|Year : 2015 | Volume
| Issue : 2 | Page : 125-129
The epidemiology of transfusion-transmissible infections among blood donors in Nnewi, South-East Nigeria
Emmanuel C Okocha1, John C Aneke1, Theodora U Ezeh1, Nancy C Ibeh2, Gloria A Nwosu1, Israel O Okorie1, Christian E Onah3
1 Department of Hematology and Blood Transfusion, Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State, Nigeria
2 Department of Medical Laboratory Science, Nnamdi Azikiwe University (NAU), Nnewi Campus, Anambra State, Nigeria
3 Department of Chemical Pathology, Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State, Nigeria
|Date of Web Publication||21-Nov-2015|
John C Aneke
Department of Hematology and Blood Transfusion, Nnamdi Azikiwe University Teaching Hospital (NAUTH), PMB 5025, Nnewi, Anambra State
Source of Support: None, Conflict of Interest: None
Background: The prevalence of transfusion-transmissible infections (TTIs) is influenced by certain blood donor characteristics. Aim: To study the epidemiology of TTIs among blood donors in a Nigerian Tertiary Hospital. Materials and Methods: Sociodemographic data and other donor information were retrieved from the donor register. The rapid test results for hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV), syphilis (venereal disease research laboratory), and human immunodeficiency virus (by determine and Stat-Pack test kits) as well as P24 antigen assays were also retrieved from the register. Chi-square statistics was used to compare the prevalence rates of TTIs among donor groups, the level of significance was set at P < 0.05. Results: The highest prevalence of TTIs was recorded for HBsAg and HCV (2.0% (29/1419) and 2.0% (28/1419) respectively), among all donors, it was nil for syphilis (0%). Commercial donors recorded the highest percent prevalence of all TTIs while voluntary donors had the least. Traders and students had a higher prevalence of TTIs among the occupational groups while laborers and the unemployed recorded the least. Blood Group A Rhesus D positive donors recorded the highest prevalence of TTIs while blood Groups A and B Rhesus D negative and AB Rhesus D positive donors recorded the least. There were no significant differences in the prevalence rates of TTIs compared by donor type, gender and occupational groups (P > 0.05). Conclusion: Donor type, occupation and blood group appear to indicate higher TTI carriage rate among our blood donor set.
Keywords: Blood donors, human immunodeficiency virus P24 antigen ELISA test, rapid test kits, transfusion transmissible infections
|How to cite this article:|
Okocha EC, Aneke JC, Ezeh TU, Ibeh NC, Nwosu GA, Okorie IO, Onah CE. The epidemiology of transfusion-transmissible infections among blood donors in Nnewi, South-East Nigeria. Afr J Med Health Sci 2015;14:125-9
|How to cite this URL:|
Okocha EC, Aneke JC, Ezeh TU, Ibeh NC, Nwosu GA, Okorie IO, Onah CE. The epidemiology of transfusion-transmissible infections among blood donors in Nnewi, South-East Nigeria. Afr J Med Health Sci [serial online] 2015 [cited 2017 May 24];14:125-9. Available from: http://www.ajmhs.org/text.asp?2015/14/2/125/170183
| Introduction|| |
Nigeria utilizes about 1.5 million units of blood annually,  this requirement cuts across the three levels of healthcare delivery in the country; primary, secondary, and tertiary. Current legislation mandates the screening of potential blood donors for the following transfusion-transmissible infection (TTIs); hepatitis C virus (HCV) hepatitis B surface antigen (HBsAg), human immunodeficiency virus (HIV) and syphilis. 
Earlier studies have identified donor characteristics such as occupation,  test seeking behavior,  and type of donor ,, to impact on the prevalence of TTIs among blood donors.
This study described the characteristics of blood donors in a tertiary hospital, in South-East Nigeria.
| Materials and Methods|| |
This was a retrospective study, carried out at the Department of Haematology and Blood Transfusion of our hospital. The study period covered from January 2012 to December 2012.
The blood donation and screening registers were retrieved from the departmental archives and relevant donor information, including gender, age, occupation, blood group, type of donation and results of rapid tests for HBsAg, HCV, syphilis, HIV as well as the P24 antigen were extracted.
Donors whose details were incomplete were excluded from the study.
Testing for HIV-1 and HIV-2 was by parallel algorithm using two different kits; determine (Alere Medical Co., Ltd., Chiba, Japan) and Stat-Pak (Chembio Diagnostic Systems, Inc., Medford, NY, USA). Subjects were regarded as HIV positive if they tested positive to both kits.
