IJBAF, November,

Novem 2016, 4(11): 398-417

ISSN: 2320 0774

A NARRATIVE REVIEW OF TRENDS OF HUMAN IMMUNODEFICIENCY VIRUS

SUB SAHARAN AFRICA
SERO STATUS AMONG BLOOD DONORS IN SUB-SAHARAN

ADDIS ADERA GEBRU1, TADESSE BEKELE TAFESSE2*, SEMGNE GOBALEE1,

ATAR 4, MOLLA TEFERI BELEW5, BELAY
GOSAYE DEGU BELAY3, DEMELASH ATARO
MEKONNE SHEBESHI7 AND YONAS YIMAM8
ALI EBRAHIM6, GETACHEW MEKONNEN
1
Department of Nursing, Faculty of Health Sciences, Woldia University, Woldia, Ethiopia
2
School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar,
Ethiopia
3
ealth, Tehran University of
Department of Disasters and Emergency Health, School of Public Health,
Medical Sciences, Tehran, Iran.
4
Department Emergency Medicine, Head of Emergency Unit and Coordinator of Emergency
Unit, Hawassa
Hawas University, Hawassa, Ethiopia
5
Health Sciences, Mekelle University, Mekelle,
Department of Public Health, College of Health
Ethiopia
6
Department of Public Health,
ealth, Faculty of Health Sciences, Samara University, Samara, Ethiopia
Health
7
Amhara Regional Health Office, North Wollo Zone Health Department, Harbu District, Woldia,
Ethiopia
8
Department of Biology, Faculty of Natural & Computational Sciences, Woldia University,
Woldia, Ethiopia
Tafesse School of Pharmacy, College of Health
*Corresponding Author: Tadesse Bekele Tafesse:
and Medical Sciences, Haramaya University, Harar, Ethiopia
Email: tadie2007@yahoo.com
Received 29 July 2016; Revised 29thAugust 2016; Accepted 2ndSept. 2016; Available online 8th Nov. 2016
th

ABSTRACT
Background: The prevalence of HIV is contributing the increasing morbidity and mortality in
Sub-Saharan
Saharan Africa region. Blood transfusion can be a life saving intervention. But it can also
life-saving
causes acute or delayed complication and may bring the risk of transfusion
transfusiontransmissible

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IJBAF, November, 2016, 4(11)
Tadesse Bekele Tafesse et al. Review Article

infections (TTIs) including HIV. The aim of this review was to summarize the current literature
on trends of HIV Sero-status among blood donors in Sub-Saharan Africa.
Method: We searched peer-reviewed published articles on trends of HIV Sero among blood
donors in Sub-Saharan Africa from March 2009 to June 2016. The articles were retrieved from
databases of PubMed, Scopus, Ovid, Google Scholar, MEDLINES, EMBASE and Science
Direct.
Results: About 24.7 million HIV cases were reported in 2014 in Sub-Saharan Africa region,
which constitutes almost three-fourth of the total HIV cases globally with a prevalence rate of
4.7% and being Southern Sub-Saharan region the most prevalent. In the region with only 12% of
the global population, blood safety as a result of the possible risk of infection from TTIs agents
are the main threats during a blood transfusion. The cause of 0.1-7.9% of HIV infection is due to
infected blood transfusion and 4.7-18.6% of patients are at risk of developing post-transfusion
HBV after blood transfusion, which can assure the occurrence of other various diseases in
relation to blood donation in the community.
Conclusion: The seropositivity of blood donors are the main threat of safe blood due to a high
prevalence of TTIs, lack of public awareness about the infections, level of education, use of
rigorous donor selection criteria and exclusion of those with clinical and theoretical risks of
carrying infectious agents and use of less sensitive screening. The trends of TTIs agents among
blood donors should be assessed in every country to ensure the safety of blood supply and the
efficiency of donor screening.
Keywords: Blood Donors, HIV, Serum, Sub-Saharan Africa, Transfusion-transmissible
infections, Trends
INTRODUCTION
Human Immunodeficiency Virus/ infection with HIV/AIDS, which constitute
Acquired Immune Deficiency Syndrome two-thirds of all the infected people and
(HIV/AIDS) nearly nine out of ten infected children [1, 2].
