Blood donors in Kenya: a comparison of voluntary and family replacement donors based on a population-based survey

Occult hepatitis B virus infections and risk factors among school-going adolescent voluntary blood donors in Kwale County Kenya, January 2020–June 2021: Cross sectional study

Background

Occult hepatitis B virus (HBV) infections remain a safety concern worldwide. The prevalence in Kenya ranges from 2.6% to 4.4% among secondary school-going voluntary blood donors. This study estimated the prevalence of occult HBV infections among school-going voluntary blood donors through donations made to Kwale Satellite Blood Transfusion Center (KSBTC).

Methods

This was a retrospective cross-sectional study on data collected by the KSBTC between January 2020 and June 2021 among secondary school-going voluntary blood donors. Data were collected in MS Excel 2013 and analyzed in Epi Info 7. Descriptive statistics were calculated and we compared donors with positive Hepatitis B surface antigen (HBsAg) to those with negative HBsAg. Crude Prevalence Odds Ratios (cPOR) at 95% confidence intervals (CI) were calculated to identify factors associated with positive HBsAg.

Results

A total of 613 records were analyzed. The mean age of the donors was 19.1 years (± 1.8 years), there were 457 males (74.5%), 502 individuals were in the age group 18–25 years (82.3%), and the mean hemoglobin level was 14.1 g/dl (±1.6 g/dl). First-time blood donors made up 84.8% of all donors (513/605) and the mean inter-donation period was 20 months (±5.8 months) for repeat donors. The sero-positivity for HBsAg was 8.8% (54/613). Age category 16–17 years with positive HBsAg were 10.2% (11/108), femaleswere10.9% (17/156), and first-time donors were 9.4% (48/513). On bivariate analyses, first-time blood donors were 1.5 times more likely to test positive for HBsAg compared to repeat donors (cPOR = 1.5, 95% CI 0.61–3.57). Females were 1.4 times more likely to test positive for HBsAg compared to male donors (cPOR = 1.4, 95% CI 0.76–2.54).

Conclusions

The majority of the voluntary blood donors were males and the majority of occult HBV infections came in the first-time blood donor group. We recommend increasing targeted recruitment of repeat donors by encouraging healthy first-timer donors to be regular donors, and suggest this population should be vaccinated against HBV infections.

First Report from Afghanistan on the Prevalence of Blood-Borne Infections: A Retrospective Cross-Sectional Multicentre Study for an Epidemiological Assessment

Background

The transfusion of blood and blood components has a significant role in healthcare services. However, it remains a possible risk factor for blood-borne infections. The present study was conducted to assess the prevalence of serological markers of common blood-borne infections among the blood donor population of Afghanistan.

Methodology

This was a cross-sectional study based on retrospectively collected data over a period of six years from 284 blood centres across 34 provinces of Afghanistan. Every blood donor’s sample was tested by rapid immunoassays for the serological markers of blood-borne infections namely hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (anti-HCV), anti-human immunodeficiency virus 1/2 (anti-HIV1/2), and anti-Treponema pallidum (anti-TP).

Results

All blood donors during the study period were males. The majority of blood donations were from the family replacement category 56.93% (n = 544,568). The overall pooled prevalence of blood-borne infections was 4.36% with a comparatively higher percentage in family replacement donors 4.88%. The seropositivity for HBsAg, anti-HCV, anti-HIV1/2, and anti-TP was 2.95%, 0.81%, 0.04%, and 0.54%, respectively.

Conclusion

Complete reliance on voluntary blood donors and screening with quality assured highly sensitive assay is recommended to ensure blood safety in the country.

