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Human Antibodies -1 (2015/2016) 1–17 1

DOI 10.3233/HAB-160304
IOS Press

Seroprevalence and diagnosis of HIV, HBV,

HCV and syphilis infections among blood
donors
Tadesse Bekele Tafessea, Addis Adera Gebrub,∗ , Semgne Gobaleea, Gosaye Degu Belyc ,
Molla Teferi Belewd , Demelash Arsoe , Belay Ali Ebrahimf , Getachew Mekonnon Shebeshig and
Yonas Yimamh
a
School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia

n
b
Department of Nursing, Faculty of Health Sciences, Woldia University, Woldia, Ethiopia

o
c
Department of Disasters and Emergency Health, School of Public Health, Tehran University of Medical Sciences,

si
Tehran, Iran
d
Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia

er
e
Department Emergency Medicine, Head of Emergency Unit and Coordinator of Emergency Unit, Hawassa
University, Hawassa, Ethiopia
fv
f
Department of Public Health, Faculty of Health Sciences, Samara University, Samara, Ethiopia
g
Amhara Regional Health Office, North Wollo Zone Health Department, Harbu District, Woldia, Ethiopia
oo

h
Department of Biology, Faculty of Natural & Computational Sciences, Woldia University, Woldia, Ethiopia
pr

Abstract.
BACKGROUND: Blood transfusion is one of the most important therapeutic options of life-saving intervention for recipients
ed

who are in diseased or non-diseased conditions with severe blood loss. However, it is associated with certain risks which can lead
to adverse consequences that may cause acute or delayed complications and bring the risk of transfusion-transmissible infections
including HIV, Hepatitis B & C and Syphilis. So, there might be a fatal risk instead of life saving. This paper aims to provide a
ct

comprehensive and reliable tabulation of available data on seroprevalence and diagnosis of HIV, HBV, HCV and Syphilis infec-
rre

tions among blood donors.

METHODS: We searched studies reporting the prevalence rate of HIV, HBV, HCV and Syphilis infections among blood donors
that were published between October 2009 and June 2016, using databases of PubMed, Scopus, MEDLINE, Elsevier, ScienceDi-
co

rect, EBSCO, Google Scholar, EMBASE, and Web of Science with keywords: “Hepatitis C Virus”, “Hepatitis B Virus”, “HIV”,
“Syphilis”, “Seroprevalence”, and “blood donor”.
un

RESULTS: The seroprevalence of HBV and HCV was highest in African countries as compared to others continents, predomi-
nantly the West African region with a range of 10.0% to 14.96% and 1.5% to 8.69%, respectively, while the overall seropositivity
of HIV and syphilis infection show a significant declining pattern through successive years globally, even though relatively higher
prevalence rate was observed among older age and those with low level of education.
CONCLUSION: There is a problem during selection, diagnoses and screening process in developing nations primarily due
to shortage of sensitive screening test kits, highly qualified human resource and lack of proper standard operating procedures
and hence, the safety of blood and blood products are the primary threats in the region. Proper clinical diagnosis and screening
method should be applied during blood donation and therefore, all the donated blood should be screened properly for transfusion-
transmitted infections.
Keywords: Blood donor, Hepatitis B Virus, Hepatitis C Virus, HIV, seroprevalence, syphilis: Transfusion-transmissible infections

1. Introduction 1

∗ Corresponding Any segment of a population; rich/poor, old/young, 2

author: Addis Adera Gebru, Department of
Nursing, Faculty of Health Sciences, Woldia University, Woldia, male/female, urban/rural dwelling, white/black can be 3

Ethiopia. E-mail: emebete21addis@gmail.com. affected by transfusion-transmissible infections (TTIs) 4

ISSN 1093-2607/15/16/$35.00 
c 2015/2016 – IOS Press and the authors. All rights reserved
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2 T.B. Tafesse et al. / Seroprevalence and diagnosis of HIV, HBV, HCV and syphilis infections among blood donors

5 including Human Immunodeficiency Virus (HIV), awareness among people, and failure to apply strict 56

6 Hepatitis B Virus (HBV) & Hepatitis C Virus (HCV) norms of sensitive screening [9]. 57

7 and syphilis. Transfusion-transmissible infections (TTIs) have 58

8 Globally, frequent road traffic accidents, surgical continued to raise concerns about blood safety as a 59

9 and obstetric blood loss, as well as anaemia from result of the risk of infection. In sub-Saharan Africa, 60

10 other sources, mainly malaria, accounts for a number the risk of TTIs is thought to be substantial because 61

11 of deaths each year and hence, the demand for blood of the highest prevalence regions with these infections, 62

12 transfusion has been reported to be high [1]. with 68% of about 38 million HIV-infected people re- 63

13 Blood transfusion is one of the most important ther- siding in this region [10], while the estimated over- 64

14 apeutic options for life-threatening disease conditions all prevalence of HCV in Sub-Saharan Africa is 3.0% 65

15 and also in sustaining life after severe blood loss. Pro- with the central African region remained the highest 66

16 vision of qualitative, safe, and adequate blood to recip- estimated prevalence of 6%, West Africa and southern 67
17 ient is the main goal of clinical blood transfusion [2]. and East Africa has an estimated prevalence of 2.4% 68
18 It is one of a life-saving aspect of health care and pub- and 1.6%, respectively [11]. The consequences of high 69
19 lic health that save millions of lives and improve the prevalence of TTIs could have major long-term social 70

n
20 health and quality of life of many more patients with and economic influence in the sub-Saharan Africa as 71

o
21 more than 81 million units of blood donation each year the recipients of blood transfusion are mostly young 72

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22 globally but more than 18 million units of blood are not people [1]. On the other hand, the risk of acquiring 73
23 screened for transfusion-transmissible infections [3].

er
HIV, in high-income countries, from a single unit of 74
24 However, blood transfusions are associated with cer- contaminated blood is estimated to be one in 1.5 to
fv 75
25 tain risks which can lead to adverse consequences that 4.7 million while the risk of HBV and HCV are be- 76
26 might cause acute or delayed complications with the tween 1 in 31,000 and 205,000 and 1 in 2 to 3 million, 77
risk of the transmission of infectious diseases due to
oo
27
respectively [12]. 78
28 their high prevalence as a significance of contaminated An assessment of the incidence of infections in the 79
29 blood transfusion and hence, it becomes fatal instead
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blood donor population is essential so as to evaluate 80