HIV/AIDS can affect any segments of HIV continues to be a major global public
population worldwide irrespective of their health issue that has been identified as one of
wealth, race, age, sex and territories. People the major causes of morbidity and mortality
living in developing countries, particularly claiming more than 35 million lives so far. In
the sub-Saharan region, are at higher risk of 2015, about 36.7 million people were living

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Tadesse Bekele Tafesse et al.
with HIV [3] and the number of people living
with HIV continues to increase globally due
to the accessibility of antiretroviral therapy
[4]. Even though new HIV infections have
declined, there is still an unacceptably high
number of new HIV infections and AIDS-
related deaths occurring each year and an
estimated of 2.1 million people were newly
infected with HIV and 1.1 million people
died of HIV/AIDS-related illnesses globally
in 2015 [3]. However, new HIV infections
and AIDS-related deaths have fallen by 35%,
and 28%, respectively, between the year
2000 and 2015 that saved the lives of some
7.8 million people [3].
In health care system, blood transfusion is an
indispensable component that contributes to
saving millions of lives each year in both
routine and emergency situations so as to
improve the life expectancy and quality of
life of patients with acute and chronic
conditions [5]. Transfusion therapy is a life-
saving therapy based on the safe use of blood
and blood products. But in some
circumstances, the provisions of unsafe blood
render blood safety and can be a dreadful
vector of some infectious and parasitic
diseases or can cause serious and sometimes
fatal reactions, which is a major public health
concern in Africa [6, 7]. The safety of blood
and blood products is of serious concern to
IJBAF, November, 2016, 4(11)
Review Article
the countries, particularly in the Sub-Saharan
African Region where there is a heavy
burden of HIV/AIDS and a high prevalence
of other transfusion transmissible infections
(TTIs) such as HBV, HCV [6], which
increasingly contributed to the morbidity and
mortality in various countries of the region.
World Health Organization (WHO) estimates
that over eight million units of blood for
transfusion are required annually for a
population of over 836 million in Africa [8].
Getting safe blood is a universal right for any
individual and it shouldnt cause any harm.
Still unsafe blood transfusion remains among
the major threats to blood safety for the
recipient and for the global spread of TTIs
agents such as HIV, hepatitis B virus (HBV),
hepatitis C virus (HCV), syphilis, malaria,
etc. They can been acquired through the
therapeutic blood transfusion process, which
is a major universal health challenge during
unsafe blood transfusion, most especially in
Africa due to a high transfusion demand [9,
10].
A lot of persisting challenges affect the
African communities such as shortage of
transfusion blood, high prevalence of TTIs,
shortage of blood transfusion service at the
national level and recruitment and retention
of voluntary non-remunerable donors, family
replacement and commercial blood donation
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Tadesse Bekele Tafesse et al.
due to the societal perception [11]. The aim
of this review was to highlight the trends of
HIV Sero status among blood donors in Sub-
Saharan Africa.
HIV/AIDS Epidemic in Sub-Saharan
Africa
HIV epidemic surveillance is an important
assessment method to analyses the HIV case
situation in order to design programme,
identify implementation of the strategic plan,
and monitoring and evaluation. During HIV
surveillance, the community surveys has
been done to collected data from HIV
prevalence data related to pregnant women
who are attending sentinel serosurveillance
sites, and prevention of parent to child
transmission services. However, the data
related with the prevalence and progress of
HIV infection among blood donors has been
yet another source of information [12].
Sub-Saharan Africa has the highest
HIV/AIDS epidemic in the world. According
to the UNAIDS report in 2014, the total
number of people living with HIV has been
estimated about 24.7 (71%) million in 2013
[13]. While new HIV infections have been
reported in all regions of the world,
approximately two-thirds are in sub-Saharan
Africa, with 46% of new cases in Eastern and
Southern Africa [3] and there were 1.1
million AIDS-related deaths [13].
IJBAF, November, 2016, 4(11)
Review Article
The prevalence rate of HIV in the sub-
Saharan Africa region was 4.7%, however, it
varies greatly between sub-regions within the
sub-Saharan Africa as well as in individual
countries. Southern Africa sub-region, for
example, is the most affected region and
considered as the Epicenter of the global
HIV epidemic with Swaziland and South
Africa has the highest HIV prevalence
(27.4%) and largest epidemic (5.9 million
people) of any country worldwide,
respectively. In relation to sub-regions, the
prevalence rate of HIV in Senegal, Western
Africa and Kenya, Eastern Africa was low to
moderate ranging from 0.5% to 6%,
respectively [13]. On the other hand, the
prevalence may also be different within a
single country, for instance, the highest
burden of HIV/AIDS (seropositivity rate of
10%) was found in Benue state according to
the national HIV sentinel seroprevalence
survey study in Nigeria in 2005 [14].
