Assessing the risk of Leishmaniasis to blood transfusion in Ethiopia with the support of ISBT I TRY IT program

¹Quality Assurance and Safety, Ethiopian Blood and Tissue Bank Service, Addis Ababa, Ethiopia, ²Director, Vitalant Research Institute, San Francisco, California, United States, ³Operations Testing Senior Manager, South African National Blood Service, Johannesburg, South Africa

Background: Leishmaniasis is a disease caused by a protozoa parasite, transmitted by sandflies, is endemic in parts of Ethiopia. Studies across the world show asymptomatic infection in blood donors, and there is risk of transfusion transmission. However, the prevalence among asymptomatic blood donors in different areas of Ethiopia is unknown. This assessment was thus conducted with the support of the ISBT I TRY IT program. The research protocol was developed as part of the ISBT I TRY 2020 program and financial assistance was provided by the ISBT office to conduct the study.

Aims: To determine if blood bank location in endemic versus non-endemic areas is associated with Leishmania infection prevalence among blood donors in Ethiopia.

Methods: A cross-sectional study was conducted among 438 blood donors at blood banks in Metema (endemic area) and Addis Ababa (non-endemic area). The study compared 219 blood donors from each location. Leishmania tests were performed on blood donor samples, using the SERION ELISA classic Leishmania IgG testing Kits. Donor demographic and transfusion data were analyzed by statistical software (Stata). Leishmania prevalence was compared between groups and logistic regression used to calculate adjusted odds ratio. Significance was defined as p < 0.05.

Results: The overall prevalence of Leishmania infection was 3.2% (14/438). The prevalence of Leishmania infection was significantly higher among blood donors from the endemic area Metema (5.48%, 12/219) compared to the non-endemic area Addis Ababa (0.91%, 2/219) (Fisher's exact test p = 0.006). The odds of Leishmania infection were 6.3 times higher among blood donors from Metema compared to Addis Ababa (OR 6.3, 95% CI 1.4–28.4, p = 0.017). The prevalence was 2.13% (4/188) among males and 4.0% (10/250) among females (OR 1.92, 95% CI 0.59–6.21, p = 0.278). The prevalence was 3.93% among new people versus 0.93% among repeat donors (p = 0.106); and ranged from 0% to 4.27% across the age groups (p = 0.510). Based on these results it can be observed that no significant associations were found with donor age, sex, blood type or between new and repeat donors.

Summary/Conclusion: Blood donors from centers in Leishmania endemic areas have markedly higher infection prevalence compared to non-endemic regions, indicating location is a key risk factor. Screening blood units from endemic areas could identify positives and reduce potential transfusion-transmitted infections. Further well-powered studies are warranted to determine the most appropriate methods to safeguard blood supply safety in such areas.

The successful completion of this study illustrates the significance of the ISBT I TRY program to enhance the capacity of young professionals to conduct research in the field of blood transfusion and answer important questions in their setting.