PREVALENCE OF MALARIA PARASITE IN DONATED BLOOD AT

PREVALENCE OF MALARIA PARASITE IN DONATED BLOOD AT NAKASERO BLOOD BANK, UGANDA Authors Mr. Ronald Ayikobua 1, Dr. Patrick Vudriko 2, Mr. Ezra Musisi 3 1 Laboratory scientist Nakasero Blood Bank-Uganda E-mail: yobboa@yahoo. co. uk 2 Lecturer in the Department of Veterinary Pharmacy, Clinics and Comparative Medicine College Of Veterinary Medicine, Animal Resource and Bio-security Makerere University E-mail: vpato 2009@gmail. com, vpato@covab. mak. ac. ug, 3 Senior Laboratory Technologist/ Supervisor Nakasero Blood Bank-Uganda E-mail: ezra. musisi@yahoo. com

Abstract Contamination of donated blood with malaria is a significant health problem facing humanity. This study determined the prevalence of malaria parasites in donated blood at Nakasero Blood Bank. Both thin and thick glass stained blood smears of 417 blood samples were examined using microscope. Of the 417 donated blood samples 17 (4. 1%) tested positive for malaria parasite. Although there was no significant difference in occurrence of Plasmodium in relation to sex, age, blood group (P>0. 05), majority of the blood donors that tested positive belonged to blood group O (5. 1%)However the relatively low prevalence of malaria parasite in the blood donors does not rule out the transmission of the malaria parasite to recipient during blood transfusion since the presence of plasmodium can be fatal to children especially under five years, pregnant women and Immuno suppressed individual as seen in cancer and HIV patients and this calls for the ministry of health to review guidelines for screening donor blood for malaria parasite before transfusion More so the Uganda Blood Transfusion Service should include malaria screening test among the tests done in the blood banks.

Introduction • Infectivity of donated blood with malaria is a significant health problem facing humanity. In Uganda, screening for malaria parasite is neither routinely done in blood banks, nor stipulated in the current Uganda National Blood Transfusion Service (UBTS) Guidelines by the Ministry of Health. As a result, the proportion of donated blood that is infected with malaria is largely unknown. Malaria infection places more than half of the world’s population at risk and in majority of the tropical and sub-tropical regions of the world and about 300 to 500 million cases and 2 to 3 million death occur per year. • However the study aimed at determining the prevalence of malaria parasites in donated blood at Nakasero Blood bank, Kampala, Uganda

Objectives and significance of the study • • General objective To determine the prevalence of malaria parasite in donated transfusion blood at Nakasero blood bank. Specific objectives To determine the prevalence of malaria parasite in donated transfusion blood at Nakasero blood bank. To determine the most common Plasmodium species in donated transfusion blood at Nakasero blood bank. Significance of the study Blood transfusion is a very important procedure in saving lives of patients who are in critical conditions. However a disease like malaria that is infectious and fatal can be transmitted through transfusion and therefore the information generated will be used by the Ministry of Health and the government of Uganda to set up policies and strategies on screening blood for malaria parasite by the Uganda blood transfusion service.

Research methods • Study design • • A cross sectional study was carried out among 417 randomly selected donated blood samples at Nakasero blood bank, Kampala between June and August 2014 Study site The study was conducted from June to August 2014 at Nakasero Blood Bank Laboratory investigations About two millilitres of whole blood was collected into ethylene diamine tetra-acetic acid (EDTA) anti-coagulated tubes. Thick and thin blood smears were prepared according to the procedures outlined by cheesbrough on new glass slides and stained using Giemsa stain.

Research methods; contn • Data management and analysis The results were presented as frequency tables and charts and further analysis was done using statistical package for social sciences (SPSS) and Ms excel. • Quality control The slides were well labeled, re-examining the slides by the second laboratory technician. • Ethical consideration Authorization was obtained from the research committee Uganda Blood Transfusion Service. The results were handled with maximum privacy and confidentiality throughout the study. The findings were disseminated to the Ministry of Health, Uganda Blood Transfusion Services and the academic community.

