Objectives: The aim of this study is to determine the prevalence of HIV among blood donors in Juba Teaching Hospital Blood Bank, South Sudan in 2013.Method and Materials: This is a retrospective study that involved the abstraction of data from registers at the blood bank. Data were collected onto data sheets and entered into a computer database. Statistical analysis was performed using SPSS Version 20 Software. A p value of &lt;0.05 was considered statistically significant.Results: Out of 1095 blood donors, 1074 (98.1%) were males and 21 (1.9%) were females. The mean age and the range for the whole group was 29+7.16 (15-69) yrs. The prevalence of HIV was higher among males than females 85 (7.9%) vs 1 (4.8%) respectively but this was not statistical significant (p=0.6). The 20 to 29 year age group had the highest prevalence of 49 (57%) with no statistical significance (p=0.3). The prevalence of HIV was 7. % (86) and there were co-infections between HIV and HBV, HCV and syphilis of14 (50%), 5 (18%), 9 (32%) with p=0.7, p=0.1, p=0.8 respectively. Blood group O positive had the highest percentage 58.1 % (n=50) and was the commonest group.Conclusion: In this study, HIV prevalence is very high among blood donors at the Juba Teaching Hospital blood bank

Abraham, Isaac W.

Alex, Loboro J.

Gore, Rose P.

Jack, Kwoji R.

Jaja, Salvador

Lino, Emmanuel Oryem

Loro, Richard L.

Seriano, Opiaka A.

Seriano, Oromo F.

Sube, Kenneth L.L.

Wani, Samuel N.