30 of life-saving [1,3,4]. The main sources of blood for the prevalence of TTIs antibodies and also the safety 81
31 blood donations are commercial (remunerated), vol- of the collected blood among blood and blood prod- 82
ed

32 untary and replacement donors and the risk of blood uct donors. This evaluation can also be used as a signal 83
33 transmission is highest with blood procured from com-
of the epidemiology of those diseases in the commu- 84
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34 mercial donors [5] due to frequent usage and incom-

nity [13]. Hence, this paper provides a comprehensive 85
35 plete screening coverage [1].
rre

and reliable tabulation of available data on seropreva- 86

36 The magnitude of TTIs varies from region to re-
lence and diagnosis of HIV, HBV, HCV and Syphilis 87
37 gion, from country to country depending on the inci-
infections among blood donors. 88
co

38 dence of infections in that particular population from

39 where blood units are sourced. In Africa, for exam-
un

40 ple, an estimated 10–15% of HIV infection is related

41 to unsafe blood transfusion as a result of higher preva- 2. Methods 89

42 lence and less comprehensive testing [6] and 12.5%

43 of patients who received blood transfusion are at risk We conducted a review based on peer-reviewed jour- 90

44 of post-transfusion hepatitis [7]. The global seropreva- nal articles on the field of Seroprevalence and diagno- 91

45 lence of HCV and HBV among blood donors varies sis of HIV, HBV, HCV, and syphilis infections among 92

46 from 0.4–19.2% and 7%, respectively [8]. Syphilis, on blood donors. We have used the databases of PubMed, 93

47 the other hand, still remains a major testing focus glob- Scopus, MEDLINE, Elsevier, ScienceDirect, EBSCO, 94

48 ally but recently continued screening in United States Google Scholar EMBASE, and Web of Science that 95

49 indicated that there is no transfusion-transmitted case were published with an English-language. In addition, 96

50 has been identified since 1966 mainly due to dimin- we also searched further information from the website 97

51 ishing reservoir and poor survival of Treponema pal- by using Google as a searching engine to strengthen 98

52 lidum, the causative agent of syphilis. However, this the introduction part of this reviewed. 99

53 scenario does not necessarily apply to Africa where the This method was used to investigate the accuracy of 100

54 seroprevalence among blood donors remains high [6] the results through comparing related research articles 101

55 as a result of poor health infrastructure, lack of health from various sources. The search was made using the 102
 Table 1
Study design, sample size, study period and study setting of Seroprevalence of HIV, HBV, HCV and syphilis infections among blood donors
Ref. Author’ name Publication Country Study setting Sample size Study period Study design
No. year
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14 Dewan et al. 2014 Bangladesh Rangamati General Hospital 2, 517 Aug. 2005 to Dec. 2012 Retrospective study
15 Kupek 2014 Brazil Southern state of Santa Catarina 82.000 2010 Retrospective study
16 Nagalo et al. 2011 Burkina Faso Regional blood transfusion centre of 4,520 Jan. to Dec. 2009 Retrospective study
Koudougou
17 Nagalo et al. 2012 Burkina Faso In three regional blood transfusion centres 31, 405 Jan. to Dec. 2009 Retrospective analysis
(Ouagadougou, Fada N’gourma and Bobo-
Dioulasso)
18 Noubiap et al. 2013 Cameroon Blood bank of the Edea Regional Hospital 543 Dec. 2011 to May 2012 Retrospective study
un
19 Ji et al. 2013 China Shaanxi Province 263,299 1999 to 2009 Retrospective study
20 Song et al. 2014 China Blood transfusion service centre in Western 66,311 Each April from 2005 to 2010 Cross-sectional study
China
co
21 Nada and Atwa 2013 Egypt Suez canal university Hospital blood bank 149,381 Jan. 1996 to Dec. 2011 Descriptive retrospective study
22 Xie et al. 2015 Equatorial Guinea Blood Bank of Malabo Region Hospital 2,937 Jan. 2011 to Apr. 2013 Retrospective study
23 Tessema et al. 2010 Ethiopia Gondar university Teaching Hospital 6361 Jan. 2003 to Dec. 2007 Retrospective study
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24 Mohammed and 2016 Ethiopia Jijiga Blood Bank, Somali Regional State 4,224 Jan. 2010 to Dec. 2013 Retrospective cross-sectional study
Bekele
25 Patel et al. 2013 India Blood bank of government control tertiary 27,407 Jan. 2009 to Nov. 2011 Retrospective study
16/12/2016; 14:03

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hospital in the central Gujarat
26 Ahmed et al. 2015 India District Level Blood Bank in a Teaching 14,520 Jan. 2013 to Dec. 2014 Descriptive cross-sectional study
ed
Hospital, Mandya, Karnataka
27 Sunderam et al. 2015 India Blood Donors at Blood Bank of Rajendra In- 63,803 Jun. 2013 to Aug. 2013 Retrospective study
stitute of Medical Sciences, Ranchi
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28 Pathak & Sehgal 2016 India Tertiary Care Hospital of North India 15,713 Jan. 2013 to Jun. 2014 Descriptive cross-sectional study
29 Mohammadali & 2014 Iran Tehran province of Tehran blood transfusion 2,026,628 Mar. 2005 to Mar. 2011 Retrospective study
Pourfathaliah centre
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30 Diarra et al. 2009 Mali National Centre for Blood Transfusion, Ba- 25,543 2007 Retrospective study
mako
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31 Stokx et al. 2011 Mozambique Provincial hospital of Tete 679 Feb. to May 2009 Cross-sectional study
32 Mavenyengwa et al. 2014 Namibia Nine regions of Namibia 24,761 2012 Retrospective study
33 Shrestha et al. 2009 Nepal Nepal Red Cross Society, Central Blood 21,716 Mar. to Sept. 2008 Cross-sectional study
er
Transfusion Service; Kathmandu
34 Buseri et al. 2009 Nigeria Ladoke Akintola University of Technology 1,410 Sept. 2007 to Jan. 2008 Cross-sectional study
si
Teaching Hospital Blood Bank, Osogbo
35 Nwokeukwu et al. 2014 Nigeria Federal Medical centre (Queeen Elizabeth 2,626
o
Jan. to Dec. 2012
n Retrospective study
Specialist Hospital) in Umuahia, Abia state
36 Motayo et al. 2015 Nigeria Blood transfusion Unit of the Federal Medi- 130 Feb. to Nov. 2013 Prospective analysis
cal centre Idi-aba, Abeokuta
37 Ahmed et al. 2016 Sudan Central blood bank in Khartoum Teaching 11,175 2015 Retrospective study
T.B. Tafesse et al. / Seroprevalence and diagnosis of HIV, HBV, HCV and syphilis infections among blood donors

