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IJBAF, November,

Novem 2016, 4(11): 398-417

ISSN: 2320 0774




Department of Nursing, Faculty of Health Sciences, Woldia University, Woldia, Ethiopia
School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar,
ealth, Tehran University of
Department of Disasters and Emergency Health, School of Public Health,
Medical Sciences, Tehran, Iran.
Department Emergency Medicine, Head of Emergency Unit and Coordinator of Emergency
Unit, Hawassa
Hawas University, Hawassa, Ethiopia
Health Sciences, Mekelle University, Mekelle,
Department of Public Health, College of Health
Department of Public Health,
ealth, Faculty of Health Sciences, Samara University, Samara, Ethiopia
Amhara Regional Health Office, North Wollo Zone Health Department, Harbu District, Woldia,
Department of Biology, Faculty of Natural & Computational Sciences, Woldia University,
Woldia, Ethiopia
Tafesse School of Pharmacy, College of Health
*Corresponding Author: Tadesse Bekele Tafesse:
and Medical Sciences, Haramaya University, Harar, Ethiopia
Email: tadie2007@yahoo.com
Received 29 July 2016; Revised 29thAugust 2016; Accepted 2ndSept. 2016; Available online 8th Nov. 2016

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

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Tadesse Bekele Tafesse et al. Review Article

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

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with HIV [3] and the number of people living the countries, particularly in the Sub-Saharan
with HIV continues to increase globally due African Region where there is a heavy
to the accessibility of antiretroviral therapy burden of HIV/AIDS and a high prevalence
[4]. Even though new HIV infections have of other transfusion transmissible infections
declined, there is still an unacceptably high (TTIs) such as HBV, HCV [6], which
number of new HIV infections and AIDS- increasingly contributed to the morbidity and
related deaths occurring each year and an mortality in various countries of the region.
estimated of 2.1 million people were newly World Health Organization (WHO) estimates
infected with HIV and 1.1 million people that over eight million units of blood for
died of HIV/AIDS-related illnesses globally transfusion are required annually for a
in 2015 [3]. However, new HIV infections population of over 836 million in Africa [8].
and AIDS-related deaths have fallen by 35%, Getting safe blood is a universal right for any
and 28%, respectively, between the year individual and it shouldnt cause any harm.
2000 and 2015 that saved the lives of some Still unsafe blood transfusion remains among
7.8 million people [3]. the major threats to blood safety for the
In health care system, blood transfusion is an recipient and for the global spread of TTIs
indispensable component that contributes to agents such as HIV, hepatitis B virus (HBV),
saving millions of lives each year in both hepatitis C virus (HCV), syphilis, malaria,
routine and emergency situations so as to etc. They can been acquired through the
improve the life expectancy and quality of therapeutic blood transfusion process, which
life of patients with acute and chronic is a major universal health challenge during
conditions [5]. Transfusion therapy is a life- unsafe blood transfusion, most especially in
saving therapy based on the safe use of blood Africa due to a high transfusion demand [9,
and blood products. But in some 10].
circumstances, the provisions of unsafe blood A lot of persisting challenges affect the
render blood safety and can be a dreadful African communities such as shortage of
vector of some infectious and parasitic transfusion blood, high prevalence of TTIs,
diseases or can cause serious and sometimes shortage of blood transfusion service at the
fatal reactions, which is a major public health national level and recruitment and retention
concern in Africa [6, 7]. The safety of blood of voluntary non-remunerable donors, family
and blood products is of serious concern to replacement and commercial blood donation

