Transfusion-transmissible viral infections among blood donors at the North Gondar district blood

12 Pages·2017·0.96 MB·English

RESEARCHARTICLE
Transfusion-transmissible viral infections
among blood donors at the North Gondar
district blood bank, northwest Ethiopia: A
three year retrospective study
BeleteBiadgo1☯,EliasShiferaw2,BerhanuWoldu2,KefyalewAddisAlene3,
MulugetaMelku2☯*
a1111111111 1 DepartmentofClinicalChemistry,SchoolofBiomedicalandLaboratorySciences,CollegeofMedicineand
a1111111111 HealthSciences,UniversityofGondar,Gondar,Ethiopia,2 DepartmentofHematologyandImmunohematology,
SchoolofBiomedicalandLaboratorySciences,CollegeofMedicineandHealthSciences,UniversityofGondar,
a1111111111
Gondar,Ethiopia,3 DepartmentofEpidemiologyandBiostatistics,InstituteofpublicHealth,CollegeofMedicine
a1111111111
andHealthSciences,UniversityofGondar,Gondar,Ethiopia
a1111111111
☯Theseauthorscontributedequallytothiswork.
*[email protected]
OPENACCESS Abstract
Citation:BiadgoB,ShiferawE,WolduB,AleneKA,
MelkuM(2017)Transfusion-transmissibleviral
infectionsamongblooddonorsattheNorth Background
Gondardistrictbloodbank,northwestEthiopia:A
Transfusion-transmissibleviralinfections,suchashepatitisCvirus(HCV),hepatitisBvirus
threeyearretrospectivestudy.PLoSONE12(7):
e0180416.https://doi.org/10.1371/journal. (HBV),andhumanimmunodeficiencyvirus(HIV),remainamajorpublichealthproblemin
pone.0180416 developingcountries.Theprevalenceoftheseviralinfectionsamongblooddonorsmay
Editor:JasonBlackard,UniversityofCincinnati reflecttheburdenofthesediseasesamongpopulations.Therefore,theaimofthisstudy
CollegeofMedicine,UNITEDSTATES wastoassessthesero-prevalenceoftransfusion-transmissibleviralinfectionsamongblood
Received:October26,2016 donors.
Accepted:May22,2017
Methods
Published:July5,2017
Aretrospectivestudywasconductedusingdataobtainedfromregistrationbooksofblood
Copyright:©2017Biadgoetal.Thisisanopen
donorsfromtheEthiopianNorthGondarDistrictBloodBankfrom2010to2012.Descriptive
accessarticledistributedunderthetermsofthe
CreativeCommonsAttributionLicense,which statistics,suchaspercentages,mediansandinterquartilerangeswerecomputed.Abinary
permitsunrestricteduse,distribution,and logisticregressionmodelwasfittedtoidentifyfactorsassociatedwitheachviralinfection.
reproductioninanymedium,providedtheoriginal
Theoddsratiowitha99%confidenceintervalwascalculated.Ap-value<0.01wasconsid-
authorandsourcearecredited.
eredstatisticallysignificant.
DataAvailabilityStatement:Allrelevantdataare
withinthepaperanditsSupportingInformation
Result
files.
Atotalof6,471blooddonorswereincludedinthestudy.Ofthese,5,311(82.1%)were
Funding:Theauthorsreceivednospecificfunding
forthiswork. male,and382(5.9%)werevoluntaryblooddonors.Overall,424(6.55%)oftheblood
donorsweresero-reactiveforatleastonetransfusion-transmissibleviralinfection.Ofall
Competinginterests:Theauthorshavedeclared
thatnocompetinginterestsexist. studyparticipants,233(3.6%)weresero-reactiveforHBV,145(2.24%)weresero-reactive
forHIV,and51(0.8%)weresero-reactiveforHCV.Four(0.062%)ofthestudy’sparticipants
Abbreviations:ELISA,EnzymeLinked
ImmunosorbentAssay;HBV,HepatitisBVirus; wereco-infected:3(75%)withHBV-HCVand1(25%)withHIV-HBV-HCV.Beingafarmer,
PLOSONE|https://doi.org/10.1371/journal.pone.0180416 July5,2017 1/12
Transfusion-transmissibleviralinfectionsamongblooddonors
HBsAg,HepatitisBSurfaceAntigen;HCV,Hepatitis unemployedoremployeddonorwassignificantlyassociatedwithtransfusion-transmissible
CVirus;HIV,HumanImmunodeficiencyVirus;TTI, viralinfectionscomparedtobeingastudentdonor.