All plasma that tested negative with the two rapid test kits were further subjected to HIV-P24 ELISA assay, using Genscreen™ ULTRA HIV Ag-Ab qualitative enzyme immunoassay kit (Bio Rad Inc., Marnes-la-Coquette-France).
The HBsAg, HCV and syphilis were tested using rapid chromatographic immunoassays that qualitatively detect HBsAg, antibodies to HCV and Treponema pallidum in plasma, respectively, (Acumen Labs and Diagnostic Centre, Bangalore, India).
Each test strip had inbuilt procedural controls.
All data analyses were done using SPSS version 20 computer software (SPSS Inc., Chicago IL, USA) and descriptive results of demographic and other donor characteristics were presented as percentages. The prevalence rates of TTIs were compared among different donor types, gender and occupational groups using the Chi-square statistics, the level of significance was set at P < 0.05. Ethical approval for the study was obtained from the institutional review board.
| Results|| |
A total of 1419 donors were seen within the study period (mean age of 29.16 ± 9.82 years) while commercial donors and students constituted the predominant donor type and occupational group, respectively [Table 1].
The general prevalence of HIV among our donors, using determine, Stat-Pak and P24 antigen test kits were 1.4% (20/1413), 0.6% (9/1417) and 1.7% (22/1306), respectively, whereas it was 2.0% (29/1419), 2.0% (28/1419) and 0.1% (1/1417) respectively, for HBsAg, HCV and syphilis, using the respective rapid test kits [Table 2].
The prevalence rates of HIV in male and female donors were 1.6% (20/1279) versus 0%, 0.7% (9/1282) versus 0% and 1.8% (21/1179) versus 0.8% (1/127) using determine, Stat-Pak and P24 antigen test kits, respectively [Table 3]. Correspondingly, it was 2.0% (26/1284) versus 2.2% (3/135), 2.1% (27/1284) versus 0.7% (1/135) and 0.1% (1/1283) versus 0% for HBsAg, HCV and syphilis by the rapid test kits, respectively [Table 3]. There was no significant difference in the prevalence of HIV using the determine, Stat-Pak and P24 antigen test kits in males compared with females (P = 0.25, 1.00 and 0.72, respectively [Table 3]). The prevalence rates of HBsAg, HCV and syphilis, were not significantly different in male and female donors (P = 0.75, 0.51 and 1.00, respectively [Table 3]).
Using determine and Stat-Pak rapid test kits, the prevalence rates of HIV among commercial, family relation and voluntary donors were 0.9% (7/813), 0.4% (3/815), 0% and 0%, 0%, 0%, respectively, while it was 1.6% (12/772), 1.8% (8/449) and 0%, respectively, using the P24 antigen test kit [Table 4]. The prevalence rates of HBsAg in commercial, family relation and voluntary donors were 1.1% (9/816), 0.9% (4/470) and 0.0% while it was 1.3% (11/816), 0.9% (4/470) and 0% respectively, for HCV, using the respective rapid test kits [Table 5]. Syphilis recorded 0% prevalence in all the three donor types [Table 4]. No significant differences were observed in the prevalence rates of HIV among the donor types, using the determine, Stat-Pak and P24 antigen test kits (P = 0.12, 0.41 and 0.87, respectively, [Table 4]). There were no significant differences in the prevalence rates of HBsAg and HCV among the different donor types (P = 0.85 and 0.67, respectively, [Table 4]).
Traders and students showed higher prevalence rates of TTIs among donor occupational groups. The prevalence rates of HIV among traders and students were 1.0% (5/502) versus 0.2% (1/524), 0.4% (2/502) versus 0.2% (1/525) and 2.5% (12/478) versus 1.2% (6/494), using determine, Stat-Pak and P24 antigen test kits, respectively [Table 5]. Correspondingly, it was 1.6% (8/508) versus 0.8% (4/525) and 1.6% (8/502) versus 1.1% (6/525) for HBsAg and HCV infections, respectively [Table 5]. Artisans and civil servants recorded their highest prevalence rates of TTIs in HCV and HIV by the P24 antigen test (0.7% (1/144) and 2.1% (2/95) respectively) while laborers and the unemployed recorded 0% prevalence rates for all TTIs [Table 5]. The prevalence rates of HIV, using determine, Stat-Pak and P24 antigen test kits among the various occupational groups of donors were not statistically significant (P = 0.40, 0.94 and 0.34, respectively, [Table 5]). There were no significant differences in the prevalence rates of HBsAg and HCV among the different occupational groups of donors (P = 0.40 and 0.77, respectively, [Table 5]).