Historical Background of HIV Infection
due to Blood Transfusion
Blood transfusion were first reported in the
early 1920s [15] in Africa and has been
practiced since the 1940s in an organized
form [8] along with new hospitals
construction and health services expansion
but both its quality of service and blood
supply adequacy continues to decline
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Tadesse Bekele Tafesse et al. Review Article

gradually until 1980s partly due to lack of people in the region do not have the trend to
information, civil war, political instability donate blood and besides that the health
and cultural issues. systems of the countries in the region are not
As the epidemic was widespread in Africa by yet developed to the level that would require
the early 1980s, it was realized that HIV much blood. It is only less than half of the
could be transmitted through blood expected amount of blood that is required to
transfusion and WHO estimated at that time meet for transfusion was collected in most of
that 5% to 10% of HIV transmission resulted the countries in the region [8].
from transfusion of contaminated blood. This Ensuring a screened supply of blood for
situation led to a major turning point and transfusion is an essential component of
prompted urgent action to avert the preventing HIV as well as other TTIs such as
transmission of infection through blood syphilis, hepatitis B, and hepatitis C [17].
transfusion [8]. In order to ensure safe blood Evaluating the trends of HIV with co-
supply as a means to prevent blood infections among the blood donors is
transfusion-transmitted HIV and other essential to monitor safe blood supply,
infections, the establishment of blood effectiveness of donors screening and
transfusion service was considered greatly. identify the occurrence of infections and their
In Sub-Saharan Africa, a region with only epidemiology patterns in the community
12% of the global population, blood safety as [18].
a result of the possible risk of infection from In order to evaluate the safety of provision of
TTIs agents are the main threats during blood blood, a mechanism has to be developed and
transfusion [16]. provided so as to monitor the trends in
HIV Prevalence and Trends among Blood prevalence of TTI agents in blood donors,
Donors which has a direct impact towards population
The demand of blood transfusion is risk in terms of increasing the incidence and
frequently increasing in African region due prevalence rate of an infectious disease due
to disasters, either manmade or natural while to TTIs [19].
rate of blood donation is generally low, An estimation of HIV infection among
estimated at about 4.15 per 1000 population general population are employing with
in 2006, as compared to developed countries various approaches and methods, even
(over 30 per 1000 population) [8]. Most though there has been a lot of limitation and

402
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Tadesse Bekele Tafesse et al.
uncontrollable constraints. However, many
researchers have been used different
methodologies in order to estimate the
prevalence of HIV in their studies such as
from blood donors in the community. But,
the majority of blood donors are male
individuals in various countries [20-22].
In sub-Saharan Africa, a limited data are
available on the serological prevalence of
TTIs agents among blood donors in relation
to HIV-infected individuals. Reports from
few literatures about the serologic prevalence
of these public important disease pathogens
include among at risk adult populations such
as pregnant women and prisoners with
unknown HIV-infection status [23].
The prevalence of TTIs in blood donations
(Median, interquartile range) by income
groups as high-income, middle-income and
low-income-countries show that 0.003%
(0.001-0.040%), 0.030% (0.008-0.18%), and
0.020% (0.003-0.16%) for HIV; 0.12%
(0.02-0.34%), 0.91% (0.28-2.46%) and
0.32% (0.09-0.69%) for HBV and 1.08%
(0.56-2.69%), 3.7% (3.34-8.47%)and 1.03%
(0.67-1.8%) for HCV, respectively [24]. This
data indicates that the prevalence of TTIs in
low-income countries is extremely high and
the transfusion of infected blood is greater
threat.
IJBAF, November, 2016, 4(11)
Review Article
The cause of 5-10% [25] of new HIV
infections globally is due to infected blood
transfusion as a result of blood collection
from unsafe donors, poor laboratory
procedures and inadequate testing of blood
and 12.5% [26] of patients are at risk of
developing post-transfusion hepatitis after
blood transfusion.
