Abstract
Background: Blood transfusion is an effective treatment for saving millions of lives, even though transfusion-transmissible infections are the major problem. The prevalence of transfusion-transmissible infections varies between different geographical populations. This study aims to assess the prevalence of transfusion-transmissible infections and associated factors among blood donors at Woliso Blood Bank, South West Shewa Zone, Oromia, Ethiopia. Method: An institutional-based cross-sectional study design was conducted. A structured and pre-tested questionnaire was used to collect data through a face-to-face interview. The data was entered in Epi Data version 3.1, and exported to STATA version 17.0 for data cleaning and analysis. A binary logistic regression analysis was performed to identify factors associated with outcome variables. Odd ratios along with the 95% confidence interval were used to present the finding and statistical significance was reported with a p-value of 0.05. Results: The overall prevalence of transfusion-transmissible infections was 9.5% (95% CI 6.3-12.9%). Participants without formal education [AOR=4.84; 95% CI= 1.09, 21.46], unprotected sexual intercourse with multiple partners [AOR=4.77; 95% CI= 1.38, 16.44], and participants with a lower frequency of blood donation [AOR=2.85; 95% CI: 1.16, 6.99] were significantly associated with transfusion transmissible infections. Conclusions: The prevalence of transfusion-transmissible infections was high in this study area. Educational level, unprotected sexual intercourse with more partners, and a number of blood donations were found to be independent predictors of transfusion-transmitted infections. Blood banks and regional health offices should work to mobilize the community and improve health promotion through prevention and control considering the associated factors identified.
Keywords
Associated Factors, Blood Bank, Blood Donor, Transfusion Transmissible Infections, South West Shewa, Woliso
1. Introduction
Blood transfusions are a vital component of medical care that saves live and improves the quality of life of millions of people around the world. Blood transfusions are used most commonly to treat patients who have had trauma, emergency, disasters, or accidents; children with severe anemia due to malaria or malnutrition; and women who are bleeding during pregnancy or childbirth. It is also used to support complicated medical and surgical operations, such as transplants and cardiovascular surgery, in countries with modern healthcare systems. Adequate health care requires timely and universal access to safe blood and blood products, as well as the appropriate use of these resources
| [1] | World Health Organization. Strategic framework for blood safety and availability 2016–2025. WHO Reg Off East Mediterr. 2017; 1–39. |
[1]
.
Our society places a high priority on transfusion safety, and clinical trials are being conducted to find ways to reduce the risk of known and emerging illnesses in all blood products. Using pathogen reduction methods, the risk of infection from bacterial and viral pathogens can be effectively reduced
| [2] | AABB, American Red Cross, America’s Blood Centers, Armed Service Blood Program. Circular of Information for the Use of Human Blood and Blood Components. Revised October 2017. Available at:aabb.org |
[2]
. Blood grouping and compatibility tests, safe blood collection procedures, accurate transfusion-transmissible infection tests, recruitment and retention of low-risk blood donors, and appropriate use and safe administration of blood are all factors that contribute to blood safety
| [3] | Every I, Surgery PC, Medical T, Surgery PC, Medical T, Technologies EH. Blood transfusion safety.: 1–6. |
[3]
.
In Ethiopia, there are currently 43 blood banks, one central national blood bank (NBB), and 42 operational regional blood banks, with at least one in each of the country's administrative regions, so the Woliso blood bank is one of the 10 BB in Oromia region
| [5] | Sahilu D, Tadesse AW. Blood Donation Practice and Associated Factors of North Shoa Zone, Oromia, Ethiopia, 2021: A Community-Based Mixed-Method Study. Am J Med Public Health. 2023;4(3): 1045. |
[5]
.
Several serious public health issues still affect blood donors, including syphilis, hepatitis B, hepatitis C, and HIV. The World Health Organization (WHO) states that syphilis, HBV, HCV, and HIV screening should be performed in all blood donors. The frequency of TTI has decreased significantly as a result of the introduction of strict donor screening protocols for blood-borne diseases
.
Blood shortages and contaminated blood are the two most important problems associated with blood transfusions in the developing world, especially in Africa. These problems often lead to severe health consequences such as postpartum hemorrhage deaths or the spread of potentially fatal infections such as HIV and hepatitis. It would be possible to avoid these harmful effects on health by taking steps to increase blood availability and safety
| [7] | Gebregziabher H, Meshasha M, Cerna P. Predicting the Seroprevalence of HBV, HCV and HIV Based on National Blood of Addis Ababa Ethiopia Using Data Mining Technology. 2017; 1(1): 44–55. |
[7]
. HIV, HBV, and HCV are very concerning due to their prolonged viremia and carrier or latent states
| [8] | Ataro Z, Urgessa F, Wasihun T. Prevalence and trends of major transfusion-transmissible infections among blood donors in the Dire Dawa Blood Bank, eastern Ethiopia: Retrospective Study. Ethiop J Health Sci. 2018; 28(6): 701–10. |
[8]
.
The lack of procedures and infrastructure to ensure a safe blood supply increases the risk of infection spreading by transfusion in many countries. These problems include a shortage of knowledgeable staff, inconsistent test kit supplies or the use of low quality test kits, an unstable supply chain, and inadequate cold chain facilities. A fragmented blood supply system, with varied technical standards and no central monitoring, can further jeopardize safety measures
| [4] | World Health Organization, Plan of Action for Universal access to safe blood transfusion; Washington, D.C., USA, September-3 October 2014 |
[4]
.
The World Health Organization (WHO) has established a goal of improving regional blood safety by 2012 by strengthening organization and management, blood donor recruitment and collection, donor blood tests, and appropriate clinical blood usage
| [9] | Bloch EM, Vermeulen M, Murphy E. Blood Transfusion Safety in Africa: A review of the literature on infectious diseases and organizational challenges. Transfus Med. Rev. 2012; 26(2): 164–80. |
[9]
. Hepatitis viruses infect approximately 2.3 billion individuals worldwide, resulting in approximately 1.4 million deaths, 90% of which are caused by hepatitis B and C viruses
| [10] | Alqahtani SM, Alsagaby SA, Mir SA, Alaidarous M, Dukhyil A Bin, Alshehri B et al. Seroprevalence of viral hepatitis B and C among blood donors in the northern region of Riyadh province, Saudi Arabia. 2021; 1–11. |
[10]
. The World Health Organization (WHO) announced a 2016 policy to eliminate viral hepatitis by 2030. Africa, particularly Sub-Saharan Africa, is responsible for a large share of the global burden of viral hepatitis, particularly chronic hepatitis B and C virus infections
| [11] | Sonderup MW, Afihene M, Ally R, Apica B, Awuku Y, Cunha L et al. Hepatitis C in sub-Saharan Africa: current status and recommendations to achieve elimination by 2030. Lancet Gastroenterol Hepatol [Internet]. 2017; 2(12): 910–9. Available from: http://dx.doi.org/10.1016/S2468-1253(17)30249-2 |
[11]
.