Blood Groups A Rh D positive and O Rh D positive showed a higher prevalence of TTIs among donor blood groups. The prevalence rates of HIV among blood Groups O Rh D positive and A Rh D positive donors were 1.5% (15/1005) versus 1.8% (4/218), 0.5% (5/1009) versus 0.9% (2/218) and 1.5% (14/926) versus 1.5% (3/205), using determine, Stat-Pak and p24 antigen test kits, respectively. Correspondingly, it was 1.8% (18/1011) versus 2.8% (6/218) and 2.4% (24/1011) versus 1.4% (3/218), respectively for HBsAg and HCV infections, using the rapid test kits. The prevalence rate of syphilis was 0.1% (1/1009) in blood Group O Rh D positive donors only, while donors with blood Groups AB Rh D positive, B Rh D negative and A Rh D negative recorded 0% prevalence rate for all TTIs.
| Discussion|| |
The donor distribution in this study showed that we had predominantly young adults (mean age of 29.16 ± 9.82 years) in our donor pool. Buseri et al.  had reported a similar age distribution among blood donors in Osogbo, Nigeria. This age distribution is not surprising as it represents the most active age stratum of the population.
The World Health Organization (WHO) encourages blood sourcing from voluntary, nonremunerated blood donors as this is adjudged the most suitable for a transfusion because of its highly reduced chance of harboring TTIs.  This study identified commercial donors as the predominant donor type, followed by family replacement donors, while voluntary donors were the least in number [Table 1]. This is at variance with the report of Kimani et al.  who reported a predominance of voluntary donors among Kenyan blood donors; no explanation was adduced for this observation.
Earlier studies had reported prevalence rates of 3.0%,  12.0%,  3.0%,  and 15.4%  in Nigerian general population, for HIV, HBV, HCV and syphilis, respectively. These were higher than the rates observed in our donor population [Table 3]. The highest prevalence rates of TTIs among our donors were observed for hepatitis B and C infections (2.0% respectively, [Table 2]). This agrees with similar reports in Nigerian blood donors as well as patients presenting to the emergency department. ,
Male donors recorded the higher prevalence of all TTIs than females, except with respect to HBsAg, where the prevalence was comparable in both gender (2.0% vs. 2.2%, respectively). Over all, there were no significant differences in the prevalence rates of TTIs in males compared with females in this study [Table 3]. This is similar to the report of Matee et al.,  in blood donors in Tanzania. Expectedly, commercial donors recorded the highest prevalence of TTIs in our study population while voluntary donors had the least, these differences were, however, not statistically significant [Table 5]. The works of Kimani, Jeremaiah,  and Buseri et al.,  were all in keeping with our observation and had similarly identified voluntary donors as having the lowest prevalence of TTIs among blood donors in Kenya, Port Harcourt (South-South Nigeria) and Osogbo (South-West Nigeria), respectively. This observation further drives home the inherent dangers in patronizing commercial blood donors and adds credence to the WHO directive on the ideal blood donor and blood safety. 
The largest groups of donors were students and traders, this occupational spectrum mirror the setting of our hospital; it is located in a commercial town and hosts undergraduates of different health professions.
The risk of acquiring sexually transmitted infections has been documented to be higher in occupations that involve people of lower educational background, who move around a lot in the course of their work. ,, Our study showed that traders and students had the highest prevalence rate across all TTIs while it was 0% in laborers and in the unemployed and quite negligible in artisans and civil servants [Table 5]. Even though these differences were not statistically significant, it may appear that some form of economic empowerment may add to the factors that may predispose certain occupational groups to TTIs in our population. An average trader in the town of this study may be better economically endowed than an artisan, laborer or the unemployed; even though they may have similar educational and other social characteristics.
This study showed that blood Group A Rh D positive donors had the highest prevalence of most TTIs; this is, contrary to other reports, which noted a preponderance of HIV infection in Group O Rh D positive subjects in Nigeria. , The reason for this discrepancy was not apparent from this study.
| Conclusion|| |
The high proportion of commercial donors in our study population and the high prevalence of TTIs observed in this group and in traders as well, call for renewed attention with regards to donor recruitment in blood transfusion centers in the country, coupled with increased enlightenment programs on TTIs and blood donation, with a view to reversing this trend.