Safe blood supply in sub-Saharan Africa: challenges and opportunities

The low recruitment and retention of blood donors in sub-Saharan Africa is a grave concern for blood transfusion services in the region. This problem is exacerbated by factors such as a high prevalence of transfusion-transmissible infections and anaemia, over-reliance on family replacement donors, resource constraints, and poor communication with the public. To improve blood safety and availability, innovative intervention strategies must be developed and implemented. The primary objective of this Series paper is to discuss the available evidence in the region and to provide recommendations on how to improve safe blood supply in sub-Saharan Africa. These recommendations include a call for renewed attention to donor recruitment in blood transfusion centres, a consistent and structured educational intervention, the development and adherence to national policies on blood donor selection with focus on voluntary donations, and comprehensive screening of donations for transfusion-transmissible infections. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.

The apheresis platelet donation was increased after a nationwide ban on family/replacement donation in China

BACKGROUND

A nationwide ban on family/replacement donation (FRD) went into effect on April 1, 2018 in China. To date, no reports relevant to the trend of plateletpheresis donations before and after a nationwide ban on FRD were found.

METHODS

We used two independent full samples, consisting of 135,851 and 82,129 plateletpheresis donors from Guangzhou and Chengdu between October 2012 and September 2019, respectively. A pseudo-panel data approach was applied by grouping three time-invariant covariates - gender, blood donation history, and birth year across 14 cross-sections (a 6-month interval each) to form a total of 24 cohort groups (14 × 24 = 336 cohorts, i.e., cells) with each having common covariates. The outcome was average apheresis platelet units per donor in each cell. We performed a two-piecewise linear mixed model with the cross-section (i.e., time) just right before the ban as a time breakpoint (i.e., 11th cross-section) to examine the trend of outcome with the adjustment of three time-invariant covariates. We removed the FRDs in each of the first 11 cross-sections to detect its possible influence on the trend.

RESULTS

The final model for the samples from Guangzhou presented a two-piecewise linear trend of the outcome over time with a horizontal line to the left of the breakpoint (β_timeBefore11 = 0.0111, p = 0.0976) and a significantly positive linear trend to the right (β_timeAfter11 = 0.0404, p < 0.0001). The male donors and the donors with plateletpheresis donation history had an increased baseline outcome and a significant outcome change over time after the ban. Such a two-piecewise linear trend pattern can be replicated using the samples from Chengdu with some minor variations. Removing the FRD before the ban can change the pattern.

CONCLUSION

The significant increase of the average apheresis platelet units per donor over time after the FRD ban may be related to the implement of the FRD ban and the improved donation behavior of male donors and/or donors with platelet donation history after the ban. Our findings may potentially motivate the policymakers in other countries where the FRD for plateletpheresis donation is still legitimate to phase out their FRD strategy and ultimately achieve 100% voluntary plateletpheresis donation.

Transfusion-Transmitted Infections and associated risk factors at the Northern Zone Blood Transfusion Center in Tanzania: A study of blood donors between 2017 and 2019

Background

Blood transfusion saves many people every year that would otherwise have died. The present study aimed to provide an update and insightful information regarding prevalence of the common Transfusion-Transmitted Infections (TTIs) and associated factors among blood donors in Tanzania.

Methods

This was a cross-sectional study involving retrospectively collected data of blood donors from the Tanzania Northern Zone Blood Transfusion Center between 2017 and 2019. Descriptive statistics were performed to describe characteristics of the blood donors. Univariable and multivariable logistic regression analyses were performed to determine association between prevalence of TTIs and socio-demographic factors. P-value <0.05 was considered statistically significant.

Results

A total of 101, 616 blood donors were included in the present study of which 85,053(83.7%) were males while 16,563 (16.3%) were females. Of all participants, the majority 45,400 (44.7%) were aged between 18 and 25 years; 79,582 (78.3%) were voluntary non-remunerated donors while 22,034 (21.7%) were replacement donors. The vast majority of them 99,626 (98%) were first time blood donors while 1990 (2%) were multiple donors. The overall prevalence of TTIs was 10.1% (10,226 out of 101,616) of which the leading was HBV accounting for 5.1% (5,264 out of 101,616). Being a replacement donor was associated with all the four types of TTIs: HIV (AOR = 1.22, 95% CI = 1.10–1.35), HBV (AOR = 1.35, 95% CI = 1.27–1.44), HCV (AOR = 1.28, 95% CI = 1.12–1.46), and syphilis (AOR = 1.33, 95% CI = 1.20–1.48).

