact that the study in Jos was carried out in the National Blood Transfusion Service Center whereas our study was done in a hospital based blood bank. Blood drive for voluntary blood donation is a regular practice in national blood transfusion centers in Nigeria unlike hospital based blood banks that rely mostly on walk in voluntary donors. Commercially remunerated blood donors recorded the highest prevalence of TTIs, while voluntary donors had the least. This finding further corroborates the earlier suggestion by World Health Organization (WHO) that voluntary donors are less likely to transmit transfusion transmissible-infection than family replacement and commercial donors [54]. An individual in desperate financial need is less likely to reveal his/her actual health status and the monetary reward could make it appealing to high risk donors.

A larger part (62.9%) of donors in this study were repeat donors. This is owing to the fact that majority of the donors were commercial donors. Commercial donors are more likely to repeat because of the financial remuneration that is intended to motivate it.

Limitations of study

The rapid kits used for this study are in vitro qualitative methods. The quantitative values cannot be determined by these screening tests. A negative result at any time does not preclude the possibility of latent infection as most of the test kits were antibody based (HCV, HIV and syphilis) and surface antigen based (HBV). The essence of the pre-donation screening is to determine deferment status; hence, the algorithm is direct except for HIV that has three steps. However for logistics reasons, all HIV screening in this study were benched at UNIGOLD (second stage). More so, the borderline between family replacement and commercial donors is gray as sometimes patient relatives may recruit commercial donors and present same as replacement on their own.

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Conclusion

The present study clearly showed a high prevalence of transfusion-transmissible infection among blood donors in the studied population. The high remunerated blood donor pool and male dominated donor population call for renewed attention to donor recruitment in blood transfusion centers in the country and also consistent enlightenment programmes on transfusion-transmissible infections with a view of reversing this trend. There is a need for stringent selection of blood donors with the emphasis on getting voluntary donations and comprehensive screening of donors for TTIs.

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Funding

This study was funded by the authors.

Availability of data and materials

Datasets generated and analysed in this study are available from the corresponding author on reasonable request.

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Abbreviations

HBsAg	Hepatitis B surface antigen
HBV	Hepatitis B virus
HCV	Hepatitis C virus
HIV	Human immunodeficiency virus
TTIs	Transfusion-transmissible infections
VDRL	Venereal disease research laboratory

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Authors’ contributions

HUO conceived the study, analysed data, did statistical analysis and prepared the manuscript; IMO analysed data and prepared the manuscript; EAA analysed data and prepared the manuscript; DCO anlysed data and prepared the manuscript. All authors read and approved the final manuscript.

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Notes

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Ethics approval and consent to participate

This study was approved by Health Research Ethical Committee (HREC) of the University of Calabar Teaching Hospital. As only secondary data was used in this study, consent to participate was not required.

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Competing interests

The authors declare no competing interest.

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Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Contributor Information

Henshaw Uchechi Okoroiwu, Phone: +234 8038833901, Email: moc.liamg@wahsnehuwioroko.

Ifeyinwa Maryann Okafor, Email: moc.liamg@21yfirofako.

Enosakhare Aiyudubie Asemota, Email: moc.liamg@atomesa53ason.

Dorathy Chioma Okpokam, Email: moc.liamg@evolahgo.

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