https://orcid.org/0000-0002-8367-5497
Figures
Abstract
Background
Transfusion-transmissible infections (TTIs) remain a major public health problem in countries with limited resources, particularly in Gabon. Complete information on the prevalence in Gabon of the main TTIs among blood donors is still lacking in the national context. The purpose of this systematic review and meta-analysis was to determine the prevalence and factors associated with TTIs among blood donors in Gabon.
Methods
This systematic review and meta-analysis was reported in accordance with the PRISMA 2020 guidelines. It was the result of data from several comprehensive studies published between 2014 and 2022, the purpose of which focused on the prevalence and factors associated with TTIs among blood donors in Gabon. The quality of the articles was assessed using the Joanna Briggs Institute critical appraisal checklist for studies reporting prevalence data. The overall prevalence of TTIs among blood donors was determined using the random effects model. Heterogeneity between studies was assessed using I2 statistics. Publication bias was assessed by visual inspection of the funnel plot and Egger’s statistics.
Results
A total of 175,140 blood donors from the nine eligible studies were admitted to this study. The combined prevalence of HIV, HBV, HCV and syphilis obtained in the random effects model was 3.0%, 6.0%, 4.0% and 3.0%, respectively. Moreover, being a male blood donor and aged between 25 and 44 years was significantly associated with HBV infection and being a female blood donor and aged 35 years and over was significantly associated with HIV infection. Family or replacement blood donors had a high infection burden for all four TTIs of study.
Citation: Mangala C, Maulot-Bangola D, Moutsinga A, Okolongo-Mayani SC, Matsomo-Kombet GE, Moundanga M, et al. (2024) Prevalence and factors associated with transfusion-transmissible infections (HIV, HBV, HCV and Syphilis) among blood donors in Gabon: Systematic review and meta-analysis. PLoS ONE 19(8): e0307101. https://doi.org/10.1371/journal.pone.0307101
Editor: Luisa Gregori, U.S. Food and Drug Administration, UNITED STATES OF AMERICA
Received: July 21, 2023; Accepted: June 28, 2024; Published: August 19, 2024
Copyright: © 2024 Mangala et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: The authors received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Blood transfusion is intended to resolve problems linked to a drop in labile blood products (LBP) in patients suffering from severe anemia, a traffic accident or during surgery. But some infections can be transmitted by blood transfusion. These transfusion-transmissible infections (TTIs) are an ongoing threat in blood transfusion in resource-limited countries, particularly those in sub-Saharan Africa [1–4]. These transfusion-transmissible infections are due to certain hematogenous germs which can be viruses, bacteria, parasites and prions. But the germs most encountered in TTIs in blood donors are the human immunodeficiency virus (HIV), hepatitis B and C viruses (HBV and HCV), and Syphilis, because of their levels high prevalence rates [5].
Several studies conducted on transfusion-transmissible infections have shown that the prevalence of TTIs varies between resource-limited and high-income countries. Some authors have shown that the prevalence of TTIs (HIV, HBV, HCV and Syphilis) in high-income countries is very low. In particular those of HIV, HBV, HCV and Syphilis which were respectively 0.002%, 0.02%, 0.007% and 0.02%. While in resource-limited countries, particularly sub-Saharan African countries, the prevalence of TTIs in these countries was high, notably HIV, HBV, HCV and Syphilis was respectively 0.70%, 2.8%, 1.0% and 0.90%. This difference reflects the prevalence of TTIs in the population of these two categories of countries [6–8]. The situation of TTIs in Gabon is almost identical to that of countries with limited resources because some previous studies carried out on TTIs showed that the prevalence of TTIs was worrying [9].
Developed countries have succeeded in reducing the incidence of TTIs. However, blood safety continues to be a major issue in developing countries [10,11].
The circulation of hematogenous pathogens in the transfusional settings must challenge blood bank managers on a daily basis to strengthen donation screening strategies. But also to update information on transfusion-transmissible infections in order to improve and strengthen the monitoring of pathogens circulating in the donor. Similarly, haemovigilance should be a central concern of any blood bank manager [12–14].
In sub-Saharan African countries, data on transfusion-transmissible infections must be updated daily to better ensure optimal surveillance of TTIs. In Gabon, the documentation on TTIs is insufficient to ensure optimal monitoring of the infectious agents circulating among blood donors. But this must be accompanied by a strengthening of current donation screening strategies for better production of reliable data allowing good decisions to be made on the surveillance of TTIs in the country [15–18].
Monitoring transfusion-transmissible infections in blood donors can provide a better understanding of the epidemiology of these TTIs. This can also strengthen prevention and screening strategies to ensure a safe blood supply and also better manage this infectious burden. Strengthening documentation on the prevalence of the main transfusion-transmissible infections (HIV, HBV, HCV and syphilis) which circulate among Gabonese blood donors. It is with this in mind that we conducted this study focused on a systematic review and a meta-analysis whose objective is to determine the prevalence and factors associated with transfusion-transmissible infections among blood donors in Gabon.
Methods
Study design
This study resulted from a systematic review with meta-analysis of summarized data from several studies focused on the prevalence of the main transfusion-transmissible infections (HIV, HBV, HCV and Syphilis) among blood donors in the Gabonese context. Indeed, we carried out a meta-analysis on the data retrieved from the full articles. These were obtained by reading the article most often presenting the results of all the participants included in each study.