Transfusiontransmittedinfection;WHO,World
HealthOrganization.
Conclusion
Theprevalenceoftransfusion-transmissibleviralinfectionsissubstantialandhas
increasedovertime.Hence,itdemandsmorevigilanceinroutinescreeningofdonated
bloodpriortotransfusion.Furthercommunity-basedstudiestoidentifysocietalriskfac-
torsarenecessary.
Introduction
Bloodtransfusionsavesmillionsoflivesworldwideeachyear[1].However,transfusion-trans-
missibleinfections(TTIs)areamajorproblemassociatedwithbloodtransfusion,particularly
indevelopingcountries[1].Themagnitudeofthisproblemisdirectlyrelatedtotheprevalence
ofTTIsamongblooddonors[2].Inseveralsettings,humanimmunodeficiencyvirus(HIV),
hepatitisBvirus(HBV),andhepatitisCvirus(HCV)arethemajorTTIs[3–5].Eachblood
transfusioncarriesariskoftransmittingblood-bornepathogens[6].Forinstance,insub-Saha-
ranAfrica,5–12%ofpatientswhoreceivedbloodtransfusionsareatriskofpost-transfusion
hepatitisandHIVinfections[7].Forthisreason,thepreventionandcontrolofTTIsisthe
leadingconcernandpriorityoftheWorldHealthOrganization(WHO)andbloodtransfusion
programsinSub-SaharanAfricancountries,includingEthiopia[8].
TTIscanposerisksforhealthcareworkers.Becausetheprevalenceoftransfusion-transmis-
siblepathogensishighinthegeneralpopulation,theoccupationalriskofexposuretothese
pathogensforhealthcareworkersposesamajorpublichealthchallenge.AccordingtoWHO
estimates,3millionhealthcareworkersexperiencepercutaneousexposurestobloodpathogens
worldwideeachyear.Ofthese,2millionareexposedtoHBV[9].AstudyconductedinBulle
Hora,Ethiopia,showedthatHBVwashigheramonghealthcareworkers(7.3%)thannon-
healthcareworkers(0.9%)[10].
TheprevalenceofTTIsamongblooddonorsvariesacrosstheworld,aswellaswithincoun-
tries,contingentontheprevalenceofthesevirusesinthegeneralpopulation[11,12].Accord-
ingtoaWHOreport,Ethiopiaisclassifiedundergeographicalregionswithintermediateto
hyper-endemicviralhepatitisinfections[13].Theprevalenceofviralhepatitisvarieswithin
districtsandtargetgroupsinEthiopia[14–23].TheoverallpooledprevalenceofHBVwas
7.4%.Insub-groups,theprevalencevariedat5.2%inHIVinfectedindividuals,8.0%incom-
munitybasedstudies,8.4%inblooddonors,11.0%inimmigrants,and6.9%inothergroups
[24].Similarly,theprevalenceofHCVandHIViscommoninEthiopiawithregionaldiffer-
ences.AstudyconductedamongclinicallysuspectedcasesinGondarindicatedahighpreva-
lenceofHCVat12.4%[14].
SeveralprogramshavebeenimplantedinEthiopiatoreducetheburdenofHBVinthe
community.Theseprogramsincludethefollowing:theExpandedProgrammeonImmuniza-
tionPolicy,updatedin2007andincludingchildhoodimmunizationagainstHBVusingapen-
tavalentformatages6,10and14weeksafterbirth;implementingantenatalscreeningfor
HBsAgofallpregnantwomenandthevaccinationoftheirbabiesatbirth;andrecommending
thevaccinationofhighriskgroupssuchashealthprofessionalsagainstHBV.However,these
programshavenotbeenroutinelyenforcedinmosthealthcaresettingsacrossthecountry[25].