English

AJOL - African Journals Online

South Sudan Medical Journal                                                                                         Vol 7. No 4. November 2014 orIgINAL rESEArCH76Prevalence of HIV among blood donors at Juba Teaching Hospital Blood Bank, South SudanKenneth L L Subea, Oromo F Serianoa, Rose P Gorea, Salvador Jajaa, Richard L Lorob, Emmanuel  Oryem Linob, Opiaka A Serianoc, Samuel N Wania, Loboro J Alexa, Kwoji R Jacka, and Isaac W Abrahamaa. College of Medicine, University of Juba, South Sudan.b. National Ministry of Health, South Sudan.c. Private diagnostic laboratoryCorrespondence: Kenneth Sube kennethsube@yahoo.com BackgroundSince the first reported cases in 1981, HIV remains one of  the most serious health and developmental challenges worldwide [1]. HIV is one of  the most frequently recorded transfusion-transmissible infections (TTIs) [2]. HIV screening among blood donors is therefore a key safety issue in addition to screening for other TTIs such as HBV, HCV and syphilis. According to the World Health Organization (WHO) guidelines screening of  all blood for TTIs should be mandatory [3]. As a result, there is reduction in TTIs in countries where routine serological screening of  donors is carried out [4].The prevalence rate of  HIV among blood donors differs between countries and regions depending on several factors such as the general HIV prevalence, education of  the public regarding blood donation, the selection of  donors and pre-donation screening [3]. As a result in high income countries, the prevalence of  HIV among blood donors is as low as 0.001% while in low income countries it may be higher than 0.5%.AbstractObjectivesThe aim of  this study is to determine the prevalence of  HIV among blood donors in Juba Teaching Hospital Blood Bank, South Sudan in 2013.Method and MaterialsThis is a retrospective study that involved the abstraction of  data from registers at the blood bank. Data were collected onto data sheets and entered into a computer database. Statistical analysis was performed using SPSS Version 20 Software. A p value of  <0.05 was considered statistically significant.ResultsOut of  1095 blood donors, 1074 (98.1%) were males and 21 (1.9%) were females. The mean age and the range for the whole group was 29+7.16 (15-69) yrs. The prevalence of  HIV was higher among males than females 85 (7.9%) vs 1 (4.8%) respectively but this was not statistical significant (p=0.6). The 20 to 29 year age group had the highest prevalence of  49 (57%) with no statistical significance (p=0.3). The prevalence of  HIV was 7. % (86) and there were co-infections between HIV and HBV, HCV and syphilis of14 (50%), 5 (18%), 9 (32%) with p=0.7, p=0.1, p=0.8 respectively. Blood group O positive had the highest percentage 58.1 % (n=50) and was the commonest group. ConclusionIn this study, HIV prevalence is very high among blood donors at the Juba Teaching Hospital blood bank.The Republic of  South Sudan has emerged from war in the past 9 years. These were years of  isolation, but with the advent of  peace there is a great movement of  people between South Sudan and neighbouring countries and within South Sudan. Countries bordering South Sudan, such as Kenya, Uganda and the Democratic Republic of  Congo, have high HIV prevalence rates of  6.3%, 6.5% and1.6% respectively [5]. These high rates and the movement of  people is likely to fuel the HIV/AIDS epidemic in South Sudan, and the impact is likely to be felt most in Juba.Juba Teaching Hospital is a tertiary referral hospital with 500 beds and this is where the main blood bank has been located until July 2014 when the National Blood Bank was inaugurated. This provides services for the whole country. We searched the literature and could not find any information on the prevalence of  HIV among blood donors in the Republic of  South Sudan.The aim of  this study was to determine the prevalence of  HIV among blood donors in Juba Teaching Hospital  Vol 7. No 4. November 2014                                South Sudan Medical  Journal 77orIgINAL rESEArCHBlood Bank.Method and materialsThis is a retrospective study involving analysis of  blood donors’ records in the blood bank of  Juba Teaching Hospital from June to August 2013. These two months were randomly selected from the twelve months of  the year.From the records  demographic data (age and sex), transfusion transmissible infections test results (HIV+ve/-ve, HBsAg+ve/-ve, HCV+ve/-ve, and syphilis serology +ve/-ve) and blood group results (A, B, AB, O and Rhesus +ve/-ve) of  the donors were abstracted. HIV, HBsAg, HCV and VDRL/Syphilis were tested using Uni-Gold (Trinity Biotech Plc-Ireland), HBsAg (Cypress diagnostic-Belgium) dipstick,  Anti-HCV (Cypress diagnostic-Belgium) dipstick, and VDRL (Cypress diagnostic-Belgium) dipstick respectively. Anti-sera (Cypress diagnostic-Belgium) was used to identify respective