Email updates

Keep up to date with the latest news and content from BMC Infectious Diseases and BioMed Central.

Open Access Highly Accessed Research article

Seroprevalence of HIV, HBV, HCV and syphilis infections among blood donors at Gondar University Teaching Hospital, Northwest Ethiopia: declining trends over a period of five years

Belay Tessema157*, Gizachew Yismaw2, Afework Kassu23, Anteneh Amsalu4, Andargachew Mulu2, Frank Emmrich56 and Ulrich Sack56

Author Affiliations

1 Department of Medical Laboratory Technology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

2 Department of Microbiology and Parasitology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

3 Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado Denver, USA

4 Department of Medical Laboratory Technology, College of Medicine and Health Sciences, University of Hawassa, Hawassa, Ethiopia

5 Institute of Clinical Immunology, Faculty of Medicine, University of Leipzig, Leipzig, Germany

6 Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany

7 Institute of Medical Microbiology and Epidemiology of Infectious diseases, Faculty of Medicine, University of Leipzig, Leipzig, Germany

For all author emails, please log on.

BMC Infectious Diseases 2010, 10:111  doi:10.1186/1471-2334-10-111


The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-2334/10/111


Received:23 November 2009
Accepted:10 May 2010
Published:10 May 2010

© 2010 Tessema et al; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Transfusion-transmissible infectious agents such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis are among the greatest threats to blood safety for the recipient. This study aimed to determine the seroprevalence, risk factors and trends of HIV, HBV, HCV and syphilis infections among blood donors over a period of five years at Gondar University Teaching Hospital, Northwest Ethiopia.

Methods

A retrospective analysis of consecutive blood donors' records covering the period between January 2003 and December 2007 was conducted. Logistic regression analysis was used to determine risk factors associated with HIV, HBV, HCV and syphilis infections.

Results

From the total of 6361 consecutive blood donors, 607 (9.5%) had serological evidence of infection with at least one pathogen and 50 (0.8%) had multiple infections. The overall seroprevalence of HIV, HBV, HCV and syphilis was 3.8%, 4.7%, 0.7%, and 1.3% respectively. Among those with multiple infections, the most common combinations were HIV - syphilis 19 (38%) and HIV - HBV 17 (34%). The seropositivity of HIV was significantly increased among female blood donors, first time donors, housewives, merchants, soldiers, drivers and construction workers. Significantly increased HBV seropositivity was observed among farmers, first time donors and age groups of 26 - 35 and 36 - 45 years. Similarly, the seroprevalence of syphilis was significantly increased among daily labourers and construction workers. Statistically significant association was observed between syphilis and HIV infections, and HCV and HIV infections. Moreover, significantly declining trends of HIV, HCV and syphilis seropositivity were observed over the study period.

Conclusions

A substantial percentage of the blood donors harbour HIV, HBV, HCV and syphilis infections. Strict selection of blood donors and comprehensive screening of donors' blood using standard methods are highly recommended to ensure the safety of blood for recipient.

Background

The discovery of transfusion-transmissible infections (TTIs) has heralded a new era in blood transfusion practice worldwide with emphasis on two fundamental objectives, safety and protection of human life [1]. Blood safety remains an issue of major concern in transfusion medicine in Ethiopia where national blood transfusion services and policies, appropriate infrastructure, trained personnel and financial resources are inadequate.

Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) are of great concern because of their prolonged viraemia and carrier or latent state. They also cause fatal, chronic and life-threatening disorders. Blood transfusion accounts for 5-10% of HIV infections in sub-Saharan Africa [2]. Similarly, 12.5% of patients who received blood transfusion are at risk of posttransfusion hepatitis [3]. HBV is highly contagious and relatively easy to be transmitted from one infected individual to another by blood transfusion, during birth, by unprotected sex, and by sharing needles and has a relatively higher prevalence in the tropics [4,5]. A study conducted in Addis Ababa, Ethiopia showed that HCV antibody prevalence was 0.9% and higher among HIV-positive compared to HIV-negative individuals (4.5% vs. 0.8%, respectively). Similarly, higher prevalence of HCV antibodies was seen among HIV-positive compared to HIV negative antenatal care attenders (2.9% vs. 0.8%, respectively), and sex workers (5.3% vs. 1.3%, respectively) [6].