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due to the societal perception [11]. The aim The prevalence rate of HIV in the sub-
of this review was to highlight the trends of Saharan Africa region was 4.7%, however, it
HIV Sero status among blood donors in Sub- varies greatly between sub-regions within the
Saharan Africa. sub-Saharan Africa as well as in individual
HIV/AIDS Epidemic in Sub-Saharan countries. Southern Africa sub-region, for
Africa example, is the most affected region and
HIV epidemic surveillance is an important considered as the Epicenter of the global
assessment method to analyses the HIV case HIV epidemic with Swaziland and South
situation in order to design programme, Africa has the highest HIV prevalence
identify implementation of the strategic plan, (27.4%) and largest epidemic (5.9 million
and monitoring and evaluation. During HIV people) of any country worldwide,
surveillance, the community surveys has respectively. In relation to sub-regions, the
been done to collected data from HIV prevalence rate of HIV in Senegal, Western
prevalence data related to pregnant women Africa and Kenya, Eastern Africa was low to
who are attending sentinel serosurveillance moderate ranging from 0.5% to 6%,
sites, and prevention of parent to child respectively [13]. On the other hand, the
transmission services. However, the data prevalence may also be different within a
related with the prevalence and progress of single country, for instance, the highest
HIV infection among blood donors has been burden of HIV/AIDS (seropositivity rate of
yet another source of information [12]. 10%) was found in Benue state according to
Sub-Saharan Africa has the highest the national HIV sentinel seroprevalence
HIV/AIDS epidemic in the world. According survey study in Nigeria in 2005 [14].
to the UNAIDS report in 2014, the total Historical Background of HIV Infection
number of people living with HIV has been due to Blood Transfusion
estimated about 24.7 (71%) million in 2013 Blood transfusion were first reported in the
[13]. While new HIV infections have been early 1920s [15] in Africa and has been
reported in all regions of the world, practiced since the 1940s in an organized
approximately two-thirds are in sub-Saharan form [8] along with new hospitals
Africa, with 46% of new cases in Eastern and construction and health services expansion
Southern Africa [3] and there were 1.1 but both its quality of service and blood
million AIDS-related deaths [13]. supply adequacy continues to decline

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

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uncontrollable constraints. However, many The cause of 5-10% [25] of new HIV
researchers have been used different infections globally is due to infected blood
methodologies in order to estimate the transfusion as a result of blood collection
prevalence of HIV in their studies such as from unsafe donors, poor laboratory
from blood donors in the community. But, procedures and inadequate testing of blood
the majority of blood donors are male and 12.5% [26] of patients are at risk of
individuals in various countries [20-22]. developing post-transfusion hepatitis after
In sub-Saharan Africa, a limited data are blood transfusion.
available on the serological prevalence of It is obvious that the prevalence rate of HIV
TTIs agents among blood donors in relation among blood donors has varied among
to HIV-infected individuals. Reports from countries and regions based on several
few literatures about the serologic prevalence factors such as general HIV prevalence,
of these public important disease pathogens education of the public regarding blood
include among at risk adult populations such donation, selection of donors and pre-
as pregnant women and prisoners with donation screening are common among
unknown HIV-infection status [23]. others. For example, the prevalence of HIV
The prevalence of TTIs in blood donations among blood donors in high income
(Median, interquartile range) by income countries is lower than low income countries,
groups as high-income, middle-income and which is 0.001% and 0.5%, respectively [27].
low-income-countries show that 0.003% These trends in TTIs in blood donors tend to
(0.001-0.040%), 0.030% (0.008-0.18%), and significantly decrease in the developed world
0.020% (0.003-0.16%) for HIV; 0.12% compared with those in the developing
(0.02-0.34%), 0.91% (0.28-2.46%) and countries due to blood screening strategies.
0.32% (0.09-0.69%) for HBV and 1.08% The trends of TTIs agents among blood
(0.56-2.69%), 3.7% (3.34-8.47%)and 1.03% donors should be assessed in every country to
(0.67-1.8%) for HCV, respectively [24]. This ensure the safety of blood supply and the
data indicates that the prevalence of TTIs in efficiency of donor screening. The
low-income countries is extremely high and information could also reflect the occurrence
the transfusion of infected blood is greater of various diseases related with blood donors
threat. in the community. On this basis, a number of
studies were conducted in the sub-Saharan

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Africa region and the report suggested that In Cameroon, based on the study by Ymele et
there are various rate of prevalence of TTIs al (2012) in 2008 at the Blood Bank of the
agents. Here, we have summarized some Central Hospital in Yaound, out of the total
research works about the seroprevalence of 4,650 donors, which were identified, the
TTIs agents from different countries in the results of the laboratory tests were available
region. for 4,644 (99.98%) blood donors and the
In Burkina Faso, according to the study by seroprevalence of HIV, HBV and HCV was
Nagalo et al (2011) in Koudougou, from the 206 (4.44%), 565 (12.14%), and 67 (1.44%),
total of 4,520 blood donors in 2009; 1,348 respectively. HBV infection was most
(29.82%) were infected with at least one frequent in men and a total of 837 (18%) sets
pathogen and 149 (3.30%) had serological of blood were destroyed due to infection by
evidence of multiple infections with the at least one of the three viruses. Even though
overall seroprevalence rate of HIV, HBV, co-infections were not very common, 36
HCV and syphilis of 2.21%, 14.96%, 8.69% (0.77%), 0.22% and 0.06% cases of HIV-
and 3.96%, respectively [28]. Another study HBV, HBV-HCV and HIV-HCV co-
by the same group was studied on a total of infections, respectively, of cases were
31,405 first-time volunteer blood donors in recorded while the co-infection with the three
2009 from regional blood transfusion centers. viruses was only 2 (0.04%) among blood
The result showed that 24.0% were infected donors [30]. On another study which was
with at least one pathogen and 1.8% had conducted by Noubiap et al (2013) in Edea,
serological evidence of multiple infections out of 543 blood donors 115 (21.2%) donors
with the seroprevalence of HIV, HBV, HCV were infected with at least one pathogen and
and syphilis of 1.8%, 13.4%, 6.3% and 2.1%, the overall seroprevalence rates of HIV,
respectively [29]. It is possible to conclude HBV, HCV, and syphilis were 22 (4.1%), 55
based on the conducted studies in Burkina (10.1%), 26 (4.8%), and 31 (5.7%),
Faso, HBV and HCV remain the greatest respectively. Compared to voluntary donors,
threats to blood safety and relatively high family replacement donors were significantly
prevalence of viral markers in first-time more infected by at least one screened
volunteers. Hence, there should be strict pathogen [31]. In both of the studies, the
blood selection among blood donors so as to seroprevalence of HBV is greater. Collecting
decrease the risk of TTIs to the community. sets of blood which are infected could be the