AstudyconductedamonghealthcareworkersinBahirDar,northwestEthiopia,reportedthat
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Transfusion-transmissibleviralinfectionsamongblooddonors
HBVvaccinationstatuswaslow.Only5.4%reportedthattheytookthreeormoredosesofthe
HBVvaccine[26].Similarly,anotherstudyrevealedthatthestatusoftheHBVvaccination
amongsurgeonspracticinginEthiopiawaslow,withonly24outof98surgeons(23.5%)hav-
ingreceivedthevaccination[27].
Quality-guaranteedscreeningofalldonatedbloodforTTIs,includingHIV,HBV,and
HCV,isrecommendedbytheWHOandadoptedbytheEthiopiangovernmentfortheprovi-
sionofsafeandefficaciousbloodandbloodcomponents[28].Thisincludestheselectionof
eligibleblooddonors,thecollectionofblood,theprocessingandtestingofthedonatedblood,
theissuingofcompatibleblood,andsafeadministrationofthebloodtorecipients.Inresponse
tothisstrategy,EthiopiarevokedresponsibilitiesforbloodtransfusionfromtheEthiopianRed
CrossSocietyandgrantedittotheNationalBloodTransfusionServiceAgency,agovernment
agencymanagedundertheFederalMinistryofHealthandRegionalHealthbureaucreatedin
2010toensurebloodsafetyandaccessibility[29].Twenty-fivebloodbankswerefunctionalin
thecountryin2014.TheNorthGondarDistrictBloodBankisoneofthebloodbankslocated
innorthwestEthiopia[29].
MonitoringtimetrendsinTTIsamongblooddonorsprovidesevidencetoassesstheeffec-
tivenessofbloodsupplyscreeningprograms,andmayindicatechangesindiseaseprevalence
incommunities.TherearefewepidemiologicalstudiesconductedinEthiopiaonTTIsamong
blooddonors[16–18,20,21].However,dataarelimitedbetween2010and2012innorthwest
Ethiopiafortheanalysisoftrends.Therefore,theaimofthisstudywastoassessthesero-preva-
lenceofHBV,HCV,andHIVamongblooddonorsattheNorthGondarDistrictBloodBank,
northwestEthiopia,between2010and2012.
Materialsandmethods
Studydesignandsetting
AretrospectivecohortstudywasconductedattheNorthGondarDistrictBloodBankamong
blooddonorswhodonatedbloodfrom2010to2012.TheBloodBankisinGondartown,
located738kmnorthwestofthecapitalcity,AddisAbaba.Itprovidesservicesforacatchment
populationofapproximatelyfivemillionpeopleinNorthGondarandneighboringdistricts.
Onaverage,thebloodbankcollects2,500unitsannually.Themajorityofthisbloodisusedfor
emergency,surgical,andgynecologicalcases.
Studypopulation
StudyparticipantswereallblooddonorswhodonatedbloodattheNorthGondarDistrict
BloodBankfrom2010to2012.Theyconsistedofvoluntaryandreplacement(family)blood
donorswhoweighedmorethan50kgandwereolderthan17yearsofage.Atotalof6,471
blooddonorrecordswerereviewedandincludedinthestudy.
Serologicalinvestigations
SerumorplasmasamplesweretestedforHBV,HIVandHCVusingtheEnzymeLinked
ImmunosorbentAssay(ELISA)(HIV1/2:VironostikaHIVUni-FormIIAg/Abfourthgenera-
tionELISA,Bio-Merieux,Boxtel,Netherlands;HBsAg:athirdgenerationELISA,Hepanostika
HBsAgUNi-FormII,Bio-Merieux,Boxtel,Netherlands;HCV:Humananti-HCVthirdgener-
ationELISA,HumanGasellschaftforBio-chemicalanddiagnosticMbH,Germany).Alltests
wereperformedaccordingtothemanufacturer’sinstructions.
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Transfusion-transmissibleviralinfectionsamongblooddonors
Datacollectionandstatisticalanalysis
Dataonsocio-demographicvariablesandlaboratorytestresultswerecollectedfromblood
donors’registrationbooksusingthedataextractionformat.Collecteddatawerethencross-
checkedforcompleteness,enteredintoEpiInfosoftware(version3.5.1),andthentransferred
toSPSSversion20softwareforanalysis.Descriptivestatisticswereperformed,andtheresults
werepresentedintables.Bothbivariateandmultivariablebinarylogisticregressionmodels
werefittedtoidentifyfactorsassociatedwitheachviralinfection.Theoddsratioandits99%
confidenceintervalwereusedtodeterminethestrengthoftheassociation.Ap-value<0.01in
themultivariablebinarylogisticregressionanalysiswasconsideredtobestatisticallysignificant.