Registration of protocol design
Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) protocols were used for this review [19]. The protocol had been registered in PROSPERO with a registration number: CRD42023407124.
Search strategy
Studies on the prevalence of transfusion-transmissible infections (HIV, HBV, HCV and syphilis) among blood donors in the Gabonese transfusional settings were systematically searched January 3, 2023 in the various databases, namely PubMed, Embase and Google Scholar. To search the data for this study, we developed search terms in accordance with the Medical Subject Headings thesaurus (MeSH) and Boolean operators (AND, OR) were used to search the articles. The following terms in combination with key terms, such as: “Transfusion-transmissible viral hepatitis”, “Prevalence of transfusion-transmissible infections”, “Prevalence”, “Risk factors”, “Transfusion-transmissible infections”, “HIV”, “Hepatitis C virus”, “Syphilis”, “Hepatitis B virus”, “Blood donor”, “Blood transfusion” and “Gabon” were used.
Selection criteria
This study was conducted and written in accordance with the guidelines of PRISMA of the year 2020 [19,20]. The articles were selected independently by two groups composed of three authors each: group N°1 (CM, SCOM, AM) and group N°2 (DMB, MM, CMM). The full texts of the studies were assessed by the two groups of authors and in case of discrepancies, the third group of authors (AKFMO, JF, GEMK) was responsible for removing the ambiguity. And concerning the three hundred and sixty-eight studies that were retrieved from the various databases, nine studies met the eligibility criteria, namely the published studies having Gabonese blood donors as participants, having determined the prevalence of one or more TTIs (HIV, HBV, HCV and syphilis), having been published between 2014 and 2022, and the methodology based on 3rd or 4th generation serological tests. All studies published in English and French were included. On the other hand, for non-inclusion criteria, three hundred and fifty-nine articles were excluded for various reasons such as studies lasting more than 9 years, studies having been carried out outside the Gabonese transfusional settings, studies with a size of less than 300 participants, studies with inconsistent and non-usable results, and other reasons not allowing us to associate these studies with our meta-analysis study (Fig 1).
Quality assessment
The methodological quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal checklist for studies reporting prevalence data [21,22]. This critical appraisal checklist consisted of nine questions that inquired about study size (≥ 300), study setting information, methods used, participants (donor only) and other information related to the purpose of the study contributed to the evaluation of the different studies selected by a scoring system. Studies were considered to be of high quality for a score between 7–9, of moderate quality for a score between 4–6 and of poor quality for a score less than or equal to 3. The quality of the studies was independently assessed by two members (CM and DMB) and checked by a third member of the team (JF).
Data abstraction
All data from eligible studies were extracted simultaneously by two researchers (CM and DMB) and then they checked for inconsistencies. Data extraction was performed using a standardized form in Microsoft Excel. Data collected included first author name, year of publication, sample size, study design, study region, baseline prevalence of each study, factors associated with each TTI, sociodemographic data, and serological status. Then, all abstractions and calculations were verified by all members of the research team. And for more information on included articles, authors were contacted where necessary. However, studies for which data were not obtained or calculated were simply excluded from the systematic review and meta-analysis.
Statistical analysis
The prevalence of people positive for TTIs among blood donors was taken as the size of the effect. RevMan software version 5 was used for data management of the studies included for the meta-analysis and to present the results in graphical form (Forest plot). STATA software version 18 (Stata Corp LLC, Texas, USA) for statistical analysis was used in this study. The extent of heterogeneity between the included studies was determined quantitatively by the I2 statistical test [23]. The values of I2 made it possible to show whether the heterogeneity was low (25%), medium (50%) or high (≥ 75%). The extent of heterogeneity was determined by the P-value of the I2 statistics and a P- value < 0.05 was considered significant heterogeneity. The random-effects model was used for the medium and high levels of heterogeneity between the included studies [24]. Additionally, publication bias was assessed using the visual funnel chart test and Egger’s statistics. The random-effects model was used to account for the combined prevalence of TTIs among blood donors. ORs were determined for each of the reported variables (risk factors) and pooled in a meta-analysis. The 95% confidence interval and P-value were determined to estimate the association between risk factors and each TTI. The results were presented in the form of text and graphics.
Results
Socio-demographic characteristics of blood donors
The literature search found 368 articles, 9 of which were declared eligible and included in this systematic review and meta-analysis study (Fig 1). A total of 175,140 blood donors were included in the study, 78.1% were men and 21.9% women. The representative age groups were between 18–24, 25–34, 35–44 and ≥ 45 years, with a percentage of 34.6%, 44.5%, 16.1% and 4.8% respectively. Family donations represented 64.5% of blood bank donations (Table 1). Of 175,140 blood donors included in the study, 15,473 blood donors tested positive for one of the TTIs either by the ELISA test or the Determine® test (Table 2).