Syphilis is also a systemic disease caused by Treponema pallidum which can be spread by sexual contact, blood transfusion and via vertical transmission [7]. In sub-Saharan Africa, syphilis remains a serious public health problem. Prevalence of active syphilis infection among African countries showed 12.8% in Tanzania [8], and 3.8% in Kenya [9]. A study conducted to assess the prevalence of infection with HIV, syphilis and HBV among Ethiopian blood donors in 1995 showed that the seroprevalence of HIV-1, syphilis and HBV was 16.7%, 12.8% and 14.4%, respectively [10].

The high prevalence of HIV, HBV, HCV and syphilis has heightened the problems of blood safety in Ethiopia. Thus, continuous monitoring of the magnitude of transfusion-transmissible infections in blood donors is important for estimating the risk of transfusion and optimizing donor recruitment strategies to minimize infectious diseases transmission. Therefore, this study was conducted to determine the seroprevalence, risk factors and trends of HIV, HBV, HCV and syphilis infections among blood donors at Gondar University Teaching Hospital in Northwest Ethiopia.

Methods

Study design, setting and study subjects

A retrospective analysis of consecutive blood donors' records covering the period between January 2003 and December 2007 was conducted at Gondar University Teaching Hospital. The hospital is a tertiary level teaching hospital that provides health service to over five million inhabitants in Northwest Ethiopia, and is located 727 Km north from the capital city, Addis Ababa. Institutional ethical clearance was obtained from the research and publication committee of Gondar University. However, due to the nature of the study (retrospective review of blood donors' records), informed consent was not obtained from the study subjects.

Blood donors were either volunteers, or relatives or friends of patients and commercial donors who were recruited and paid by patients, their families, or friends to replace blood used or expected to be used for patients from the blood bank of the hospital. In the blood bank unit of the hospital, the first step in screening for potential blood donors is taking past medical history of the client. Individuals are required to give answers to a panel of questions on previous illnesses and medical conditions. Past history of blood transfusion and questions targeted to ascertain risky sexual behavior and practice are also part of the questionnaire. Apparently healthy subjects of age 17 to 65 years with body weight above 45 kg would qualify for donation. The medical and socio-demographic histories of the donors were recorded in the logbook and venous blood was collected in blood banking bags following standard procedures.

Laboratory diagnosis for HIV 1 and 2

Each donor's serum sample was screened for HIV-1 and HIV-2 using Vironostika HIV Uni-Form II Ag/Ab (BioMerieux, Boxtel, The Netherlands) following the manufacturer's instructions.

Laboratory tests for HBsAg and HCV antibodies

Sera were checked for the presence of hepatitis B surface antigen (HBsAg) using ELISA, Hepanostika HBsAg (Murex Biotech Ltd, Dartford, UK). Similarly, IgG antibodies to HCV were detected using an ELISA technique (Murex anti-HCV version 4.0) according to the manufacturer's instructions.

Laboratory diagnosis for syphilis

Serum from all donors was tested for the presence of treponemal antibodies using rapid plasma reagin test (RPR) following the manufacturer's instructions (RPR, Wampole Laboratories, Princeton, N.J., USA).

ABO blood grouping and Rhesus (RH) typing

ABO and Rh blood groups determinations were carried out on a slide using monoclonal blood grouping antisera; anti-A, anti-B, anti-AB, and anti-D (BIOTEC Laboratories Ltd, Great Britain).

Statistical analysis

Data were entered, cleaned and analysed using SPSS version 13 statistical package. To ensure the quality of data entered into the computer, two people independently cross-checked each entry. Differences in prevalence of HIV, HBV, HCV and syphilis for Socio-demographic variables were tested for significance using logistic regression. Moreover, linear regression was used to assess the statistical significance of trends in seroprevalence of these pathogens over the study period. P value less than 0.05 was considered statistically significant.

Results

Demographic characteristics of donors

As shown in Table 1, a total of 6361 consecutive blood donors were screened at Gondar University Teaching Hospital blood bank unit during the study period. Of these, 5592 (87.9%) donors were males and 769 (12.1%) were females. The median age of the study subjects was 25 years (range 17 - 65 years). Of all donors, 3357 (52.8%) were in the age group of 17-25 years, 4372 (68.7%) were first time donors, 2952 (46.4%) were blood group O and 5984 (94.1%) were Rhesus D (RH) positive. In addition, daily labourers (27.8%), farmers (24.8%) and students, more frequently Collage/University students (21.2%) were constitute a major chunk of the blood donors. The relatively higher number of farmer and daily labourer donors may be due to the fact that farmers constitute a major portion of the general population and majority of the commercial blood donors are daily labourers.