In developed countries, prevention of TTIs has been achieved by reducing unnecessary transfusions, using only regularly screened volunteer donors, excluding donors with risk factors and screening all blood donated for infection. However, in many developing countries, none of these measures is consistently implemented and the risk of TTIs remains high
| [12] | Bonja F, Hussein M, Alemu J, Gemechu D, Birhaneselassie M. The prevalence of transfusion-transmitted infections: A focus on hepatitis B virus among blood donors in. 2017; 7: 7–14. |
[12]
. At the national blood bank in Ethiopia, the prevalence of the main TTIs (Hepatitis B virus = 5.23 %, HIV = 2.29 % t and Hepatitis C virus = 2.30 %) is high. As a result, regular monitoring of the amount of transfusion-transmitted infections in blood donors is critical to prevent infectious disease transmission
| [7] | Gebregziabher H, Meshasha M, Cerna P. Predicting the Seroprevalence of HBV, HCV and HIV Based on National Blood of Addis Ababa Ethiopia Using Data Mining Technology. 2017; 1(1): 44–55. |
[7]
.
The prevalence of infection or the proportion of blood donations with a positive result is directly related to the safety of the blood supply because this has an impact on the residual risk of blood products used for patient care and also on the risk due to errors in blood quarantine and release (even though test-positive donations are discarded). So that the prevalence of an infection in blood donations is dependent on the prevalence of the infection in the population from which donors are selected and on the effectiveness of donor motivation, mobilization and selection processes
| [13] | Global Status Report on Blood Safety and Availability. 2016. Geneva: World Health Organizations; 2017. Licence: CC BY-NC-SA 3.0 IGO. Available at http//apps.who.int/iris |
[13]
.
Transfusion-transmittable infections among blood donors are the subject of limited epidemiological investigations in Ethiopia
| [14] | Abdella S, Berheto TM, Tolera G, Belete W, Deressa T, Feleke A et al. Seroprevalence of transfusion-transmittable infections: HIV, Hepatitis B, C, and Treponema pallidum and associated factors among blood donors in Ethiopia: A retrospective study. PLoS One [Internet]. 2020; 15(10 October): 1–13. Available from: http://dx.doi.org/10.1371/journal.pone.0241086 |
[14]
. Most Ethiopian studies focused on secondary data analysis /trend analysis of TTI among voluntary blood donors, which may have limitations to identify associated risk factors. No research was carried out in the Woliso Blood Bank to determine the prevalence and associated factors. Therefore, the objective of this study is to assess the prevalence and associated factors of Transfusion-transmittable infections among blood donors at the Woliso Blood Bank of the South West Shewa Zone, Oromia Region, Ethiopia, 2021.
2. Materials and Methods
2.1. Setting, Design and Period of Study
An institutional-based cross-sectional study was conducted at Woliso Blood Bank in Southwest Shewa. It is one of the 20 zones in the Oromia Regional State, located 114 kilometers from Addis Ababa, the country's capital city. The Woliso Blood Bank is a government organization that was founded in 2013 by the Oromia Regional Health Bureau in partnership with the FMoH to promote voluntary, non-remunerated blood donation and blood collection. It aims to serve all populations of 5,561,976 (S/W/Shewa 1,110,112, N/Shewa 1,450,525, W/Shewa 2,381,072, and Orom/F/esp./zone 620,267) by preventing morbidity and death from blood shortages by providing safe and adequate blood in a timely and free basis depending on hospital demand. Currently, 14 hospitals receive blood from the blood bank on a regular basis
| [5] | Sahilu D, Tadesse AW. Blood Donation Practice and Associated Factors of North Shoa Zone, Oromia, Ethiopia, 2021: A Community-Based Mixed-Method Study. Am J Med Public Health. 2023;4(3): 1045. |
[5]
. The study was conducted from November 1 to 30 2021.
2.2. Source of Population and Study Population
All volunteer blood donors in Woliso city and the catchment district were the source population, and all volunteer blood donors whose age ranged between 18 and 65 years were the study population.
2.3. Inclusion and Exclusion Criteria
Blood donors with an age greater than or equal to 18 and less than 65 years with good health were included in the study. Furthermore, donors after 3 months with a weight greater than 48 kg and volunteer blood donors who signed consent were included in the study, and participants who were unwilling to participate in the study during data collection and those with nausea, vomiting, headache and discomfort were excluded from the study.
2.4. Sample Size Determination
The sample size (n) required for objective 1 was calculated using a single population proportion formula with a 95% CI, a 3% margin of error, and the prevalence of similar studies
| [12] | Bonja F, Hussein M, Alemu J, Gemechu D, Birhaneselassie M. The prevalence of transfusion-transmitted infections: A focus on hepatitis B virus among blood donors in. 2017; 7: 7–14. |
[12]
.
n=3.8416*0.0776/0.0009=288
Taking10%non-response,thefinalsamplesizewas0.1*288+288=317.
The sample size of the second objective was smaller than that of the first objective. Therefore, the final sample size by taking 10% nonresponses was 317.
2.5. Sampling Procedure/Technique
A systematic sampling technique was used among volunteer blood donors from the blood bank who met the facility's donation criteria. Using the blood donor database, a sampling frame was built. The blood bank receives an average of 900 blood donations each month. After calculating the k-value, a random starting point was chosen using the lottery method. The following formula is used to determine the sampling interval: K=N/n, where N is the population size (total number of blood bank collections during data collection time, which is 900), n is the calculated sample size (317) and k is 3. Using this method, each individual in the population had a known and equal chance of being chosen.