Conclusions

Our study has demonstrated that Tanzania has relatively high prevalence of TTIs compared to some countries in Sub-Saharan Africa. HBV infection seems to be the most common infection among blood donors and replacement blood donors are at a higher risk of harboring the commonest TTIs among blood donors.

Seroprevalence and Risk Factors for Hepatitis B Virus Infection in Adolescent Blood Donors within Selected Counties of Western Kenya

Hepatitis B virus is a widespread public health menace approximated to have infected 257 million people chronically by 2015. Data on the prevalence of HBV is important in formulating public health policies on HBV control like safe blood transfusion. Adolescents aged 15 to 24 years, known to engage in risky activities associated with HBV spread, constitute major blood donors in Kenya. Notwithstanding current blood donation safety measures, HBV still remain hazardous transfusion-transmissible infections in donated blood. This study therefore was to determine the prevalence of HBsAg and related risk factors among this donor group. A cross-sectional study was conducted from April 2019 to August 2019 in Siaya, Kisumu, and Homa Bay counties. One thousand (1000) voluntary blood donors 18 to 25 years old were recruited. A predonation questionnaire was used to record their sociodemographic features and prior risk exposures. Blood samples were initially tested for HBsAg using Murex HBsAg Version 3 (DiaSorin, UK) and positives confirmed using ARCHITECT HBsAg Qualitative Confirmatory assay (Abbott Ireland) as per the manufacturer's instructions. A result was considered positive if the first and confirmatory tests were all reactive. Generally, the prevalence of HBV was 3.4%, with no significant association between various sociodemographic variables and HBsAg positivity. Nevertheless, scarification and risky sexual behavior were significantly linked to HBV infections (odds ratio (OR) = 8.533, 95%confidence interval (CI) = 3.128‐23.275, p value of 0.001 and OR = 5.471, 95%CI = 1.925‐15.547, p value of 0.002, respectively). This study revealed a prevalence of 3.4% HBsAg among adolescent blood donors, with perilous sexual behaviors being the most significant risk factor, evidence that sexual contact still plays a major role in transmission of HBV among this donor group despite blood transfusion safety measures put in place. These study findings should therefore be put into consideration while framing health policies to mitigate effects of HBV infection on safe blood transfusion.

Prevalence and associated risk factors of transfusion transmissible infections among blood donors at Regional Blood Transfusion Center Nakuru and Tenwek Mission Hospital, Kenya

Introduction

Unsafe transfusion practices can put millions of people at risk of Transfusion Transmissible Infections (TTIs). In Kenya the current blood transfusion scheme involves screening of blood for HIV, Hepatitis B virus (HBV), Hepatitis C virus (HCV) and syphilis. Malaria is also a blood-borne disease which is not currently screened for. In Kenya blood donor selection criteria were reviewed in 2009. Regular review of effectiveness of donor selection criteria can help reduce TTIs prevalence amongst donors and thus make the blood supply safer.

Methods

A cross sectional study was conducted between November 2011 to January 2012 among 594 blood donors in the Regional Blood Transfusion Center Nakuru and Tenwek Mission Hospital. Socio-demographic characteristics and associated risk factors were collected using a standard blood transfusion service questionnaire. Donors were obtained through systematic sampling. Each donor sample was screened, for HIV-1 and HIV-2, HBV, HCV, syphilis and malaria parasites.

Results

The overall prevalence of TTIs was 14.1%, which ranged from 0.7% for malaria to 5.6% for HBsAg. Blood donors who were married (P=0.0057), had non-formal or just primary education (P=0.0262), had multiple sexual partners (P=0.0144) and in informal occupation (P=0.0176) were at higher risk of HIV positivity. History of blood transfusion/blood products (P=0.0055), being married (P=0.0053) were high risk factors associated with positive syphilis. Being male (P=0.0479) was a high risk factor to HBV infection.