Combined prevalence of TTIs (HIV, HBV, HCV and syphilis)
The combined prevalence of the four transfusion-transmissible infections among blood donors namely HIV, HBV, HCV and syphilis was 3.0%, 6.0%, 4.0% and 3.0% respectively. Subgroup analysis revealed that there were considerable variations in the estimate of the combined prevalence of HIV, HBV, HCV and syphilis between studies conducted in the Gabonese region. We did not find any obvious publication bias in the included studies to determine the overall prevalence of each TTI i.e. HIV, HBV, HCV and Syphilis using funnel plots (S1–S8 Figs) and the regression based on the Egger test (P = 0.9314; P = 0.1840; P = 0.4357 and P = 0.9001 respectively). The random-effects model was used and the heterogeneity value of the included studies for HIV was I2 = 98,5%, Q = 330.2 P = 0.0001 (Fig 2). The heterogeneity of the included studies for HBV in the presence of the random effects model was I2 = 99,3%, Q = 770 with a significant P-value (P = 0.0001) (Fig 3). Similarly, the heterogeneity value of the included studies for HCV was I2 = 99.75%, Q = 1611.9 P = 0.001 (Fig 4). And for syphilis, the heterogeneity of the included studies was I2 = 93.6% Q = 153.7 P = 0.0001 (Fig 5).
Risk factors associated with transfusion-transmissible infections among blood donors
The study analyzed risk factors associated with transfusion-transmissible infections in blood donors. Male gender was significantly associated with HBV infection (OR = 1.81, 95% CI: 1.7–2.0, P = 0.0001) and female gender was significantly associated with infection to HIV (OR = 1.89, 95% CI: 1.7–2.2, P = 0.0002). Age groups between 35–44 and ≥ 45 years were significantly associated with HIV infections (OR = 1.73, 95% CI: 1.5–2.0, P = 0.0002 and OR = 1.34, 95% CI: 1.01–1.8, P = 0.038 respectively). For HBV infection, age groups between 18–24, 25–34 and 35–44 years were significantly associated (OR = 1.21, 95% CI: 1.03–1.4, P = 0.017; OR = 1.57, 95% CI: 1.3–1.8, P = 0.0001 and OR = 1.51, 95% CI: 1.3–1.8, P = 0.0001 respectively). Family or replacement blood donors were significantly associated with HIV infection (OR = 1.34, 95% CI: 1.2–1.5, P = 0.0002) and with HBV infection (OR = 1.24, 95% CI : 1.2–1.3, P = 0.0001) (Table 3). Age groups between 35–44 and ≥ 45 years were significantly associated with HCV infection (OR = 1.25, 95% CI: 1.0–1.5, P = 0.038 and OR = 1.41, 95% CI: 1.0–2.0, P = 0.047 respectively). For Syphilis infection, age groups between 25–34, 35–44 and ≥ 45 years were significantly associated (OR = 1.43, 95% CI: 1.2–1.7, P = 0.0001; OR = 3.52, 95% CI: 2.9–4.2, P = 0.0001 and OR = 7.71, 95% CI: 6.3–9.5, P = 0.0001 respectively). But also family or replacement blood donors were significantly associated with HCV infection (OR = 2.88, 95% CI: 2.3–3.7, P = 0.0001) (Table 4).
Discussion
Donating blood in hospitals saves lives, especially during surgery or in cases of severe anemia in children and pregnant women. But blood transfusion also constitutes a risk of transmitting transfusion-transmissible infections, in particular HIV, HBV, HCV and syphilis [34]. These TTIs are constantly encountered in transfusion circles in the world in general and in Gabon in particular. In this review, male blood donors (78.1%) and the age group between 25–34 (44.5%) were more frequent blood donors. This observation could be explained by the fact that young people are more motivated to donate blood for a simple reason which is free screening for TTIs after having adopted risk behaviors (unprotected sexual intercourse, tattooing, drug injection, etc.) exposing them to any contamination. But the low attendance of women would be due to their physiological state (pregnancy, menstruation). Some studies carried out in Africa and the rest of the world, notably in Cameroon (85.20%), India (90.70%), Iran (96.79%) and Nigeria (98.70%) have shown that younger men were more active in blood donation [35–38]. The combined prevalence of TTIs among blood donors namely HIV, HBV, HCV and syphilis was 3.0%, 6.0%, 4.0% and 3.0% respectively. The combined prevalence of HIV was high compared to the prevalences obtained in meta-analyses carried out in Iranian blood donors (0.0079%) [39] and Ethiopian blood donors (2.69%) [34]. Heterogeneity of included studies for combined HIV prevalence was high (I2 = 98.5%, P = 0.0001). Possible reasons for this difference could be attributed to the algorithms and test kits used to diagnose HIV. But also the type of blood donors (voluntary and family) could also influence this variation observed in these different studies carried out in these different countries. However, family blood donors are more at risk, which could also justify this difference in combined prevalence. Some studies conducted on blood transfusion in some countries have shown that the prevalence of HIV is high, hence the need to strengthen current blood donor selection and screening algorithms [40–45]. Similarly, the combined prevalence of HBV was high compared to the prevalences obtained in systematic reviews carried out in blood donors Eastern Mediterranean and Middle Eastern countries (2.03%) [46] and in Ethiopian blood donors (4.91%) [47,48]. The heterogeneity of the included studies for the combined prevalence of HBV was high (I2 = 99.3%, P = 0.0001). This could be explained by prevention practices against TTIs which differ from one country to another but also the financial situation of the populations making them vulnerable to any contamination with sexually transmitted infections. In addition, the discrepancy could also be due to the donation screening strategies used in the different blood banks. Note that in several studies conducted in other countries revealed that the prevalence of HBV was high among blood donors and this requires corrective measures to reduce the prevalence of TTIs including HBV [42,49–52].