Ethicalconsiderations
ThestudywasconductedafterethicalclearancewasobtainedfromtheSchoolofBiomedical
andLaboratorySciences,CollegeofMedicineandHealthSciences,theUniversityofGondar.
PermissionwasalsoobtainedfromtheheadofNorthGondarDistrictBloodBank.Datawere
keptinaconfidentialmanner.Asthestudyusedsecondarydata,informedconsentwasnot
soughtfromstudyparticipants.
Results
Demographiccharacteristics
Atotalof6,471individualsdonatedbloodandwerescreenedforviralinfectionsduringthe
threeyearperiodattheGondarDistrictBloodBank.Approximately5,311(82.1%)and3,070
(47.4%)oftheblooddonorsweremalesandaged18–25years,respectively.Themedianageof
theparticipantswas26years(range:48years).Almostallofthe6,089(94.1%)blooddonations
wereobtainedfromareplacementdonation(Table1).
Transfusion-transmissibleviralinfectionprevalence
Overall,424(6.55%;99%CI:5.76%,7.34%)blooddonorshadserologicalevidenceforatleast
oneTTI(i.e.,HBV,HCV,orHIV).Four(0.062%)blooddonorswereco-infectedwithmore
Table1. DemographiccharacteristicsofblooddonorsattheNorthGondarDistrictBloodBank,northwestEthiopia,2010to2012.
Variables Categories Frequency Percent
Age(years) 18–25 3,070 47.4
26–35 2,191 33.9
36–45 846 13.1
>45 364 5.6
Sex Male 5,311 82.1
Female 1,160 17.9
Occupation Student 1,842 28.5
Farmer 1,728 26.7
Governmentemployed 947 14.6
Privateemployed 296 4.6
Self-employed 1,068 16.5
Unemployed 590 9.1
Typeofdonation
Voluntary 382 5.9
Replacement 6,089 94.1
https://doi.org/10.1371/journal.pone.0180416.t001
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Transfusion-transmissibleviralinfectionsamongblooddonors
Table2. FrequencyofHIV,HBVandHCVinfectionswithrespecttodonationyearamongblooddonorsattheNorthGondardistrictBloodBank,
northwestEthiopia.
Yearof Totalscreened HBVpositive HCVpositive HIVpositive Totalsero-prevalence(HBV,HCV,orHIV)N(%)
donation N(%) N(%) N(%) N(%)
2010 2,006(31.0%) 57(2.8%) 12(0.6%) 36(1.8%) 100(5.0%)
2011 2,171(33.5%) 55(2.5%) 10(0.5%) 46(2.1%) 111(5.11%)
2012 2,294(35.4%) 121(5.3%) 29(1.3%) 63(2.7%) 213(9.28%)
Total 6,471(100%) 233(3.6%) 51(0.8%) 145(2.24%) 424(6.55%)
https://doi.org/10.1371/journal.pone.0180416.t002
thanoneviralinfection:3(75%)withHBV-HCVand1(25%)withHIV-HBV-HCVinfections.
Thenumberofdonorsgraduallyincreasedfrom2,006(31.0%)in2010to2,294(35.4%)in
2012.TheoverallprevalenceofTTIsalsoincreasedfrom100(5.0%)in2010to213(9.28%)in
2012(Table2).
Sero-prevalenceandassociatedfactorsofHBVinfection
Theoverallsero-prevalenceofHBVwas233(3.6%;99%CI:3.0%,4.2%)andwas4.14%among
malesand3.48%amongfemales.Inthemultivariablebinarylogisticregressionanalysis,
farmer(AOR=2.20;99%CI:1.25,3.89),employed(AOR=2.48;99%CI:1.46,4.23),and
unemployed(AOR=4.00;99%CI:2.15,7.46)donorswereatahigherriskofHBVinfection
comparedtostudentdonors.Inaddition,theoddsofHBVamongpeoplewhodonatedblood
in2012werealmosttwotimesaslikelyofhavingHBVamongpeoplewhodonatedbloodin
2010(AOR=1.84;99%CI:1.20,2.80)(Table3).