2.6. Data Collection Method
2.6.1. Data Collectors and Supervisors
Based on their experience with data collection and supervision, three data collectors of health professionals and one supervisor were assigned.
2.6.2. Data Collection Instruments
The structured questionnaire was adapted from studies conducted before this study
| [12] | Bonja F, Hussein M, Alemu J, Gemechu D, Birhaneselassie M. The prevalence of transfusion-transmitted infections: A focus on hepatitis B virus among blood donors in. 2017; 7: 7–14. |
| [16] | Ya G, Az A, Ma A, Ma A, Aa A. Transfusion Transmitted Infections: Prevalence and associated factors, National Center for Blood Transfusion and Research, Sana’a Capital, Yemen. 2021; 1–7. |
| [20] | Teklemariam Z, Mitiku H, Weldegebreal F. Seroprevalence and trends of transfusion-transmitted infections in Harar blood bank in Harari region state, eastern Ethiopia : eight-year retrospective study. 2018; –8. |
[12, 16, 20]
and modified in context. The questionnaire was prepared in English, translated into Afan Oromo for data collection, and then retranslated to English to check its consistency. It consists of two sections that comprise information on the sociodemographic characteristics of study participants and their exposure to various risk factors.
2.7. Study variables
2.7.1. Dependent Variable
Transfusion-transmissible infections.
2.7.2. Independent Variable
Sociodemographic characteristics include age, sex, marital status, education, and occupation; behavioral factors include multiple sexual partners, therapeutic drug injection, alcohol use, smoking, and chat chewing; clinical factors include previous transfusions, surgery, and health service-related factors; previous donation and post-donation counselling; previous exposure to sharp injuries (cut); history of tooth extraction; and history of blood contact.
2.8. Operational Definitions
Voluntary blood donors without remuneration: were blood donors who gave blood voluntarily without any payment and not for their own family.
Replacement donors: blood donors who replace blood used by their relatives or friends from blood bank stocks.
Donor screening criteria: Physical and clinical assessment criteria used to accept or reject a blood donor.
Transfusion-transmitted infection: blood-borne infections that can be transmitted during the blood transfusion process (human immunodeficiency virus, hepatitis B virus, hepatitis C virus and syphilis).
Positive for TTIS: If donor samples contain one or more TTIs (the donor sample should be positive for TTIS two times by the ELISA test).
2.9. Data Quality Control
To ensure data quality, the principal investigator gave a one-day training to supervisors and data collectors on the data collection tool. Pretesting was conducted outside the study area on 5% of the sample size before data collection in the same area of the study, and some amendments were made based on the pretest findings. The questionnaire was checked daily for accuracy, consistency, and completeness by the supervisor. Furthermore, the supervisor gave feedback and corrections on the data collected on a daily basis to the data collectors. Standard operating procedures were strictly followed for TTI screening. For quality assurance, all TTI positive samples and 10% of negative samples were collected to be blindly reexamined by other laboratory technologists.
2.10. Data Processing and Analysis
The data was entered into Epi Data version 3.1, and it was exported to STATA version 17.0 for data cleaning and analysis. The sociodemographic characteristics of the study participant were described using descriptive statistics and the results were presented using a frequency table. A bivariate logistic regression analysis was used to examine the determinants of TTI, and a p value below 0.25 was entered into the multivariate logistic regression model. Multivariate logistic regression analysis was used to examine the association between the determinant variables of TTI. A p-value of less than 0.05 in the multivariate logistic regression analysis was considered statistical significance in the multivariate logistic regression analysis. The crude and adjusted odds ratios were presented with a 95% confidence interval. Hosmer Leme show goodness-of-fit was used to test for model fitness.
3. Results
3.1. Sociodemographic Factors
Three hundred seventeen voluntary blood donors from 317 sampled participants participated in this study, with a 100% response rate. The study consisted of 230 (72.6%) males and 87 (27.4%) females. The mean (± standard deviation) of the participants was 28.40 (± 9.34) years. The majority of study participants (98.1%) were urban dwellers and approximately two-fifths (46.1%) were students. Approximately half (48.3%) of the participants donated blood for the first time (
Table 1).
Table 1. Sociodemographic characteristics of voluntary blood donors at the Woliso Blood Bank of South West Shewa, Oromia Region, Ethiopia, 2021.
Variables | Categories | Frequency | Percentage |
Age category | 18-24 years | 136 | 42.9 |
25-31 years | 60 | 18.9 |
32-38 years | 71 | 22.4 |
39 and above years | 50 | 15.8 |
Gender | Male | 230 | 72.6 |
Female | 87 | 27.4 |
Marital status | Single | 175 | 55.2 |
Married | 134 | 42.3 |
Divorced | 6 | 1.9 |
Widowed | 2 | 0.6 |
Residence | Rural | 6 | 1.9 |
Urban | 311 | 98.1 |
Educational status | No formal education | 13 | 4.1 |
Primary | 155 | 48.9 |
Secondary and above | 149 | 47.0 |
Occupational status | Civil servant | 125 | 39.4 |
Daily labor | 54 | 17.0 |
Student | 138 | 43.5 |
3.2. Clinical and Behavioral Characteristics of Study Participants
Among the study participants, approximately 4.1% had received blood products and approximately 1.9% were exposed to unsafe injections. Tooth extraction, post-donation counseling, sex, a history of STD in the family, and an unprotected sex habit were found in 10.4%, 21.8%, 53.3%, 10.4%, and 14.8% of the study participants, respectively. (
Table 2).
Table 2. Clinical history and behavioral characteristics of voluntary blood donors at the Woliso Blood Bank of South West Shewa, Oromia Region, Ethiopia, 2021.