Table 1. Socio—demographic characteristics of blood donors at Gondar University Teaching Hospital in Northwest Ethiopia 2003-2007

Seroprevalence of HIV, HBV, HCV and syphilis

The overall seroprevalence rate of HIV, HBV, HCV and syphilis was 3.8%, 4.7%, 0.7% and 1.3% respectively (Table 2). Of all donated blood during the study period, 607 (9.5%) had serological evidence of infection with at least one pathogen and 50 (0.8%) had multiple infections. Among those with multiple infections, the most common combinations were HIV- syphilis 19 (38%) and HIV - HBV 17 (34%) (Table 3). As shown in Table 4, the seroprevalence of HIV was significantly increased among female blood donors (P < 0.001) compared to male blood donors, first time donors (P < 0.001) compared to repeat donors, and among housewives (P < 0.001), merchants (P < 0.001), soldiers (P = 0.020), drivers (P = 0.041) and construction workers (P = 0.009) compared to students. The seroprevalence of syphilis was significantly increased among daily labourers (P = 0.001) and construction workers (P = 0.013) compared to students. Similarly, the seropositivity of HBV was significantly increased among donors with the age groups of 26 - 35 and 36 - 45 years compared to the age group greater than 45 years, farmers (P = 0.005) compared to students and first time donors (P < 0.001) compared to repeat donors (Table 5).

Table 2. Trends of seropositivity of HIV, Syphilis, HBV and HCV among blood donors at Gondar University Teaching Hospital in Northwest Ethiopia 2003 - 2007

Table 3. Prevalence of co-infections of HIV, HBV, HCV and syphilis among blood donors at Gondar University Teaching Hospital in Northwest Ethiopia 2003-2007

Table 4. Socio–demographic characteristics of blood donors by HIV and Syphilis sero positivity at Gondar University Teaching Hospital in Northwest Ethiopia 2003-2007

Table 5. Socio–demographic characteristics of blood donors by hepatitis B and C virus seropositivity at Gondar University Teaching Hospital in Northwest Ethiopia 2003-2007

The prevalence rate of syphilis, HBV and HCV among HIV infected donors was 7.9%, 7.1%, and 2.2% respectively, compared with the prevalence rate of 1.0%, 4.6% and 0.6% among HIV-seronegative donors. Furthermore, statistically significant association was observed between syphilis and HIV infection (P < 0.001) (Table 4), and HCV and HIV infection (P = 0.002) (Table 5).

Trends of HIV, HBV, HCV and syphilis seroprevalence

Significantly declining trends of HIV (P = 0.021), HCV (P < 0.001) and syphilis (P < 0.001) seroprevalence were observed over the five years study period. The seroprevalence of HIV was 5.0% in 2003 and decreased to 3.6% in 2004 and slightly increased to 4.0% in 2005 but subsequently decreased to 3.2% in 2006 and 3.1% in 2007. The seroprevalence of HBV was decreased from 5.4% in 2003 to 2.9% in 2006 and increased further to 4.5% in 2007. HCV prevalence decreased steadily from 1.4% in 2004 to 0.6% in 2005, 0.3% in 2006, and 0.2% in 2007. Similarly, the prevalence of syphilis decreased progressively from 3.9% in 2003 to 1.9% in 2004, 0.1% in 2005 and 0.2% in 2006 and 2007 (Table 2).

Discussion

In this study, significantly declining trends of HIV, HCV and syphilis seroprevalence were observed among blood donors over the study period. This finding is consistent with the observed declining trend of HIV seroprevalence in the general population in Ethiopia [11], declining trend of HIV prevalence among blood donors in Ethiopia [12], declining trend of HIV prevalence among pregnant women, and declining trend of syphilis infections among pregnant women in Addis Ababa [13]. The initial rise in HIV seroprevalence among the blood donors represents the peak of the epidemic when denial was prevalent and little attention was paid to the disease. The subsequent decline in HIV seroprevalence may be due to the effect of the prevention programs that have been instituted in recent years [14].

The overall seroprevalence of HIV (3.8%) in this study is similar to the 3.8% seroprevalence in Ghana [15]. However, it is lower when compared with the 5.5% in Maiduguri [16], 10.6% in Nigeria [17] and 16.7% in Ethiopia [10]. The significantly increased HIV seropositivity among female donors compared to male donors is in accordance with the previous report [18]. This significantly increased HIV seropositivity among female donors might be due to their increased vulnerability to HIV infection as a result of biological, social and economic disadvantages related to their gender [19].

