Sudan Medical Journal ا ع ا طث ١ ا غ دا ١

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1 : Sudan Medical Journal ا ع ا طث ١ ا غ دا ١ Prevalence of some transfusion-transmissible infections among first time and repeat voluntary and family replacement donors in North Central Nigeria Olawumi H Oluwayemisi, FWACP, Shittu A Olasunkanmi, FMCPath, Ogunfemi M Kehinde, FMCPath Department of Haematology *,**, and Blood Transfusion **, University of Ilorin Teaching Hospital, Ilorin, Nigeria اورشار تعط اىمعذ ح اىرهاتاخ وقو ت ه اىىقد أوال ومرر اىطىع ح واألسرج اىماوح ه اسرثذاه ف شماه وسػ و د ر ا. 131 د. ** * * ا ال ا ا ا ١ ٠ غ, د. ش ١ ر او ١ ا الع ى, د. ا غ ف ١ ر ١ اخ و ١ ١ ذ * لغ أ شاض ا ذ ظا ؼح ا ٠ س ٠ إ س ٠. ** لغ أ شاض ا ذ م ا ذ غرشف ظا ؼح ا رذس ٠ ظ إ س ٠ إ س ٠. ميخص أهذاف: ف ١ ع ١ ش ٠ ا ا ؼذ ٠ ذ ا ث ذا األخش ف أفش ٠ م ١ ا ظ ب ا صحشاء ا ىثش ذؼر ذ ؼظ ت ن ا ذ ػ ا رثشع ا غش ا ثذ ٠ )إػادج اال رشاس( أل ا ع اخ ا ا حح ا ط ػ ١ ح ا ر ا فرشض أ ذى أوصش أ ا ا ل ١ ح. زا فإ ان حاظح شاظؼح عال ح ا غث ١ ح رثشػاخ إػادج اال رشاس أل ا ا صذس ا شئ ١ غ ال ذ ف غرشف ت ن ا ذ اعر ادا ذ ٠ ا. زا وا ا ذف ز ا ذساعح ذحذ ٠ ذ عال ح ا غث ١ ح رثشػاخ إػادج اال رشاس خالي ماس ح ؼذالخ ا رشاس ا يHBsAg ىافحح ف ١ ش ط )ع ( ىافحح ف ١ ش ط مص ا اػح ا ثشش ٠ ح غ ذ ه ا ع اخ ا ا حح ا ط ػ ١ ح. أساى ة: وا د ز دساعح اعرطالػ ١ ح أظش ٠ د ف ا غرشف ا رؼ ١ ف ش اي عػ ١ ع ١ ش ٠ ا ح ١ س ذ ذع ١ ذ 832 ا رثشػ ١ ا حر ١. ز FRD وا ا ا رثشػ ١. ا ىشف ػ HBsAg ذ إظشاء ىافحح ا ر اب ا ىثذ ا تائ األظغا ا عادج ف ١ ش ط اإل ٠ ذص تاعرخذا ع ػاخ عش ٠ ؼح أوذ ع ١ ح ELISA تاعرخذا ع ػاخ ا ص ؼح لث INTECO ذشخ ١ ص إ ع رشا ا ىح ا رحذج. اىىرائح: وا د ؼذالخ ا رشاس ا شا ح ىافحح ف ١ ش ط مص ا اػح ا ثشش ٠ ح HBsAg ىافحح ف ١ ش ط )ع ( ت ١ 832 ا ا ح ١ ػ ا ر ا. وا ا رشاس ا عادج ف ١ ش ط )ع ( أػ تىص ١ ش ت ١ إػادج اال رشاس ا رثشػ ١ ) 3.6 مات = P( ى ٠ ى ان اخرالف ح ظح ف ؼذالخ ا رشاس ىافحح ف ١ ش ط مص ا اػح ا ثشش ٠ ح HBsAg ت ١ ا ع ػاخ ا ا حح اش ١. وا ؼذي ا رشاس HBsAg أػ تىص ١ ش ت ١ أ ي شج ذىشاس ا ا ح ١ ) 11.5 مات = P(. ت ١ ا ا ح ١ أ ي شج وا د ؼذالخ ا رشاس HBsAg ىافحح ف ١ ش ط )ع ( أػ تىص ١ ش ف إػادج اال رشاس ا رثشػ ١. ٠ ى ان فشق وث ١ ش ف ؼذالخ ا رشاس ت ١ ذىشاس ا ا ح ١. اسرىراج: أل ي شج إػادج اال رشاس ذ ٠ ؼذالخ ا رشاس أػ ػ ا ا رثشػ ١ أل ي شج ى ذىشاس إػادج اال رشاس ذ ٠ ؼذالخ ا رشاس اش ح ال رثشػ ١ ذىشاس. ز ه ٠ ثغ تزي ا ع د رشع ١ غ ذىشاس إػادج اال رشاس رصثح ا رثشػ ١ ا ؼاد ٠ ح أظ ص ٠ ادج ذؼض ٠ ض ذذفك ا ذ ف ت ن ا ذ ذ ٠ ا. Abstract Background: In Nigeria, and many other countries in sub-saharan Africa, most blood banks depend on family replacement donors (FRD) because voluntary donors that are supposed to be safer are few. There is therefore the need to review the relative safety of donations from FRD since they are the main source of blood in our hospital-based blood banks. The aim of this study was therefore to determine the relative safety of donations from FRD by comparing their Corresponding author Olawumi Hannah Oluwayemisi Tel: toyem66@yahoo.com prevalence rates for HBsAg, anti-hcv and anti-hiv with those of voluntary donors. Materials and Methods: This was a prospective study conducted in a Teaching Hospital in North Central Nigeria in which 832 prospective donors were recruited; of these 525were FRD and 370 were voluntary donors. Screening for HBsAg, anti-hcv and anti-hiv antibodies was performed using rapid kits and confirmed by ELISA methodology using kits manufactured by Inteco Diagnostics, England, United Kingdom. Results: The overall prevalence rates for anti- HIV, HBsAg and anti-hcv among the 832 donors were 1.4%, 8.8% and 2.5% respectively. The anti-hcv prevalence was significantly higher amongst FRD than

2 voluntary donors (3.6% versus 0.7%; P=0.008) but there was no observable difference in the anti-hiv and HBsAg prevalence rates between the two donor groups. The HBsAg prevalence rate was significantly higher among first time than repeat donors (11.5% versus 4.7%; p =0.001). Amongst first time donors the HBsAg and anti-hcv prevalence rates were significantly higher in FRD than voluntary donors. There was no significant difference in the prevalence rates among the repeat donors. Conclusion: First time FRD have overall higher prevalence rates than first time voluntary donors, but repeat FRD have similar prevalence rates as repeat voluntary donors. Efforts should therefore be made to encourage repeat FRD to become regular voluntary donors in order to increase and sustain the blood supply in our blood banks. Keywords: Transfusion-transmissible infections, voluntary