Hospital
38 Saghir et al. 2012 Yemen The military hospital in Hodeidah 1,483 Nov. 2008 to Oct. 2010 Survey
male donors
3
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4 T.B. Tafesse et al. / Seroprevalence and diagnosis of HIV, HBV, HCV and syphilis infections among blood donors

120
Number Percentage Study Setting
100
Military Hospital
80 Province 4%
60
12%

40 Reginal
Generalized Blood
20 Hospital Transfusion
4% Center
0
28%
National/Central
Blood Bank
8%

University/Medical
College Teaching
Fig. 1. Percentage distribution of study samples recurited during data Regional Hospital Hospital
collection for the analysis of seroprevalence of HIV, HBV, HCV and 12% 32%

n
syphilis infections among selected studies from 2009–2016.

o
103 following keywords from peer-reviewed journal arti- Fig. 2. Percentage distribution of study settings used during data col-

si
104 cles: “Blood Donors”, ”Seroprevalence”, “HIV”, lection for determination of seroprevalence of HIV, HBV, HCV and

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105 “Hepatitis C Virus”, “Hepatitis B Virus”, “Syphilis” syphilis infections among selected studies from 2009–2016.
106 and “Transfusion-transmissible infections” that were
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untary and replacement blood donors recorded data 135
107 published between October 2009 and June 2016.
followed by a panel of questions comprising medical 136

history 5(20%) of the study participants. Full history

oo
137

and physical examination 3(12%), recruited donors 138

108 3. Results
for donation per the criterion set using questionnaire 139
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2(8%), scrutinized data from registers of blood sam- 140

109 Studies from 17 different countries that were pub-
ple screened in past years 1(4%), serologic screen- 141
110 lished from October 2009 to June 2016 and were
ed

ing based on computerized records 1(4%), extracting 142

111 conducted on the sero status of HIV, HBV, HCV
data from data base 1(4%), data of all donated blood 143
112 and syphilis (Table 1) were included in the reviewed.
from multifunctional blood transfusion service centre
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144
113 Among those reviewed studies, most of them were 1(4%) and pre-transfusion counselling and screening 145
from India (16%) followed by Nigeria (12%) and then
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114
by qualified, trained doctors and staff using specific 146
115 Ethiopia & China (8% each). More than half (56%) criteria 1(4%) were among the other sampling tech- 147
116 of the studies were used sample size greater than niques used. Study sampling techniques are summa- 148
co

117 6820 study participants from different study settings as rized in Table 1. 149
118 shown in Fig. 1. The blood donors donate units of blood at different 150
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119 No trials studies were considered and majority of the study settings as shown in Fig. 2. Majority of the stud- 151
120 studies were used retrospective or cross-sectional study ies collect units of blood during their data collection 152
121 design, which accounts 17 (68%) and 6 (24%), respec- from University/Medical College Teaching Hospitals 153
122 tively. The remaining studies (4% each) used prospec- 8(32%) and regional blood transfusion centres 7(28%). 154
123 tive analysis and survey. All apparently healthy study The donated blood were screened for HIV, HBsAg, 155
124 participants were selected for the blood donation after HCV and syphilis infections using different screen- 156
125 a panel of question about medical history with the age ing test kits based on standard operating procedure 157
126 ranging from 16 to 65 years old and a body weight of of each country and manufacturer’s instrumental in- 158

127 at least 45 kg, even though the age limits in some stud- structions. The studies were used pre-donation rapid 159

128 ies was not mentioned (Table 2). The studies were ana- testing procedures, enzyme-linked Immunosorbent as- 160

129 lyzed with different software such as SPSS with differ- say (ELISA), Prism (Abbott Laboratories, Wiesbaden, 161

130 ent version, STATA version 9, EPI Info version 6.04; Germany) anti-HIV1, 2 and anti-HCV; CHIRON RIBA 162

131 Microsoft Excel spread sheet 2007 and WinPepi Ver- HCV 3.0 SAI (Novartis Vaccines and Diagnostics, 163

132 sion 3.8. Emeryville, CA, USA) for screen-positive anti-HCV, 164

133 Regarding the sampling technique used, the major- Enzygnost Integral II (Siemens, Marburg, Germany for 165

134 ity of the reviewed studies 9 (36%) were used vol- the fourth generation of anti-HIV Ag/Ab (“combo”); 166
 Table 2
Sampling technique, instrumentation, selection criteria, analysis and overall finding of seroprevalence of HIV, HBV, HCV and syphilis infections among blood donors
Ref. Sampling technique Screening test kits Inclusion criteria Exclusion Analysis P-value Result Conclusion
No. criteria
Galley Proof

14 Record was All serological tests Data for Non-tribal Data was P < 0.05 was Tribal male donors were 2369 Among tribal
scrutinized from were performed individual donor donors were analyzed using considered (94.12%) and female donors were voluntary blood
registers of blood using screening kits of tribal origin excluded SPSS version 17 statistically 148 (5.88%). Ninety six (3.81%) donors of Rangamati,
sample screened in and HBV, HCV and was examined. significant samples were positive for TTIs; Hepatitis B infection
past years. HIV was detected Blood donors Frequency of seropositivity for is the most prevalent
using immunochro- were HBsAg, HCV & Syphilis was TTIs
matographic (ICT) representative 3.46%, 0.28%, & 0.04%,
method. Macroscopic from ten respectively. None of the samples
un
non-treponemal different tribal were positive for HIV infection.
flocculation test groups.
method was used in
co
VDRL test to detect
anticardiolipin
antibody
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15 Based on their Prism, CHIRON Apparently Individuals with Data was Not Available The highest seroprevalence was High prevalence of
computerized RIBA HCV 3.0 SAI, healthy risky sexual analyzed using observed for the hepatitis B Hepatitis B markers
16/12/2016; 14:03

