Transfusion-Transmissible Infections Among Blood Donors In Sub-Saharan Africa: Systematic Review And Meta-Analysis
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Date
2021-12
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University of Ghana
Abstract
Background
Blood transfusion, as whole blood for a single patient or processed into blood products for multiple patients, is a life-saving intervention, saving millions of lives worldwide annually. Despite its importance and value, blood transfusion is associated with the risks of transmitting deadly infections such as Hepatitis B virus, Hepatitis C virus, Human Immunodeficiency Virus (HIV), and Treponema pallidum (Syphilis) to the recipients. Blood safety has been a major public health issue globally due to inadequate infrastructure, national blood transfusion policies and programs, personnel, and financial resources, predominantly in Sub-Saharan Africa with chronic resource constraints. This study aimed at comprehensively reviewing the prevalence of transfusion-transmissible infections among blood donors in Sub-Saharan Africa.
Methods
The systematic review and meta-analysis was designed, conducted and reported using best practices and validated tools and guidelines. Studies from 1st January 2000 to 31st October 2021 that reported transfusion-transmissible infections among blood donors in sub-Saharan Africa were retrieved from relevant electronic databases, including PubMed, SCOPUS, HINARI, Cochrane database library, Web of Science, Google Scholar, and Africa Journals Online, without language restrictions. The following search terms were used: blood transfusion-transmitted infections, blood transfusion-related infections, blood transfusion-transmissible infections, TTIs, blood transfusion infections, and each of the countries in Sub-Saharan Africa. Grey literature including conference proceedings, preprints repositories as well as references of retrieved studies were searched for additional studies. Experts in blood transfusion were contacted for unpublished studies. I (the candidate) screened title and abstract of articles and relevant data were extracted pretested eligibility criteria and data extraction form, respectively. The methodological quality of articles was assessed using Hoy et al critical appraisal checklist
for prevalence studies and the pooled prevalence of HIV, HBV, HCV and syphilis were determined using the random-effects model. Heterogeneity between the studies was assessed using the I2 statistic. Sub-group analysis was performed by diagnostic methods used, country and geographical region to detect subgroup differences. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines for reporting systematic reviews. The protocol was registered in the International Register: Prospective Register of Systematic Reviews (PROSPERO) with registration number: CRD42021259042, available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021259042.
Results:
A total of 989 articles were retrieved, and after deduplication, 752 were screened for eligibility. One hundred and twenty-five full-text articles were assessed for eligibility of which 95 studies from different countries in Sub-Saharan Africa met the inclusion criteria. In the random effects model, the overall pooled prevalence (PP) of TTIs was 10.1% (95% CI; 8.4 to 11.7%; n=2,046,506, 95 studies, I2 =99.9%). The pooled prevalence of the individual TTIs was: HBV (PP 6.9%, 95% CI 5.9 to 7.9%, , n=1,306,763, 75 studies , I2 =99.9%), HCV (PP 2.0%, 95% CI 1.6 to 2.5%, n=1,228,214, 65 studies, I2=99.9%), HIV (PP 3.2%, 95% CI 2.5 to 4.0%, n=1,633,198, 61 studies, I2=99.9%) and syphilis (PP 2.8%,95% CI 1.9 to 3.6%, n=965,488, 43 studies, I2=99.9%). Eastern Africa had the highest TTIs pooled prevalence (PP 11.2%, 95% CI, 7.3 to 15.1%, 29 studies, I2=99.9%). Most individuals had co-infections: HBV and HCV co-infections (PP 0.7%, 95% CI 0.2% to 1.2%, 23 studies), HBV and HIV (PP 0.8%, 95% CI 0.3% to 1.3%, 19 studies, I2=99.9%), HCV and HIV (PP 0.3%, 95% CI 0.1% to 0.4%, 16 studies, I2=99.3%), HBV, HCV and HIV (PP 3.3%, 95% CI 3.0% to 9.6%, 2 studies, I2=99.8%), HBV and Syphilis ( PP 0.27%, 95% CI 0.1% to 0.4%, 11 studies, I2=96.7%) and HCV and Syphilis (PP 0.2%, 95% CI 0.03% to 0.3%, 16 studies, I2=99.4%). The systematic
review showed demonstrable declining trends in the pooled prevalence for the TTIs: HBV (PP of 16.8 % in 2001 to 6.9 % in 2021), HCV (PP of 4.0% to 2.1% in 2021), HIV (PP of 12.9% in 2000 to 3.2% in 2021) and Syphilis (PP of 7.5% in 2003 to 2.8% in 2021). The systematic review revealed the most widely used blood screening tests in Sub-Saharan Africa as Enzyme immunoassays (57.9%) and RDTs (49.5%). The most sensitive tool, PCR was hardly used. Replacement donors accounted for 99% of blood donors in Sub-Saharan Africa
Conclusion:
Despite, this systematic review and meta-analysis showing a huge decline in transfusion transmissible infections from 2001 to 2021 among blood donors in trends analyses, the pooled prevalence of 10.1% TTIs in Sub-Saharan Africa (which translates into 1 positive per every 10 donors screened) is high and has serious implications for public health and clinical practice. Worryingly, given that several studies from 2018 to 2021 appeared to show no further decline in the common TTIs, calls for intensified effort towards scaling down the TTIs among blood donors in SSA with the ultimate goal of ensuring the safety of recipients of whole blood or blood products in this region. Also, it is evident that the widely used diagnostic criteria for blood screening in Sub-Saharan Africa are the RDTs and Enzyme immunoassays which are less sensitive or specific, means the likelihood of some of the infections not being detected is high and calls for intensifying effort that will ensure screened blood products are safe for transfusion.
Keywords:
Transfusion-transmissible Infections, Blood donors, Sub-Saharan Africa, Systematic review, Meta-analysis, Pooled prevalence, Trends
Description
MPhil. Applied Epidemiology And Disease Control
Keywords
Transfusion-transmissible Infections, Blood donors, Sub-Saharan Africa, Systematic review, Meta-analysis