Sero-Prevalence Of Treponema Pallidium Among Blood Donors In Etsako West In Edo State

ABSTRACT

Bloodtransfusionisatherapeuticprocedurethathasproventobeeffectiveinsavingmillionsoflives.However,itssafetyis stillacrucialissue thatneedsdueattention.Unsafebloodtransfusionisoneofthesourcesoftransmissionforinfectiousagents.Therefore,theobjectiveofthisstudywastoassessthesero-prevalenceofTransfusionTransmittableInfection(TTI)suchasTreponemapallidum,andassociatedfactorsamongblooddonorsinEtsako West In Edo State.

Aretrospectivecross-sectionalstudydesignwasusedtomeasuretheprevalenceoftransfusiontransmittableinfection usingdatacollectedfrom2014to2019infourteenbloodbankfacilitiesinAgenebode General Hospital Agenebode, Etsako West General Hospital.ScreeningofTreponemapallidum wasdonebyusingtheEnzyme-LinkedImmunosorbentAssay(ELISA).PresenceofTreponemapalliduminfectionwasassessedusingrapidplasmareagin(RPR).RecordsofblooddonorswerecollectedusingachecklistfromCentralBloodBankLaboratory(BBL)electronicdatabaseandreviewed. comparativelyhigherin2014,5.70%andlowestin2019,3.40%.TheoddsofgettingatleastoneTTIandTreponemapalliduminunemployedblooddonorswere2.4[2.0,2.8]and8.1[6.1,10.7]respectively.TheprobabilityofgettingthosewhohaveTreponemapallidumwerehigherinblooddonorsthosewholiveEtsako WestofthecountrythanthosewholiveinUrbanareas.Olderage,male,occupation,donationsfrommobilesites,residentsofsemiurbanandruralsettingswerefoundtobestronglyassociatedwithsero-positivityofTreponemapallidum.Hence,strictdonorscreeningandtestingparticularlytakingtheabovefactorsintoconsiderationisstronglyrecommended.Datawasentered,cleanedandanalyzedusingSPSSversion23.LogisticregressionwasfittedtoidentifyfactorsassociatedwithcumulativeTTIspositivity,andforeachofthetrans-fusiontransmittableinfection.P value< 0.05 wasconsideredstatisticallysignificant.

TABLE OF CONTENTS

TITLE PAGE

APPROVAL PAGE

DEDICATION

ACKNOWLEDGEMENT

ABSTRACT

TABLE OF CONTENT

CHAPTER ONE

• INTRODUCTION
  • Background Of The study
  • Problem Statement
  • Aim/Objective Of The study
  • Significance of the study
  • Research Questions
  • Scope of the study