Conclusion

The prevalence of TTIs indicates a need to review the questionnaire and apply it strictly for donor selection. The 0.7% prevalence of malaria, poses a serious health risk to non-immune recipients of transfusion. Malaria should be included among mandatory TTI tests in Kenya.

Seroprevalence and determinants of transfusion transmissible infections among voluntary blood donors in Homabay, Kisumu and Siaya counties in western Kenya

Objective

Since the implementation of a series of blood donation safety improvements in Kenya, information about seroprevalence and determinants of transfusion transmissible infections among voluntary blood donors especially in high HIV burden regions of Homabay, Kisumu and Siaya counties remain scanty. A cross-sectional study examining HIV, syphilis, hepatitis B and C virus sero-markers and associated determinants was conducted among voluntary blood donors. Their demographic characteristics and previous risk exposure were recorded in a pre-donation questionnaire, while blood samples collected were screened for hepatitis B, hepatitis C, human immunodeficiency viruses by ELISA and RPR (syphilis), then confirmed using CMIA.

Results

Overall TTIs seroprevalence was 114 (9.4%), distributed among HIV, HBV, HCV and syphilis at 14 (1.15%), 42 (3.46%), 39 (3.21%) and 19 (1.56%), respectively, with co-infections of 3 (0.25%). There were no significant differences in proportions distributions among demographic variables. However, high risk sex was significantly associated with higher odds of HBV infections [> 1 partner vs. 0–1 partner; odd ratio (OR) 2.60; 95% confidence interval (CI) 1.098–6.86; p = 0.046]. In conclusion, a substantial percentage of blood donors still harbor transfusion transmissible infections despite recent safety improvements with greater majority cases caused by HBV infections arising from previous exposure to high risk sex.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3276-y) contains supplementary material, which is available to authorized users.

Estimating Tanzania's National Met and Unmet Blood Demand From a Survey of a Representative Sample of Hospitals

Estimating blood demand to determine collection goals challenges many low-income countries. We sampled Tanzanian hospitals to estimate national blood demand. A representative sample based on probability proportional to size sampling of 42 of 273 (15%) Tanzanian transfusing hospitals was selected. Blood bank registers, patient medical records, and blood component disposition records were reviewed prospectively from June to September 2013 to determine the number of components requested and the number and proportion issued, not issued due to nonavailability, and not issued for other reasons. Data were estimated for an annual national estimate. Of an estimated 278 371 components requested in 2013, 6648 (2.4%) were not issued due to nonavailability, 34 591 (12.4%) were not issued for other reasons, and 244 535 (87.8%) were issued. Of these 278 371 components, 86 753 (31.2%) were requested by adult medical, 74 499 (26.8%) by pediatric medical, and 57 312 (20.6%) by obstetric units. In these 3 units, the proportion of units not issued due to nonavailability was 1.8%. Private (4.1%) and large (6%) hospitals had the largest proportion of units not issued because of nonavailability. Of 244 535 issued components, 91 690 (37.5%) were collected, tested, and issued from blood banks that are not part of the Tanzania National Blood Transfusion Services (TNBTS). Nearly 98% of blood component demand was met. However, a large portion of the blood supply for the hospitals came from non-TNBTS blood banks. TNBTS could increase availability of safe blood through assuring the quality of donor selection and donation testing at non-TNBTS blood banks.

Hepatitis B, Hepatitis C, Human immunodeficiency virus and syphilis frequency among blood donors: A single center study