ct
records. All Enzygnost Integral II, individuals & behaviour, STATA markers (3.0% for anti-HBc and of both lifetime and
candidates were VDRL Bras, whose age is in having been statistical 0.2% for HBsAg), followed by recent infection were
ed
screened for their FTA-ABS test and the range of diagnosed with a software, version those for syphilis (0. 08% observed among
past obstruction in the EIA test by 18–60 years range of chronic 9 VDRL), HIV-1 (0.06%), and blood donor & 1st
the blood bank Abbott, Hepanostika and infectious HCV (0.05%). time donors, male &
computerized records Anti-HBc Uni-Form diseases, as well of older age has
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prior to serological & ORTHO HCV 3.0 as for exposure elevated the risk of
screening and then ELISA Test System to certain most TTIs
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they underwent blood-borne
medical checks & diseases
interviewed
fv
16 A panel of questions Hepanostika HBsAg Apparently Individuals with Data was P values below From the total of 4,520 blood In the regional blood
comprising a medical Ultra, Rapid Plasma healthy less than analyzed using 0.05 were donors in 2009, 1,348 (29.82%) transfusion centre of
er
history Reagin test (RPR) individuals aged 17 years & EPI-Info version considered were infected with at least one Koudougou, Burkina
and Hepanostika 17–64 years with greater than 6.04. Odds ratio statistically pathogen and 149 (3.30%) had Faso, HBV and HCV
si
HCV Ultra, Vironos- a weight > 64 years and was calculated to significant serological evidence of multiple are the most
tika HIV Uni-Form II 50 kg body weight  determine risk
o infections. The overall
n prevalent TTIs and it
Ag/Ab. 50 kg factors seroprevalence rate of HIV, HBV, is a high risk among
For confirmation test associated with HCV and syphilis was 2.21%, blood donors and
using a second HIV, HBV, HCV 14.96%, 8.69% and 3.96%, also a threat towards
enzyme-linked & syphilis. respectively. The highest blood safety.
T.B. Tafesse et al. / Seroprevalence and diagnosis of HIV, HBV, HCV and syphilis infections among blood donors

immunosorbent assay prevalence of HBsAg &HIV were

found among blood donors from
rural areas and in the age groups
of 20–29 years and > 40 years
old, respectively
5
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 6
Table 2, continued
Ref. Sampling technique Screening test kits Inclusion criteria Exclusion Analysis P-value Result Conclusion
No. criteria
17 A panel of questions Blood banking bags Healthy first Those Data was P-values below 24.0% were infected with at least The safety of blood
Galley Proof

comprising a medical time voluntary individuals with analyzed using 0.05 were one pathogen out of 31,405 donation is at risk as
history donors with the previous EPI-Info version considered first-time volunteer blood donors. HBV & HCV in
age range of transfusion, 6.04. Odds ratio statistically Among them 1.8% had first-time volunteer
17–65 years with having signs of was calculated to significant serological evidence of multiple donors is relatively at
a weight > hepatitis, determine risk infections. The overall high prevalence rate.
50 kg pregnant women factors seroprevalence of HIV, HBV, Hence, selection of
and having associated with HCV and syphilis was 1.8%, blood donors should
experienced HIV, HBV, HCV 13.4%, 6.3% and 2.1%, be taken into
un
high-risk sexual & syphilis. respectively consideration so as to
behaviour within improve the situation.
2 weeks
co
preceding the
intended
donation
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18 Blood donor data 5 ml red-top Apparently Individuals with Data were p-Values of less Among 543 blood donors, 349 Blood safety remains
record vacutainers and healthy blood any health coded, entered, than 0.05 were (64.3%) were family replacement a major challenge
16/12/2016; 14:03

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Serum specimens donors with the disorder and & analyzed considered donors and 150 (21.2%) were among first-time
age range of who are < 18 & using SPSS statistically infected with at least one blood donors in
ed
18–65 years, > 65 years version 17.0 significant pathogen. The overall Ede’a, Cameroon, as
weighing  seroprevalence rates of HIV, in other developing
50 kg, with a HBV, HCV, and syphilis were countries where
hemoglobin 4.1%, 10.1%, 4.8%, and 5.7%, hospital-based blood
pr
level  respectively. banks and family
12.5 g/dl, and replacement donors
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without serious are predominant
illness, jaundice,
sickle cell
fv
disease, or
current fever
er
19 By extracting data Enzyme linked First-time A blood donor All statistical P < 0.05 was The majority of the donors were Even though there is
from the Xi’an Blood immunosorbent voluntary blood who had tests were set as men (64.48%), and 84.65% were a decline in HBV and
si
Service database assays (ELISA) donors previous performed using statistically under 40 years of age. The overall HCV infection, HBV
donation SAS 9.1 significant
o prevalence of rates of HIV, HBV,
n is the primary threat
experience HCV, and syphilis were 0.02%, to blood safety, while
1.16%, 0.51%, and 0.31%, the increasing
respectively. There was a prevalence of syphilis
significant decrease in the trend might also be a
T.B. Tafesse et al. / Seroprevalence and diagnosis of HIV, HBV, HCV and syphilis infections among blood donors

for Hepatitis infection while a potential threat.

significant increase was shown in
syphilis.
File: hab–1-hab304.tex; BOKCTP/xjm p. 6
 Table 2, continued
Ref. Sampling technique Screening test kits Inclusion criteria Exclusion Analysis P-value Result Conclusion
No. criteria
20 Data of all donated Pre-donation rapid Individuals with Those Data were P < 0.05 was From 66,311 blood donors, 1,769 Due to increasing
Galley Proof

blood each April testing procedures; the age range of individuals with coded, entered, set as (2.67%) and 44 (0.07%) had prevalence of TTIs,
from multifunctional Enzyme 18–55 years, a physical and cleaned, statistically serological evidence of infection there were primary
blood transfusion immunoassays (EIA); with a body mental disorder validated and significant with at least one pathogen and threats to blood
service center Rapid Plasma Reagin weight above analyzed using multiple infections, respectively. safety.
(RPR) and 50 kg for males IBM SPSS The seroprevalence of HIV, HBV,
enzyme-linked and 45 kg for Statistics 19.0 HCV and syphilis infections was
immunosorbent assay females, as well 0.31%, 0.87%, 0.86% and 0.70%,
(ELISA) as physically and respectively. The trend analysis
un
mentally fit were indicated that there is a significant
accepted as increase of TTIs during the study
eligible donors year from 2.44% to 3.71% and
co
older age group and lower
educated group showed a higher
prevalence of TTIs.
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21 Full history and Fully-automated Not Available Not Available All data were P value of The seroprevalence of HBsAg and The high prevalence
physical examination chemilumeniscence evaluated with  0.05 was anti-HCV were 2.3% (3440) and of hepatitis C
16/12/2016; 14:03