Table3. Sero-prevalenceofHBVinfectionaccordingtosocio-demographiccharacteristicsofblooddonorsattheNorthGondarDistrictBlood
Bank,northwestEthiopia.
Variables HBV COR(99%CI) AOR(99%CI)
Reactive Non-reactive
Agegroup
18–25 103 2,967 1.00
26–35 75 2,116 1.02(0.69,1.52)
36–45 37 809 1.32(0.8,2.2)
>45 18 346 1.49(0.76,2.2)
Sex
Male 185 5,126 1.00
Female 48 1,112 1.2(0.78,1.8)
Occupation
Student 32 1,810 1.00 1.00
Farmer 63 1,665 2.14(1.24,3.77) 2.20(1.25,3.89)
Employed* 97 2,214 2.49(1.45,4.21) 2.48(1.46,4.23)
Unemployed 41 549 4.22(2.3,7.9) 4.00(2.15,7.46)
Typeofdonation
Voluntary 5 377 1.00
Replacement 228 5,861 2.93(0.91,9.74)
Yearofdonation
2010 57 1,949 1.00 1.00
2011 55 2,116 0.89(0.54,1.45) 0.87(0.53,1.43)
2012 121 2,173 1.90(1.23,2.90) 1.84(1.20,2.80)
COR:CrudeOddsRatio;AOR:AdjustedOddsRatio;CI:ConfidenceInterval;and
*Employed:governmentemployed,privateemployedandself-employed
https://doi.org/10.1371/journal.pone.0180416.t003
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Transfusion-transmissibleviralinfectionsamongblooddonors
Table4. Sero-prevalenceofHCVinfectionaccordingtosocio-demographiccharacteristicsofblooddonorsattheNorthGondarDistrictBlood
Bank,northwestEthiopia.
Variables HCV COR(99%CI) AOR(99%CI)
Reactive Non-reactive
Agegroup
18–25 16 3,054 1.00
26–35 22 2,169 1.94(0.83,4.53)
36–45 6 840 1.4(0.40,4.70)
>45 7 357 3.74(1.15,12.13)
Sex
Male 44 5,267 1.00
Female 7 1,153 0.73(0.25,2.08)
Occupation
Student 5 1,837 1.00 1.00
Farmer 14 1,714 3.00(0.78,11.51) 3.12(0.81,12.00)
Employed* 27 2,284 4.34(1.23,15.26) 4.35(1.23,15.23)
Unemployed 5 585 3.13(0.61,16.08) 2.91(0.56,14.95)
Yearofdonation
2010 12 1,994 1.00 1.00
2011 10 2,161 0.76(.025,2.32) 0.74(0.86,5.08)
2012 29 2,265 2.13(0.87,5.17) 2.09(1.85,5.09)
COR:CrudeOddsRatio;AOR:AdjustedOddsRatio;CI:ConfidenceInterval;and
*Employed:governmentemployed,privateemployedandself-employed
Typeofdonationwasnotincludedinthemodelbecauseithaszerovaluesinoneofthecell.
https://doi.org/10.1371/journal.pone.0180416.t004
Sero-prevalenceandassociatedfactorsofHCVinfection
Thesero-prevalenceofHCVinfectionamongblooddonorswas51(0.80%;99%CI:0.5%,
1.1%).Inthebivariatebinarylogisticregressionanalysis,beingablooddonorolderthan45
yearsin2012andemployedwassignificantlyassociatedwithHCVinfection.However,inthe
multivariableanalysis,beingemployedandablooddonorin2012weretheonlysignificant
factorsassociatedwithHCVinfection.TheoddsofHCVamongthosewhodonatedbloodin
2012weretwotimeshigherthanamongthosewhodonatedbloodin2010(AOR=2.09;99%
CI:1.85,5.09).Similarly,theoddsofHCVamongpeoplewhowereemployeddonorswere
almostfourtimeshigherthanamongstudentdonors(AOR=4.35;99%CI:1.23,15.23)
(Table4).