We aimed to provide updated results for seroprevalence of hepatitis B, hepatitis C viruses while presenting first data for human immunodeficiency virus and syphilis seropositivity amongst blood donors in Adana, Turkey. Screening and confirmatory test results of 62,461 donors were evaluated. HBsAg, anti-HCV, anti-HIV1/2 and syphilis seropositivity was 1.92%, 0.48%, 0.20%, 0.18% respectively, based on screening tests, and 1.66%, 0.05%, 0.003%, 0.10% respectively, according to confirmatory tests. Transfusion-transmitted infections (TTI) was more prevalent in low-educated donors. HBsAg and syphilis seropositivity rates were higher in married subjects. We found that the prevalence of HBV and HCV was significantly decreased in the last two decades in Adana. Importantly, this study provides first data in HIV and syphilis seropositivity rates among blood donors in our region and both HIV and syphilis seroprevalences were found to be low compared to many regions of Turkey. However, considering the fact that increasing number of immigrants may change prevalences and trends of TTI both in Adana and in Turkey, strict monitorization and yearly reporting of TTI rates seem necessary to be able to take proactive measures.

Namibia's transition from whole blood-derived pooled platelets to single-donor apheresis platelet collections

BACKGROUND

Few African countries separate blood donations into components; however, demand for platelets (PLTs) is increasing as regional capacity to treat causes of thrombocytopenia, including chemotherapy, increases. Namibia introduced single-donor apheresis PLT collections in 2007 to increase PLT availability while reducing exposure to multiple donors via pooling. This study describes the impact this transition had on PLT availability and safety in Namibia.

STUDY DESIGN AND METHODS

Annual national blood collections and PLT units issued data were extracted from a database maintained by the Blood Transfusion Service of Namibia (NAMBTS). Production costs and unit prices were analyzed.

RESULTS

In 2006, NAMBTS issued 771 single and pooled PLT doses from 3054 whole blood (WB) donations (drawn from 18,422 WB donations). In 2007, NAMBTS issued 486 single and pooled PLT doses from 1477 WB donations (drawn from 18,309 WB donations) and 131 single-donor PLT doses. By 2011, NAMBTS issued 837 single-donor PLT doses per year, 99.1% of all PLT units. Of 5761 WB donations from which PLTs were made in 2006 to 2011, a total of 20 (0.35%) were from donors with confirmed test results for human immunodeficiency virus or other transfusion-transmissible infections (TTIs). Of 2315 single-donor apheresis donations between 2007 and 2011, none of the 663 donors had a confirmed positive result for any pathogen. As apheresis replaced WB-derived PLTs, apheresis production costs dropped by a mean of 8.2% per year, while pooled PLT costs increased by an annual mean of 21.5%. Unit prices paid for apheresis- and WB-derived PLTs increased by 9 and 7.4% per year on average, respectively.

CONCLUSION

Namibia's PLT transition shows that collections from repeat apheresis donors can reduce TTI risk and production costs.

Investments in blood safety improve the availability of blood to underserved areas in a sub-Saharan African country

BACKGROUND AND OBJECTIVES

Since 2004, several African countries, including Namibia, have received assistance from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Gains have been documented in the safety and number of collected units in these countries, but the distribution of blood has not been described.

MATERIALS AND METHODS

Nine years of data on blood requests and issues from Namibia were stratified by region to describe temporal and spatial changes in the number and type of blood components issued to Namibian healthcare facilities nationally.

RESULTS

Between 2004 and 2007 (early years of PEPFAR support) and 2008-2011 (peak years of PEPFAR support), the average number of red cell units issued annually increased by 23.5% in seven densely populated but less-developed regions in northern Namibia; by 30% in two regions with urban centres; and by 35.1% in four sparsely populated rural regions.

CONCLUSION

Investments in blood safety and a policy decision to emphasize distribution of blood to underserved regions improved blood availability in remote rural areas and increased the proportion of units distributed as components. However, disparities persist in the distribution of blood between Namibia's urban and rural regions.

Prevalence of p24 antigen among a cohort of HIV antibody negative blood donors in Sokoto, North Western Nigeria--the question of safety of blood transfusion in Nigeria

INTRODUCTION

Blood transfusions remain a substantial source of HIV in SSA particularly among children and pregnant women.

AIMS AND OBJECTIVES

This aim of this retrospective study was to investigate the prevalence of p24 antigen among HIV antibody seronegative blood donors in Sokoto, North West Nigeria.