Variables | Characteristics | Frequency | Percentage |
Received blood product | Yes | 13 | 4.1 |
No | 304 | 95.9 |
Number of donation | First time | 164 | 51.7 |
Repeatedly | 153 | 48.3 |
Use drug | Yes | 3 | 0.9 |
No | 314 | 99.1 |
Exposed to unsafe injection | Yes | 6 | 1.9 |
No | 311 | 98.1 |
Tooth extraction | Yes | 33 | 10.4 |
No | 284 | 89.6 |
Sharing sharps | Yes | 9 | 2.8 |
No | 308 | 97.2 |
Had sex | Yes | 169 | 53.3 |
No | 148 | 46.7 |
Unprotected sex | Yes | 47 | 14.8 |
No | 270 | 85.2 |
History of STDs | Yes | 33 | 10.4 |
No | 284 | 89.6 |
Had tattoo | Yes | 16 | 5.0 |
No | 301 | 95.0 |
Post donation counselling | Yes | 69 | 21.8 |
No | 248 | 78.2 |
Heard about TTIs | Yes | 273 | 86.1 |
No | 44 | 13.9 |
Know how TTIs transmit | Yes | 272 | 85.8 |
No | 45 | 14.2 |
Drinking alcohol | Yes | 34 | 10.7 |
No | 283 | 89.3 |
Chewing chat | Yes | 13 | 4.1 |
No | 304 | 95.9 |
Smoking cigarette | Yes | 6 | 1.9 |
No | 311 | 98.1 |
3.3. Seroprevalence of HIV, HBV, HCV, and Syphilis Among Voluntary Blood Donors
The overall seroprevalence of transfusion-transmissible infections (the proportion of voluntary blood donors with at least one transfusion-transmissible infection marker) was 9.5% (95% CI: 6.3, 12.9). The prevalence of HBV, syphilis, HIV and HCV was 5.05% (95% CI 3.0, 7.0), 3.15% (95% CI 1.0, 5.0), 0.63% (95% CI 0.0, 2.0) and 0.63% (95% CI 0.0, 2.0), respectively. In this study, co-infections were not detected in all study participants. (
Figure 1).
Figure 1. Prevalence of Hepatitis B Virus, Syphilis, HIV, and Hepatitis C Virus among voluntary blood donors at Woliso Blood Bank of South West Shewa, Oromia Region, Ethiopia, 2021.
3.4. Factors Associated with Transfusion-Transmittable Infections
A binary logistic regression analysis was used to examine the associated factors of transfusion-transmissible infections. Variables with a p-value below 0.25 in the bivariate logistic regression analysis were entered into the multivariate logistic regression model. Consequently, in the crude analysis, older age, participants without formal education, hearing information about transfusion transmissible infections, knowing how transfusion transmissible infections are transmitted, first-time donation, receiving blood products, having sex, unprotected sexual intercourse with more partners, and history of STD were significantly associated with transfusion transmissible infections.
Multivariate logistic regression analysis was then used to identify independent predictors of transfusion-transmitted infections and to declare statistical significance with a p-value less than 0.05. Therefore, unprotected sexual intercourse with more partners is 4.77 times (AOR = 4.77; 95% CI: 1.38–16.44; P<0.013) more likely to develop a transfusion-transmitted infection compared to those who have not had unprotected sexual intercourse with more partners.
Participants with the first donation were statistically significant predictors of transfusion-transmitted infections, in which the odds of having a transfusion-transmitted infection among study participants increased by a factor of 2.85 (AOR = 2.85; 95%CI: 1.16–6.99; P<0.022) as compared to those who donated repeatedly. The odds of having a transfusion-transmissible infection among participants without formal education were 4.84 times (AOR = 4.84; 95% CI: 1.09–21.46; P<0.038) higher than those of people who learned secondary and higher. (
Table 3).
Table 3. Variables associated with TTI by both the crude and adjusted odds ratio among voluntary blood donors at the Woliso Blood Bank of South West Shewa, Oromia Region, Ethiopia, 2021.
Variables | TTIs status | COR (95%CI) | AOR (95%CI) |
Yes N (%) | No N (%) |
Age (Years) |
18-24 | 6(1.9) | 130 (41.0) | 1 | 1 |
25-31 | 5(1.6) | 55(17.4) | 1.9(0.58-6.73) | 2.96(0.48-17.99) |
32-38 | 9(2.8) | 62(19.6) | 3.14(1.07-9.23) | 6.57(0.76-56.78) |
>=39 | 10(3.2) | 40(12.6) | 5.42(1.85-15.83) | 8.08(0.86-75.42) |
Educational status |
No formal edu. | 5(1.6) | 8(2.5) | 4.85(1.42-16.54) | 4.84(1.09-21.46) |
Primary | 8(2.5) | 147(46.4) | 0.42(0.1-1.01) | 1.42(0.21-9.56) |
Secondary& above | 17(5.4) | 132(41.6) | 1 | 1 |
Heard TTIs |
Yes | 22(6.9) | 252(79.5) | 1 | 1 |
No | 8(2.5) | 35(11.0) | 3.08(1.31-7.27) | 1.49(0.47-4.75) |
Knowhow transmit |
Yes | 21(6.6) | 250(78.9) | 1 | 1 |
No | 9(2.9) | 37(11.7) | 2.46(1.01-5.92) | 1.02(0.33-3.19) |
Number of donate |
First time | 20(6.3) | 133(42.0) | 2.31(1.04-5.12) | 2.85(1.16-6.99) * |
Repeatedly | 10(3.2) | 154(48.6) | 1 | 1 |
Received blood |
Yes | 5(1.5) | 8(2.5) | 4.75(1.36-16.49) | 2.22(0.47-7.10.39) |
No | 26(8.2) | 278(87.7) | 1 | 1 |
Had sex |
Yes | 21(6.6) | 148(46.7) | 2.19(0.97-4.95) | 0.47(0.11-2.06) |
No | 9(2.8) | 139(43.8) | 1 | 1 |
Unprotected sex |
Yes | 14(4.4) | 33(10.4) | 6.73(3.01-15.04) | 4.77(1.38-16.44) * |
No | 16(5.0) | 254(80.1) | 1 | 1 |
History of STD |
Yes | 9(2.8) | 24(7.6) | 4.69(1.94-11.39) | 1.18(0.34-4.12) |
No | 21(6.6) | 263(83.0) | 1 | 1 |