The combined prevalence of HCV was higher compared to the prevalence obtained in study carried out in Ethiopia (0.819%) [53]. It was similar to that obtained in the meta-analysis conducted in Democratic Republic Congo (5.0%) [54]. It should also be noted that Egypt has the highest prevalence of HCV (14.5%) in the world [55,56]. The heterogeneity value of the included studies for HCV prevalence was high (I2 = 99.75%, P = 0.001). This gap between the different prevalences could be justified by the non-application of preventive measures against TTIs but also due to screening strategies that sometimes differ from one country to another. Some authors have shown that the prevalence of HCV in blood donors is worrying [42,57–60]. The combined prevalence of syphilis was higher compared to prevalences obtained in studies carried out among Ethiopian blood donors (1.50%) [34] and Iranian blood donors (0.1%) [61]. The value of heterogeneity of the included studies for syphilis was high (I2 = 93.6%, P = 0.0001). This finding could be explained by the different diagnostic methods used by each country in blood banks. But also by the blood donor selection methods which differ from one blood bank to another or from one country to another. Several studies conducted in transfusion settings in different countries have shown that the prevalence of syphilis is high [62–66]. The female gender was more at risk and significantly associated with HIV infection, whereas the male gender was more at risk and significantly associated with HBV infection. Blood donors aged 35 and over were at greater risk and significantly associated with HIV, HCV and Syphilis infections. On the other hand, blood donors aged 18 to 44 were more at risk and significantly associated with HBV infections. Family donors were more at risk and significantly associated with HIV, HBV and HCV infection. These results could be explained by the fact that blood donors aged 18 to 44 are the most sexually active and are exposed to any contamination with a sexually transmitted infection (HIV, HCV, HBV and syphilis) because the majority of these young people do not respect prevention measures during sexual intercourse. Indeed, several authors have shown that sex and age were factors associated with TTIs. For example, studies conducted in Egypt, Malawi and India which showed that young people were more exposed than other categories of blood donors [67–70]. Note also that blood donor type was also significantly associated with TTIs. According to the WHO, family blood donors are the most at risk of transmitting TTIs and moreover they are made up mostly of young people whose age varies between 18 and 35. This would also be explained by the age group where sexual activity is intense and often leads to the adoption of risk behavior, that is to say the absence of preventive measures (wearing a condom for example). These data corroborate those obtained in several studies carried out in certain regions of Africa notably in Ethiopia and in other regions of the world notably in India and Pakistan [67,71–73]. To reduce the infection rate among blood donors, it would be necessary to strengthen rigorous blood donor selection strategies in order to exclude at-risk blood donors. And regarding blood donors at higher risk, namely family donors, blood bank managers must initiate awareness campaigns to further motivate voluntary donors to give blood. In addition, not to condition the acquisition of a blood bag by compensation donations because this would promote a supply of family blood donations, that is to say donations at risk. In the case of hepatitis B, it would also be necessary for health authorities to step up vaccination campaigns in order to also reduce the rate of HBV infection in the general population and above all. in blood donors.
Strengths and limitations
This systematic review and meta-analysis study is, to our knowledge, the first systematic review and meta-analysis estimating the combined prevalence of transfusion-transmissible infections among blood donors in Gabon. Additionally, the included studies were only from areas of the country where the prevalence of infection-borne infections has been documented. However, we did not find an evident reduction in heterogeneity after using the random effects model of the pooled prevalences of the included studies. But unfortunately, this significance of the heterogeneity of the combined prevalence can be influenced by the sample size. Also the number of studies included in the systematic review can also favor a deviation of the inference.
Conclusion
This systematic review and meta-analysis showed that the combined prevalence of TTIs was high among Gabonese blood donors. To reduce the risk of TTIs and ensure transfusion safety, it is necessary to respect the selection criteria, the blood donor selection algorithm and the use of very sensitive and specific techniques for the detection of TTIs. Furthermore, prevention of TTIs among blood donors should be strengthened with emphasis on public awareness campaigns. Blood bank managers should also implement all applications to improve donation safety strategies in a comprehensive approach to TTI monitoring to reduce this burden.
Supporting information
S5 Fig. Egger’s publication bias plot of HIV studies.
https://doi.org/10.1371/journal.pone.0307101.s006
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S6 Fig. Egger’s publication bias plot of HBV studies.
https://doi.org/10.1371/journal.pone.0307101.s007
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S7 Fig. Egger’s publication bias plot of HCV studies.
https://doi.org/10.1371/journal.pone.0307101.s008
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S8 Fig. Egger’s publication bias plot of Syphilis studies.
https://doi.org/10.1371/journal.pone.0307101.s009
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S1 Table. Search strategy for Pubmed, Embase and Google Scholar.
https://doi.org/10.1371/journal.pone.0307101.s010
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S3 Table. Assessment of methodological quality of included articles.
https://doi.org/10.1371/journal.pone.0307101.s012
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S4 Table. Scoring criteria for quality of studies (Adapted from Stanifer et al.).
https://doi.org/10.1371/journal.pone.0307101.s013
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Acknowledgments
We would like to thank all members of the research team of the association for the research of infectious and tropical diseases (ARITD) of Gabon for their availability and their help in the production of this manuscript. We would also like to thank Itu Mangala, Andrea Mayele-Lekoungou and Wami Beny Mangala for their support and feedback throughout this hard work.