In the present study, the seropositivity rate of HIV and HBV was significantly increased among first time donors compared to repeat donors. This is in agreement with the previous studies [20-22]. The significantly increased HIV and HBV seroprevalence among first time donors might be due to the fact that people who regularly donate blood usually have a profile of low-risk of HIV and HBV infection because they were selected many times [23]. The significantly increased HIV seroprevalence among housewife donors is also consistent with previous study [24] which shows that these women acquired the infection from their partners, who commonly have sexual relations with other women without their partner's knowledge. The partner, considering her relationship to be monogamous, does not use protective methods to avoid infection.

The seroprevalence of HBV (4.7%) is lower than the previous reports, 10.4% in Nigeria [25], 15.0% in Ghana [15] and 14.4% in Ethiopia [10]. The seroprevalence rate of HCV (0.7%) is in agreement with values ranging between 0 and 1.4% reported from USA and Europe [26,27] and 0.9% in Ethiopia [6]. However, it is lower than the 2.8% in Ghana [28] and the 2.9% in Port Harcourt [29]. Similarly, the seroprevalence of syphilis (1.3%) in this study is lower than the 3.6% in Maiduguri [23], 7.5% in Ghana [30], 12.8% in Ethiopia [31] and 12.7% in Tanzania [32] but is higher than the 0.1% reported in Port Harcourt [33]. The reason(s) for the relatively lower rate of seroprevalence of HBV, HCV and syphilis in this study compared with other studies cannot be discerned. The improvement in technology might make current screening reagents to be more specific and reliable; and could also be a pointer that there are geographical differences in prevalence.

Significantly increased in seroprevalence of HBV was observed in the age groups of 26 - 35 and 36 - 45 years compared to the age group of greater than 45 years. This is in concurrence with previous reports by Baba et al. [16] and Ejele et al. [33] in which higher prevalence was observed among youths. This observation is worrisome since the most productive and economically viable age group of the populations is worst hit. There is the need for renewed intensification of preventive programmes aimed at high risk behavioural change.

In this study, high prevalence rate of HIV, HBV, HCV and syphilis co-infections was revealed among blood donors. However, none of the donors showed the presence of three or four markers. The HIV - HBV co-infection rate of 17/50 (34%) and the 19/50 (38%) HIV - syphilis co-infection observed in this study are higher than the result in Port Harcourt[33] and lower than the 40% HIV/HBV co-infection rate reported by Lodenyo et al. [34]. This high rate of co-infection and the statistically significant relationship between HIV and syphilis, and HIV and HCV infections might be due to the fact that these pathogens share common modes of transmission and risk groups [6,16,25,35].

Conclusion

A substantial percentage of the blood donors harbour transfusion-transmissible infections, 9.5% with at least one pathogen and 0.8% with multiple infections. Transmission of transfusion-transmissible infections during the serologically negative window period still pose a threat to blood safety in environments where there is a high rate of transfusion-transmissible infection. Therefore, strict selection of blood donors with the emphasis on getting voluntary donors and comprehensive screening of donors' blood for HIV, HBV, HCV and syphilis using standard methods are highly recommended to ensure the safety of blood for recipient. The prevalence of HIV, HBV, HCV, and syphilis co-infection needs to be studied on a larger scale for the better understanding of the impact on clinical outcome and treatment response.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

BT was the primary researcher, conceived the study, designed, participated in data collection, conducted data analysis, drafted and finalized the manuscript for publication. GY, AA and AM assisted in data collection and reviewed the initial and final drafts of the manuscript. AK, FE and US interpreted the results, and reviewed the initial and final drafts of the manuscript. All authors read and approved the final manuscript.

Acknowledgements

We acknowledge all the staff members of blood bank unit, Gondar University Teaching Hospital for the proper documentation of blood donor's information and for their technical support during data collection.

Financial support. There was no financial support.

References

  1. Klein HG: Allogenic transfusion risk in the surgical patients.

    AMJ surg 1995, 170:21-26. Publisher Full Text OpenURL

  2. UNAIDS: Report on the global AIDS epidemic. Geneva, Joint United Nations program on HIV/AIDS; 2002.

  3. Fasola FA, Otegbayo IA: Post-transfusion hepatitis in sickle cell anaemia; retrospective-prospective analysis.

    Nig J Clin Pract 2002, 5:16-19. OpenURL

  4. Drosten C, Nippraschk T, Manegold C, Meisel H, Brixner V, Roth WK, Apedjinov A, Gunther S: Prevalence of Hepatitis B virus DNA in anti-HBCpositive/HBsAg- negative sera correlates with HCV but not HIV serostatus.