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source of TTIs agents and carrying out remarkable seroprevalence of TTIs were
screening tests before blood collection has to observed that needs a careful blood screening
be implemented using rapid tests methods so during transfusion.
as to collect only from donors with negative Based on studies conducted in different
tests. geographical regions in the country, there are
Kabinda and its team (2014) has conducted a varied reports on the prevalence rates of
research so as to assess the knowledge, HIV, HBV, HCV and syphilis among blood
attitudes, practices and behaviors among 595 donors in Ethiopia. For example, the
blood donors in South Kivu, Democratic seroprevalence of HIV, HBV, HCV and
Republic of Congo and identify risk factors syphilis among blood donors ranges from
for viral markers. Motivation to donate blood 0.1% to 3.8%; 4.7% to 10.9%; 0.4% to 0.7%
in 95.9% of cases respect ethical rules of and 0.1% to 1.3%, respectively, in different
donation and the prevalence of viral markers geographical locations of the country [9, 34,
in blood donors for HIV, HBV and HCV was 35]. However, the estimated national HIV
1.6%, 4.8% and 3.9%. The level of education adult prevalence in 2011 was 1.5% [42]. On
and replacement blood donors are among the the other hand, the serological evidence of
most risk factors [32]. infection with at least one pathogen ranges
In Bioko Island of Equatorial Guinea, Xie et from 9.5% to14.1% while the multiple
al (2015) conducted a study on 2,937 infections ranges from 0.8% to1.07% [9, 35].
consecutive blood donors from January 2011 Another study by Gezahegn et al (2012) in
to April 2013 at the Blood Bank of Malabo the Southwest Ethiopia indicated that the
Region Hospital. At least one TTI cases were seroprevalence of HIV among blood donors
observed in 1,098 (37.39%) specimens and was higher among rural dwellers (1.4%) than
185 (6.29%) were harbored co-infections out urban communities (0.8%), which contradicts
of the total blood donors with the general the national prevalence rates of urban/rural
seroprevalence of 230 (7.83%) HIV, 294 settings with higher prevalence rates in urban
(10.01%) HBV, 109 (3.71%) HCV and 632 communities, i.e. 4.2% versus 0.6% [36]; and
(21.51%) T. pallidum. HBV-T. pallidum and the infection was higher among blood donors
HIV-T. pallidum were the most frequent TTI for replacement purpose (1.5%) as compared
co-infections with 60 (2.04%) and 46 to those on voluntary basis (0.3%) [34]. In
(1.57%) cases, respectively [33]. There is a general, both the studies observed that there