References
- 1. Candotti D, Tagny-Tayou C, Laperche S. Challenges in transfusion-transmitted infection screening in Sub-Saharan Africa. Transfusion Clinique et Biologique [Internet]. 2021; 28(2):163–70. pmid:33515730
- 2. Mangala C, Fokam J, Bangola DM, Moundanga M, Nkoa T. Residual Risk of HIV in African Transfusional Setting: Systematic Review and Meta-Analysis. International STD Research & Reviews [Internet]. 2021 Jun 5;25–36. [CrossRef] [Google Scholar].
- 3. 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. Gregori L, editor. PLOS ONE [Internet]. 2021;16(3):e0249061. pmid:33760870
- 4. Peliganga LB, Mello VM, de Sousa PSF, Horta MAP, Soares ÁD, Nunes JP da S, et al. Transfusion Transmissible Infections in Blood Donors in the Province of Bié, Angola, during a 15-Year Follow-Up, Imply the Need for Pathogen Reduction Technologies. Pathogens [Internet]. 2021;10(12):1633. pmid:34959588
- 5. Aabdien M, Selim N, Himatt S, Hmissi S, Merenkov Z, AlKubaisi N, et al. Prevalence and trends of transfusion transmissible infections among blood donors in the State of Qatar, 2013–2017. BMC Infectious Diseases [Internet]. 2020 Aug 20;20(1). pmid:32819294
- 6.
World Health Organization. Blood safety and availability [Internet]: WHO; 2023. [cited 2024, 2, 21]. Available from :http://www.who.int/mediacentre/factsheets/fs279/en/.
- 7. Ahmadpour E, Foroutan-Rad M, Majidiani H, Moghaddam SM, Hatam-Nahavandi K, Hosseini S-A, et al. Transfusion-Transmitted Malaria: A Systematic Review and Meta-analysis. Open Forum Infect Dis. 2019;6(7):ofz283. pmid:31334300
- 8. Bisseye C, Mombo LE, Meyet Me Bie S, Edou A, Eko-Mba JM, Etho-Mengue JC, et al. Tendances des maladies infectieuses transmissibles par le sang dans un centre rural de don de sang du sud-est du Gabon (Koula-Moutou). Revue médicale panafricaine [Internet]. 2018;31. [CrossRef] [Google Scholar]. pmid:31007828
- 9. Rana V, Cheema S, Kulhari K, Yadav A, Sachdeva A. Prevalence of transfusion transmissible infections and associated factors among healthy blood donors in North Indian population– 4-year experience of licensed blood bank at tertiary care hospital. Journal of Marine Medical Society [Internet]. 2022;0(0):0. [CrossRef] [Google Scholar].
- 10. Siraj N, Achila OO, Issac J, Menghisteab E, Hailemariam M, Hagos S, et al. Seroprevalence of transfusion-transmissible infections among blood donors at National Blood Transfusion Service, Eritrea: a seven-year retrospective study. BMC Infectious Diseases [Internet]. 2018 Jun 7;18(1). pmid:29879912
- 11. Busch MP, Bloch EM, Kleinman S. Prevention of transfusion-transmitted infections. Blood [Internet]. 2019 Apr 25;133(17):1854–64. pmid:30808637
- 12. Dodd RY, & Stramer SL. Transfusion‐Transmitted Infections. Practical Transfusion Medicine [Internet]. 2017; 10;153–67. [CrossRef] [Google Scholar].
- 13. Gehrie EA. Transfusion‐transmitted viral infections (TTVIs). Rossi’s Principles of Transfusion Medicine [Internet]. 2022; 10;507–22. [CrossRef] [Google Scholar].
- 14. Zaaijer HL. Prevention of Transfusion-Transmitted Infections: Dilemmas. Frontiers in Medicine [Internet]. 2017; 12;4. pmid:29312940
- 15. Bartonjo G, Oundo J, Ng’ang’a Z. Prevalence and associated risk factors of transfusion transmissible infections among blood donors at Regional Blood Transfusion Center Nakuru and Tenwek Mission Hospital, Kenya. Pan African Medical Journal [Internet]. 2019 Sep 16;34. pmid:31762899
- 16. Mangala C, Fokam J, Maulot-Bangola D, Rebienot-Pellegrin O, Nkoa T. Genetic diversity of the human immunodeficiency virus of type 1 in Gabonese transfusional settings. BMC Infectious Diseases [Internet]. 2023;23(1). pmid:36997860
- 17. Seifried E, Schmidt M. Transfusion-transmitted virus infections (TTVIs). Rossi’s Principles of Transfusion Medicine [Internet]. 2016 15;581–98. [CrossRef] [Google Scholar].
- 18. Weimer A, Tagny CT, Tapko JB, Gouws C, Tobian AAR, Ness PM, et al. Blood transfusion safety in sub‐Saharan Africa: A literature review of changes and challenges in the 21st century. Transfusion [Internet]. 2018; 59(1):412–27. pmid:30615810
- 19. Page MJ, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow CD, et al. Updating guidance for reporting systematic reviews: Development of the PRISMA 2020 statement. Center for Open Science; 2020.
- 20.
Tetzlaff J, Page M, Moher D. PNS154 the prisma 2020 statement: Development of and key changes in an updated guideline for reporting systematic reviews and meta-analyses. Value in health. Elsevier bv. 2020;23:S312–S313. https://doi.org/10.1016/j.jval.2020.04.1154
- 21. JBI. The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews: Checklist for Analytical Cross Sectional Studies 2016. http://joann abriggs.org/research/criti cal-appra isal- tools. html; accessed date: 09 july 2023.
