Prevalence and factors associated with transfusion transmissible infections among blood donors at Regional blood transfusion center Nakuru and Tenwek Mission Hospital, Kenya

Abstract

Blood transfusion is an essential therapeutic procedure. Although timely transfusion saves millions of human lives worldwide each year, unsafe transfusion practices can put millions of people at risk of transfusion transmissible infections. In Kenya the blood transfusion policy requires screening of blood for HIV-1 and HIV-2, hepatitis B surface antigen (HBsAg), hepatitis C virus antibodies (ant-HCV) and syphilis. Malaria is also a blood-borne disease which is not currently screened for. Blood donor selection criteria in Kenya were reviewed in 2009. Since the epidemiology of Transfusion Transmissible Infections (TTIs) evolves with time, regular review of effectiveness of donor selection criteria can help reduce TTI’s prevalence amongst donors and thus make blood supply safer. A cross sectional study was conducted among blood donors in Regional Blood Transfusion Center Nakuru and Tenwek Mission Hospital, Kenya. Donor samples were obtained through systematic sampling. Each donor sample was screened, for HIV-1 and HIV-2, hepatitis B surface antigen (HBsAg), hepatitis C virus antibodies (ant-HCV), syphilis and malaria parasites. Associated risk factors were determined using the standard donor questionnaire. A total of 594 participants were enrolled into the study. Males constituted 72% (n=429), 53% (n=315) of overall donors being between 16-20 years of age. Sixty two percent of donors (n=367) were students, 75% (n=446) were single and 67% (n=399) had attained secondary school education. The overall prevalence of TTI’s was 14.1%; n=84 (11.9% in Nakuru and 25% in Tenwek). The prevalence of Transfusion Transmissible Infections among blood donors in the two sites ranged from 0.7% for malaria to 5.6% for HBsAg. In multivariate analysis, blood donors who were married (OR=4.56; P-value=0.0057) with non-formal/primary education (OR=9.05; P-value=0.0262), informal occupation (OR=4.08; P-value=0.0176) and multiple sexual activity (OR=189.78; P-value=0.0144), were at higher risk of HIV infection. History of blood transfusion/blood products (OR=9727.90; P-value=0.0055) and being married (OR=12.27; P-value=0.0053) were high risk factors associated with positive syphilis. Male gender (OR=2.92; P-value=0.0479) was a high risk factor to HBV infection. This study identifies a low risk donor as unmarried, less than 30 years of age, and having education beyond primary level who donates voluntarily. Potential donors with history of previous transfusion and multiple sexual activity should be deferred from donation. Measures should be taken to prevent transfusion transmission of malaria. The donor selection questionnaire should be updated to screen persons exposed to malaria.