Key፡* Significant at p-value <0.05; COR: crude odds ratio; AOR: adjusted odds ratio; CI: confidence interval. Those with a p value of 0.25 and less than were entered into multivariate regression; TTI: transfusion-transmissible infection; STD: sexually transmitted disease
4. Discussion
In this study, the overall Seroprevalence of transfusion-transmitted infections was 9.5% (95% CI 6.3 to 12.9). It was similar to the study carried out at the Yemeni National Blood Transfusion and Research Center in Sana'a (8.8% (95% CI: 5.79–11.81)
| [16] | Ya G, Az A, Ma A, Ma A, Aa A. Transfusion Transmitted Infections: Prevalence and associated factors, National Center for Blood Transfusion and Research, Sana’a Capital, Yemen. 2021; 1–7. |
[16]
, the study in Tanzania (10.1% (95% CI: 9.92–10.28)
| [17] | Mremi A, Yahaya JJ, Nyindo M, Mollel E. 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. PLoS One [Internet]. 2021; 16(3 March): 1–12. Available from: http://dx.doi.org/10.1371/journal.pone.0249061 |
[17]
, the Sidama region of Ethiopia (7.29% (95% CI: 4.69–9.89)
| [12] | Bonja F, Hussein M, Alemu J, Gemechu D, Birhaneselassie M. The prevalence of transfusion-transmitted infections: A focus on hepatitis B virus among blood donors in. 2017; 7: 7–14. |
[12]
and Eastern Ethiopia (12.4% (95% CI: 9.5–15.3)
| [20] | Teklemariam Z, Mitiku H, Weldegebreal F. Seroprevalence and trends of transfusion-transmitted infections in Harar blood bank in Harari region state, eastern Ethiopia : eight-year retrospective study. 2018; –8. |
[20]
. However, it was higher than another study conducted in northern Ethiopia, which was 6% (95% CI: 5.75–6.25)
| [22] | Negash M, Ayalew M, Geremew D, Workineh M. Seroprevalence and associated risk factors for HIV, Hepatitis B and C among blood donors in the South Gondar District blood bank, northwest Ethiopia. BMC Infect Dis. 2019; 19(1): 1–10. |
[22]
and and Harar blood bank of eastern Ethiopia, 6.6% (95% CI: 6.14–7.06)
| [20] | Teklemariam Z, Mitiku H, Weldegebreal F. Seroprevalence and trends of transfusion-transmitted infections in Harar blood bank in Harari region state, eastern Ethiopia : eight-year retrospective study. 2018; –8. |
[20]
and lower than reports from Kenya, 14.1% (95% CI: 11.3–16.9)
| [18] | Bartonjo G, Oundo J, Ng’ang’a Z. Prevalence and associated risk factors for transfusion transmissible infections among blood donors at the nakuru and tenwek mission hospital regional blood transfusion center, Kenya. Pan Afr Med J. 2019; 34: 1–13. |
[18]
. These variations may be due to differences in the study population, the study setting, and the sample size used to estimate prevalence.
The seroprevalence of HBV in this study was 5.05% (95% CI: 2.65, 7.45). This finding was similar to the study conducted in Tanzania (5.1% (95% CI: 4.97, 5.23)
| [17] | Mremi A, Yahaya JJ, Nyindo M, Mollel E. 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. PLoS One [Internet]. 2021; 16(3 March): 1–12. Available from: http://dx.doi.org/10.1371/journal.pone.0249061 |
[17]
, the Regional Blood Transfusion Center Nakuru and Tenwek Mission Hospital Regional Blood Transfusion Center of Kenya (6.0% (95% CI: 4.1, 7.9)
| [18] | Bartonjo G, Oundo J, Ng’ang’a Z. Prevalence and associated risk factors for transfusion transmissible infections among blood donors at the nakuru and tenwek mission hospital regional blood transfusion center, Kenya. Pan Afr Med J. 2019; 34: 1–13. |
[18]
, Eastern Ethiopia (6.6% (95% CI: 4.42, 8.78)
| [20] | Teklemariam Z, Mitiku H, Weldegebreal F. Seroprevalence and trends of transfusion-transmitted infections in Harar blood bank in Harari region state, eastern Ethiopia : eight-year retrospective study. 2018; –8. |
[20]
, and the Sidama Region of Ethiopia (4.2% (95% CI: 2.2, 6.2)
| [12] | Bonja F, Hussein M, Alemu J, Gemechu D, Birhaneselassie M. The prevalence of transfusion-transmitted infections: A focus on hepatitis B virus among blood donors in. 2017; 7: 7–14. |
[12]
. However, this finding was higher than previous systematic review reports from Pakistan 2.04% (95% CI: 0.81, 4.22)
| [15] | Sana MK. A systematic review of transfusion-transmissible infections among blood donors and associated safety challenges in Pakistan. 2020; 405–20. |
[15]
, Yemen's national blood transfusion and research center in Sana’a 2.5% (95% CI: 0.84, 4.16)
| [16] | Ya G, Az A, Ma A, Ma A, Aa A. Transfusion Transmitted Infections: Prevalence and associated factors, National Center for Blood Transfusion and Research, Sana’a Capital, Yemen. 2021; 1–7. |
[16]
, and lower than the study of the Bahir Dar district blood bank in northwest Ethiopia 6.0% (95% CI: 5.75, 6.25)
| [19] | Shiferaw E, Tadilo W, Melkie I, Shiferaw M. Sero prevalence and trends of transfusion-transmissible infections among blood donors at the Bahir Dar district blood bank, northwest Ethiopia: A four-year retrospective study. PLoS One. 2019; 14(4): 1–13. |
[19]
. The possible explanation for these variations could be due to behavioral characteristics such as unprotected sex, tooth extraction, and tattoos, which were high in these study participants. Furthermore, HBV has a high prevalence in the general population, which arises from the high potential for virus infection.
