Department of Human Anatomy,Ahmadu Bello University, Zaria, Kaduna State, Nigeria..
Elite International Academy of Health Technology, MTD Zaria, Kaduna State, Nigeria
Dept. of Hematology, Sch of Med. Lab. Sciences, A.B.U Teaching Hospital Zaria
Department of Human Anatomy, Ahmadu Bello University, Zaria, Nigeria
Laboratory Department, Federal Medical Centre,Birnin kudu Jigawa State Nigeria
All Correspondent to: firstname.lastname@example.org
Background: Transfusion transmitted infections threatened the safety of patients requiring blood transfusion, which in turn imposes serious challenges for the availability of safe blood products. The aim of the study is to determine the prevalence of transfusion transmitted infections in blood donors and to evaluate the demographic characteristics of reactive and non-reactive blood donors. Materials and Methods: A retrospective study of transfusion screening tests done in Hajiya Gambo Sawaba General Hospital Zaria between January and December 2016. Data retrieved from the laboratory record books, were analyzed using simple percentages. Results: A total of 1875 blood donors with mean age of 28 was recorded. 1850(98.6%) were males and 25(1.4%) females. Three hundred and fifty nine (19.1%) donations were reactive to all screening assay. The prevalence of Hepatitis B, Hepatitis C, Human Immuno Deficiency Virus and Syphillis was found to be 127(6.8%), 190 (10.1%), 33(1.8%) and 9(0.4%) respectively. Conclusion: This study revealed that there is a substantial percentage of the blood donors harbored transfusion transmitted infections. There is a need for stringent selection of blood donors with the emphasis on comprehensive screening of donors blood using standard methods to ensure the safety of blood recipient.
Key words: Blood, donors, Screening, Transfusion Transmissible Infection.
Transfusion-transmitted infections are increasingly becoming major mode of transmission of various diseases, in the high prevalence areas in sub-sahara Africa. This is because of high level of occurrence of blood demanding health conditions. Transfusion transmitted infections are major concern among health workers (WHO, 2008). Patients on transfusion therapy are at increased risk of transfusion transmitted infections and every year more than 90million units of blood are collected worldwide. Each transfusion carries a risk of transmitting blood-borne pathogens including mainly HIV, HBV, HCV and syphilis (Bihl et al, 2007). To improved blood transfusion safety WHO recommends an integrated strategy including establishment of well-organized blood transfusion services, prioritization of blood donation from non-remunerated donors, screening of donated blood for at least the four-major transfusion-transmissible infections (TTIs) with quality-assured assay, rational use of blood implementation of effective quality control system (WHO 2008).
Selection of donors with low TTIs risk followed by effective laboratory screening has been part of a critical process of reducing the risk of transmission to a very low level in the past 20 years (WHO, 2002). Nevertheless, particularly in low resource countries, a significant proportion of donated blood remains unsafe as it is either not screened for all major TTIs or not in a quality controlled manner, according Dodd 2007. Most blood banks in Africa are small hospital based and relying on an important proportion of replacement donors in contrast with western transfusion unit organized with large pools of voluntary donors Dodd (2007). In addition, recommended screening tests like immunoassays (EIA) or nucleic acid testing (NAT) are technically, logically and financially still far beyond reach of many resources constrained blood banks. Every blood banks follows screening procedures to prevent such infections but infective agents escape detection due to window period, a period where in the infective agent presence cannot be detected, though it is present in donors blood (Moor 1999). Blood bank in developed countries are doing Nucleic Acid Amplification Testing (NAT) since 1999 to screened donated blood (Pathaks 2010). The window period for for testing for HIV, HBV, HCV has been significantly reduced with NAT.
The infections of HBV and human immune deficiency virus (HIV) are a rapidly growing issue of public health concern, it has been observed that HBV and HIV co infection interferes with the natural history of HBV infection and as associated with higher HBV DNA levels (Gibson 1997, colin1999). Human immune deficiency virus(HIV) infection causes a broad spectrum disease and has a varied clinical cause, from mild, flulike symptoms to AIDs, which is life threatening and the end stage of infection (MOH Mozambique 2007). Factors that can contribute to HIV transmission through blood transfusion include the window period.
Hepatitis B surface antigen testing was introduced 1970s and its transmission was consistently reduced since then (WHO 2004). Still, 300 million are infected worldwide. HBV Surface antigen is routinely included in donor screening but it fails to detect presence of HBV during window period. Chronic carriers of HBV may have low level viremia and may not have detectable HBsAg level, so some centers have started testing antibodies against HBV core protein (Diarra, 2009). Hepatitis C virus currently affect over four million peoples in USA and therefore it is the commonest transfusion transmitted infection and main indication for liver transplantation. High risk group is constituted by those who received transfusion prior to 1991 or the ones who are drug abusers using shared needles (Laperche, 2009). Incubation period can be as long as decades and this contributes to high rates of infection. Approximately 90% of individuals infected with HCV are either asymptomatic or have only mild symptoms (Matee, 2006). Syphilis is caused by infection with treponemapallidium. It is spread primarily through sexual contact. T.pallidium can also be transmitted by vertical transmission by mother to fetus or through blood if donor is already infected (Peeling2004). Approximately 57% 0f all transfusion transmissible infections and 16% of transfusion related deaths have been associated with bacterial contamination (Wagner 2004). Blood components may be contaminated with bacteria at many stages of preparation, including blood collection, processing, probing and transfusion. Bacteria may enter into blood components from many sources; exposure to donor skin bacteria by vein puncture, contaminated bags and infected environment of blood banks or hospitals, (Wagner 2004). Parasites are common infectious agents worldwide and several protozoans have shown to be transmitted via blood transfusion (Kitchen, 2006).