Limitation of this study
The authors could not calculate the residual risk of TTIs in the population because there were no controls and repeat tests were not done for individual donors.
The authors could not calculate the individual prevalence of HIV 1 and 2 because rapid test kits used in this study cannot differentiate between HIV 1 and 2.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
The Nigerian National Blood Transfusion Policy, National Blood Transfusion Service. Abuja: Federal Ministry of Health; 2006. p. 1.
Asiki G, Mpendo J, Abaasa A, Agaba C, Nanvubya A, Nielsen L, et al.
HIV and syphilis prevalence and associated risk factors among fishing communities of Lake Victoria, Uganda. Sex Transm Infect 2011;87:511-5.
Goncalez T, Sabino E, Sales N, Chen YH, Chamone D, Busch M, et al.
Human immunodeficiency virus test-seeking blood donors in a large blood bank in São Paulo, Brazil. Transfusion 2010;50:1806-14.
Kimani D, Mwangi J, Mwangi M, Bunnell R, Kellogg TA, Oluoch T, et al.
Blood donors in Kenya: A comparison of voluntary and family replacement donors based on a population-based survey. Vox Sang 2011;100:212-8.
Jeremiah ZA, Koate B, Buseri F, Emelike F. Prevalence of antibodies to hepatitis C virus in apparently healthy Port Harcourt blood donors and association with blood groups and other risk indicators. Blood Transfus 2008;6:150-5.
Buseri FI, Muhibi MA, Jeremiah ZA. Sero-epidemiology of transfusion-transmissible infectious diseases among blood donors in Osogbo, south-west Nigeria. Blood Transfus 2009;7:293-9.
WHO. Universal Access to Safe Blood; February 11, 2010. Available from: http://who.int/bloodsafety/universalbts/en/index.html. [Last accessed on 2013 Dec 06].
Mahy M, Nzima M, Ogungbemi MK, Ogbang DA, Morka MC, Stover J. Redefining the HIV epidemic in Nigeria: From national to state level. AIDS 2014;28 Suppl 4:S461-7.
Aminu M, Okachi EE, Abubakar SM, Yahaya A. Prevalence of hepatitis B virus surface antigen among healthy asymptomatic students in a Nigerian University. Ann Afr Med 2013;12:55-6.
Ejele OA, Nwauche CA, Erhabor O. Seropositivity of hepatitis C virus in Niger Delta of Nigeria. Niger Postgrad Med J 2006;13:3-6.
Ophori EA, Atanunu O, Johnny EJ, Adu M. Seroprevalence of syphilis in apparently healthy students from a tertiary institution in Benin City, Nigeria. Jpn J Infect Dis 2010;63:437-9.
Kassim OD, Oyekale TO, Aneke JC, Durosinmi MA. Prevalence of seropositive blood donors for hepatitis B, C and HIV viruses at the Federal Medical Centre, Ido-Ekiti Nigeria. Ann Trop Pathol 2012;3:47-55.
Halim NK, Madukwe U, Saheeb BD, Airauhi LU. Hepatitis B surface antigen and antibody to hepatitis C virus among accident and emergency patients. East Afr Med J 2001;78:480-3.
Matee MI, Magesa PM, Lyamuya EF. Seroprevalence of human immunodeficiency virus, hepatitis B and C viruses and syphilis infections among blood donors at the Muhimbili National Hospital in Dar es Salaam, Tanzania. BMC Public Health 2006;6:21.
Singh YN, Malaviya AN. Long distance truck drivers in India: HIV infection and their possible role in disseminating HIV into rural areas. Int J STD AIDS 1994;5:137-8.
Mathai J, Sulochana PV, Satyabhama S, Nair PK, Sivakumar S. Profile of transfusion transmissible infections and associated risk factors among blood donors of Kerala. Indian J Pathol Microbiol 2002;45:319-22.
Nneli RO, Ekpo BO, Egene J, Ohaeri OC. Prevalence of Rh and ABO blood groups in HIV seropositive pregnant women in Enugu, Nigeria. Niger J Physiol Sci 2004;19:7-9.
Dirisu JO, Alli TO, Adegoke AO, Osazuwa F. A Survey of prevalence of serum antibodies to human immunodeficiency deficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) among blood donors. N Am J Med Sci 2011;3:35-8.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]