ct
auto-analyzer Cobus SPSS version 14 considered 7.2% (10729), respectively. There infections among
e411; VDRL, Latex significant were no any positive HIV and blood donors at Suez
ed
Agglutination test syphilis cases in the study. There Canal University
was high prevalence of both Hospital Blood Bank
HBsAg and anti-HCV among in Egypt serves as a
male (2.3%, 7.3%, respectively) sentinel warning for
pr
and rural donors (2.6%, 7.9%, blood safety for
respectively) more than female recipients.
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(2.1%, 6.6%, respectively) and
urban donors (2%, 6.6%,
respectively).
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22 A panel of questions Colloidal gold All healthy Individual who The data were Statistical From the total of 2,937 There was a
comprising a medical immunochromato- subjects with the had a recent analyzed by significance was consecutive blood donors, 1098 remarkably high
er
history graphic assay test age range of illness history or SPSS for defined as P < (37.39%) had at least one TTI and prevalence of TTIs
strips and 18–60 years, received a blood Windows 0.05. 185 (6.29%) multiple infections. on Bioko Island,
si
enzyme-linked weighing  transfusion more version 17.0 The overall seroprevalence of Equatorial Guinea,
immunosorbent assay 50 kg and with a than once, had
o HIV, HBV, HCV and T.pallidum
n which is a series
(ELISA) kits hemoglobin donated blood were 7.83%, 10.01%, 3.71% and threat for blood
level  12.5 g/dl within 3 months 21.51%, respectively. The safety.
seroprevalence of HIV, HBV,
HCV and T.pallidum were highest
T.B. Tafesse et al. / Seroprevalence and diagnosis of HIV, HBV, HCV and syphilis infections among blood donors

among blood donors of 38 to

47 years, 18 to 27 years and
48 years age, respectively.
7
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 8
Table 2, continued
Ref. Sampling technique Screening test kits Inclusion criteria Exclusion Analysis P-value Result Conclusion
No. criteria
23 A panel of questions, Vironostika HIV Apparently Ill individuals Data were P value less than From the total of 6361 Transmission of TTIs
Galley Proof

comprising a medical Uni-Form II Ag/Ab; healthy subjects with age of < 17 entered, cleaned 0.05 was consecutive blood donors, 607 during
history ELISA, Hepanostika of age 17 to and > 65 years and analyzed considered (9.5%) had serological evidence The serologically
HBsAg and Rapid 65 years with and  45 kg using SPSS statistically of infection with at least one negative window
plasma reagin test body weight version 13 significant pathogen and 50 (0.8%) had period still pose a
(RPR) above 45 kg statistical multiple infections. The overall threat to blood safety
package seroprevalence of HIV, HBV, in environments
HCV & syphilis was 3.8%, 4.7%, where there is a high
0.7%, and 1.3% respectively. rate of TTI.
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Significantly increased HBV
seropositivity was observed
among farmers, first time donors
co
and age groups of 26–35 and
36–45 years while daily labourers
and construction workers showed
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significantly increased
seroprevalence of syphilis.
16/12/2016; 14:03

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24 Blood donors’ Microwell ELISA Blood donors Those donors The data was P-value was Among the total 4224 donors, There was high
records Test; ELISA attended the who didn’t collected, used to calculate 4171 (98.7%) were males and the seroprevalence of
ed
(Vironstiks) kit and Jijiga blood bank screened for entered and statistical majority donors 4139 (98%) were TTIs among blood
Rapid plasma reagin during 4 years TTIs analyzed using significances replacement donors. The donors, high
(RPR) test period and those Epi Info 3.5.1 prevalence of HIV, HBsAg, HCV, prevalence of HBV,
screened for and Microsoft & Syphilis antibodies was 0.1%, low participation of
pr
HBV, HCV, HIV Excel 2007 10.9%, 0.4%, and 0.1%, females and low
and syphilis respectively. proportion of
oo
antibodies voluntary donors
25 Voluntary and Enzyme linked Not Available Not Available Data entry & P value less than Of the 27,407 donors, 13,168 There was an
fv
replacement blood immunosorbent assay analysis was 0.05 was (48%) were replacement and increasing trend in
donors record (ELISA) kits; 4th carried out by considered 14,239(52%) voluntary donors & seroprevalence of
Generation using Microsoft statistically 95.40% were male. The overall HIV, HBsAg, and
er
Microlisa-HIV Ag Excel spread significant seroprevalence of TTIs was anti- HCV
and Ab), HBsAg sheet 2007 1.67% and Seropositivity of HIV,
si
(Hepalisa) and HBsAg, anti- HCV, and syphilis
anti-HCV (HCV
o was 0.30%, 0.85%, 0.21% and
n
Microlisa) and Ultra 0.25%, respectively. The
rapid test strip prevalence of HIV, HBsAg, HCV
and VDRL positivity among
replacement donors was 0.42%,
T.B. Tafesse et al. / Seroprevalence and diagnosis of HIV, HBV, HCV and syphilis infections among blood donors

1.10%, 0.24% and 0.33%,

respectively while in Voluntary
donors, it was 0.20%,
0.63%,0.18% and 0.19%,
respectively
File: hab–1-hab304.tex; BOKCTP/xjm p. 8
 Table 2, continued
Ref. Sampling technique Screening test kits Inclusion criteria Exclusion Analysis P-value Result Conclusion
No. criteria
26 Detailed history ELISA, and rapid All apparently Any donor with Statistical Not Available Out of total 14,520 blood donors, There was a good
Galley Proof

collected and general plasma reagin (RPR) healthy adult a history of any analysis was 12,432 (85.6%) were voluntary awareness among the
physical examination test voluntary donors acute illness in done using the donors while 2,088 (14.4%) were population about
at blood camps past & recent, χ2 test replacement donors. A total of blood donation that
organized by tuberculosis, 212 samples found to be positive ensures adequate
Blood Bank, uncontrolled for TTI with overall prevalence of supplies of safe blood
District Hospital diarrhea, 1.4%. The prevalence of HIV, on a continuing basis.
Mandya, pulmonary HBV, HCV and syphilis was Among the TTI,
Karnataka and disease, recent 0.2%, 1.06%, 0.14%, and 0.05%, HBV was more
un
replacement jaundice, liver respectively. common in both
donors; Donors disease, voluntary &
with age of 18 to cardiovascular replacement donors,
co
60 years disease, and 70.5% and 86.2%,
malignancy; respectively.
history of
rre
epilepsy,
malaria,
significant
16/12/2016; 14:03