donors, family replacement donors. Introduction Transfusion of blood and blood products, though life saving, may be associated with complications that include transfusion transmissible infections (TTI). The safety of blood therefore depends on proper screening for TTI. Also because of the window period risk of infectivity, stringent donor selection criteria are also crucial in-order to ensure blood safety. There are three types of blood donors: voluntary non-remunerated, family replacement and paid donors. The goal of the world Health organization (WHO) is collection of blood exclusively from voluntary non-remunerated donors by 2020 because it is believed that sustenance of regular voluntary non-remunerated blood donors will ensure a sufficient, stable and safe blood supply and contribute to a significant reduction in the risk for infections such as HIV, hepatitis B, hepatitis C and syphilis (1). In most developed countries almost 100% of blood supply is from voluntary donors (1). In some African countries a relatively high proportion of donors are voluntary, for example in Kenya and Eritrea, voluntary blood donors constitute over 50% of the donor 132 population (2,3). In our centre donor blood supply is limited owing to the low numbers of regular voluntary blood donors. Such is the case in most centers in Nigeria as well as many countries in sub-saharan Africa (4-8). Most blood banks in Nigeria and other countries in sub-saharan Africa depend on Family Replacement donors (FRD) which has been the trend for so many years (4,8,9). Studies that were conducted in developed countries and in sub Saharan Africa have shown that voluntary non-remunerated blood donors are safer FRD in terms of transmission of diseases but most of them did not differentiate first time and repeat donors (2,3,5,10-15). Repeat donors would have tested negative during a previous donation (allowing for repeat donation); as such it is a biased comparison with first time donors independent of whether voluntary or replacement (9). Since FRD are the main source of blood in our hospital based banks there is the need to review the relative safety of FRD by taking into account first time and repeat donors. The aim of this study was therefore to determine the relative safety of donations from FRD by comparing their prevalence rates for HBsAg, anti-hcv and anti-hiv with those of voluntary donors. Materials and Methods A cross-sectional study was conducted among prospective blood donors in the blood bank of University of Ilorin Teaching Hospital, Ilorin, a medium sized teaching hospital located in North Central Nigeria. A total of 832 donors were recruited into the study. These included 525 FRD and 307 voluntary donors. The FRD were either family members or friends of the recipients. The voluntary donors included walk-in donors, students and staff of the university. Only donors who passed the screening test for haemoglobin concentration and consented to participate in the study were recruited. The socio-demographic details and history of blood donation were obtained using a structured questionnaire designed for the study. Screenings for HBsAg and anti-hcv antibodies were performed using rapid kits manufactured by Biotest Biotech Company

3 Limited, China and HIV antibodies screening was performed using determine kits manufactured by Alere Medical, Japan according to manufacturers instructions. Confirmation testing was performed by ELISA methodology using kits manufactured by Inteco Diagnostics, England, United Kingdom according to manufacturer s instructions. Data was analyzed using SPSS version 20. Results were calculated as frequencies, means, standard deviations, cross-tabulation, chisquare and Fisher's exact test. P-value was set at Results A total of 832 donors of mean age 30.51±9.417 (age range years) were recruited into the study. Four hundred and ninety-five were first time donors while 337 were repeat donors. Six hundred and ninetytwo were males while 140 were females. Majority of the males (74.7%) were FRD while majority of the female donors (94.3%) were voluntary donors. This difference was statistically significant (p=0.000). The male donors were significantly older than the females; mean age of 31.52±8.9 and 25.51±10.3 years respectively (p<0.0001). Four hundred and forty-nine were married while 383 were single. Three hundred and seven were voluntary donors while 525 were FRD. The voluntary