In this study, the seroprevalence of syphilis was 3.15% (95% CI 1.25, 5.05). This result was similar to studies carried out in eastern Ethiopia (3.4%; 95% CI: 1.8–5.0)
| [20] | Teklemariam Z, Mitiku H, Weldegebreal F. Seroprevalence and trends of transfusion-transmitted infections in Harar blood bank in Harari region state, eastern Ethiopia : eight-year retrospective study. 2018; –8. |
[20]
. However, it was higher compared to other studies conducted in Kenya 2.0% (95% CI: 0.87, 3.13)
| [18] | Bartonjo G, Oundo J, Ng’ang’a Z. Prevalence and associated risk factors for transfusion transmissible infections among blood donors at the nakuru and tenwek mission hospital regional blood transfusion center, Kenya. Pan Afr Med J. 2019; 34: 1–13. |
[18]
, Sidama Region of Ethiopia 0.8% (95% CI: 0.0, 1.6)
| [12] | Bonja F, Hussein M, Alemu J, Gemechu D, Birhaneselassie M. The prevalence of transfusion-transmitted infections: A focus on hepatitis B virus among blood donors in. 2017; 7: 7–14. |
[12]
, northwest Ethiopia 1.1% (95% CI: 0.91, 1.29)
| [19] | Shiferaw E, Tadilo W, Melkie I, Shiferaw M. Sero prevalence and trends of transfusion-transmissible infections among blood donors at the Bahir Dar district blood bank, northwest Ethiopia: A four-year retrospective study. PLoS One. 2019; 14(4): 1–13. |
[19]
, Kenya 1.2% (95% CI: 1.10, 1.30)
| [21] | Awili HO, Gitao GC, Muchemi GM. Seroprevalence and Risk Factors for Hepatitis B Virus Infection in Adolescent Blood Donors within selected counties in Western Kenya. Biomed Res Int. 2020; 2020. |
[21]
and Yemen's national blood transfusion and research center in Sana’a 1.2% (95% CI: 0.00, 2.4)
| [16] | Ya G, Az A, Ma A, Ma A, Aa A. Transfusion Transmitted Infections: Prevalence and associated factors, National Center for Blood Transfusion and Research, Sana’a Capital, Yemen. 2021; 1–7. |
[16]
. The lower rate of seroprevalence of syphilis in most studies might be due to the conceivable fact that syphilis is less often transmitted by blood. The duration of the study and the cultural and behavioral characteristics of the study participant could be some of the possible explanations.
The seroprevalence of HIV in voluntary blood donors in this study was 0.63%. This finding was similar to a study conducted in the Harar blood bank of eastern Ethiopia (0.6% (95% CI: 0.46, 0.74)
| [20] | Teklemariam Z, Mitiku H, Weldegebreal F. Seroprevalence and trends of transfusion-transmitted infections in Harar blood bank in Harari region state, eastern Ethiopia : eight-year retrospective study. 2018; –8. |
[20]
, the Sidama Region of Ethiopia (1.6% (95% CI: 0.4, 2.8)
| [12] | Bonja F, Hussein M, Alemu J, Gemechu D, Birhaneselassie M. The prevalence of transfusion-transmitted infections: A focus on hepatitis B virus among blood donors in. 2017; 7: 7–14. |
[12]
and Eastern Ethiopia (1.4% (95% CI: 0.37, 2.43)
| [20] | Teklemariam Z, Mitiku H, Weldegebreal F. Seroprevalence and trends of transfusion-transmitted infections in Harar blood bank in Harari region state, eastern Ethiopia : eight-year retrospective study. 2018; –8. |
[20]
. However, it was lower than the Kenyan reports (9.0% (95% CI: 6.7, 11.3)
| [18] | Bartonjo G, Oundo J, Ng’ang’a Z. Prevalence and associated risk factors for transfusion transmissible infections among blood donors at the nakuru and tenwek mission hospital regional blood transfusion center, Kenya. Pan Afr Med J. 2019; 34: 1–13. |
[18]
, and higher than study results of the Yemen's national blood transfusion and research center in Sana'a (0.3% (95% CI: 0.0, 0.6)
| [16] | Ya G, Az A, Ma A, Ma A, Aa A. Transfusion Transmitted Infections: Prevalence and associated factors, National Center for Blood Transfusion and Research, Sana’a Capital, Yemen. 2021; 1–7. |
[16]
and Northern Ethiopia (0.5% (95% CI: 0.43, 0.57)
| [22] | Negash M, Ayalew M, Geremew D, Workineh M. Seroprevalence and associated risk factors for HIV, Hepatitis B and C among blood donors in the South Gondar District blood bank, northwest Ethiopia. BMC Infect Dis. 2019; 19(1): 1–10. |
[22]
. These discrepancies could be due to the behavioral characteristics of study participants with different study areas and sample sizes.
In this study, the seroprevalence of HCV was 0.63%. This finding was similar to the study conducted in the Yemen National Blood Transfusion and Research Center in Sana'a: 1.2% (95% CI: 0.0, 2.4)
| [16] | Ya G, Az A, Ma A, Ma A, Aa A. Transfusion Transmitted Infections: Prevalence and associated factors, National Center for Blood Transfusion and Research, Sana’a Capital, Yemen. 2021; 1–7. |
[16]
, in eastern Ethiopia: 1.0% (95% CI: 0.13, 1.87)
| [20] | Teklemariam Z, Mitiku H, Weldegebreal F. Seroprevalence and trends of transfusion-transmitted infections in Harar blood bank in Harari region state, eastern Ethiopia : eight-year retrospective study. 2018; –8. |
[20]
, in northern Ethiopia: 0.6% (95% CI: 0.52, 0.68)
| [22] | Negash M, Ayalew M, Geremew D, Workineh M. Seroprevalence and associated risk factors for HIV, Hepatitis B and C among blood donors in the South Gondar District blood bank, northwest Ethiopia. BMC Infect Dis. 2019; 19(1): 1–10. |
[22]
, and in the Sidama Region of Ethiopia: 0.5% (95% CI: 0.0, 1.0)
| [12] | Bonja F, Hussein M, Alemu J, Gemechu D, Birhaneselassie M. The prevalence of transfusion-transmitted infections: A focus on hepatitis B virus among blood donors in. 2017; 7: 7–14. |
[12]
. However, it was lower than the Kenyan reports (8.0% (95% CI: 5.82, 10.18)
| [18] | Bartonjo G, Oundo J, Ng’ang’a Z. Prevalence and associated risk factors for transfusion transmissible infections among blood donors at the nakuru and tenwek mission hospital regional blood transfusion center, Kenya. Pan Afr Med J. 2019; 34: 1–13. |
[18]
, and the Harar blood bank in eastern Ethiopia (0.8% (95% CI: 0.64, 0.96)
| [20] | Teklemariam Z, Mitiku H, Weldegebreal F. Seroprevalence and trends of transfusion-transmitted infections in Harar blood bank in Harari region state, eastern Ethiopia : eight-year retrospective study. 2018; –8. |
[20]
. A possible reason might be due to the behavioral characteristics of the study participants with different study areas and sample sizes.