METHODS

A total of 15,061 HIV antibody negative blood donors with mean age and age range (29.2 ± 8.18 and 18-50 years) were screened for p24 antigen between January 2010 to July 2013 using the Diapro Diagnostic immunoassay kit for P24 antigen (King Hawk Pharmaceuticals Beijing China).

RESULTS

The overall prevalence of p24 antigen among the HIV antibody negative donors sample was 5.84%. The yearly prevalence was 9.79, 8.12, 2.7 and 2.84% respectively in 2010, 2011, 2012 and 2013. Of the total number of blood donor tested, 14,968 (99.38%) were males while 93 (0.62%) were females. The prevalence of P24 antigen was significantly higher among male blood donors 873 (5.8%) compared to females 7(0.05%), (p= 0.001). P24 positivity was significantly higher among blood group O blood donors compared to A, B and AB donors (494 (3.29%) compared to 184 (1.89%), 196 (1.30%) and 6 (0.04%)) respectively, p = 0.001). The prevalence of P24 antigen was significantly higher among Rhesus positive blood donors compared to Rhesus negative (807 (5.36%) versus 73 (0.48%), p =0.001).

CONCLUSION

Blood transfusion in Nigeria is associated with increased risk of HIV transmission. There is the urgent need to optimize the screening of blood donors in Nigeria by the inclusion of p24 antigen testing into the blood donor screening menu. The Nigerian government urgently need to adopt the WHO blood safety strategies to reduce the risk of transmission of HIV through blood transfusion.

The degree of safety of family replacement donors versus voluntary non-remunerated donors in an Egyptian population: a comparative study

BACKGROUND

Screening donated blood for transfusion-transmissible infections is considered an important strategy for maximising the safety of blood transfusions.

MATERIALS AND METHODS

A total of 17,118 donors, classified into two groups--family replacement donors and voluntary non-remunerated donors--were investigated for hepatitis B virus (HBV) surface antigen and antibodies against hepatitis C virus (HCV), human immunodeficiency virus (HIV) and Treponema pallidum. In addition cytomegalovirus (CMV) antibodies were searched for in 160 donors (80 from each group). All the laboratory tests were done using enzyme-linked immunosorbent assays.

RESULTS

Of the total cohort of donors, 87.7% were family donors and 12.3% were voluntary non-remunerated donors. There was a highly significant difference in age and gender between the two types of donors with voluntary donors being much younger and including a much higher proportion of male donors than female donors. The prevalences of HBV, HCV and CMV IgG were much higher in family donors than in voluntary donors, with the differences being highly statistically significant. There was also a significantly higher prevalence of syphilis among family replacement donors. As regards HIV and CMV IgM, significant differences were not detected between the two groups.

DISCUSSION

The results of our study clearly showed that the prevalence of transfusion-transmissible infections is much higher among family replacement donors than among voluntary donors, and that voluntary donors are the best way of achieving safer blood.

External financial aid to blood transfusion services in sub-Saharan Africa: a need for reflection

Jean-Pierre Allain and colleagues argue that, while unintended, the foreign aid provided for blood transfusion services in sub-Saharan Africa has resulted in serious negative outcomes, which requires reflection and rethinking.

Moving on from voluntary non-remunerated donors: who is the best blood donor?

Blood transfusion safety in sub-Saharan Africa (SSA) is marred by the high prevalence of infectious agents, chronic blood shortage and lack of resources. However, considerable pressure is applied by richer countries and international transfusion bodies to establish voluntary, non-remunerated blood donors (VNRD) as the only source of blood, excluding the traditional family/replacement donors on the grounds of a higher level of safety. Such a policy increases the cost of a unit of blood by two to fivefold and exacerbates the pre-existing blood shortage. This review provides compelling evidence that first-time VNRD are no safer than family/replacement donors and that only repeat donation provides improved blood safety. In order to limit blood shortage and maintain affordability of the blood supply in SSA, both types of donors should be accepted and both should be encouraged to donate regularly.