donors were significantly younger than the FRD; mean age of 27.83±10.38 and 32.08±8.426 respectively (p<0.0001). Out of the 832 blood donors 103 (12.4%) were tested positive for one or more of the TTI. There was a higher prevalence among male than female donors (14.0% versus 4.3%; p=0.001). The prevalence was higher among FRD than voluntary donors (14.5% versus 8.8%; p=0.016). The prevalence of HIV antibodies, Hepatitis B surface antigen and HCV antibodies in the total donors were 1.4%, 8.8% and 2.5% respectively, (Table 1). Table 1: Prevalence of TTI among Voluntary and Family replacement donors. Voluntary Family replacement Total p-value HIV 5(1.6) 302(98.4) 7(1.3) 518(98.7) 12(1.4) 820(98.6) HBsAg 20(6.5) 287(93.5) 53(10.1) 472(89.9) 73(8.8) 759(91.2) HCV 2(0.7) 305(99.3) 19(3.6) 506(96.4) 21(2.5) 811(97.5) TTI 27(8.8) 280(91.2) 76(14.5) 525(85.5) 103(12.4) 729(87.6) There was no significant difference in the prevalence of HIV and HBsAg between voluntary and FRD but the prevalence of HCV was significantly higher among FRD than voluntary donors (3.6% versus 0.7%; p=0.008), (Table 1). The prevalence of TTI was significantly higher among first time than repeat donors (14.7% versus 8.9%; p=0.012). There was no significant difference in the prevalence of HIV and HCV antibodies between first time and repeat donors but the prevalence of HBsAg was significantly higher among first time than repeat donors (11.5% versus 4.7%; p=0.001), (Table 2). Table 2: Prevalence of TTI among First time and Repeat donors. First time Repeat Total p-value HIV 5(1.0) 490(99.0) 7(2.1) 330(97.9) 12(1.4) 820(98.6) HBsAg 57(11.5) 438(88.5) 16(4.7) 321(95.3) 73(8.8) 759(91.2) HCV 14(2.8) 481(97.2) 7(2.1) 330(97.9) 21(2.5) 811(97.5) TTI 73(14.7) 422(85.3) 30(8.9) 307(91.1) 103(12.4) 729(87.6)

4 Considering only first time donors, the prevalence of TTI was significantly higher among FRD than voluntary donors (18.6% versus 8.2%; p=0.002), the prevalence of HBsAg and HCV were also significantly higher among FRD but there was no significant difference in the prevalence of HIV, (Table 3). Table 3: Prevalence of TTI among First time voluntary and Family replacement donors. Voluntary Family replacement Total p-value HIV 1(0.5) 182(99.5) 4(1.3) 308(98.7) 5(1.0) 490(99.0) HBsAg 13(7.1) 170(92.9) 44(14.1) 268(85.9) 57(11.5) 438(88.5) HCV 1(0.5) 182(99.5) 13(4.2) 299(95.8) 14(2.8) 481(97.2) TTI 15(8.2) 168(91.8) 58(18.6) 312(81.4) 73(14.7) 422(85.3) Considering only repeat donors, there was no significant difference in the prevalence of any of the TTIs between FRD and voluntary donors (Table 4). Table 4: Prevalence of TTI among Repeat voluntary and Family replacement donors. Voluntary Family replacement Total p-value HIV 4(3.2) 120(96.8) 3(1.4) 210(98.6) 7(2.1) 330(97.9) HBsAg 7(5.6) 117(94.4) 9(4.2) 204(95.8) 16(4.7) 321(95.3) HCV 1(0.8) 123(99.2) 6(2.8) 207(97.2) 7(2.1) 330(97.9) TTI 12(9.7) 124(90.3) 18(8.5) 195(91.5) 30(8.9) 307(91.1) Discussion In this study, there were more male than female donors. This is consistent with a previous study done in our centre (8) and other studies done within and outside Nigeria (2,10,12-14,16,17). Cultural beliefs especially in Africa where it is believed that males are healthier than females coupled with the monthly menstruation, as well as pregnancy and lactation which are conditions responsible for deferment of female donors may explain the lower proportion of females compared to male donors. However overrepresentation of males is not globally uniform as shown in China where females predominate (18). The proportion of voluntary donors among females is significantly higher than the proportion of voluntary donors among male donors. This is in keeping with study conducted by Dongdem et al in Ghana (19). Female donors were also significantly younger than the male donors. This is in keeping with the study in Osogbo in South Western Nigeria in which majority of the male donors were between years whereas majority of the female donors were between years (16). Usually, when there is a need to donate blood for a sick relative, men are recruited rather than women because of the belief that men are healthier than women. Women usually have the opportunity to donate blood when there is a voluntary blood donation drive which is common among students of higher institutions. This may explain why the female donors are younger and have a higher proportion of voluntary donors. Family replacement donors were older than voluntary donors in this study. This finding is similar to that of Kimani et at in a study carried out in Kenya (2) and Allain et al in sub- Saharan Africa (9). This finding may be due to the fact that voluntary blood donation drives are usually conducted among students of higher institution who are young people. Family replacement donors, on the other hand, are likely to be parents, friends and colleagues of parents of patients. 134