Sero-prevalenceandassociatedfactorsofHIVinfection
TheHIVprevalenceamongblooddonorswas145(2.24%;99%CI:1.8%,2.7%).HIVsero-prev-
alencewas2.3%inmalesand0.71%infemales.Theage-specificdistributionofHIVinfection
revealedthatahighprevalencewasdetectedamongblooddonorswhowereolderthan45years
at14(3.9%).Inthebivariatebinarylogisticregressionanalysis,age,occupation,andyearof
blooddonationweresignificantlyassociatedwithHIVinfection.However,inthemultivariable
analysis,onlyoccupationwassignificantlyassociatedHIVinfections.Farmers(AOR=4.02;
95%CI:1.79,9.03),employed(AOR=3.75;99%CI:1.70,8.28),andunemployed(AOR=5.97;
99%CI:2.43,14.61)donorsweremorelikelytobeinfectedwithHIVthanstudentdonors
(Table5).
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Transfusion-transmissibleviralinfectionsamongblooddonors
Table5. Sero-prevalenceofHIVinfectionaccordingtosocio-demographiccharacteristicsofblooddonorsattheNorthGondarDistrictBlood
Bank,northwestEthiopia.
Variables HIV COR(99%CI) AOR(99%CI)
Positive Negative
Agegroup
18–25 46 3,024 1.00
26–35 58 2,133 1.79(1.07–3.00)
36–45 27 819 2.17(1.2–4.10)
>45 14 350 2.63(1.18–5.85)
Sex
Male 123 5,188 1.00
Female 22 1,138 0.82(0.45–1.50)
Occupation
Student 13 1,829 1.00 1.00
Farmer 48 1,680 4.02(1.79,9.03) 4.02(1.79,9.03)
Employed* 60 2,251 3.75(1.67,8.28) 3.75(1.70,8.28)
Unemployed 24 566 5.96(2.44,14.61) 5.97(2.43,14.61)
Typeofdonation
Voluntary 4 378 1.00
Replacement 141 5,948 2.24(0.6–8.33)
Yearofdonation
2010 36 1,970 1.00
2011 46 2,125 1.18(0.66,2.11)
2012 63 2,231 1.55(1.89,2.66)
COR:CrudeOddsRatio;AOR:AdjustedOddsRatio;CI:ConfidenceInterval;and
*Employed:governmentemployed,privateemployedandself-employed
https://doi.org/10.1371/journal.pone.0180416.t005
Discussion
Bloodtransfusionisconsideredtobeapotentialriskfactorforthetransmissionofviruses
suchasHBV,HCVandHIV,whicharelife-threateningandglobalpublichealthproblems.In
thisstudy,wefoundthattheoverallsero-prevalenceofTTIswas6.55%(99%CI:5.76–7.34%),
whichisinagreementwithapreviousreportfromHawassa,Ethiopia(7.0%)[16].However,
thisprevalenceislowerthanotherstudiesconductedindifferentpartofEthiopia,suchas
Gondar(9.5%)[15],BahirDar(43.2%)[18],WolaitaSodo(29.5%)[17],andJijiga(11.5%)
[21].TheprevalencereportedinthisstudywasalsolowercomparedtootherAfricancountries
thatreportedanoverallprevalenceofviralinfectionrangingfrom9.5%to21.2%[30–32].This
maybebecauseourstudyfocusedonlyonthreeviralinfections(i.e.,HIV,HBV,andHCV),
whereaspreviousstudiesincludedtheseviralinfectionsinadditiontosyphilis.Anotherpossi-
blereasonforthislowprevalenceofTTIsinourstudycouldbeduetodifferencesintime
periodbecauseourstudyuseddatacollectedin2010to2012.Thisisrelativelyrecentwhen
comparedtodatausedbythemajorityoftheabovestudies[15,18,30,31].