CHAPTER TWO

2.0     LITERATURE REVIEW

2.1      REVIEW OF THE STUDY

2.2      BLOOD TRANSFUSION

2.2.1  Purpose of Blood Transfusion

2.2.2  Blood Types

2.2.3  Types of Blood Transfusions

2.3      TRANSFUSION-TRANSMISSIBLE INFECTIONS IN BLOOD DONORS

2.4      TREPONEMA PALLIDIUM

2.4.1  Pathophysiology of Treponemapallidum

2.4.2  Laboratory identification of Treponemapallidum

2.4.3  Classification of Treponemapallidum

CHAPTER THREE

3.0     METHODSANDMATERIALS

3.1    Studysettingandsamplesize

3.2      Studydesign

3.3      Studypopulation

3.4      Laboratoryscreeningmethods

3.5      Datamanagementandanalysis

3.6      Ethicalclearance

CHAPTER FOUR

4.0      Results and discussion

4.1      Results

4.1.1  Socio-demographiccharacteristicsofstudyparticipants

4.1.2  Sero-prevalenceoftransfusiontransmissibleinfections

4.1.3  FactorsassociatedwithTTIs

4.2      Discussion

4.2.1  Sero-prevalence ofTreponemapallidum

4.2.2  FactorsassociatedwithTTIs

CHAPTER FIVE

5.0   Conclusion and Recommendation

ABBREVIATIONS AND THEIR MEANINGS

AOR:              Adjusted odds ratio

CI:                   Confidence interval

ELISA:            Enzyme linked immunosorbent assay

FPA:               False-positive antibodies

HBV:               Hepatitis B virus

HCV:               Hepatitis C virus

HIV:                Human immunodeficiency virus

NBTS: National blood transfusion service

NRS:               Northern red sea region

RD:                 Replacement donors

SPSS:              Statistical package for social services

SRS:                Southern red sea region

TPHA:            TreponemaPallidumHemoagglutination Assay

TTI:                 Transfusion transmitted infection

VNRBD:         Voluntary non-replacement blood donors

CHAPTER ONE

1.0                                                        INTRODUCTION

1.1                                           BACKGROUND OF THE STUDY

Blood transfusion has proven to be effective in saving millions of lives and has improved the wellbeing of many in need of blood transfusion. However, in developing countries, such as Nigeria, despite its advantage, unsafe blood transfusion is still a challenge (WHO, 2020). Although blood transfusion saves many lives, if unsafe, it could be source of transmission of infectious agents; like Treponemapallidum (Ozaras et al., 2020).

Treponemapallidum, formerly known as Spirochaetapallida, is a spirochaete bacterium with various subspecies that cause the diseases syphilis, bejel, and yaws. It is transmitted only among humans. It is a helically coiled microorganism usually 6–15 μm long and 0.1–0.2 μm wide (Ozaras et al., 2020).

Treponemapallidum is considered as global issue of health concern among people. The world Health Organization (WHO) estimated about one million people getting infected daily worldwide by one or more sexually transmitted diseases.1 Six millions of new cases of syphilis were determined annually among persons aged 15 to 49 years worldwide with high prevalence of fetal and neonatal deaths. Treponemapallidum is endemic in low income countries, but only occurs at low prevalence in middle and high income countries (Ozaras et al., 2020).

Treponemapallidum spirochetes transmitted via sexual intercourse, and congenitally, despite a refrigerated blood components are less infective for syphilis, transmissions through blood components still occur. Treponemapallidum is also transmitted through blood transfusion as shown by high antibodies detection in healthy African blood. Treponemapallidum prevalence among blood donors in sub-Saharan African countries varies (Tigabu et al., 2019).

In Sub-Saharan Africa (SSA), high prevalence of Treponemapallidum has been a challenge for more than three decades. Though the majority of treponemapallidum transmission is also transmitted through unsafe blood transfusion.  Independent studies conducted in different parts of the country revealed that, Treponemapallidum prevalence among blood donors ranges from 1.2% to 7.5% in Afirca (Bisetegen et al., 2016). Treponemapallidum can survive for several years at − 78 °C, in the blood from syphilis patients may still be infectious within 4 days storage at − 4 °C (Bisetegen et al., 2016). Syphilis and HIV affect similar patient groups and co-infection is common. The risk factors for blood donors infected with syphilis are also risk factors for other blood borne diseases (Liu et al., 2019). Screening for high-risk groups before blood donation currently depends entirely on pre-donation health consultation. They donate blood or need postpone and withdraw from blood donation depend to the report of blood donors on medical history and dangerous behavior (Liu et al., 2019). In fact, many blood donors did not earnestly fill out the “health status inquiry form of blood donors”, some of them did not understand the contents of the questionnaire and could not accurately fill out, or concerned about the privacy disclosure in the process of blood donation on a public environment. Moreover, the diversity of blood donation motives also made it impossible for some blood donors to report truthfully, resulting in some high-risk groups entering the blood donation process. For instance, some blood donors may not know that their behaviors are dangerous behaviors which are susceptible to transfusion diseases, or some blood donors who have the clear risky behaviors intentionally concealed to detect whether they are infected. In addition, some blood donors have not read the health checklist carefully in order to save time.

Blood donation in high-risk groups is a threat to blood safety. It is a matter of concern whether the high-risk group of blood donors is effectively excluded from the health consultation before blood donation. In order to optimize donor selection, a validated donor questionnaire should be used and confidentiality in all steps of donation. The possibility of a confidential self-exclusion should be explicitly pointed out to donors.