Results • Demographic characteristics of the blood donors Of the 417 donated blood, majority (67. 87%) were from males and only 32. 12% were from females. Most (64. 3%) of the participants were in the age group of 17 – 20 while the least (0. 72%) age group were those above 50. Majority of the donated blood was from blood group O donors (51. 8%), followed by group A (23. 98%) and blood group B- donors being the least (Table 1).

Table 1: Distribution of blood donors in relation to the demographic characteristics Variables Characteristics Frequency % Frequency sex Male 283 67. 87 Female 134 32. 12 17 -20 268 64. 30 21 -30 109 26. 10 31 – 40 41 9. 83 41 -50 13 3. 12 3 0. 72 A+ 100 23. 98 B+ 91 21. 82 B- 1 0. 24 O+ 216 51. 80 O- 2 0. 48 AB+ 7 1. 68 Age 50 > Blood groups n=417

The prevalence of malaria parasite in donated transfusion blood 4. 1% Negative 95. 9% Positive

Table 2: Distribution of malaria parasite in relation to the demographic characteristics of the donors Variables Sex Age Characteristics n=417 Frequency Positive %Positive Male 274 9 2. 20 Female 126 8 1. 92 17 -20 244 12 70. 60 21 -30 103 3 17. 65 31 – 40 39 1 5. 88 41 -50 11 1 5. 88 3 0 0. 00 A+ 95 5 29. 41 B+ 90 1 5. 88 B- 1 0 0. 00 O+ 205 11 64. 71 O- 2 0 0. 00 AB+ 7 0 0. 00 50 > Blood groups Negative 17/417 (positive) P-value 0. 233 0. 685 0. 964

The common plasmodium species in the donated blood • P. falciparum was the only prevailing (100%) species in the donated blood samples; P. ovale, P. malariae, and P. vivax were not detected. •

Discussion • This study showed low prevalence (4. 1%) of malaria parasite in blood donated at Nakasero blood bank. Which is low compared to 28% reported by Agboola et al. , (2010) in Lagos, Nigeria. The low prevalence of Plasmodium infection in this study may be attributed to the dry period during which the study was done. Abdullah et al. , (2009) also reported that Malaria infestation in any population could vary by seasons and is particularly higher during the rainny season and lower during dry seasons. The presence of malaria parasite in the donor blood would possibly be due to asymptomatic malaria parasitaemia in the donors. • High prevalence of malaria parasite was seen in blood group O compared to the rest. This may be attributed to the fact that majority of the donated blood were from group O donors and this further explains why majority of the blood that tested positive were from blood group

Discussion • • • There was no significant statistical difference (P>0. 05) in the prevalence of malaria infection with age. This suggests that there is no relationship between age and presence of malaria parasite in the donors. However, the high prevalence of malaria parasite among donors aged 17 – 20 is due to the same age group being the dominant donors during the study. Equally this low prevalence could not in actual fact stop blood recipients from getting infected with the malaria parasite. Jeffery Mc. Cullough, (2005), reported that malarial parasites have been largely found in platelets of infected individuals. Moreover the presence of Plasmodium species in blood and its products may lead to fatalities when the blood is transfused especially into children under 5 years, pregnant women, and Immuno-suppressed patients as seen in cancer and HIV patients as stated by Hung et al. , (1994) Plasmodium falciparum (100%) was the sole species found in donated blood as compared to other species Inspite of the presence of malaria parasite in donated blood currently, Uganda has no guidelines on screening for malaria parasites in donated blood.

Conclusion and Recommendations • • In conclusion, there was low infection of transfusion blood with malaria parasite. Regardless of the prevalence, the presence of Plasmodium falciparum in donate blood from donors that were presumed to be healthy raises a serious concern on the safety of donated blood in Uganda. The Ministry of Health should review the existing guidelines for screening malaria and mandatory universal donor screening policy for malaria, for exclusion of blood donors with plasmodia parasitaemia to further enhance blood safety in our communities. The ministry should initiate pathogen de-activation techniques for blood to substitute the tedious microscopic screening for malaria. There is need to carry out a study during rainy seasons when malaria infestation is high.

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