The Incidence of HIV in Blood Donors
Chapters One
OBJECTIVE OF THE STUDY
The general objective of this study is to determine the incidence of HIV in blood donors at Shanahan Hospital Nsukka in Enugu state. Other specific objectives are:
- To test for the presence of HIV antibody in donors serum or plasma.
- To determine the possible way of transmitting HIV/AIDs.
- To detect whether the incidence of HIV in blood donors is more in males than in females.
CHAPTER TWO:
LITERATURE REVIEW
Definition of blood
Blood refers to the fluid that circulates through the body’s vascular system comprising of the heart, arteries, capillaries, and veins and is the chief means of transport within the body. It transports oxygen from the lungs to the body tissues, carbon dioxide from the tissues to the lungs, nutritive substances and metabolites to the tissues It also removes waste products to the kidneys and other organs for excretion. Blood has an essential role in the maintenance of fluid balance. In cases of injuries, blood cells and antibodies in the blood move to the point of infection to fight the invading pathogens. To stop bleeding at injured sites, blood-clotting substances flow to the injured site with broken cells. Hormones also move from the endocrine glands to the organs they influence through the blood. Blood also plays a major role in regulating the body temperature and helps to carry excess heat to the surface layers of the skin where the heat escapes to the surrounding air (Barbara et al., 2014).
Importance of blood
Blood is the most precious fluid in the human body and incomparable to anything else. In spite of the rapid and remarkable progress of medical science today, there has been little success in producing anything equivalent to blood and its various components. For those who require blood for any reason including emergencies resulting from accidents or other conditions leading to blood lose, blood donation remains the only mechanism to help them have access to blood to replenish their system (Gilreath et al., 2014). Blood donation allows individuals to give or share some of their blood for use in medical
purposes to help another person (Aldebert et al., 2012). Blood transfusion on the other hand, is a process of receiving blood or blood products into one’s circulatory system intravenously, especially after an accident or during an operation or other medical purposes (Olaiya et al., 2004). Blood donation remains the only way by which collected blood can be, accumulated for safe storage and used later to meet emergency requirements for saving lives. The decision to transfuse blood can only made based on established guidelines, laboratory tests, and clinical observation or for surgery. Freshly donated blood is preferred than other forms of blood by transfusion programs depending on resource availability, with the aim of achieving self-sufficiency (WHO, 2010).
Global blood supply
More than half of all blood donations globally are collected in the high- income countries, which only carry 18 % of the world’s population (Mulugeta et al., 2016). There is remarkable difference in blood use between high-income countries and low-income countries. More than 65 % of blood donated in low-income countries finds use for transfusing children under five years, yet more than 70% of donated blood in high- income countries is used in patients aged over 65 years. The rates of blood donations are much higher in high-income countries estimated at 36.8 donations per 1000 population but only 3.9 donations per 1000 population in low-income countries. There has been a remarkable increase in blood donations from voluntary unpaid donors from 2004 to 2012 in high-income countries (WHO, 2014).
Blood demand and supply in Nigeria
The demand for blood in Nigeria is at between 200,000 and 300, 000 units per year. However, with World Health Organizations’ guidelines of 10-20 units per 1,000 people, then the need should range between 380,000 – 760,000 units annually. Currently, only 125,000 units of blood are collected through the National Blood Transfusion Service (NBTS). Family replacement donors cover the blood supply deficit (Michelle et al., 2016). In Nigeria, family replacement donors according to studies only account for 35 % of donors. Further complication for the blood supply situation in Nigeria arises from the fact that over 70 % of blood donors are first time donors and more often than not, only donate once in their lifetime. Education for potential donors improves recruitment and every year the NBTS estimates that more than 500,000 Nigerians benefit through various channels to enlighten them on blood donation issues (MOH, 2014).
Many national blood transfusion services are finding it hard to cope with the blood supply demand due to host of factors, especially due to lack of adequate resources to build the necessary infrastructure to test all the donated blood for infectious agents easily transmitted through blood. The safety of donated blood remains a major challenge in many developing countries including Nigeria. This is because in these countries there are hardly adequate financial and human resources to meet the needs of functionally sound national blood transfusion service (Florent et al., 2012). Poor budgetary allocations to national blood transfusion services are just part of myriad problems facing the blood supply system in many of these countries. Lack of a sufficient pool of volunteer donors is another problem that needs urgent attention. Insufficient blood donor screening.