ct
weight loss,
unusual, or
ed
excessive
bleeding and
who has recently
pr
donated blood
within 3 months;
Donors on
oo
anti-platelet,
antiepileptic
fv
drugs, or
antidiabetic
drugs
er
27 Blood donors’ Not Available Apparently Age < 18 years Data were Not Available Out of total 63,803 blood donors, TTIs were more
records healthy subjects & > 60 years, entered, cleaned 56.3% were voluntary while prevalent in
si
of age 18 to weight < 45 kg, and analyzed
o 43.7% were replacement donors. replacement donors
60 years with current history using SPSS The prevalence of HIV, HBV, than voluntary donors
n
body weight of medication, software HCV and Syphilis was 0.08%, and a rising trend was
above 45 kg recent blood 1.01%, 0.14% and 0.03%, observed for HIV and
transfusion, any respectively. HBV infections
infection, among blood5donors
T.B. Tafesse et al. / Seroprevalence and diagnosis of HIV, HBV, HCV and syphilis infections among blood donors

anemia and from 2008–2012

recent history of
any surgical
procedure
9
File: hab–1-hab304.tex; BOKCTP/xjm p. 9
 10
Table 2, continued
Ref. Sampling technique Screening test kits Inclusion criteria Exclusion Analysis P-value Result Conclusion
No. criteria
28 Pre-transfusion ELISA using All donors who Donors who did Not Available Not Available The overall seroprevalence of The prevalence of
Galley Proof

counseling and BIORAD came to donate not fulfill the HIV, HBV, HCV & syphilis was HBV was the highest
screening which was GENSCREEN blood in the criteria for blood 0.2%, 1.54%, 0.49%, and 1.45%, among the various
done by qualified, ULTRA HIV Ag-Ab blood bank as donation, paid respectively. The seroprevalence markers in both
trained doctors and kit (4th generation well as voluntary and commercial of HBV, HCV and syphilis groups and less TTIs
staff using specific ELISA), BIORAD donors who donors and those amongst voluntary donors was were seen among
criteria Monolisa HBsAg donated in the with history of 0.57%, 0.14%, and 0.53%, voluntary donors as
ULTRA kit (3rd outreach blood high risk respectively and none for HIV. compared to
generation ELISA) donation camps behavior Higher prevalence of TTIs was replacement donors
un
and BIORAD HCV seen in men than women and in
Ag-Ab ULTRA kit the age group of 20–39 years.
(4th generation Higher prevalence of HIV was
co
ELISA), and seen in donors aged 30–39 years
BIORAD TPHA 500 while HBsAg and HCV was seen
test kit in the age group of 20–29 years
rre
and male donors were the
predominant (96.77%).
16/12/2016; 14:03

ct
29 All volunteer blood 3rd generation ELISA Donors who Those donors Statistical Level of The overall frequencies of HIV There was a
donor after medical kits and rapid plasma were selected by who don’t fulfill analysis was significance set Ag/Ab, anti-HCV, HBS Ag and declining trend in the
ed
interview regain (RPR) test medical the screening carried out using at p < 0.05 syphilis antibodies were 5.4, 112, prevalence of
screening based criteria SPSS software 388 and 10.5 per 100,000 blood-borne
on standard donations, respectively. infections that
criteria for blood indicates the
pr
donation effectiveness of
screening methods
oo
and selection of
appropriate donors
fv
30 Voluntary and Antibodies for HIV-1 Individuals of Individuals with Data analysis Level of From 25,543 donations, 17,449 It is crucial to
replacement donors and HIV-2 age 18 to chronic illnesses, was performed significance set (68%) were replacement donors intensify the
(Genscreen VIH1/2 60 years with women currently using Epi Info at p < 0.05 while 8094 (32%) were voluntary promotion of
er
version 2, BioRad, body weight breast-feeding or software version donors. The positive rate of the volunteer donor
France), HCV above 55 kg, and menstruating, 6.04 TTIs in blood units collected for recruitment in order
si
(Murex, Abbott, in good physical vaccination HIV, HCV, HBsAg and syphilis to progressively
France), hepatitis B and mental within the three
o was 2.6%, 3.3%, 13.9% and
n abandon the use of
surface antigen health. weeks before 0.3%, respectively. HIV, HBsAg donations from
(HBsAg) (Monolisa donation and and syphilis was significantly replacement donors
AgHBS plus, persons at risk of (p < 0.001) higher in blood units
BioRad, France) and sexually collected from replacement
T.B. Tafesse et al. / Seroprevalence and diagnosis of HIV, HBV, HCV and syphilis infections among blood donors

T. pallidum(VDRL) transmitted donors while rate of HCV

diseases positivity was similar in both
groups
File: hab–1-hab304.tex; BOKCTP/xjm p. 10
 Table 2, continued
Ref. Sampling technique Screening test kits Inclusion criteria Exclusion Analysis P-value Result Conclusion
No. criteria
31 All consenting Quality-assured rapid Individuals of Less than 25 and Measures of P < 0.05 Out of 679 eligible candidates, There is substantial
Galley Proof

candidate donors test Determine age 25 to older than prevalence were indicated 127 (18.7%) had serological risk of transfusion-
underwent first the HIV-1/2 (Abbott 65 years and in a 65 years of age, expressed in statistical confirmation of at least one TTI transmissible
national selection Laboratories, Illinois, good physical had a chronic percentage & significance with lower prevalence in infections in Tete
questionnaire USA); Rapid test and mental disease or was at reported with voluntary (15.2%) than in Province,
Healthease HBsAg health. risk of having a 95% confidence replacement donors (22.4%). The Mozambique, except
(Neomedic Ltd., Sea sexual intervals. overall seroprevalence of HIV, for HCV. On the
Cow Lake, South transmitted Comparisons HBsAg and syphilis infection was other hand, locally
Africa); rapid plasma infection (STI), between 8.5%, 10.6 % and 1.2%, used assays led to
un
regain (RPR) test pregnancy, subgroups were respectively while no HCV unnecessary rejection
menstruation, done using the infection was found. Due to the of many safe
medication, Pearson sensitivity of the local assay, 110 donations.
co
recent Chi-Square test. cases were rejected because of
vaccination or false positive results
surgery), or the
rre
presence of a
physical or
16/12/2016; 14:03