Malaria is endemic in tropical and subtropical regions of Africa with up to 300 million infections and one million deaths annually (Kinde et al,2000). It can also be transmitted from an infected to her fetus or from an infected blood to the recipient. WHO accepts the use of rapid and simple serological assays for TTIs and quality controlled (WHO, 2009) and Rapid test-based screening protocols still tends to be used increasingly in African blood banks. Therefore, the need to investigate the prevalence of transfusion transmissible infections among blood donors at Hajiya Gambo Sawaba General Hospital, Zaria Nigeria.
Materials And Methods
This retrospective study was conducted at blood transfusion unit of Hajiya Gambo Sawaba General Hospital Zaria, Kaduna state. Three hundred and ninety blood donors were prospectively recruited in the study from 1 January 2016 up to December 2016. Only Physically fit 18-55years old were included in the study, donors were excluded if they were below 18 years old, weigh less than <50kg, anemic, had a history of jaundice, malaria, asthma, engage in high risk behavior (i.e unsafe intercourse, drug abuse) had a past history of HBV, HCV, HIV-1 and HIV-2 or syphilis or were apparently unhealthy or malnourished. After the prospective donor has passed the hemoglobin check. Determine and uni-gold rapid test kits were used to test for HIV. The single rapid kit used for testing Hepatitis B surface Antigen (HBsAg) is ACON while Dialspot is used for testing Hepatitis C virus (HCV) and also syphilis. Blood donation process is stopped when any of the donors is reactive for any of the TTI markers. Data on blood donor’s age, sex, blood group, serological result of HCV, HBsAg, HIV and syphilis were collected at the time of blood collection, by using a structured questionnaire. Summary of statistics such as frequencies and percentages were computed. The results were presented using tables, charts and graphs.
The findings of this study showed that male is more than female. This is expected because traditionally, female is not encouraged to donate blood as the male. The study also shows hepatitis B and C virus, HIV and syphilis antibodies to be 10.1%, 6.8%, 1.8% and 0.4% respectively. The result of HBsAg in this study varied from that of Olaleye, et al (2007) which shows a very high prevalence (30.8%) of HBsAg in Ibadan. Other studies in Nigeria have also reported higher prevalence of 15.8% in University of Maiduguri Teaching Hospital Borno State, and 13.4% in Abakaliki by Idiona (2014), while Alikor and Erhabor (2007) reported a 12.4% prevalence among children in tertiary hospitals Niger Delta, Nigeria. However, the prevalence reported in this study is higher than the 8.3% prevalence reported in previous study conducted by Luka et al., at Ahmadu Bello University Teaching Hospital Zaria Kaunda state. It also higher than the 7.6%, 9.3% and 3.9% prevalence reported by Ugwuja et al(2009) in Nnewi, Awka and Abakalikl, Nigeria respectively.
The sero prevalence of HCV antibody found among blood donors in this study is lower when compared to the same study carried out in other locations, A study carried out in South Eastern state of Nigeria by Chukwurah, et al., (2005) found that 7.6% of blood donors had HCV revalence. In similar study carried out in Lagos, Nigeria, Afolabi, et al., (2012) reported that 8.4% of blood donors were positive for HCV antibody. This study agrees with the 6% HCV prevalence report by Egah et al.(2007), in Jos, Plateau state Nigeria.
Marked variation of HIV antibody has been reported in different part of Nigeria. Some workers reported the prevalence of HIV antibody to be lower than 1.8% as found in this study, while others reported higher prevalence of HIV antibody in other studies. Elele, et al., (2013) reported 4% prevalence of HIV antibody among blood donors in Port Harcourt, South Southern Nigeria had. Over all, the prevalence of HBsAg, HCV, HIV and syphilis antibodies found in this study is among the lowest reported in Nigeria. This observation may portably be due to the positive impact of HIV education and public enlightenment which have been in place in Zaria for many years. This might have helped in the reduction of the spread of HIV, HBsAg, HCV and syphilis since they have similar modes of transmission. Another factor that may account for the low prevalence of transfusion Transmissible infections in this study may be due to the fact that most of the donors were not commercial donors.
Results of the study which showed that the prevalence of HBsAg, HCV, HIV and syphilis antibody were 10.1%, 6.8%, 1.8% and 0.4% which suggest that HBV and HCV infections is still a health challenge that must be given more attention.
We are grateful to the Management of Gambo Sawaba General Hospital Zaria especially the Head and staff of the Laoratory for permission and cooperation during the work. We are also grateful to the staff of Elite International Health Academy Zaria for support and assistant.
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