    J Clin Virol 2004, 29:59-68. PubMed Abstract | Publisher Full Text OpenURL

  5. Finlayson MDC, Hayes PC, Simpson KJ: Diseases of the liver and biliary system: Hepatitis. In Davidson's principles and practice of medicine. Edited by Haslett C, Chilvers ER, Hunter JAA. Churchill Living stone, London; 1999:706-715. OpenURL

  6. Ayele W, Nokes DJ, Abebe A, Messele T, Dejene A, Enquselassie F, Tobias F, Wit R, Fontanet A: Higher Prevalence of Anti-HCV Antibodies Among HIV-Positive Compared to HIV-Negative Inhabitants of Addis Ababa, Ethiopia.

    J Med Viro 2002, 68:12-17. Publisher Full Text OpenURL

  7. Murray P, Rosenthal K, Kobayashi G, Pfaller M: Medical Microbiology. 4th edition. Mosby company, St.Loius; 2002:379-380.

  8. Todd J, Munguti K, Grosskurth H, Mngara J, Changalucha J, Mayaud P, Mosha F, Gavyole A, Mabey D, Hayes R: Risk factors for active syphilis and TPHA sero conversion in rural African population.

    Sex Transm infect 2001, 77:37-45. PubMed Abstract | Publisher Full Text | PubMed Central Full Text OpenURL

  9. Temmerman M, Fonck K, Bashir F, Inion I, Ndinya-Achola JO, Bwayo J, Kirui P, Claeys P, Fransen L: Declining syphilis prevalence in pregnant women in Nairobi since 1995: another success story in STDs.

    Int J STD AIDS 1999, 10:405-408. PubMed Abstract | Publisher Full Text OpenURL

  10. Rahlenbeck SI, Yohannes G, Molla K, Reifen R, Assefa A: Infection with HIV, syphilis and hepatitis B in Ethiopia: a survey in blood donors.

    Int J STD AIDS 1997, 8:261-4. PubMed Abstract | Publisher Full Text OpenURL

  11. UNAIDS/WHO: Epidemiological Fact Sheets on HIV and AIDS.

    Ethiopia 2008. OpenURL

  12. Kassu A, Moges F, Mekonnen F, Mengistu G, Abate E, Mekonnen E, Molla K, Zewde T, Assefa A, Wondmikun Y, Ota F: Seroprevalence of human immunodeficiency virus among blood donors in Northwest Ethiopia, 1995-2002.

    Trop Doct 2006, 36:106-107. PubMed Abstract | Publisher Full Text OpenURL

  13. Tsegaye A, Rinke de Wit TF, Mekonnen Y, Beyene A, Aklilu M, Messele T, Abebe A, Coutinho R, Sanders E, Fontanet AL: Decline in Prevalence of HIV-1 Infection and Syphilis Among Young Women Attending Antenatal Care Clinics in Addis Ababa, Ethiopia: Results From Sentinel Surveillance, 1995-2001.

    JAIDS 2002, 30:359-362. PubMed Abstract | Publisher Full Text OpenURL

  14. Federal Ministry of Health/National HIV/AIDS Prevention and Control Office: AIDS in Ethiopia.

    Addis Ababa: MOH sixth report 2007. OpenURL

  15. Ampofo W, Nii-Trebi N, Ansah J, Abe K, Naito H, Aidoo S, Nuvor V, Brandful J, Yamamoto N, Ofori-Adjei D, Ishikawa K: Prevalence of Blood-borne infectious Diseases in blood donors in Ghana.

    J Clin Microbiol 2002, 40:3523-5. PubMed Abstract | Publisher Full Text | PubMed Central Full Text OpenURL

  16. Baba MM, Hassan AW, Gashau W: Prevalence of hepatitis B antigenaemia and human immunodeficiency virus in blood donors in Maidugiri, Nigeria.