blood groups. Out of  1195 blood donors, only 1079 had a complete set of  variables in the records, and so were included in the analysis.Ethical clearance was obtained from the Ethical Committee of  the National Ministry of  Health.Data were collected onto data sheets and then entered into a computer database. Statistical analysis was performed using SPSS Version 20 Software. A p-value of  <0.05 was considered statistically significant. Descriptive statistics were used to summarize the data in the form of  means, medians, standard deviation and frequencies. Results are displayed in tables and a pie chart. Chi-square test was used to determine associations of  categorical variables. A p-value <0.05 is regarded as statistically significant.ResultsOf  the 1095 blood donors in this study, 1074 (98.1%) were males and 21 (1.9%) females. The mean age for the range for the whole group was 29+7.16 (15-69) years: for males it was 29.1+7.18 (15-69) years while for females it was 26.9+5.79 (18-45) years.The prevalence of  HIV in males was 85/1074 (7.9%) and in females 1/21 (4.8%), p=0.6 with the age group 20-29 years with highest prevalence (4.5%) - see Table 1. In the sub-population with TTIs there were 86/420 (20%) HIV+ve, 195/420 (47%) HBsAg+ve, 34/420 (8%) HCV+ve, and 105/420 (25%) VDRL+ve blood donors as illustrated in Table 2 and Figure 1. Age Group (Years) TotalHIV positive <19 20-29 30-39 40-49p-Value 5 (0.5%)49 (4.5%)24 (2.2%)8 (0.7%)86 (7.9%)0.9Table 1. Distribution of HIV status (number and %) by age groups of blood donorsTable 2. Distribution of  TTIs by sex  among blood  donorsHIV +ve HBsAg+ve HCV+ve VDRL+ve TotalMale 85(99%)193(99%)34(100%)102(97%)414Female 1(1%) 2(1%) 0 3(3%) 6Total 86 195 34 105 420Figure 1. Distribution (percent) of HIV, HBV, HCV and syphilis among blood donorsTable 3. Distribution of blood groups among  blood donorsBlood group Frequency Percentage (%)A+ve 270 24.7A-Ve 2 0.2B+Ve 179 16.3B-Ve 0 0AB+Ve 21 1.9AB-Ve 0 0O+Ve 614 56.1O-Ve 9 0.8South Sudan Medical Journal                                                                                         Vol 7. No 4. November 2014 orIgINAL rESEArCH78Among the blood groups of  the donors, blood group O positive had the highest  percentage in the whole population (n=614; 56.1%) - see Table 3 - and  of  those infected with HIV (n=50; 58.1%) and the least were O negative with (n=0) with p=0.7 as shown in Table 4. There was no A negative, B negative and AB negative among the blood donors. There were co-infections between HIV and HBV, HCV and syphilis of  14 (50%), 5 (18%) and 9 (32%) with p-values of  0.7, 0.1, 0.8 respectively.DiscussionThe first case of  HIV/AIDS in the Republic of  Sudan was reported in 1986 before the independence of  South Sudan. The Sudan National AIDS Control Programme (SNAP) was established in 1987 [6]. While the demand for blood products will continue to be high because of  the need of  blood in surgical, obsterical, medical and other conditions, HIV poses an immense challenge to transfusion medicine in regions of  the world where the quality of  blood can not be garanteed. Hence for the safety of  blood and its products, strategies to select appropriate blood donors are imporant and all donated blood should be tested for HIV and other transfusion transmissible infections.The prevalence of  HIV among  blood donors in this study was 7.9%  which is very high. This is higher than studies conducted in Nigeria which report HIV prevalence rates ranging from 0.45% to 7.7% [7]. Also studies conducted in Ethiopia show levels between 3.5% to 5% as reported by Ethiopian Federal Ministry of  Health. Other studies in Ethiopia have however reported very high prevalence rates of  16.7% [8], 10.6% and 11.9% [9]. In Ghana a prevalence rate of  3.5% [10] has been reported. The prevalence of  HIV is high in South Sudan mainly because most, if  not all, blood donors are family replacement donors rathar than voluntary donors. Schneiber and Busch 1996 [11] assert that commercially remunerated blood and family replacement blood donation are more likely to transmit TTIs than voluntary donors. Indeed the majority of  blood donors in sub-Saharan Africa are family  replacement donors who have a higher risk for TTIs [12, 13].In this study there were fewer female blood  donors than male donors. Other African studies have shown low female blood donor percentage [14, 15]. This observation has also been reported in many studies done in Asia [16]. Low blood donation by women is attributed to cultural beliefs in South Sudan that women should not donate blood because of  the monthly blood loss that occurs during menses. Hence the few who donate blood are those forced to do so when male relatives or friends are not available to donate blood for relatives requiring blood products. There is no scientific basis for this belief, so potential female blood donors should be encouraged to donate