CHAPTER THREE
METHODOLOGY
Study design
This was a cross-sectional descriptive and analytical study involving student blood donors in selected secondary schools within Enugu (Figure 3.1). Enugu was chosen for the study due its dense population and high demand for blood. Enugu also houses the national referral hospital where the demand for blood is very high. Blood samples were collected consecutively from all students who filled the informed consent form (Appendix 1), assented to be included in the study and met the NBTS guidelines for blood donor selection (Appendix 2). The study was conducted for a period of two months beginning September 2015.
Study Population
The study population comprised student blood donors in secondary schools within Nairobi. All students aged 16 years and above as required by the NBTS guidelines (Appendix 2) in these schools were targeted.
CHAPTER FOUR
RESULTS
Demographic characteristics of students
Four hundred and thirty-four (434) student blood donors comprising 248 (57.14 %) males and 186 (42.86 %) females enrolled in this study. Their ages ranged between 16–28 years with a mean age of 17.25 ±1.057 years. Mean ages were 18 ± 1.433 while the ages of the females were 17 ± 1.057 years. The majority (33.9 %, n = 434) of the donors were 16 years old, followed by those aged 17 years (28.6 %, n=434). Students aged 19 years and above were fewest at (14.3 %, n = 434).
Table 4.1: Demographic characteristics of the study population
CHAPTER FIVE
DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS
Discussion
HIV prevalence among student blood donors in Enugu state
The prevalence of HIV among student blood donors in this study was 0.7 %. Recruitment of safe blood donors is still a major challenge for many developing countries like Nigeria, yet safe blood donors free from risks of transmitting diseases is the cornerstone of blood safety. In some countries taboos, socio-cultural beliefs and religion are still major obstacles towards altruistic donations and discourage people from engaging in benevolent donations. HIV/AIDS and associated stigma also tend to discourage a number of people from donating blood fearing to discover their status.
The general HIV prevalence in the population in the specific country, public awareness regarding HIV and blood donation, the selection of donors and steps taken to ensure thorough pre-screening of blood donors are all important factors requiring due attention (Aldebert et al., 2012). In high-income countries, much emphasis has been put on proper donor selection and the HIV prevalence is as low as 0.001 % while in low-income countries the prevalence has remained high (WHO, 2009). Hassan et al (2008) reported an average incidence of 2.8 % of HIV among apparently healthy blood donors in Kaduna Northern central Nigeria, but Zachariah et al (2002) reported HIV incidence of 22 % among blood donors in Kampala Uganda in East Africa, which is significantly higher than the Nigerian studies. The prevalence of HIV infection among blood donors varies from one geographical location to another and can provide a reasonable ‘proxy’ for HIV infection levels in a larger adult population (WHO, 2002). The majority of blood donors in Sub-Saharan Africa are family members and friends. This group of donors is considered particularly high risk since relatives and friends are likely to donate without considering their health conditions and only donate because they feel obligated to save a family member or friend (Nwankwo et al., 2012). A comparative study on HIV prevalence between voluntary donors in Nigeria found a great variation, with the HIV prevalence among voluntary donors at 1.7 % and 10 % among family replacement donors respectively (Kimani et al., 2011).