Studies conducted in Nigeria related to sero-prevalence of pathogens among blood donors are fragmented and done in a very few parts of the country, not national figures to represent prevalence in Nigeria.

1.2      STATEMENT OF THE PROBLEM

Blood donation is an important procedure that saves millions of lives. However, unsafe transfusion practices carry the risk of transfusion-transmissible infections (TTIs). An unsafe blood transfusion is very costly from both an economic and a human point of view, not only for the recipients themselves, but also for their families and their communities (Greinacher et al., 2017). Treponemapallidum (TP) is one of the infections that is transmitted through unsafe transfusion practices. Treponemapallidum is a chronic infection affecting an estimated 36 million people worldwide, with 11 million new cases occurring annually (Lafond  et al., 2016). This study shall be carried out to make a survey on the seroprevalence and risk factors on treponemapallidum among blood donors

AIM AND OBJECTIVES OF THE STUDY

The aim of this study is to assess magnitude of the sero-prevalence of Treponemapallidum, and associated factors among blood donors in Etsako West in Edo State. The objectives of the study are:

1. To determine the sero-prevalence of treponemapallidium among blood donors.
2. To study the mode of transmission of treponemapallidium

• To study the prevention of treponema palladium

1. To make a recommendation on improving screening and testing strategies at blood banks to ensure safety of blood recipients.

1.4      SIGNIFICANCE OF THE STUDY

This study will serve as a means of developing a strategy for prevention and treatment of treponemapallidum. The study will serve as a guide to policy makers in improving screening and testing strategies at blood banks to ensure safety of blood recipients.

1.5      RESEARCH QUESTIONS

This study will provide answers to the following questions:

1. What is the seroprevalence of treponemapallidum among blood donors in Etsako West in Edo State?
2. What is the prevalence of transfusion transmitted infections in blood donors?

• What are the preventive measures of treponema palladium

1.6      Scope of the study

In this study a retrospective cross-sectional study design was used to measure the prevalence of transfusion transmittable infections using data collected in fourteen blood bank facilities in Edo State General Hospital. Presence of Treponemapallidum infection was assessed using rapid plasma reagin (RPR). Records of blood donors were collected using a checklist from Central Blood Bank Laboratory (BBL) electronic database and reviewed. Data was entered, cleaned and analyzed using SPSS version 23. Logistic regression was fitted to identify factors associated with cumulative TTIs positivity, and for each of the transfusion transmittable infection. P value < 0.05 was considered statistically significant.

CHAPTER FIVE

Conclusion

The current magnitude of Transfusion Transmittable Infections (TTIs) in Etsako West in Edo State was conducted. Older age, male, occupation, donations from mobile sites, being resident in semiurbanandruralsettingwerefoundtobestronglyassociatedwithsero-positivityofatleastoneTTI.Hence,strictdonorscreeningandtestingparticularlytakingtheabovelistedfactorsintoconsiderationisstronglyrecommended. However, the Treponemapallidum antibody-positive rate of blood donors is associated with age, educational level, and times of blood donation. Therefore, developing a strategy according to these factors will help to improve blood safety.

Recommendations

Non-specific assays such as Venereal Diseases Research Laboratory (VDRL)and rapid plasma reagin (RPR) tests identify those individuals who may have been more recently infected. They detect antibodies to cardiolipin or lipoidalantigen (reagin); the plasma levels of these antibodies rise significantly in active infection due to the cellular damage. The use of non-specific assays is of most value in diagnostic testing where it can be used to identify recently infected individuals.

When the incidence and prevalence of syphilis in the blood donor populationare high and cannot be reduced through donor selection strategies, it may be necessary to consider screening using a non-treponemal assay (e.g. VDRL or RPR)to identify only the highest-risk donors – those with evidence of recent infections.

For routine screening, however, this strategy carries a high risk of false negative results as the sensitivity of these assays is lower than specific assays and the test results may not always be positive, even when the infection is recent.

To minimize the risk of syphilis infection through the route of transfusion:

1 Screening should be performed using a highly sensitive and specific test for treponemal antibodies: either TPHA or enzymeimmunoassay.

2 In populations where there is a high incidence of syphilis, screening should be performed using a non-treponemal assay: VDRL or RPR.