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is a significantly declining trends of TTIs reason for the differences of blood donation
seropositivity over the study periods and the attitude might be due to socio-cultural
HBV infection was the most prevalent TTI in influence and belief of the society as the case
every geographical regions, while the of the majority in the sub-Saharan Africa
prevalence and incidence rates significantly region.
vary between geographical areas. In Kenya, about 135,000 units of blood were
In Ghana, Walana et al (2014) conducted a collected entirely from voluntary blood
retrospective hospital-based study at the donors per year and screened by the National
Laboratory unit of the Kintampo North Blood Transfusion Service and
Municipal Hospital from January 2010 to approximately another 20,000 units were
December 2012 and out of the 3402 people collected by the public hospitals from family
who were screened for blood donation, 18.9 replacement donors but may not be screened
% of the blood donors screened were infected all of them completely. The screening rate in
with at least one of the viral transfusion public hospitals for HIV, HBV and HCV was
transmissible infectious agents, which is about 60% but higher for syphilis. Data
relatively high. The seroprevalence rates showed that family replacement donors were
among the various age groups for HIV, HBV 3 times, 1.4 times, 1.5 times and 2.7 times
and HCV ranged between 4.7-6.1%, 5.9- more likely to test positive for HIV, HBV,
15.9%, and 2.3-5.0%, respectively, among HCV and syphilis, respectively, as voluntary
them 19.5% were males and 11.4% were donors [17]. This situation might be due to
females. Year-on-year seroprevalence lack of screening while collecting the blood
indicates that HBV (9.6%) is the most as most family replacement donors donates
threaten followed by HIV (4.9%) and HCV their blood in public hospitals. In order to
(4.4%) among the studied population. Co- reduce the TTIs, hospitals has to increase the
infections were seen in 22 out of the 3402 screening rate of the blood collected from
blood donors and HBV-HCV 10 (45.5%) was family replacement donors.
the most frequent TTI co-infections [37]. In Mali, there were a total of 25,543
There is a large variation in terms of gender donations from replacement (68%) and
seroprevalence of TTIs in the country, which voluntary donors (32%) at the National
might be due to the majority of the people Centre for Blood Transfusion in 2007. The
who donated blood was males. The possible seropositivity rate of HIV, HBV, HCV and

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syphilis in blood units collected was 660 relatively healthy and they were aware of
(2.6%), 3548 (13.9%), 831 (3.3%) and 84 blood safety.
(0.3%), respectively. Seropositivity rate of In Nigeria, the largest populated country in
HIV, HBV and syphilis collected from Africa, the practice of blood donation was
replacement donors was significantly higher provoked due to misconceptions, lack of
than volunteer donors but with approximately infrastructure and overdependence of family
equal rate of positivity for HCV [38]. The replacement and remunerable donors, which
promotion for recruiting volunteer donors might be less safe [40]. A number of studies
should be scaled-up to desolate the use of were conducted on the seroprevalence of
replacement donors in addition to improve TTIs diseases among blood donors. For
the awareness of the individuals through example, the seroprevalence of HIV, HBV,
education. and HCV among blood donors ranges from
A study from Namibia by Mavenyengwa et 0.96% to 6.2%; 5.9% to 18.6% and 0.86% to
al (2014) evaluates the TTIs of the 24,761 6.0%, respectively, in different geographical
blood donated and 316 (1.3%) of the locations of the country [10, 40-43]. The
donations tested positive for HIV, syphilis, overall seroprevalence of TTIs among the
HBV and HCV while the remaining prospective blood donors with at least one
donations was tested as negative for any of TTIs marker varies, for example, 15.5% [40]
the TTIs. Among the positive donations in the North-Central Nigeria to 28.8% [41] in
tested, HBV cases were the most common the South-west Nigeria. Both the studies
while HCV was the least. There were indicated that the HIV prevalence declined
relatively low co-infections cases with 1.8% from year to year. This may probably be due
cases of HBV-HCV, 0.9% cases of HBV- to awareness of the community, positive
HIV and only 1.0% case of HIV-HCV co- impact of HIV education and public
infection among the blood donors with enlightenment campaign about the disease
overall co-infection cases of 0.024% of all everywhere for many years and which helped
the donations [39]. Based on this finding, in reducing the spread of HIV. However, TTI
there is a relatively low seroprevalence rate agents are still prevalent in the blood donors
of the TTIs as compared to other countries. with hepatitis B infection is the predominant
This indicates that the blood donors are threat in the community.