Ourstudyrevealedthatthesero-prevalenceofTTIsincreasedfrom5.0%in2010to9.28%
in2012.AlthoughitdoesnotdemonstratethetrendofTTIsinthestudyarea,asitisathree
yearretrospectivedataset,itmaysuggestthateithertheoverallprevalenceofTTIsisincreased
inthecommunityovertimeorthesensitivityofthetestmethodsusedtoscreendonatedblood
areimprovedasaresultofchangesinpoliciesandstrategiesthatgovernmentshaveenforced
tocontrolTTIs.AnotherreasonforthismightberelatedtotheshiftofdutyfromtheRed
CrossSocietytotheNationalBloodTransfusionServiceAgencyin2010[29].After2010,the
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NationalBloodTransfusionServiceAgencydevelopednationalbloodpolicy,standards,oper-
atingprocedures,andguidelinestoensurethesafetyandaccessibilityofblood.Thisinvolved
advocatingtheimportanceofblooddonation,recruitingblooddonorsviacampaigns,andrig-
oroustestingofdonatedbloodforTTIs.Thiscreatestheopportunitytorecruitmoreblood
donorswhohaveriskybehaviorforTTIs,whichultimatelyincreasesthemagnitudeofthe
problem.Insupportofthisargument,ourstudyrevealedthattheoddsofHBVandHCV
infectionsamongpeoplewhodonatedbloodin2012werealmosttwotimeshighercompared
topeoplewhodonatedbloodin2010.
Inourstudy,thesero-prevalenceofHBVamongblooddonorswas3.6%(99%CI:3.0%,
4.2%),whichislowercomparedtopreviousstudiesconductedinEthiopia[15,16,18–21,33]
andelsewhereintheworld[30,34–37].Thislowerprevalencemightbeattributedtodiffer-
encesinthespecificityandsensitivityofthescreeningtest.ThebloodbankintheGondardis-
trictusesaconventionalHBSAgtest(i.e.,thethirdgenerationELISAtest)forthescreeningof
HBV.TheconventionaldonorscreeningforHBsAgmayyieldserologicallynegativeresults
despitethepresenceofHBVDNA[38].Studieshaveshownthat20%ofoccultHBVinfections
arenegativeforallHBVseromarkers[39].Therefore,ifmoleculartechniqueshadbeenused
forthescreening,themagnitudemostlikelywouldhavebeenmorethanthecurrentfinding.
Theotherexplanationmightbeadifferenceinthegeographicalvariationsthathavebeen
reportedintheoccurrenceofviralinfections,aswellasadifferenceinthemodeofprospective
donorselectionandstudypopulations.However,whencomparedwiththeglobalprevalence
ofchronicHBVinfectioncategory,itiswithintherangeofintermediateclusters(2–7%)[40],
indicatingthatHBViscommoninthestudyarea.
TheprevalenceofHCVinfectioninthisstudywas0.8%(99%CI:0.5%,1.1%).Comparable
figureswerereportedinGondar,Ethiopia(0.7%)[15],Hawassa,Ethiopia(0.6%)[16],and
Dessie,Ethiopia(0.61%)[33].However,ahigherprevalencewasobservedinpreviousstudies
carriedoutinEthiopia[18–20]andelsewhereintheworld[30,37,41–44].Ontheotherhand,
alowerprevalencewasobservedinpreviousstudiesdoneinJijiga,Ethiopia(0.4%)[21].The
possibleexplanationforthevariationinthemagnitudeofHCVinfectionsacrossstudiesmight
beduetodifferencesinriskbehaviorsacrossdifferentgeographicallocationsanddifferences
insocio-culturalpractices.Culturalpracticessuchastattooingandsharingofcontaminated
materials,suchasneedlesarecommonamonguneducatedpeople[45].Thesepracticescould
increasetheriskofbeinginfectedwithHCV.Employeddonorswerefourtimesmorelikelyto
beinfectedwithHCVwhencomparedtostudentdonors.Thismightberelatedtooccupa-
tionalinjuries,suchasneedlesticksinhealthcaresettings[46,47].
RegardingtheprevalenceofHIVinfection,ourstudydemonstratedthat2.24%(99%CI:
1.8%,2.7%)ofblooddonorsweresero-reactive,whichissimilartotheresultobtainedfrom
theEthiopianDemographicandHealthSurveyReport[48].ThehighestprevalenceofHIV
infection(4.1%)wasobservedindonorswhowereunemployed.Similarresultshavebeen
reportedinpreviousstudies[15,49,50].Thismightbeduetolowsocio-economiclevelsof
unemployeddonors,astheyaremostlikelytoindulgeinriskysexualrelationshipsthatmay
exposethemtoTTIs.EmployeddonorswerealsoathigherriskofHIV-infectioncomparedto
studentdonors.ThereasonforhighprevalenceofTTIsamongemployeddonorsascompared
tostudentdonorsmightberelatedtoincreasedexposuretoTTIs,mostlikelyduetothepossi-
bilityofengaginginmoreriskybehaviorsovertimeandthetransfusionofunsafebloodand/
orbloodproductsintheirlifetime.Similarly,farmerswerealsoathigherriskofhavingHIV
infectionthanstudents.Thismightberelatedwiththelowerawarenessoffarmersaboutthe
modeoftransmissionandpreventionofHIV.PreviousstudiesconductedinEthiopiashowed
thatfarmershadpoorknowledgeaboutHIVpreventionmethods,whichmayleadtounpro-
tectedsexualpractices[51].