5 The sero-prevalence of one or more of the TTI in this study was 12.4%. This high prevalence is similar to that of Tanzania in which Matee et al reported a prevalence of 15.9% (12). In Osogbo which is located in South West of Nigeria the prevalence was much higher (28.8%). The high proportion of commercial donors in the Osogbo study may account for the very high prevalence. On the other hand, in Eritrea which is located in Eastern Africa, Fessehaye et al (3) reported a much lower prevalence of 3.8%. Prevalence rates of less than 1% have been reported in India (10,17). The prevalence of Hepatitis B surface antigen (8.8%) was highest, followed by that of HCV antibodies (2.5%) and that of HIV antibodies (1.4 %,) was the least. This pattern is similar to that obtained in Osogbo Nigeria in which the prevalence of Hepatitis B surface antigen, HCV antibodies and HIV antibodies was 18.6%, 6.0% and 3.1% respectively16. Similar pattern was obtained in Mali,20 Ethiopia (21), and China (18). Another finding in this study is a higher sero-prevalence of TTI among males compared to female donors. This is in keeping with studies in Kenya (2) and India (17,22). But in the study by Matee et al in Tanzania, there was not sex difference in the prevalence of TTI (12). The prevalence of TTI was also significantly higher among first time than repeat donors and HBsAg was responsible for this because there was no significant difference in the prevalence of HIV and HCV antibodies between first time and repeat donors. This higher prevalence of HBsAg in first time donors may be due to the fact that a repeat donor had been tested previously and presumably found to be seronegative to HBsAg, if he or she was not informed that the previous donation was rejected because of reactivity to HBsAg (9). The fact that HBV infection is acquired References 1. WHO. World Health Organization. WHO Global Database on Blood Safety (GDBS) Kimani D, Mwangi J, Mwangi M, Bunnell R, Kellogg TA, Oluoch T, et al. Blood mostly during childhood in this part of the world may also explain why positivity in a repeat donor is low compared to first time donors (9). Among the total number of donors, the prevalence of TTI was higher among FRD than voluntary donors. This is similar to findings in studies conducted in South Western Nigeria (16), in Kenya (2), Tanzania (12), Eritrea (3), Pakistan (13), and India (17,22,23). There was no significant difference in the prevalence of HIV and HBsAg between voluntary and FRD but the prevalence of HCV was significantly higher among FRD than voluntary donors. Among first time donors the prevalence of TTI was significantly higher in FRD than voluntary donors. This is in keeping with study by Noubiap et al in Cameroon (14). However, among repeat donors, there was no significant difference in the prevalence of any of the TTIs between FRD and voluntary donors. In conclusion, among the general donor population in Ilorin, the prevalence of TTI was significantly higher among FRD than voluntary donors, among male than female donors, and among first time than repeat donors. Among first time donors the prevalence of TTI was also higher among FRD than voluntary donors but there was no difference in prevalence between FRD and voluntary donors among repeat donors. Repeat FRD are therefore as safe as repeat voluntary donors. So, in countries like Nigeria where the majority of blood donors are FRD with very low proportion of voluntary donors, efforts should be directed toward sensitizing and encouraging repeat FRD to become regular voluntary donors. This will help to reduce blood shortage and improve blood safety in Nigeria as well as other countries in Sub Saharan Africa. donors in Kenya: a comparison of voluntary and family replacement donors based on a population-based survey. Vox sanguinis 2011;100(2): Fessehaye N, Naik D, Fessehaye T. Transfusion-transmitted infections. A 135

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