It is obvious that the prevalence rate of HIV
among blood donors has varied among
countries and regions based on several
factors such as general HIV prevalence,
education of the public regarding blood
donation, selection of donors and pre-
donation screening are common among
others. For example, the prevalence of HIV
among blood donors in high income
countries is lower than low income countries,
which is 0.001% and 0.5%, respectively [27].
These trends in TTIs in blood donors tend to
significantly decrease in the developed world
compared with those in the developing
countries due to blood screening strategies.
The trends of TTIs agents among blood
donors should be assessed in every country to
ensure the safety of blood supply and the
efficiency of donor screening. The
information could also reflect the occurrence
of various diseases related with blood donors
in the community. On this basis, a number of
studies were conducted in the sub-Saharan
403
Tadesse Bekele Tafesse et al.
Africa region and the report suggested that
there are various rate of prevalence of TTIs
agents. Here, we have summarized some
research works about the seroprevalence of
TTIs agents from different countries in the
region.
In Burkina Faso, according to the study by
Nagalo et al (2011) in Koudougou, from the
total of 4,520 blood donors in 2009; 1,348
(29.82%) were infected with at least one
pathogen and 149 (3.30%) had serological
evidence of multiple infections with the
overall seroprevalence rate of HIV, HBV,
HCV and syphilis of 2.21%, 14.96%, 8.69%
and 3.96%, respectively [28]. Another study
by the same group was studied on a total of
31,405 first-time volunteer blood donors in
2009 from regional blood transfusion centers.
The result showed that 24.0% were infected
with at least one pathogen and 1.8% had
serological evidence of multiple infections
with the seroprevalence of HIV, HBV, HCV
and syphilis of 1.8%, 13.4%, 6.3% and 2.1%,
respectively [29]. It is possible to conclude
based on the conducted studies in Burkina
Faso, HBV and HCV remain the greatest
threats to blood safety and relatively high
prevalence of viral markers in first-time
volunteers. Hence, there should be strict
blood selection among blood donors so as to
decrease the risk of TTIs to the community.
IJBAF, November, 2016, 4(11)
Review Article
In Cameroon, based on the study by Ymele et
al (2012) in 2008 at the Blood Bank of the
Central Hospital in Yaound, out of the total
4,650 donors, which were identified, the
results of the laboratory tests were available
for 4,644 (99.98%) blood donors and the
seroprevalence of HIV, HBV and HCV was
206 (4.44%), 565 (12.14%), and 67 (1.44%),
respectively. HBV infection was most
frequent in men and a total of 837 (18%) sets
of blood were destroyed due to infection by
at least one of the three viruses. Even though
co-infections were not very common, 36
(0.77%), 0.22% and 0.06% cases of HIV-
HBV, HBV-HCV and HIV-HCV co-
infections, respectively, of cases were
recorded while the co-infection with the three
viruses was only 2 (0.04%) among blood
donors [30]. On another study which was
conducted by Noubiap et al (2013) in Edea,
out of 543 blood donors 115 (21.2%) donors
were infected with at least one pathogen and
the overall seroprevalence rates of HIV,
HBV, HCV, and syphilis were 22 (4.1%), 55
(10.1%), 26 (4.8%), and 31 (5.7%),
respectively. Compared to voluntary donors,
family replacement donors were significantly
more infected by at least one screened
pathogen [31]. In both of the studies, the
seroprevalence of HBV is greater. Collecting
sets of blood which are infected could be the
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Tadesse Bekele Tafesse et al.
source of TTIs agents and carrying out
screening tests before blood collection has to
be implemented using rapid tests methods so
as to collect only from donors with negative
tests.
Kabinda and its team (2014) has conducted a
research so as to assess the knowledge,
attitudes, practices and behaviors among 595
blood donors in South Kivu, Democratic
Republic of Congo and identify risk factors
for viral markers. Motivation to donate blood
in 95.9% of cases respect ethical rules of
donation and the prevalence of viral markers
in blood donors for HIV, HBV and HCV was
1.6%, 4.8% and 3.9%. The level of education
and replacement blood donors are among the
most risk factors [32].