blood. This can be achieved by increasing public awareness through the mass media, civil societies, community based organizations, religious leaders, community leaders, women groups, etc. The recruitment and training of  more female staff  will also encourage more women to come forward and donate blood.In this study HIV contributes 20% (86) of  all TTIs. This percentage is a higher than in the study by Azene et al in Ethiopia who reported the contribution of  HIV to all TTIs to be 11.7%. The most affected age group was the 20-29 years group (n=49, 57%) of  all HIV positive donors, although this was not satistically significant (p=0.9). This is similar to an Ethiopian study where 58.2% of  HIV positive blood donors were in the  20-29 years age group [17]. The difference with our study is that it was much larger and covered a period of  4 years.Co-infection between HIV and the other TTIs does occur since they have the same mode of  transmission namely: sexual intercourse, mother to child, and blood transfusion. Barth et al [18] noted that the prevalence rates of  HBsAg+ve and HCV+ve among HIV positive donors were 15% and 7% respectively. These figures are less than in our study (50% and 18%) which may be due to the fact that our sample size is smaller.Even though blood group O positive is the most infected and commonest blood group, statistically, it is not significant (p=0.7). This may be due to blood group O being a universal donor and so is easily used as a replacement donor. RecommendationsIn consideration of  the results of  this study, we Table 4. Distribution of HIV status by blood groups of blood donors.Blood Groups TotalA+Ve A-Ve B+Ve B-Ve AB+Ve AB-Ve O+Ve O-VeHIV Positive18 (21%) 0(0%) 15 (17.4%) 0(0%) 3 (3.5%) 0(0%) 50 (58.1%) 0 (0%) 86 (100%)HIV Negative252(25%) 2(0.2%) 165(16.4%) 0(0%) 18(1.8%) 0(0%) 563(55.8%) 9(0.9%) 1009Total 270 2 180 0 21 0 613 9 1095p-Value 0.7 Vol 7. No 4. November 2014                                South Sudan Medical  Journal 79orIgINAL rESEArCHrecommend strenghtening of  the health system as well as increasing public awareness towards encouraging more voluntary donors than family replacements. Health Education should focus on changing sexual behaviours of  youth so as to have an impact in reducing   prevalence of  HIV among blood donors.A study is needed to determine the distribution of  blood groups among the population. There is a need to monitor the trends in the prevalence of  HIV and other TTIs among blood donors over time and to institute strategies to reduce these infections.Limitations of the studyData were collected during only 2 months in the year, 1. and from only one blood bank.There were no data on the selection of  donors 2. (presumed to be family replacement donors) or their level of  education. AcknowledgementsWe are grateful to the director of  Juba Teaching Hospital, Dr Wani Lolik, for allowing us to conduct this study at the hospital, and to the director of  Laboratories, Mr Charles Mazinga and his colleagues for permitting us to collect data from the blood bank registration book.Conflicts of interestNone.ContributorsAll members participated and contributed equally in this research varying from literature review, questionnaire design, data collection, entry and statistical analysis, and typing, discussing and reviewing the manuscript.References UNAIDS The Global HIV/AIDS Epidemic. August 1. 2014. Fact Sheet http://www.unaids.org/en/resources/campaigns/globalreport2013/factsheet Lange JM, Van den Berg H, Dooren LJ, Vossen LM, Kuis 2. W, Goudsmit J. HTLV III/LAV infection in nine children infected with a single plasma donor: clinical outcomes and recognition patterns of  viral proteins. J Infect Dis 1986 154:171-4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3284103 World Health Organization. Screening donated blood for 3. transfusion-transmissible infections: recommendations. Geneva: WHO. 2009. http://www.ncbi.nlm.nih.gov/books/NBK142990 Chiavetta JA, Escobar M, Newman A, He Y et al. Incidence 4. and estimated rates of  residual risk for HIV, hepatitis C, hepatitis B and human T-cell lymphotropic viruses in blood donors in Canada, 1990–2000.  Canadian Med. Assoc. J . Oct 14, 2003; 169(8): 767-773. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC203278/pdf/20031014s00018p767.pdf  UNAIDS. HIV/AIDS in Sub-Saharan Africa, Country 5. Statistics, revised January 2012/Fact Sheet(Accessed on12/7/2014):  UNAIDS (www.unaids.org/en/regionscountries/countries)Sudan National AIDS Council, Republic of  Sudan. n.d. 6. National strategic plan and sectoral plans on HIV/AIDS, 2004-2009. http://www.fmoh.gov.sd/English/St_Plan/doc/strategic%20plan%20and%20sectoral%20plans%20on%20HIV-AIDS.pdf   Aleruchi O, Peterside NF, Ezekoye CC.  