- 22. Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and incidence data. Int J Evid Based Healthc. 2015;13(3):147–53. pmid:26317388
- 23. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88. [CrossRef] [Google Scholar]. pmid:3802833
- 24. Higgins J, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(6):1539–58. pmid:12111919
- 25. Rerambiah LK, Rerambiah LE, Bengone C & Siawaya JFD. The risk of transfusion-transmitted viral infections at the Gabonese National Blood Transfusion Centre. Blood transfusion, 2014; 12(3), 330. [CrossRef] [Google Scholar]. pmid:24333085
- 26. Tonda J, Mickala P, Mombo LE, Mengue JCE, Mongo-Délis A, Mbacky K, et al. Séroprévalence du virus de l’immunodéficience humaine, des virus des hépatites B et C et de Treponema pallidum chez les donneurs de sang dans une zone rurale au sud-est Gabon (Koula-Moutou). Journal of Applied Biosciences, 2017; 110, 10783–10789. [CrossRef] [Google Scholar].
- 27. Eko Mba JM, Ndong MJN & Bisseye C. Caractéristiques sociodémographiques associées au risque de transmission du VIH, du VHC et de Treponema pallidum par les donneurs de sang de premier don de Libreville (Gabon): dynamique trisannuelle des infections de 2009 à 2015. International Journal of Biological and Chemical Sciences, 2017; 11(1), 350–359. [CrossRef] [Google Scholar].
- 28. Eko Mba JM, Bisseye C, Ntsame Ndong JM, Mombo LE, Bengone C, Mouelet Migolet G, et al. Prevalent hepatitis B surface antigen among first-time blood donors in Gabon. Gregori L, editor. PLOS ONE [Internet]. 2018 Apr 13;13(4):e0194285. pmid:29652917
- 29. Bisseye C, Mombo LE, Bie SMM, Edou A, Mba JME, Etho-Mengue JC et al. Trends of blood-borne infectious diseases in a rural blood donation center of southeast Gabon (Koula-Moutou). Pan African Medical Journal,2018; 31(1).
- 30. Ngassaki-Yoka CD, Ndong JMN & Bisseye C. ABO, rhesus blood groups and transfusion-transmitted infections among blood donors in Gabon. Sudan Journal of Medical Sciences, 2018; 13(1), 12–21. [CrossRef] [Google Scholar].
- 31. Bisseye C, Eko Mba JM, Ntsame Ndong JM, Kosiorek HE, Butterfield RJ, Allain JP et al. Decline in the seroprevalence of syphilis markers among first-time blood donors in Libreville (Gabon) between 2004 and 2016. BMC Public Health, 2019; 19(1), 1–6.
- 32. Mangala C, Nkoa T, Maulot-Bangola D, Codjo FVV & Fokam J. Seroprevalence and Risk Factors Associated with Human Immunodeficiency Virus Infection Type 1 in Donors of the National Blood Transfusion Center of Libreville (Gabon). International STD Research & Reviews, 2021; 10(2), 16–24. [CrossRef] [Google Scholar].
- 33. Maulot-Bangola D, Nkoa T, Rebienot PO, Mangala C, Moundanga M, Fokam J et al. Prevalence and risk factors of Hepatitis B virus infection among blood donors in Gabonese National Blood Transfusion Center: A cross-sectional and analytic study. International Journal of Medicine and Medical Sciences, 2021; 13(1), 5–12. [CrossRef] [Google Scholar].
- 34. Samje M, Fondoh VN, Nguefack-Tsague G, Kamalieuk LKJ, Mbanya D, Murphy EL, et al. Trends in serological markers of transfusion transmissible infections in blood donations at the Bamenda Hospital-based Blood Service, Cameroon. Transfusion Clinique et Biologique [Internet]. 2021;28(3):228–33. pmid:34102320
- 35. Doley N. Trend of Seroprevalence of Transfusion Transmissible Infections among Donors of a Blood Bank in a Tertiary Care Centre in Kolkata. Journal of Medical Science And clinical Research [Internet]. 2017 May 28;05(05):22283–9. [CrossRef] [Google Scholar].
- 36. Emadi B, Ghahraman Rezaieh M, Sedighi M. Seroprevalence and trends of transfusion transmissible infections among retrospective blood donors in Western Azerbaijan Regional Blood Transfusion Center, Iran: A ten-years evaluation. Transfusion and Apheresis Science [Internet].2021;60(3):103132. pmid:33846093
- 37. Okoroiwu HU, Okafor IM, Asemota EA, Okpokam DC. Seroprevalence of transfusion-transmissible infections (HBV, HCV, syphilis and HIV) among prospective blood donors in a tertiary health care facility in Calabar, Nigeria; an eleven years evaluation. BMC Public Health [Internet]. 2018 May 22;18(1). pmid:29788937
- 38. Mohamed Z, Kim JU, Magesa A, Kasubi M, Feldman SF, Chevaliez S, et al. High prevalence and poor linkage to care of transfusion‐transmitted infections among blood donors in Dar‐es‐Salaam, Tanzania. Journal of Viral Hepatitis [Internet]. 2019 Feb 27;26(6):750–6. pmid:30712273
- 39. Musavi H, Rahimi H, Kooti W, Dorostkar R, Azami M, Sharghi M, et al. Prevalence of human immunodeficiency virus in Iranian blood donors: systematic review and meta-analysis. Arch Iran Med. 2018;21(6):260–7.