In Bioko Island of Equatorial Guinea, Xie et
al (2015) conducted a study on 2,937
consecutive blood donors from January 2011
to April 2013 at the Blood Bank of Malabo
Region Hospital. At least one TTI cases were
observed in 1,098 (37.39%) specimens and
185 (6.29%) were harbored co-infections out
of the total blood donors with the general
seroprevalence of 230 (7.83%) HIV, 294
(10.01%) HBV, 109 (3.71%) HCV and 632
(21.51%) T. pallidum. HBV-T. pallidum and
HIV-T. pallidum were the most frequent TTI
co-infections with 60 (2.04%) and 46
(1.57%) cases, respectively [33]. There is a
IJBAF, November, 2016, 4(11)
Review Article
remarkable seroprevalence of TTIs were
observed that needs a careful blood screening
during transfusion.
Based on studies conducted in different
geographical regions in the country, there are
varied reports on the prevalence rates of
HIV, HBV, HCV and syphilis among blood
donors in Ethiopia. For example, the
seroprevalence of HIV, HBV, HCV and
syphilis among blood donors ranges from
0.1% to 3.8%; 4.7% to 10.9%; 0.4% to 0.7%
and 0.1% to 1.3%, respectively, in different
geographical locations of the country [9, 34,
35]. However, the estimated national HIV
adult prevalence in 2011 was 1.5% [42]. On
the other hand, the serological evidence of
infection with at least one pathogen ranges
from 9.5% to14.1% while the multiple
infections ranges from 0.8% to1.07% [9, 35].
Another study by Gezahegn et al (2012) in
the Southwest Ethiopia indicated that the
seroprevalence of HIV among blood donors
was higher among rural dwellers (1.4%) than
urban communities (0.8%), which contradicts
the national prevalence rates of urban/rural
settings with higher prevalence rates in urban
communities, i.e. 4.2% versus 0.6% [36]; and
the infection was higher among blood donors
for replacement purpose (1.5%) as compared
to those on voluntary basis (0.3%) [34]. In
general, both the studies observed that there
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Tadesse Bekele Tafesse et al.
is a significantly declining trends of TTIs
seropositivity over the study periods and the
HBV infection was the most prevalent TTI in
every geographical regions, while the
prevalence and incidence rates significantly
vary between geographical areas.
In Ghana, Walana et al (2014) conducted a
retrospective hospital-based study at the
Laboratory unit of the Kintampo North
Municipal Hospital from January 2010 to
December 2012 and out of the 3402 people
who were screened for blood donation, 18.9
% of the blood donors screened were infected
with at least one of the viral transfusion
transmissible infectious agents, which is
relatively high. The seroprevalence rates
among the various age groups for HIV, HBV
and HCV ranged between 4.7-6.1%, 5.9-
15.9%, and 2.3-5.0%, respectively, among
them 19.5% were males and 11.4% were
females. Year-on-year seroprevalence
indicates that HBV (9.6%) is the most
threaten followed by HIV (4.9%) and HCV
(4.4%) among the studied population. Co-
infections were seen in 22 out of the 3402
blood donors and HBV-HCV 10 (45.5%) was
the most frequent TTI co-infections [37].
There is a large variation in terms of gender
seroprevalence of TTIs in the country, which
might be due to the majority of the people
who donated blood was males. The possible
IJBAF, November, 2016, 4(11)
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reason for the differences of blood donation
attitude might be due to socio-cultural
influence and belief of the society as the case
of the majority in the sub-Saharan Africa
region.
In Kenya, about 135,000 units of blood were
collected entirely from voluntary blood
donors per year and screened by the National
Blood Transfusion Service and
approximately another 20,000 units were
collected by the public hospitals from family
replacement donors but may not be screened
all of them completely. The screening rate in
public hospitals for HIV, HBV and HCV was
about 60% but higher for syphilis. Data
showed that family replacement donors were
3 times, 1.4 times, 1.5 times and 2.7 times
more likely to test positive for HIV, HBV,
HCV and syphilis, respectively, as voluntary
donors [17]. This situation might be due to
lack of screening while collecting the blood
as most family replacement donors donates
their blood in public hospitals. In order to
reduce the TTIs, hospitals has to increase the
screening rate of the blood collected from
family replacement donors.
