Systematic review of prevalence and risk factors of transfusion transmissible infections among blood donors, and blood safety improvements in Southern Africa

Abstract

Blood and blood products are listed as one of the essential medicines by the World Health Organization (WHO). In addition to inadequate supply, most sub‐Saharan Africa (SSA) nations fail to meet their blood needs because many donated blood units are discarded because they are contaminated with transfusion‐transmitted infections (TTIs). We sought to estimate the prevalence of TTIs, identify the risk factors for TTIs among blood donors, and identify the efforts and interventions that have been made to improve blood safety in Southern African nations, particularly the nations of the South African Development Community (SADC). We investigated the prevalence and risk factors for TTIs, blood safety interventions, and blood quality improvement in the SADC region from major PubMed/MEDLINE, Cochrane Library, and HINARI databases from 1 January 2011 to 31 April 2021. All investigations followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). In meta‐analysis, we estimated the pooled TTIs prevalence and summarised the same using forest plots. A total of 180 articles published from the SSA region were identified covering our three targeted themes: TTI prevalence, risk factors for TTIs, and blood safety improvements. Of these 180 articles, only 27 (15%) focused on the SADC region. The overall pooled TTI prevalence estimate was 2.0% (95% CI: 1.0–3.0) and hepatitis B was the most prevalent TTI in the region (prevalence = 3.0; 95% CI: 2.0–5.0). The prevalence of HIV, HCV, and syphilis was 2.0% (95% CI: 1.0–4.0), 1.0% (95% CI: 0.0–2.0), and 2.0% (95% CI: 0.0–8.0), respectively. In general, replacement donors and first‐time donors were more likely to be infected with TTIs than repeat donors. Twelve articles explored blood safety research in the region; however, they vary greatly highlighting the need for consistent and more comprehensive research. Few publications were identified that were from the SADC region, indicating lack of research or resources towards improving both quantity and quality of blood donation. TTI prevalence remains one of the highest in the world and blood safety recommendations vary across the region. More effort should be directed towards developing a cohesive regional blood transfusion policy and effective blood monitoring and evaluation strategies.

Seroprevalence of human immunodeficiency virus in African blood donors: a systematic review and meta-analysis

“…Our study shows that the pooled prevalence of HIV among blood donors in Africa is 2.66%, which is higher compared to 0.31% in China, 81 0.06% in Pakistan, 82 0.004% in Iran, 83 0.32% in India 84 and 2.0% in previous systematic reviews conducted in the Southern African Development Community. 9 The higher prevalence in Africa compared with other continents may be due to the higher prevalence of HIV in the general population, overreliance on family replacement and remunerated blood donors, and lower coverage of HIV testing services in the general population. 85 , 86 , 87 This high prevalence of HIV among blood donors in Africa is worrisome as the risk of transfused transmitted infection is higher in settings with higher prevalence among blood donors.…”

“…The heterogeneity in the prevalence of HIV among blood donors across the African continent may be explained by the existing differences in the prevalence of HIV in the general population across different countries and regions, differences in access to and quality of screening tools, lifestyle, and the social and demographic profile of each country. 9 , 90 , 91…”

“… 6 , 7 Different studies on the prevalence of HIV among blood donors have been conducted in various African countries. For instance, the prevalence of HIV among blood donors is 2.69% in Ethiopia, 8 2.0% in the South African Development Community region, 9 2.21% in Burkina Faso, 10 and 0.18% in Eritrea. 11 However, a comprehensive study analyzing and synthesizing the available evidence on the prevalence of HIV among blood donors in Africa is still lacking.…”

Advancing Hepatitis C Elimination in Africa: Insights from Egypt

“…Unlike other Hepatitis Viruses (such as HBV, et al), HCV have higher tendency to cause chronic infections which can persist for years without noticeable symptoms leading to long term liver damage; it exhibit remarkable genetic diversity with multiple genotypes and numerous subtypes which affect the treatment response and the course of disease; also unlike Hepatitis A and B, there's no specific vaccine for HCV, Prevention relies on avoiding risk factors and practicing safe behaviors; and also HCV often progress silently with few early symptoms which can even sometimes appear, and simultaneously with significant liver damage have occurred [1][2][3][4]. HCV stands as a primary cause of chronic liver disease, with persistent infection linked to severe conditions such as cirrhosis, hepatocellular carcinoma, liver failure, and mortality [5][6][7]. while other hepatitis viruses (like HAV, and HEV) Primarily spread through contaminated water and food, HCV is mainly transmitted through bloodto-blood contact, and in that case intravenous drug use, unsafe medical procedures, and blood transfusion are the most common routes of transmission.…”

Advancing Hepatitis C Elimination in Africa: Insights from Egypt

“…In contrast, other hepatitis viruses (such as HEV and HAV) mostly spread through contaminated water and food. 8,9 According to estimates available, the hepatitis C virus (HCV) continues to be a major public health concern in Africa, where over 91 million people have either hepatitis B or C, accounting for 26% of the global burden of these infections and causing approximately125000deaths annually. Nevertheless, a number of obstacles stand in the way of effective management, as over 70% of hepatitis B cases worldwide occur in Africa, requiring intensive prevention and treatment initiatives.…”