- 40. Abate M, Wolde T. Seroprevalence of Human Immunodeficiency Virus, Hepatitis B Virus, Hepatitis C Virus, and Syphilis among Blood Donors at Jigjiga Blood Bank, Eastern Ethiopia. Ethiopian Journal of Health Sciences [Internet]. 2016; 26(2):153. pmid:27222628
- 41. Grujic J, Bujandric N, Budakov-Obradovic Z. A ten-year trend of human immunodeficiency virus infection in voluntary blood donors in the South Backa district of Vojvodina. Medicinski pregled [Internet]. 2019;72(11–12):346–50. [CrossRef] [Google Scholar].
- 42. Lim SH, Lee S, Lee YB, Lee CH, Lee JW, Lee S-H, et al. Increased prevalence of transfusion-transmitted diseases among people with tattoos: A systematic review and meta-analysis. Khan MR, editor. PLOS ONE [Internet]. 2022 Jan 27;17(1):e0262990. pmid:35085358
- 43. Ozim CO, Mahendran R, Amalan M, Puthussery S. Prevalence of human immunodeficiency virus (HIV) among pregnant women in Nigeria: a systematic review and meta-analysis. BMJ Open [Internet]. 2023;13(3):e050164. pmid:36858473
- 44. Yu Y, Xu J, Li M. Prevalence of HIV infection among Chinese voluntary blood donors during 2010‐2017: an updated systematic review and meta‐analysis. Transfusion [Internet]. 2019; 59(11):3431–41. pmid:31532001
- 45. Melku M, Ambachew S, Enawgaw B, Abebe M, Abebe Z, Deressa T, et al. Sero-epidemiology and associated factors of HIV, HBV, HCV and syphilis among blood donors in Ethiopia: a systematic review and meta-analysis. BMC Infectious Diseases [Internet]. 2021 Aug 9;21(1). pmid:34372772
- 46. Babanejad M, Izadi N, Najafi F, Alavian SM. The HBsAg prevalence among blood donors from eastern Mediterranean and middle eastern countries: a systematic review and meta-analysis. Hepat Mon. 2016;16(3):35664. pmid:27226804
- 47. Bialfew Y, Hailu G, Samuel T. Prevalence and Associated Factors of Hepatitis B Virus Infection among Blood Donors in Debre Markos Blood Bank Centre, Northwest Ethiopia, 2018. Epidemiology: Open Access [Internet]. 2018;08(04). [CrossRef] [Google Scholar].
- 48. Fite RO, Kooti W, Azeze GA, Tesfaye B, Hagisso SN. Seroprevalence and factors associated with hepatitis B virus infection in blood donors in Ethiopia: a systematic review and meta-analysis. Archives of Virology [Internet]. 2020 Mar 26;165(5):1039–48. pmid:32219546
- 49. Badawi MM, Atif MS, Mustafa YY. Systematic review and meta-analysis of HIV, HBV and HCV infection prevalence in Sudan. Virology Journal [Internet]. 2018; 15(1). pmid:30253805
- 50. Koboyo Nadjir L, Kolou M, Katawa G, Kwame Kwarteng A, Raouf Issa A, Magnang H, et al. Seroprevalence of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus among volunteer blood donors in the National Blood Transfusion Center of Lome. International Journal of Blood Transfusion and Immunohematology [Internet]. 2017 Oct 27;7(2):1–5. [CrossRef] [Google Scholar].
- 51. Lingani M, Akita T, Ouoba S, Sanou AM, Sugiyama A, Tarnagda Z, et al. High prevalence of hepatitis B infections in Burkina Faso (1996–2017): a systematic review with meta-analysis of epidemiological studies. BMC Public Health, 2018; 18, 1–11. pmid:29699534
- 52. Yendewa GA, Wang G-M, James PB, Massaquoi SPE, Yendewa SA, Ghazawi M, et al. Prevalence of Chronic Hepatitis B Virus Infection in Sierra Leone, 1997–2022: A Systematic Review and Meta-Analysis. The American Journal of Tropical Medicine and Hygiene [Internet]. 2023; 109(1):105–14. pmid:37217165
- 53. Lake EA, Fite RO, Gebrekirstos LG, Gebremedhin MH, Obsa MS, Gelaw KA. Seroprevalence of hepatitis c virus infection among blood donors in Ethiopia: a systematic review and meta-analysis. BMC Infectious Diseases [Internet]. 2021 J;21(1). pmid:33516181
- 54. Shindano TA, Kabinda JM, Mitashi P, Horsmans Y. Hepatitis B virus infection in the Democratic Republic of Congo: a systematic review of prevalence studies (2000–2016). Journal of Public Health [Internet]. 2018 Jan 19;26(5):595–603. [CrossRef] [Google Scholar].