    Niger J Med 2000, 9:10-12. OpenURL

  17. Amadi AN, Mba LE: Distribution of HIV infection in Abia State, Nigeria.

    Niger J Med Invest Pract 2001, 2:38-40. OpenURL

  18. Kebede D, Aklilu M, Sanders E: The HIV epidemic and the state of its surveillance in Ethiopia.

    Ethiop Med J 2000, 38:283-302. PubMed Abstract OpenURL

  19. Bere M, Sunada R: Women and AIDS: Social economic and political factors that increase risk for women.

    Great Britain, Scot print LTD 1993. OpenURL

  20. Glíuck D, Koerner K, Caspari G, Elbert G, Gaus W, Gríassmann W, Hesse R, Holzberger G, Sternberger J, Vornwald A: Epidemiology of HIV in blood donors in West Germany.

    Dtsch Med Wochenschr 1988, 113:1383-9. PubMed Abstract | Publisher Full Text OpenURL

  21. Aymard JP, Janot C, Contal P, Linel C, Monange G, Streiff F: Epidemiologic study of HIV serology in blood donors from 5 departments in northeastern France.

    Ver Fr Transfus Hemobiol 1989, 32:421-9. OpenURL

  22. Petersen LR, Doll LS, White CR, Johnson E, Williams A: Heterosexually acquired human immunodeficiency virus infection and the United States blood supply: considerations for screening of potential blood donors.

    Transfus 1993, 33:552-557. Publisher Full Text OpenURL

  23. Chikwem JO, Mohammed I, Okara GC, Ukwandu NC, Ola TO: Prevalence of transmissible blood infections among blood donors at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria.

    East Afr Med J 1997, 4:213-6. OpenURL

  24. Szwarewald CL, Bastos FIB, Castilho EA: The dynamics of the AIDS epidemic in Brazil: a space-time analysis in the period 1987-1995.

    BJID 1998, 2:175-86. OpenURL

  25. Mustapha SK, Jibrin YB: The prevalence of hepatitis B surface antigenaemia in patients with human immunodeficiency virus (HIV) infection in Gombe, Nigeria.

    Ann Afr Med 2004, 3:10-12. OpenURL

  26. Stevens CE, Taylor PE, Pindyck J: Epidemiology of Hepatitis C virus.

    J Am Med Assoc 1997, 263:49-53. Publisher Full Text OpenURL

  27. Sharara AI, Hunt CM, Hamilton JD: Hepatitis C.

    Ann Intern Med 1996, 125:658-8. PubMed Abstract | Publisher Full Text OpenURL

  28. Wansbrough-Jones MH, Frimpong E, Cant B, Harris K, Evans MR, Teo CG: Prevalence and genotype of hepatitis C virus infection in pregnant women and blood donors in Ghana.

    Trans R Soc Trop Med Hyg 1996, 92:496-9. Publisher Full Text OpenURL

  29. Koate BBD, Buseri FI, Jeremiah ZA: Seroprevalence of hepatitis C virus among blood donors in Rivers State, Nigeria.

    Transfus Med 2005, 15:449-51. PubMed Abstract | Publisher Full Text OpenURL

  30. Adjei AA, Kudzi W, Armah H, Adiku T, Amoah AG, Ansah J: Prevalence of antibodies to syphilis among blood donors in Accra, Ghana.

    Japanese Infect Dis 2003, 56:165-7. OpenURL

  31. World Health Organization (WHO): Status of blood safety in the WHO African Region: Report of the 2004 Survey WHO Regional Office for Africa.

    Brazzaville 2007, 1-25. OpenURL

  32. Matee M, Magesa P, Lyamuya E: Seroprevalence of human immunodeficiency virus, hepatitis B and C viruses and syphilis infections among blood donors at the Muhimbili National Hospital in Dar Es Salaam, Tanzania.

    BMC Public Health 2006, 6:21-24. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text OpenURL

  33. Ejele OA, Erhabor O, Nwauche CA: Trends in the prevalence of some transfusion-transmissible infections among blood donors in Port Harcourt, Nigeria.

    Haema 2005, 8:273-7. OpenURL

  34. Lodenyo H, Schoub B, Ailly R, Kairu S, Segal I: Hepatitis B and C virus infection and liver function in AIDS patients at Chris Hani Baragwanath Hospital, Johannesburg.

    East Afr Med J 2000, 77:13-15. PubMed Abstract OpenURL

  35. Mustapha SK, Kudi AA, Asaka LE: Prevalence of hepatitis B surface antigen (HBsAg) and HIV among blood donors in Gombe.

    J Life Environ Sci 2002, 4:231-235. OpenURL

Pre-publication history

The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1471-2334/10/111/prepub