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Studies that were conducted in Sudan on the 3.42%, 6.58%, 14.27% and 4.12%,
seroprevalence of TTIs diseases among blood respectively [47]. Except for Mali, which is
donors showed that the seroprevalence of almost similar value; in all the studies
HIV, HBV, and HCV among blood donors conducted the seroprevalence reported is
ranges from 0.4% to 0.7%, 5.5% to 6.0% and higher than the estimated national value.
0.2% to 3.4% [44, 45]. The prevalence of From the reported studies, we can conclude
syphilis was 5.4% [45] in the capital city, that there should be a great effort to take care
Khartoum. The overall prevalence of viral while screening for TTIs agents as it is a
TTIs was 9.6% [44] in White Nile State - routine practice globally so as to guarantee
central Sudan while it was 5.6% [45] in the safety of the blood and blood products to
Khartoum. The seroprevalence of TTIs is be transfused.
higher in country-side, which might be Health and Economic overview of unsafe
associated with the level of education and blood transfusion
awareness of blood safety among the Someone might be in need of blood every
communities and might also be due to the second in the world. The demand for blood
availability of laboratory instruments and transfusion is high in Sub-Saharan Africa as
reagents for proper blood screening. Another there are a lot of clinical conditions; surgery,
study by Sube et al (2014) at Juba Teaching trauma, severe anemia especially due to
Hospital Blood Bank, South Sudan, reported malaria and pregnancy-related complications
that the seroprevalence of HIV among blood are among the majors [11, 48]. Blood
donors was 7.9% with the co-infections of transfusion occurring during hospitalization
HIV-HBV (50%), HIV-HCV (18%) and for such problems has been associated with
HIV-syphilis (32%) [46]. The high increased morbidity and mortality and with
seroprevalence might be mainly due to most longer stays in hospital, use of healthcare
blood donors were family replacement services, and costs [49].
donors rather than voluntary donors. Greater proportion of transfusions could be
In most of the countries, high level of given to women with obstetric emergencies
seroprevalence of TTIs were observed, for and children suffering from severe anemia as
instance, the estimated national HBV a result of malaria and malnutrition but the
prevalence in 2010/2011 in Burkina Faso, pattern of blood usage is very different in
Ethiopia, Ghana, Mali and Nigeria was 9.8%, countries, particularly in sub-Saharan Africa,

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where diagnostic and treatment options are transfusion, there are several infectious as
more limited due to the economic impact well as non-infectious risks with a chance of
with limited resource societies. The deficit 1% transfusion-associated problem including
has a particular impact on women and TTIs from a single unit of blood transfusion
children with severe life-threatening cases. If [52]. Unavailability of blood or infected
there is an access to safe blood, up to 150 blood transfusion has a direct impact on the
000 pregnancy-related deaths could be morbidity and mortality of the society in
avoided each year worldwide [48]. Even general and individuals and their families in
where sufficient blood is available, many particular. This has a large consequence on
people are exposed to avoidable, life- the development of a country as it make to
threatening risks through the transfusion of loss the productive labour and bring burden
unsafe blood, however, transfusion is the in the national health and economy [48].
only option for saving their life whatever the Besides HIV, the other TTIs agents such as
level and development of the healthcare HBV and HCV are among the major causes
system. of chronic liver diseases worldwide that
The collection, processing and use of blood bring another burden on the health and
transfusion use a unique technology that economic status of individuals. Cirrhosis and
requires a lot of resource so as to keep the hepatocellular carcinoma are common
safety of the blood. This situation requires chronic liver diseases which contributed due
not only the application of science and to HBV and HCV [53].
technology to blood processing and testing In general, in order to get a safe and ample
but also requires social mobilization to unit of blood, financial resource is
promote voluntary blood donation who are unquestionable. It will support the country to
free of infectious diseases. have an appropriate infrastructure, develop
Regarding to human health and economic appropriate policies, trained personnel and
points of view, unsafe or inadequate blood improve national blood transfusion services
transfusion is very costly and hence, access and also support the running of a voluntary
to safe blood and blood products cannot be non-remunerated donor transfusion service,
achieved without cost, i.e., every treatment and minimizes the emerging threats of
has its own economic costs [48, 50, 51]. On transfusion-transmitted infection as a result
the other hand, in relation to blood of improvement of the screening service.

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CONCLUSION data abstraction and analysis, and prepared

The seroprevalence of TTIs agents such as the manuscript
HIV, HBV, HCV and syphilis are positively AAG, TBT, DA, MTB, BAE, GMS, YY: All
higher among blood donors in sub-Saharan are participated in the development of the
Africa, with HBV the most prevalent in the protocol, preparing and editing the
Western sub-Saharan areas. The seropositive manuscript
blood donors is remaining as present threat of All authors read and approved the final
safe blood practice due to lack of public manuscript.
awareness about TTIs and national screening ACKNOWLEDGEMENTS
programs, societal belief and culture about We are grateful to all persons who provided
voluntary blood donation, level of education, technical help and assisted in writing the
use of rigorous donor selection criteria and manuscript. It is hereby acknowledged
exclusion of those with clinical and colleagues and all those who assisted in
theoretical risks of carrying infectious agents conducting the review and/or critiquing the
and use of less sensitive screening methods manuscript.
that may detect infectious agents during the Funding/Support: There was no any support
window period. The insights of HIV and it was part of group motivation.
counseling services among blood donors in Author conflict: The authors report no
Sub-Saharan Africa are generally promising; conflict of interest in this work.
however, application is low. Therefore, there REFERENCES
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