The frequency of HIV found in this study (0.7 %) is much lower than that found by other studies like the one carried out by Nyamongo et al (2001) involving all donor groups in five provinces of Nigeria, which reported prevalence rate of 9.7 %. Although relatively low HIV prevalence is seen among secondary school student blood donors, the figures contrast sharply to those observed by Glynn et al. (2000) when they analyzed the trends in viral infections among blood donors in the USA and only found a prevalence rate of 0.15 % for HIV. The American Red Cross Blood Services (ARCBS) in a study conducted between 1992 through 2001; found HIV sero-prevalence rates of 0.002 % amongst the general donor population, but only 0.00006 % amongst high school student donors (ARCBS, 2012). The figures in the ARCBS study are almost 10,000 times lower than those found in this study, suggesting that a lot still needs to be done in order to assure the safety of blood donated by secondary school students in Nigeria. A study in a rural population India showed a HIV prevalence of 1.56 % among voluntary donors and 2.11% in replacement donors (Sonwane et al., 2003), but another study by Kumar et al., (1996), in Bangalore found a HIV prevalence among voluntary donors to be much lower at only 0.042 % (p=14266). In Uganda, the MOH surveillance reports showed a HIV prevalence of 0.7 % among school going blood donors (MOH, 2001). In the more developed countries, chances of transmitting HIV through donated blood is low due to stringent blood screening measures in place. The use of whole-virus lysate ELISAs and p24 antigen based assays has increased the sensitivity of the assays and thus viral products are detectable early during the window period. The average window period for the most sensitive ELISA for HIV is now to about 20 days (Shimian et al., 2012)
Majority of cases of transfusion-associated HIV transmission may be the result of blood donated during the window period when the viral load of individuals is still low. Using whole-Virus lysate enzyme immuno assays (EIA’S) to screen blood may reduce the window period to about 45 days (95 % , CI 34-55 days). Studies show that the average window period for the most sensitive ELISA for HIV antibodies is now about 20 days giving an average infectious window period of 25 days (95 % , CI= 9-41 days) (Shimian et al, 2012). For effective exclusion of blood donors percieved to bear risk and to protect the blood supply from viral contamination, the criteria used must take into account the specific epidemiological situation of any given country or region. The general observation in this study was that blood donated by secondary school students in Enugu state has a significantly lower frequency of HIV antibodies (0.53-0.81 %) compared to the general population (6.1 %) (NASCOP, 2015).
Students knowledge on blood donation and blood transfusion practices
This study also aimed to establish the level of knowledge on blood donation and blood transfusion practices among student blood donors in Enugu state, Nigeria. The mean knowledge on blood donation and blood transfusion practices among student blood donors was not satisfactory at 33.2 % and SD 30.58± 394(86.2 %) of students who participated in the survey. Age range suitable for donation, and the acceptable interval between two donations were known to 44(11.16 %) and 98(24.87 %) student donors respectively. Complications of blood and component transfusion were areas that elicited a poor response with only 22.58 % of the student blood donors possessing good knowledge. On some of the basic parameters, namely, the age range of donors, minimum weight, the acceptable interval between two donations and diseases for which a donor is usually deferred (Misje et al., 2009), the student blood donors in this study revealed major gaps in knowledge.
As non-remunerated donated blood is the only blood source in Nigeria, peoples’ motivation is imperative to keep blood source sufficient. Their level of knowledge on risks of blood transfusion and steps taken to prevent and treat such incidences was also not satisfactory (MOH, 2014). Knowledge about risks associated with donated blood was only 8.12 %, indicating an overall misconception about risks to the recipients of donated blood. Blood donors come from the local communities and thus awareness of the community members and their motivation to participate voluntary blood donations is essential (Devi et al., 2012)
Conclusions
(i)From the results of the study, it can be concluded that the prevalence of HIV among secondary school student blood donors is still low (0.7 %) compared to the general population (6.1 %). As such, this category of donors still constitutes a much safer population compared to other groups of donors.
(ii)The results do not show any significant differences in the prevalence of HIV among students attending the different categories of schools suggesting that the category of school had no effect on the HIV prevalence among the students.
(iii)The results did not show a significant positive correlation between age and HIV status suggesting that older students and younger students had an equal chance of being HIV- positive.
(iv)From the results of the study, it can also be concluded that the student’s knowledge on blood donation and blood transfusion practices is low. Male students appeared slightly more knowledgeable (55.7 %) on blood donation and blood transfusion practices compared to the female students (44.1 %) though there was no statistical correlation between knowledge and the students’ gender.
Recommendations
(i)Campaigns on recruitment of secondary school students as voluntary unremunerated blood donors requires strengthening as a more cost effective strategy. Strengthening efforts to recruit donors from only low risk populations such as secondary schools is also recommended
(ii)Efforts for the development and extensive use of effective communication materials to sensitize the community on blood donations and blood transfusion practices should be implemented to improve secondary school student’s knowledge on blood donation and transfusion practices. An interventional strategy in the form of repeated short blood donation awareness campaigns with respect to blood donation and blood transfusion practices have to be taken up because a significant number of students faltered in the basic aspects of blood donation and blood transfusion practices.
Comprehensive screening of blood donors for HIV and other TTI’S using quality assured methods is highly recommended. Implementation of more sensitive tests (such as nucleic acid amplification testing) for HIV that detect early stages of HIV infections (i.e. reduce the window period) will further decrease risks of transfusion-transmitted HIV infections and improve safety of donated blood.
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