laboratory
ct
contra-indication
ed
32 Voluntary blood Abbott Prism and Individuals of Individuals of All data were P values less Out of 24,761 blood donations, A significantly low
donors selected based automated age 16 to age > 16 and > entered into than 0.05 were 316 (1.3%) donations tested prevalence of the four
on a set criterion of Treponema pallidum 65 years with 65 years with Microsoft Excel considered positive for HIV, syphilis, HBsAg TTIs in this
their age and weight Haemaglutination body weight not body weight less spreadsheet& statistically and anti-HCV. The overall population was seen,
pr
Assay(TPHA) less than 50 kg than 50 kg analyzed using significant co-infections were 0.024% of all which indicates that
SPSS version 21 the donations. The overall blood donors in
oo
prevalence of HIV, HBV, BCV Namibia are
and syphilis was 0.3%, 0.6%, relatively healthy
0.1% and 0.3%. especially the regular
fv
donors
33 Based on set Commercial ELISA Blood donors Individuals of Statistical P values less Seroprevalence of HIV, HBV, The seroprevalence
er
questionnaire kits donating blood age > 60 years analysis was than 0.05 were HCV and syphilis was 0.12%, of TTIs in Nepal is
only once during performed using considered 0.47%, 0.64% and 0.48%, lower and decreasing
si
the study period WinPepi Ver 3.8 statistically respectively. Male donors showed
in the Central significant
o higher HCV seroprevalence than
n
Blood females and age grouped of
Transfusion 20–30, 41–50 and 51–60 had
Service highest prevalence rate of HCV,
HIV and syphilis, respectively
T.B. Tafesse et al. / Seroprevalence and diagnosis of HIV, HBV, HCV and syphilis infections among blood donors
11
File: hab–1-hab304.tex; BOKCTP/xjm p. 11
 12
Table 2, continued
Ref. Sampling technique Screening test kits Inclusion criteria Exclusion Analysis P-value Result Conclusion
No. criteria
34 Blood donors Clinotech test strips; Apparently Those who had a The data P-values below Of the prospective blood donors, The high
Galley Proof

selected based on a Determine and healthy history of recent generated were 0.05 were 406 (28.8%) had serological seroprevalence of
set criterion of their Immunocomb; prospective illness, had coded, entered, considered evidence of infection with at least blood-borne
age and weight and Enzyme-linked blood donors received a blood validated and statistically one infectious marker and 36 pathogens among
donors were immunosorbent aged between transfusion or analyzed using significant (2.6%) had dual infections. The prospective blood
predominantly assays and 18& 64 years who had donated SPSS version 12 overall seroprevalence of HIV, donors in Osogbo,
Yoruba Treponema pallidum with body blood within the HBsAg, HCV and syphilis was Nigeria calls for
haemagglutination weight  50 kg 3 months prior 3.1%, 18.6%, 6.0% & 1.1%, mandatory routine
test and to the study, respectively. The highest screening of blood
un
haemoglobin history of prevalence of TTIs occurred donors for TTIs and
value  jaundice, sickle among commercial blood donors commercial blood
12.5 g/dL cell disease, and those aged 18 to 47 years old donors cannot
co
hypertension guarantee blood
current fever safety
35 Commercial/ ELISA rapid test kits Not less than Less than Data was P values less Out of 2626 blood donors, 2292 There was low
rre
replacement with 18 years 18 years analyzed with than 0.05 were (87.3%) were males, 271 (10.3%) prevalence of TTIs
very few voluntary Excel and considered females while 63 (2.4%) had agents among blood
16/12/2016; 14:03

ct
donors Epi-info statistically undocumented gender. The donors
significant seroprevalence of HIV, HBV,
ed
HCV and Syphilis were 0.3%,
0.3%, 0.2%, 0.1%, respectively &
all the cases were males. No
infectious agent was isolated from
pr
the donors > 47 years old
36 Voluntary & EIA based rapid No previous Previous history Data analysis A value of p < Prevalence rate of HIV, HBsAg, HBV recorded the
oo
replacement donors immunochromato- history of blood of blood was conducted 0.05 was HCV antibody were 6.2%, 10% highest prevalence
graphic donation, age of donation, age < using the considered as and 1.5%, respectively and there rate among blood
fv
kits 18 to 60, and 18 and > statistical statistically was no cases for Treponema donors that reaffirms
packed cell 60 years software SPSS significant palidium antibodies the endemicity of the
volume of  Version 15 infections in the
er
38% country
37 A panel of questions ELISA test Apparently Subjects of age The data were P value < 0.05 Out of 11,175 donors; 636 (5.6%) the seroprevalence of
si
on healthy with age less than 18 and entered in
o
was considered had serological evidence of infec- HBV was high while
socio-demographic range of greater than computer and statistically tion with at least one TTIs. The HIV and HCV were
data and medical 18–60 years and 60 years with
n
analyzed using significant prevalence of HIV, HBV, HCV and low in the community
history having weights body weight SPSS software syphilis were 0.4%, 6.0%, 0.2% local to Khartoum
above 45 kg below 45 kg & 5.4, respectively and 0.6% had Teaching Hospital.
serological evidence of multiple Hence, there should
T.B. Tafesse et al. / Seroprevalence and diagnosis of HIV, HBV, HCV and syphilis infections among blood donors

Infections. All donors were male. be a strict blood

donors selection and
the laboratory assay
methods for detection
of infectious agents
File: hab–1-hab304.tex; BOKCTP/xjm p. 12
 Galley Proof

Table 2, continued
Ref. Sampling technique Screening test kits Inclusion criteria Exclusion Analysis P-value Result Conclusion
No. criteria
38 Full history and Immunochromato- Physically fit Donors with Data were p-value  0.05 The frequencies of HBV, HCV, Even though the
physical examination graphic rapid test persons aged clinical anemia analyzed using was considered HIV and syphilis in the samples frequency rate of
18–48 years and with history SPSS version 16. statistically were 2.35%, 0.79%, 0.14%, and TTIs is low, it
un
of jaundice significant 0.34 %, respectively remains a major
within the past problem in blood
six months, transfusion
co
engaged in
high-risk
behavior (i.e.,
rre
unsafe
intercourse, drug
16/12/2016; 14:03

use, and so on),

ct
and donated
blood within the
ed
past three
months and <
18 years old,
pr
weighed less
than 50 kg
oo
fv
er
si
o n
T.B. Tafesse et al. / Seroprevalence and diagnosis of HIV, HBV, HCV and syphilis infections among blood donors
13
File: hab–1-hab304.tex; BOKCTP/xjm p. 13
 Galley Proof 16/12/2016; 14:03 File: hab–1-hab304.tex; BOKCTP/xjm p. 14