In this study, the chances of developing one of the TTI were 4.85 [AOR = 4.85; 95% CI 1.42, 16.54] times higher among voluntary blood donors without formal education compared to those who learned secondary and above. This finding is comparable to the study done in Eastern Ethiopia
| [20] | Teklemariam Z, Mitiku H, Weldegebreal F. Seroprevalence and trends of transfusion-transmitted infections in Harar blood bank in Harari region state, eastern Ethiopia : eight-year retrospective study. 2018; –8. |
[20]
. The seroprevalence of TTI in this study was found to decrease with increasing level of education. This could be attributed to the fact that as the level of education increases, there is a high probability that people are aware of preventive measures against TTI.
The study also showed that the odds of developing one of the TTIs were 4.77 [AOR = 4.77; 95% CI 1.38, 16.44] among voluntary blood donors who had unprotected sexual intercourse compared to those who did not practice unprotected sex. This corresponds to the research conducted in Eastern Ethiopia, Kenya and the South Gonder of Ethiopia
| [20] | Teklemariam Z, Mitiku H, Weldegebreal F. Seroprevalence and trends of transfusion-transmitted infections in Harar blood bank in Harari region state, eastern Ethiopia : eight-year retrospective study. 2018; –8. |
| [23] | Awili HO, Gitao GC, Muchemi GM. Seroprevalence and Risk Factors for Hepatitis B Virus Infection in Adolescent Blood Donors within selected counties in Western Kenya. Biomed Res Int. 2020; 2020. |
[20, 23]
and
| [22] | Negash M, Ayalew M, Geremew D, Workineh M. Seroprevalence and associated risk factors for HIV, Hepatitis B and C among blood donors in the South Gondar District blood bank, northwest Ethiopia. BMC Infect Dis. 2019; 19(1): 1–10. |
[22]
respectively. A possible explanation could be that sexual activity with multiple partners is the key mode of acquisition of sexually transmitted infections.
The study also showed that the odds of developing one of the TTIs were 2.85 [AOR = 2.85; 95% CI: 1.16, 6.99] times higher among people who donated for the first time compared to those who had donated repeatedly. This finding was supported by the findings of a cross-sectional study conducted at the South Gondar District Blood Bank, Northwest Ethiopia
| [22] | Negash M, Ayalew M, Geremew D, Workineh M. Seroprevalence and associated risk factors for HIV, Hepatitis B and C among blood donors in the South Gondar District blood bank, northwest Ethiopia. BMC Infect Dis. 2019; 19(1): 1–10. |
[22]
. The reason might be to obtain awareness about TTIs from post-blood donation counseling while participating repeatedly in such activities.
This study was intended to evaluate the prevalence of transfusion-transmissible infections with highly specific and sensitive laboratory methods. The methodological parts need particular attention because this study was limited by its cross-sectional study design, in which the temporal relationship between risk factors and outcome could not be determined because both were examined at the same time.
5. Conclusion
The prevalence of at least one transfusion-transmissible infection in this study was relatively high compared to studies conducted earlier in Ethiopia. Furthermore, the study identified the determinants of TTI among voluntary blood donors based on sociodemographic, clinical and behavioral characteristics. Finally, the level of education, the number of donations and the unprotected sexual intercourse with more partners were found to be independent predictors of one of the TTI.
6. Recommendations
Special attention should be paid to transfusion-transmitted infections, particularly HBV and syphilis infections in the southwest Shewa region of Oromia, Ethiopia. The national blood bank should work in collaboration with different stakeholders and all other district blood banks to strengthen a screening plan and post-donation counselling strategies to monitor implementation at all levels to reduce TTI. More prospective studies must be conducted rigorously to identify the cause and effect relationship of TTI with its contributing factors. Additionally, each of the blood banks and Regional Health Bureaus in the study area should mobilize the community to increase the number of voluntary donors and improve health promotion of prevention and control of transmissible transmission infections considering the associated factors identified.
Abbreviations
CI | Confidence Interval |
ELISA | Enzyme-Linked Immune Sorbent Assay |
ETB | Ethiopian Birr |
EU | European Union |
FMOH | Federal Ministry of Health |
HBV | Hepatitis B Virus |
HBsAg | Hepatitis B Surface Antigen |
HCV | Hepatitis C Virus |
HIV | Human Immunodeficiency Virus |
NBB | National Blood Bank |
STD | Sexually Transmitted Disease |
TTIs | Transfusion Transmissible Infections |
WHO | World Health Organization |
Acknowledgments
The authors express their gratitude to the Public Health Department of the Ambo University College of Medicine and Health Sciences for giving us the opportunity to prepare this research. Finally, the authors express their appreciation to the study participants for their willingness to provide the required information, data collectors, supervisors, and Woliso Blood Bank staff.
Author Contributions
Alemnesh Wolde Amlak: Conceptualization, Data curation, Formal Analysis, Methodology, Writing – original draft, Writing – review & editing
Habtamu Oljira: Conceptualization, Data curation, Formal Analysis, Methodology, Writing – original draft, Writing – review & editing
Belay Tafa: Conceptualization, Data curation, Formal Analysis, Methodology, Writing – original draft, Writing – review & editing
Samuel Demissie Darcho: Conceptualization, Data curation, Formal Analysis, Methodology, Software, writing – original draft, Writing – review & editing
Sisay Dabi Begna: Conceptualization, Data curation, Formal Analysis, Methodology, Software, writing – original draft, Writing – review & editing
Ethics Approval and Consent to Participate
Ethics approval and approval were obtained from the Ethics and Research Review Committee of the Ambo University College of Medicine and Health Sciences (Ref. No: PGC / 272 / 2021) In addition to that, informed, voluntary, written, and signed consent was obtained from each study participant after a brief explanation of the study objective, ensuring that participation was voluntary. The participant was informed that the questionnaires were confidential and that they had the right to refuse to respond to the questionnaire or participate in the study at any time they wanted. Post-donation counseling was provided to those positive donors in a confidential manner. Finally, the test result was kept in soft copy using Pass Word, as well as in hard copy by locking it at Woliso Blood Laboratory.