In Mali, there were a total of 25,543
donations from replacement (68%) and
voluntary donors (32%) at the National
Centre for Blood Transfusion in 2007. The
seropositivity rate of HIV, HBV, HCV and
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Tadesse Bekele Tafesse et al.
syphilis in blood units collected was 660
(2.6%), 3548 (13.9%), 831 (3.3%) and 84
(0.3%), respectively. Seropositivity rate of
HIV, HBV and syphilis collected from
replacement donors was significantly higher
than volunteer donors but with approximately
equal rate of positivity for HCV [38]. The
promotion for recruiting volunteer donors
should be scaled-up to desolate the use of
replacement donors in addition to improve
the awareness of the individuals through
education.
A study from Namibia by Mavenyengwa et
al (2014) evaluates the TTIs of the 24,761
blood donated and 316 (1.3%) of the
donations tested positive for HIV, syphilis,
HBV and HCV while the remaining
donations was tested as negative for any of
the TTIs. Among the positive donations
tested, HBV cases were the most common
while HCV was the least. There were
relatively low co-infections cases with 1.8%
cases of HBV-HCV, 0.9% cases of HBV-
HIV and only 1.0% case of HIV-HCV co-
infection among the blood donors with
overall co-infection cases of 0.024% of all
the donations [39]. Based on this finding,
there is a relatively low seroprevalence rate
of the TTIs as compared to other countries.
This indicates that the blood donors are
IJBAF, November, 2016, 4(11)
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relatively healthy and they were aware of
blood safety.
In Nigeria, the largest populated country in
Africa, the practice of blood donation was
provoked due to misconceptions, lack of
infrastructure and overdependence of family
replacement and remunerable donors, which
might be less safe [40]. A number of studies
were conducted on the seroprevalence of
TTIs diseases among blood donors. For
example, the seroprevalence of HIV, HBV,
and HCV among blood donors ranges from
0.96% to 6.2%; 5.9% to 18.6% and 0.86% to
6.0%, respectively, in different geographical
locations of the country [10, 40-43]. The
overall seroprevalence of TTIs among the
prospective blood donors with at least one
TTIs marker varies, for example, 15.5% [40]
in the North-Central Nigeria to 28.8% [41] in
the South-west Nigeria. Both the studies
indicated that the HIV prevalence declined
from year to year. This may probably be due
to awareness of the community, positive
impact of HIV education and public
enlightenment campaign about the disease
everywhere for many years and which helped
in reducing the spread of HIV. However, TTI
agents are still prevalent in the blood donors
with hepatitis B infection is the predominant
threat in the community.
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Tadesse Bekele Tafesse et al.
Studies that were conducted in Sudan on the
seroprevalence of TTIs diseases among blood
donors showed that the seroprevalence of
HIV, HBV, and HCV among blood donors
ranges from 0.4% to 0.7%, 5.5% to 6.0% and
0.2% to 3.4% [44, 45]. The prevalence of
syphilis was 5.4% [45] in the capital city,
Khartoum. The overall prevalence of viral
TTIs was 9.6% [44] in White Nile State -
central Sudan while it was 5.6% [45] in
Khartoum. The seroprevalence of TTIs is
higher in country-side, which might be
associated with the level of education and
awareness of blood safety among the
communities and might also be due to the
availability of laboratory instruments and
reagents for proper blood screening. Another
study by Sube et al (2014) at Juba Teaching
Hospital Blood Bank, South Sudan, reported
that the seroprevalence of HIV among blood
donors was 7.9% with the co-infections of
HIV-HBV (50%), HIV-HCV (18%) and
HIV-syphilis (32%) [46]. The
seroprevalence might be mainly due to most
blood donors were family replacement
donors rather than voluntary donors.
In most of the countries, high level of
seroprevalence of TTIs were observed, for
instance, the estimated national
prevalence in 2010/2011 in Burkina Faso,
Ethiopia, Ghana, Mali and Nigeria was 9.8%,
IJBAF, November, 2016, 4(11)
Review Article
3.42%, 6.58%, 14.27% and 4.12%,
respectively [47]. Except for Mali, which is
almost similar value; in all the studies
conducted the seroprevalence reported is
higher than the estimated national value.
From the reported studies, we can conclude
that there should be a great effort to take care
while screening for TTIs agents as it is a
routine practice globally so as to guarantee
the safety of the blood and blood products to
be transfused.
Health and Economic overview of unsafe
blood transfusion
Someone might be in need of blood every
second in the world. The demand for blood
transfusion is high in Sub-Saharan Africa as
there are a lot of clinical conditions; surgery,
trauma, severe anemia especially due to
malaria and pregnancy-related complications
are among the majors [11, 48]. Blood
transfusion occurring during hospitalization
for such problems has been associated with
high increased morbidity and mortality and with
longer stays in hospital, use of healthcare
services, and costs [49].
