A systematic review and meta-analysis of the risk of transfusion transmitted malaria from blood donors in sub-Saharan Africa Dr Selali Fiamanya University of Oxford Centre for Tropical Medicine and Global Health; WorldWide Antimalarial Resistance Network (WWARN) United Kingdom Introduction: Transfusion transmitted malaria (TTM) is a major component of global transfusion transmitted infections, however estimates of its incidence are scarce. It is important as it may increase the morbidity and mortality of blood donation recipients, the majority of whom are young children and pregnant women who are often anaemic or suffering from other co-morbidities. It may also jeopardise global malaria elimination efforts by acting as a reservoir for subclinical parasite transmission. This systematic review aims to assess the current prevalence of Plasmodium parasite carriage in blood donors in high-endemic regions in sub-Saharan Africa and to provide estimates of spatial and temporal heterogeneity of TTM risk across Africa. Methods: Publication databases and clinical trial registries were searched for articles reporting prevalence studies of malaria parasitaemia amongst blood donors in sub-Saharan Africa (SSA) published between 2000 and 2017. Grey literature sources such as the World Health Organization (WHO) website and individual countries ministry of health websites were searched for published reports, and reference lists of papers were also screened. Risk of Bias was assessed using the Joanna Briggs Institute Prevalence Critical Appraisal Tool. Results: Twenty six studies were included in the meta-analysis (22,508 subjects). This included two studies each from Northern, Eastern and Middle Africa and fourteen studies from Western Africa. Pooled prevalence of malaria parasitaemia was 23.46% (95%CI: 19.74% 27.19%), ranging from 0.00% to 74.15%. Discussion and Conclusions: 2 Prevalence of blood donors carrying Plasmodium remains high in SSA, with large variability between regions. As transmission and immunity wane in Africa this prevalence will likely decrease but the severity of TTM will likely increase, thereby posing a potentially serious threat to recipients, and possibly interfering with elimination efforts.
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