14 T.B. Tafesse et al. / Seroprevalence and diagnosis of HIV, HBV, HCV and syphilis infections among blood donors

Table 3
167 Hepanostika HBsAg Uni-Form/Ultra (BioMérieux, The overall seroprevalence rate of transfusion-transmitted infections
168 Geneva/Boxtel, Switzerland/The Netherlands) and (TTIs) among blood donors
169 ORTHO HCV 3.0 ELISA Test System (Ortho Clinical Prevalence (%) TTIs
170 Diagnostics, Raritan, NJ, USA) for hepatitis B sero- Country
HIV HBV HCV Syphilis
171 logical markers; Enzyme immunoassay (EIA) test by Bangladesh
172 Abbott (Abbott Park-II, USA) and Rapid Plasma Rea- 201414 0.0 3.46 0.28 0.04
173 gin test (RPR) (Cypress Diagnostics, Langdorp, Bel- Brazil
201415 0.06 3.0 0.05 0.08
174 gium) for syphilis (antibodies to Treponema pallidum).
Burkina Faso
175 All the detailed screening test kits are summarized in 201116 2.21 14.96 8.69 3.96
176 Table 2 with the exception of the study conducted by 201217 1.8 13.4 6.3 2.1
177 Sunderam et al., 2015 [27]. Cameroon
201318 4.1 10.1 4.8 5.7
178 As shown from Table 3, the seroprevalence distribu- China
179 tion of TTIs in African countries was high, particularly 201319 0.02 1.16 0.51 0.31
180 for the hepatitis B virus cases. This indicates that there 201420 0.31 0.87 0.86 0.70
181 is a problem during selection and screening process of Egypt
201321

n
0.0 2.3 7.2 0.0
182 those individuals who came to donate to the health in- Equatorial Guinea

o
183 stitutions and/or blood bank and hence, the safety of 201522 7.83 10.01 3.71 21.51

si
184 blood and blood products are the primary threats in Ethiopia
185 the region. On the other hand, there is also a challenge 201023 3.8 4.7 0.7 1.3

er
201624 0.1 10.9 0.4 0.1
186 while diagnosing the donors, which might be due to India
201325
187 shortage of sensitive instruments, highly qualified hu-
fv 0.3 0.85 0.21 0.25
188 man resource and lack of proper standard operating 201526 0.2 1.06 0.14 0.05
procedures. 201527 0.08 1.01 0.14 0.03
oo
189
201628 0.2 1.54 0.49 1.45
Iran∗ (201429 )
Mali
pr

190 Discussion 200930 2.6 13.9 3.3 0.3

Mozambique
201131 8.5 10.6 0.0 1.2
ed

191 Screening of blood has an important public health Namibia

192 benefits among blood donors, which has also an im- 201432 0.3 0.6 0.1 0.3
ct

193 pact to the community so as to make an early diagno- Nepal

200933 0.12 0.47 0.64 0.48
194 sis and treatment for transfusion-transmissible infec-
rre

Nigeria
195 tions (TTIs). The 25 studies included in this review 200934 3.1 18.6 6.0 1.1
196 show that a considerable number of blood donors were 201435 0.3 0.3 0.2 0.1
co

197 participated in the studies from various study settings, 201536 6.2 10.0 1.5 0.0
Sudan
198 mostly at regional blood transfusion centres, general 201637 0.4 6.0 0.2 5.4
un

199 Hospitals and University Teaching Hospitals; having Yemen

200 different socio-economic characteristics. 201238 2.35 0.79 0.14 0.34
201 Different selection criteria were applied to recruit HIV: human immunodeficiency virus; HBV: hepatitis B virus; HCV:
202 the participants including a panel of questions regard- hepatitis C virus; ∗ In the case of Iran, the overall frequency of HIV,
HBV, HCV and syphilis was expressed cases per 100,000 donations.
203 ing socio-demographic aspects and medical history, It was 5.4,112,388 and 10.5, respectively.
204 history of high-risk behaviour such as unsafe inter-
205 course, drug use, and so on. . . , physical examination The knowledge, attitude and practice of blood dona- 215
206 and biochemical tests using screening test kits from tion were relatively poor among individuals based on 216

207 different manufacturers for each blood donors. The the reviewed studies, particularly in developing coun- 217

208 majority of the donors were voluntary and replace- tries, even among physicians in a tertiary health facil- 218

209 ment blood donors with few commercial donors as ity. According to a study conducted by Benedict et al., 219

210 well in contrast to study conducted by Khedmat et al., 2012; only 41.4% physicians donated blood previously 220

211 2009, which use only voluntary donors [39]. A poten- with 56.9% donating less than once per a year [40]. 221

212 tial seropositivity of HIV, HBV, HCV and syphilis in- Blood donation have a dual advantage in terms of life- 222

213 fections was identified among donors with some risk saving aspects and to know the status of one’s TTIs, 223

214 factors. which could help individuals to get early diagnosis and 224
 Galley Proof 16/12/2016; 14:03 File: hab–1-hab304.tex; BOKCTP/xjm p. 15

T.B. Tafesse et al. / Seroprevalence and diagnosis of HIV, HBV, HCV and syphilis infections among blood donors 15

225 treatment so as to reduce the blood-borne transmission gies for screening of blood and blood products. The re- 273

226 of diseases and improve the safety of blood transfu- gions are responsible for setting integrated blood trans- 274

227 sion. A lot of risk factors were also identified during fusion and prevention and control of the seropreva- 275

228 the donor selection, diagnosis and screening time and lence of HIV, HBV, HCV and syphilis infections pol- 276

229 risky sexual behaviour was one of those risk factors for icy and program implementation. On the other hand, 277

230 acquiring TTIs [15]. Hence, the supply of safe blood the seroprevalence of HIV and syphilis were decline in 278

231 and blood products to the needy individuals remains the community from time to time. 279

232 under questions.

233 Based on the reviewed studies, the seroprevalence
234 of HBV and HCV was highest in African countries as Acknowledgments 280

235 compared to others, predominantly the West African

236 region with a range of 10.0% to 14.96% and 1.5% We acknowledged all persons who provided techni- 281

237 to 8.69%, respectively, while the rate of syphilis was cal assistance in writing the manuscript. 282

238 relatively low except a study conducted by Xie et

239 al., 2015, which indicates 21.5% [22]. These findings

n
240 show that the safety of blood and blood products are Conflict of interest 283

o
241 the primary threats in the region. On the other hand,

si
242 overall seropositivity of HIV infection show a signifi- We declare that no conflict of interests. 284

243 cantly declining pattern through successive years [39,

er
244 41] even though higher prevalence of TTIs were ob-
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fv 285

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