Funding
This study was supported by Ambo University.
Disclosure
This article has been uploaded to www.medrxiv.org as a preprint: https://doi.org/10.1101/2024.02.08.24302506
Data Availability Statement
The data used to support the findings of this study are available from the corresponding author upon request.
Conflicts of Interest
The authors declare no conflicts of interest.
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Cite This Article
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APA Style
Amlak, A. W., Oljira, H., Tafa, B., Darcho, S. D., Begna, S. D. (2024). Magnitude of Transfusion Transmissible Infections and Associated Factors Among Blood Donors at the Woliso Blood Bank, Oromia, Ethiopia: Across-Sectional Study. Science Journal of Clinical Medicine, 13(3), 47-56. https://doi.org/10.11648/j.sjcm.20241303.12
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ACS Style
Amlak, A. W.; Oljira, H.; Tafa, B.; Darcho, S. D.; Begna, S. D. Magnitude of Transfusion Transmissible Infections and Associated Factors Among Blood Donors at the Woliso Blood Bank, Oromia, Ethiopia: Across-Sectional Study. Sci. J. Clin. Med. 2024, 13(3), 47-56. doi: 10.11648/j.sjcm.20241303.12
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AMA Style
Amlak AW, Oljira H, Tafa B, Darcho SD, Begna SD. Magnitude of Transfusion Transmissible Infections and Associated Factors Among Blood Donors at the Woliso Blood Bank, Oromia, Ethiopia: Across-Sectional Study. Sci J Clin Med. 2024;13(3):47-56. doi: 10.11648/j.sjcm.20241303.12
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@article{10.11648/j.sjcm.20241303.12,
author = {Alemnesh Wolde Amlak and Habtamu Oljira and Belay Tafa and Samuel Demissie Darcho and Sisay Dabi Begna},
title = {Magnitude of Transfusion Transmissible Infections and Associated Factors Among Blood Donors at the Woliso Blood Bank, Oromia, Ethiopia: Across-Sectional Study
},
journal = {Science Journal of Clinical Medicine},
volume = {13},
number = {3},
pages = {47-56},
doi = {10.11648/j.sjcm.20241303.12},
url = {https://doi.org/10.11648/j.sjcm.20241303.12},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sjcm.20241303.12},
abstract = {Background: Blood transfusion is an effective treatment for saving millions of lives, even though transfusion-transmissible infections are the major problem. The prevalence of transfusion-transmissible infections varies between different geographical populations. This study aims to assess the prevalence of transfusion-transmissible infections and associated factors among blood donors at Woliso Blood Bank, South West Shewa Zone, Oromia, Ethiopia. Method: An institutional-based cross-sectional study design was conducted. A structured and pre-tested questionnaire was used to collect data through a face-to-face interview. The data was entered in Epi Data version 3.1, and exported to STATA version 17.0 for data cleaning and analysis. A binary logistic regression analysis was performed to identify factors associated with outcome variables. Odd ratios along with the 95% confidence interval were used to present the finding and statistical significance was reported with a p-value of 0.05. Results: The overall prevalence of transfusion-transmissible infections was 9.5% (95% CI 6.3-12.9%). Participants without formal education [AOR=4.84; 95% CI= 1.09, 21.46], unprotected sexual intercourse with multiple partners [AOR=4.77; 95% CI= 1.38, 16.44], and participants with a lower frequency of blood donation [AOR=2.85; 95% CI: 1.16, 6.99] were significantly associated with transfusion transmissible infections. Conclusions: The prevalence of transfusion-transmissible infections was high in this study area. Educational level, unprotected sexual intercourse with more partners, and a number of blood donations were found to be independent predictors of transfusion-transmitted infections. Blood banks and regional health offices should work to mobilize the community and improve health promotion through prevention and control considering the associated factors identified.
},
year = {2024}
}
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TY - JOUR
T1 - Magnitude of Transfusion Transmissible Infections and Associated Factors Among Blood Donors at the Woliso Blood Bank, Oromia, Ethiopia: Across-Sectional Study
AU - Alemnesh Wolde Amlak
AU - Habtamu Oljira
AU - Belay Tafa
AU - Samuel Demissie Darcho
AU - Sisay Dabi Begna
Y1 - 2024/08/15
PY - 2024
N1 - https://doi.org/10.11648/j.sjcm.20241303.12
DO - 10.11648/j.sjcm.20241303.12
T2 - Science Journal of Clinical Medicine
JF - Science Journal of Clinical Medicine
JO - Science Journal of Clinical Medicine
SP - 47
EP - 56
PB - Science Publishing Group
SN - 2327-2732
UR - https://doi.org/10.11648/j.sjcm.20241303.12
AB - Background: Blood transfusion is an effective treatment for saving millions of lives, even though transfusion-transmissible infections are the major problem. The prevalence of transfusion-transmissible infections varies between different geographical populations. This study aims to assess the prevalence of transfusion-transmissible infections and associated factors among blood donors at Woliso Blood Bank, South West Shewa Zone, Oromia, Ethiopia. Method: An institutional-based cross-sectional study design was conducted. A structured and pre-tested questionnaire was used to collect data through a face-to-face interview. The data was entered in Epi Data version 3.1, and exported to STATA version 17.0 for data cleaning and analysis. A binary logistic regression analysis was performed to identify factors associated with outcome variables. Odd ratios along with the 95% confidence interval were used to present the finding and statistical significance was reported with a p-value of 0.05. Results: The overall prevalence of transfusion-transmissible infections was 9.5% (95% CI 6.3-12.9%). Participants without formal education [AOR=4.84; 95% CI= 1.09, 21.46], unprotected sexual intercourse with multiple partners [AOR=4.77; 95% CI= 1.38, 16.44], and participants with a lower frequency of blood donation [AOR=2.85; 95% CI: 1.16, 6.99] were significantly associated with transfusion transmissible infections. Conclusions: The prevalence of transfusion-transmissible infections was high in this study area. Educational level, unprotected sexual intercourse with more partners, and a number of blood donations were found to be independent predictors of transfusion-transmitted infections. Blood banks and regional health offices should work to mobilize the community and improve health promotion through prevention and control considering the associated factors identified.
VL - 13
IS - 3
ER -
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