- 55. Muzembo BA, Akita T, Matsuoka T, Tanaka J. Systematic review and meta-analysis of hepatitis C virus infection in the Democratic Republic of Congo. Public Health [Internet]. 2016 Oct;139:13–21. pmid:27450441
- 56. Soliman G, Elzalabany MS, Hassanein T, Miller FD. Mass screening for hepatitis B and C in Southern Upper Egypt. BMC Public Health [Internet]. 2019 Oct 22;19(1). 10.1:186/s12889-019-7640-1
- 57. Bigna JJ, Amougou MA, Asangbeh SL, Kenne AM, Nansseu JR. Seroprevalence of hepatitis C virus infection in Cameroon: a systematic review and meta-analysis. BMJ Open [Internet]. 2017 Aug;7(8):e015748. pmid:28851778
- 58. Jary A, Dienta S, Leducq V, Le Hingrat Q, Cisse M, Diarra AB, et al. Seroprevalence and risk factors for HIV, HCV, HBV and syphilis among blood donors in Mali. BMC Infectious Diseases [Internet]. 2019; 19(1). pmid:31856758
- 59. Kumari S. Prevalence and trends of hepatitis B virus, Hepatitis C virus, Human immunodeficiency virus 1, 2 and syphilis infections among blood donors in a regional transfusion center in Punjab, India: A 3 years study. Indian Journal of Sexually Transmitted Diseases and AIDS [Internet]. 2020;41(1):22. pmid:33062977
- 60. Yang S, Jiao D, Liu C, Lv M, Li S, Chen Z, et al. Seroprevalence of human immunodeficiency virus, hepatitis B and C viruses, and Treponema pallidum infections among blood donors at Shiyan, Central China. BMC Infectious Diseases [Internet]. 2016 Oct 1;16(1). pmid:27716251
- 61. Esmaeilzadeh F, Mohammadi M, Amjadipour A, Jafari A, Ghelichi-Ghojogh M, Khezri R, et al. Prevalence of Syphilis Infections among the Iranian Population: A Systematic Review and Meta-Analysis. Iranian Journal of Public Health [Internet]. 2022 pmid:36248307
- 62. Alharazi T, Alzubiery TK, Alcantara JC, Qanash H, Bazaid AS, Altayar MA, et al. Prevalence of Transfusion-Transmitted Infections (HCV, HIV, Syphilis and Malaria) in Blood Donors: A Large-Scale Cross-Sectional Study. Pathogens [Internet]. 2022 Jun 26;11(7):726. pmid:35889972
- 63. Alsughayyir J, Almalki Y, Alburayk I, Alalshaik M, Aljoni I, Kandel M, et al. Prevalence of transfusion-transmitted infections in Saudi Arabia blood donors. Saudi Medical Journal [Internet]. 2022 Dec;43(12):1363–72. pmid:36517064
- 64. Ehsan H, Wahab A, Shafqat MA, Sana MK, Khalid F, Tayyeb M, et al. A Systematic Review of Transfusion Transmissible Infections Among Blood Donors and Associated Safety Challenges in Pakistan. Blood [Internet]. 2020 Nov 5;136(Supplement 1):26–8. pmid:33173367
- 65. LE A. Prevalence of Transfusion-Transmissible Infections and Associated Risk Factors among Blood Donors in Bamenda, Cameroon. Haematology International Journal [Internet]. 2021;5(2):1–12. [CrossRef] [Google Scholar].
- 66. Varma AV, Malpani G, Kosta S, Malukani K, Sarda B, Raghuvanshi A. Seroprevalence of Transfusion Transmissible Infections among Blood Donors at a Tertiary Care Teaching Hospital in Central India. International Journal of Contemporary Medical Research [IJCMR] [Internet]. 2019; 6(12). [CrossRef] [Google Scholar].
- 67. Begum CRS, Banu SN, Venkatraman J. Seroprevalence of Transfusion Transmitted Infections among blood donors in a Tertiary care Hospital in Andhra Pradesh. Annals of Pathology and Laboratory Medicine [Internet]. 2018;5(1):A82–6. [CrossRef] [Google Scholar].
- 68. Ismail N, Mostafa R, & Fouad M. Seroprevalence of HCV, HBV, HIV and syphilis among blood donors at Beni-Seuf University Hospital blood bank. Human Andrology [Internet]. 2018; 8(1):4–7. [CrossRef] [Google Scholar].
- 69. M’baya B. Seroprevalence and trends in transfusion transmissible infections among voluntary non-remunerated blood donors at the Malawi Blood Transfusion Service-a time trend study. Malawi Medical Journal 2019; 31: 118–125. pmid:31452844
- 70. Tigabu A, Engda T, & Mekonnen F. Seroprevalence of transfusion transmissible viral infections (HIV, HBV and HCV) among voluntary blood donors at University of Gondar Comprehensive Specialized Hospital, Gondar; Northwest Ethiopia. BMC Infectious Diseases 2019; 19 : 393–401. pmid:31068138
- 71. Arshad A, Borhany M, Anwar N, Naseer I, Ansari R, Boota S, et al. Prevalence of transfusion transmissible infections in blood donors of Pakistan. BMC Hematology 2016; 16 : 27–33. pmid:27891232
- 72. Biadgo B, Shiferaw E, Woldu B, Addis-Abeba K, Melku M. Transfusion-transmissible viral infections among blood donors at the North Gondar district blood. PLoS ONE 2017; 12 : e0180416. pmid:28678865
- 73. Birhaneselassie M. Prevalence of Transfusion-Transmissible Infections in Donors to an Ethiopian Blood Bank Between 2009 and 2013 and Donation. Lab Medicine 2016; 47 : 2134–139. pmid:27069031