Seroprevalence Of  7. HIV Infection among Blood Donors At The University Of  Port Harcourt Teaching Hospital, Rivers State, Nigeria: Global Journal for Biology, Agriculture and Health Sciences 2014. (2):1-7  http://www.gifre.org/admin/papers/gjbahs/1-7-HIV%20-vol-3-2-gjbahs.pdf  Rahlenbeck SI, Yohannes G, Molla K, Reifen R, Assefa A. 8. Infection with HIV, syphilis and hepatitis B in Ethiopia: a survey in blood donors. Int J STD AIDS. 1997. 8(4):261-4.(PubMed)Assefa A, Rahlenbeck S, Molla K, Alemu S. Seroprevalence 9. of  HIV-1 and syphilis antibodies in Gondar, Ethiopia, 1989-1993.  Acquir Immune Defic Syndr. 1994. 7(12):1282-5. (PubMed)Ampofo W, Nii-Trebi N, Ansah J, Abe K, Naito H, Aidoo 10. S, Nuvor V, Brandful J, Yamamoto N, Ofori-Adjei D, Ishikawa K. Prevalence of  Bloodborne infectious Diseases in blood donors in Ghana. J Clin Microbiol 2002. 40:3523-5(Pubmed) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC130790/pdf/0732.pdf  Schneiber GB, Busch M. The risk of  transfusion 11. transmitted viral infection. N. Engl. J. Med. 1996. 334 (1685). http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=518 Moore A, 1Guillermo H, Nyamongo J, 12. et al. Estimated risk of  HIV transmission through blood transfusion in Kenya. Lancet; 2001. 358:657–660  http://www.ammtac.org/data/images/fckeditor/file/Blood%20donors%20in%20Kenya.pdf   Bates I, Mnyasi G, Medina A. Reducing replacement donors 13. in Africa: challenges and affordability. Transfus Med; 2007. 17(6):434–442. http://www.ammtac.org/data/images/fckeditor/file/Blood%20donors%20in%20Kenya.pdf  Dessie A, Abera B, Wale F. Seroprevalence of  major blood-14. borne infections among blood donors at Felege Hiwot referral hospital, northwest Ethiopia. Ethiop J Health Dev; 2007. 21(1):68-69 http://ejhd.uib.no/ejhd-v21-n1/68_69_EJHD_Vol_21-168_69_EJHD_Vol_21-1.pdfSouth Sudan Medical Journal                                                                                         Vol 7. No 4. November 2014 80Tessema B, Yismaw G , Kassu A 15. et al.  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. BMC Infectious Diseases. 2010. 10:111  http://www.biomedcentral.com/1471-2334/10/111Rao P, Annapurna K. HIV status of  blood donors and 16. patients admitted in KEM hospital Pune. Indian J Hemat. Blood Transf.; 1994. 12: 174-6. http://rossscience.org/ARTICLE/OJHMT-3-1.php  orIgINAL rESEArCHGezahegn M, Kifle Woldemichael K, Ameyu Godesso A. 17. HIV Sero- Prevalence Trend among Blood Donorsin Jimma University Specialized Hospital, Southwest Ethiopia. Ethiop J Health Sci. 2012. 22 (1). http://www.ajol.info/index.php/ejhs/article/viewFile/77676/68105  Barth RE, Huijgen Q, Taljaard J, Hoepelman AIM. 18. 2010. Hepatitis B/C and HIV in sub-Saharan Africa: an association between highly prevalent infectious diseases. A systematic review and meta-analysis. Int J of  Inf. Dis. 14 (12):e1024–e1031. (PubMed).12 Dr. Margaret Betty Eyobo Member 13 Dr. Victoria Stephen Majur Member 14 Dr. Emmanuel Oryem Lino Member 15 Dr. Benjamin Malek   Member 16 Dr. Buchay Othom Rago Member 17 Dr. Santino Lino  Member 18 Dr. Cain Jacob   Member The South Sudan General Medical Council is an important regulatory body that will ensure proper conduct of  business in the health sector. With the council operational, the current illegal involvement of  non-qualified personnel and malpractices in the sector will be brought to an end. Those who are qualified to do the business in the sector will do that comfortably within the approved norms and regulations governing the sector. I would like to take this opportunity to congratulate the chairperson, his deputy and all the members of  the Medical Council for the trust bestowed upon them by H.E President Salva Kiir and the entire cabinet. Together we can build a very strong health sector that our people deserve. Yours Sincerely,Dr. Riek Gai KokMinister for Health Republic of  South Sudan South Sudan Forms the general Medical Council Press Release from the Ministry of  HealthOn my own behalf  and on behalf  of  my colleagues in both the public and private health sector, I am pleased to inform all of  you that the Council of  Ministers has unanimously endorsed the formation of  the South Sudan General Medical Council, as per the Provisional Order, 2014 for the formation of  the council.The Council of  Ministers has endorsed the nominees for the General Medical Council as indicated in the following table: S/N Name     Position 1 Prof. John Adwok Adieng  Chairperson 2 Prof. Mayen Machut Aciek  Deputy3 Dr. Anthony Lupai Simon  Member 4 Dr. Dario Kuron Lado  Member 5 Dr. Peter Adwok Otto  Member 6 Dr. Jino David Ladu  Member 7 Dr. Rose Ajak Costa  Member 8 Dr. James Vacilli   Member 9 Dr. Mabior M. Deng   Member 10 Dr. Edward Luka   Member 11 Dr. John Pasquale Rumunu Member

Prevalence of HIV among blood donors at Juba Teaching Hospital Blood Bank, South Sudan

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Prevalence of HIV among blood donors at Juba Teaching Hospital Blood Bank, South Sudan

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