Greater proportion of transfusions could be
given to women with obstetric emergencies
and children suffering from severe anemia as
HBV a result of malaria and malnutrition but the
pattern of blood usage is very different in
countries, particularly in sub-Saharan Africa,
408
Tadesse Bekele Tafesse et al.
where diagnostic and treatment options are
more limited due to the economic impact
with limited resource societies. The deficit
has a particular impact on women and
children with severe life-threatening cases. If
there is an access to safe blood, up to 150
000 pregnancy-related deaths could be
avoided each year worldwide [48]. Even
where sufficient blood is available, many
people are exposed to avoidable, life-
threatening risks through the transfusion of
unsafe blood, however, transfusion is the
only option for saving their life whatever the
level and development of the healthcare
system.
The collection, processing and use of blood
transfusion use a unique technology that
requires a lot of resource so as to keep the
safety of the blood. This situation requires
not only the application of science and
technology to blood processing and testing
but also requires social mobilization to
promote voluntary blood donation who are
free of infectious diseases.
Regarding to human health and economic
points of view, unsafe or inadequate blood
transfusion is very costly and hence, access
to safe blood and blood products cannot be
achieved without cost, i.e., every treatment
has its own economic costs [48, 50, 51]. On
the other hand, in relation to blood
IJBAF, November, 2016, 4(11)
Review Article
transfusion, there are several infectious as
well as non-infectious risks with a chance of
1% transfusion-associated problem including
TTIs from a single unit of blood transfusion
[52]. Unavailability of blood or infected
blood transfusion has a direct impact on the
morbidity and mortality of the society in
general and individuals and their families in
particular. This has a large consequence on
the development of a country as it make to
loss the productive labour and bring burden
in the national health and economy [48].
Besides HIV, the other TTIs agents such as
HBV and HCV are among the major causes
of chronic liver diseases worldwide that
bring another burden on the health and
economic status of individuals. Cirrhosis and
hepatocellular carcinoma are common
chronic liver diseases which contributed due
to HBV and HCV [53].
In general, in order to get a safe and ample
unit of blood, financial resource is
unquestionable. It will support the country to
have an appropriate infrastructure, develop
appropriate policies, trained personnel and
improve national blood transfusion services
and also support the running of a voluntary
non-remunerated donor transfusion service,
and minimizes the emerging threats of
transfusion-transmitted infection as a result
of improvement of the screening service.
409
Tadesse Bekele Tafesse et al.
CONCLUSION
The seroprevalence of TTIs agents such as
HIV, HBV, HCV and syphilis are positively
higher among blood donors in sub-Saharan
Africa, with HBV the most prevalent in the
Western sub-Saharan areas. The seropositive
blood donors is remaining as present threat of
safe blood practice due to lack of public
awareness about TTIs and national screening
programs, societal belief and culture about
voluntary blood donation, level of education,
use of rigorous donor selection criteria and
exclusion of those with clinical
theoretical risks of carrying infectious agents
and use of less sensitive screening methods
that may detect infectious agents during the
window period. The insights of HIV
counseling services among blood donors in
Sub-Saharan Africa are generally promising;
however, application is low. Therefore, there
is a need to monitor the trends in the
seroprevalence of HIV and other TTIs among
blood donors over time and to institute
strategies to reduce these infections and
proper screening procedures prior to blood
transfusion with a cost-effective approach for
prevention and control of TTIs.
Authors contribution
AAG, TBT, SG, GDB: All are participated in
developing the original idea and protocol,
IJBAF, November, 2016, 4(11)
Review Article
data abstraction and analysis, and prepared
the manuscript
AAG, TBT, DA, MTB, BAE, GMS, YY: All
are participated in the development of the
protocol, preparing and editing the
manuscript
All authors read and approved the final
manuscript.
ACKNOWLEDGEMENTS
We are grateful to all persons who provided
technical help and assisted in writing the
manuscript. It is hereby acknowledged
and colleagues and all those who assisted in
conducting the review and/or critiquing the
manuscript.
Funding/Support: There was no any support
and it was part of group motivation.
Author conflict: The authors report no
conflict of interest in this work.
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