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Transfusion-transmissibleviralinfectionsamongblooddonors
TheoverallprevalenceofHIV,HBVandHCVco-infectioninourstudywas4(0.062%).
DifferentstudiesconductedinEthiopiaalsoreportthattheco-infectionrateoftheseTTIs
rangefrom0.19to4.8%[15,16,32].Themostcommonco-infectionwasHBV-HCV(75%).
ComparableresultswereobservedinHawassa,Ethiopia(66.7%)[16],andGhana(45.5%)
[37].Theoccurrenceofco-infectionscouldbebecausetheseinfectionssharesimilarmodesof
transmission[34].
ThehighestprevalencesofHBV(7.0%)andHIV(4.1%)wereobservedinthosedonors
whowereunemployed.Thisissupportedbyfindingsfromotherstudies[15,49,50].Similarly,
unemployeddonorswerefourtimesmorelikelytobeinfectedwithHBVandsixtimesmore
likelytobeinfectedwithHIVthanstudentdonors.Thismightbeduetolowsocio-economic
levelsofunemployeddonors,astheyaremostlikelytoindulgeinriskysexualrelationships
thatmayexposethemtoTTIs.Moreover,asaconsequenceofeconomicproblems,unem-
ployeddonorsmayexperienceriskypractices,suchassharingofpersonalcareitemslike
razorsortoothbrushes,sharingofsharpkitchenmaterials,andhavingsexualcontactwitha
personinfectedwithTTIs.Furthermore,farmerdonorsweretwotimesmorelikelytobe
infectedwithHBVandfourtimesmorelikelytobeinfectedbyHIVcomparedtostudent
donors.Thismightbeduetoriskyculturalpracticessuchastattooingandsharingofsharp
materials,whicharecommoninuneducatedpeople,includingfarmers[45].Suchpractices
couldincreasetheriskofinfectionwithtransfusion-transmissiblepathogens.
Thelimitationofthisstudyisrelatedtotheretrospectivenatureofitsdesigninthatitdid
notincludeallriskfactorsassociatedwithTTIs.Withthislimitation,thestudyattemptedto
demonstratethesero-prevalenceofthemajorTTIsamongblooddonorsintheNorthGondar
District.
Conclusion
TheprevalenceofTTIsissubstantialandhasincreasedovertime.Beingafarmer,unemployed
andemployedwerefoundtobesignificantlyassociatedwithTTIs.Hence,morevigilancein
routinescreeningofdonatedbloodpriortotransfusionisneeded.Furthercommunity-based
studiestoidentifysocietalriskfactorsforblood-bornepathogensarenecessary.
Supportinginformation
S1Dataset.“S1Datasetusedforanalysis”includessocio-demographiccharacteristics,
transfusion-transmissibleviralinfections,donortypeandyearofdonation(.sav).
(SAV)
Acknowledgments
WewouldliketothanktheHeadandstaffmembersoftheNorthGondarDistrictBloodBank
whohelpedusduringdatacollection.
AuthorContributions
Conceptualization:BBMM.
Datacuration:BBMMKAAESBW.
Formalanalysis:MMBBKAA.
Fundingacquisition:MMKAABBESBW.
Investigation:BBESBWMM.
PLOSONE|https://doi.org/10.1371/journal.pone.0180416 July5,2017 9/12
Transfusion-transmissibleviralinfectionsamongblooddonors
Methodology:BBMMESBW.
Projectadministration:BBMM.
Resources:KAABBMMESBW.
Software:BBMMESBWKAA.
Supervision:BBMM.
Validation:MMBB.
Visualization:BBESBWKAAMM.
Writing–originaldraft:BBMMES.
Writing–review&editing:BBKAAMM.
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