FREQUENCY OF HBV, HCV, HIV AND SYPHILIS IN BLOOD DONORS AT BLOOD BANK IN BAHAWAL VICTORIA HOSPITAL, BAHAWALPUR

Dr.Iftikhar Ahmed, Dr.Yumna khan, Dr.Tehreem Fatima,Dr.Muhammad Afzal Randhawa, Dr.Naila Shabbir and Dr.Aamra Saeed. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 22 February 2019 Final Accepted: 24 March 2019 Published: April 2019


ISSN: 2320-5407
Int. J. Adv. Res. 7(4), 1259-1273 1260 costly from economic point of view. The blood transfusion services often struggle against competing demands for increasingly restricted resources and have remained a low priority within health care budgets so far.
Blood is one of the major sources of transmission of hepatitis B, hepatitis C, HIV and Syphilis. In Pakistan more than 1.5 million pints of blood are collected each year 3 . Out of these about 65% is from replacement donors, 25% from volunteer donors and about 10% from professional donors 4

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Blood component transfusion is a potentially important source for the transmission of blood borne infections. Careful selection and screening of blood donors are crucial strategies to reduce this risk. Data from screening may serve as an important source of information about prevalence of various infectious pathogens in the blood donor population and to some extent in the general population. Globally, transfusion of contaminated blood causes up to 16 million new infections with hepatitis B, and 5 million new infections with hepatitis C every year 5 .With each blood unit transfused, there is always a 1% likelihood of transfusion-linked risks including transfusion-transmitted infection 6 . Screening for transfusion-transmitted infections(TTIs) is a critical part of blood transfusion process as it ensures that transfusion is as safe as possible.
Blood-borne transmission remains a key vector of the Hepatitis B and C infections in Pakistan, affecting about 7.4% of the population 7 . The frequency of HIV and syphilis is low but High Risk Group (HRGs) have shown a higher prevalence rate for syphilis 8 and HIV/AIDS 9 .
International statistics show the prevalence of HBV, HCV, HIV and syphilis in blood donors to be 2.35%, 0.79%, 0.145 and 0.34% respectively 10 . While the national statistics of prevalence of HBV, HCV, HIV and syphilis in blood donors are 8.34%, 3.91%, 0% and 0.89% respectively 11 . In developing countries lack of resources for universal and effective screening of blood donors is still a major source of transmission of infections in the recipients. The health care system for blood transfusion in Pakistan is weak and as it does not offer any record management for donors. Proper administrative structure for the blood transfusion exists only in Punjab 12 . Because of the increasing incidence of transfusion-transmitted infections, it is realized that it is the need of the hour to establish an efficient safe blood transfusion programme. So, safe blood transfusion programme is initiated under the Punjab safe blood transfusion Act 1999. Punjab safe blood transfusion authority (PBTA) comprises of Director-General Health, Additional Health Secretory, One member from Provincial Assembly and one member from Armed forces. The aims of the Punjab blood transfusion authority are, first, establishment of blood transfusion and screening centers in all the big hospitals of Punjab. These are not autonomous but regulated bodies and consists of technical experts, law officers, public health officers and trained and qualified hematologists. Second, a awareness campaign should be initiated at province and district level to create awareness among peoples regarding health hazards of unsafe blood transfusion, and the awareness team include Government, Journalists, Showbiz, Social-workers and representatives of civil society.
The possibility of transmission of infections would be minimized if blood is collected from low risk targeted general public. We undertook a review of frequency of serological evidence of hepatitis B, hepatitis C, human immunodeficiency virus (HIV) and Syphilis over a month's period. Data from our institution of 100 donors over a month's span present a unique opportunity to evaluate trends in frequency of these diseases in Bahawalpur.

Literature Review
Blood transfusion has become an essential part of treatment in any medical or surgical emergencies. Transfusion transmissible infections (TTIs) pose a major health risk and there is a high prevalence of such pathogens and increased demands for blood donations in local communities. The study aims as determining the prevalence of commonly encountered transfusion transmissible infections among the blood donors and transfusion related complications among the recipients in a particular community.
In a survey held in urban centre of Cameroon, a total of 477 donors were recruited by consecutive sampling. Serum samples were tested by various rapid diagnostic tests for presence of HBV, HCV, HIV and Treponema Pallidum. Of the 477 blood donors, 64 were infected by at least one of the four transfusion transmissible infections. Prevalence of HCV, HIV, HBV and Treponema Pallidum were found to be 1.3%, 1.8%, 3.5% and 6.81% respectively 13 .
In an other study, conducted to evaluate the sero-prevalence of HBV, HCV, HIV, Syphilis and malaria among the blood donors in Bhopal along the duration of 3.5 years. The study included records of 2842 voluntary and 6718 replacement donors. Sero-prevalence of HIV, HBV, HCV, Syphilis and malaria was found to be 0.09%, 0.80%, 1.19%, 0.73% and 0.00% in the voluntary donors and 0.45%, 0.59%, 0.80%, 1.78% and 0.00% in replacement donors. Overall transfusion-transmissible infections prevalence in voluntary and replacement donors was 2.81% and 3.62% respectively 14 .
Similarly in another retrospective observational study carried out in SS Medical college, Rewa, India, over a period of 5 years, all blood donor samples were screened for HBV, HCV, HIV. Out of 29540 donors, 28117 (95.18%) were males and 1428 (4.82%) were females. Among all donors, majority (56.98%) are in age group of 18-30 years. The overall sero-prevalence of HBV, HCV and HIV was found to be 1.18%, 0.33% and 0.80% respectively 15 .
In another retrospective study which was conducted at Gondar University Teaching Hospital North East Ethiopia in 2010. The results showed from a total sample size of 6361 blood donors, 10.5% had serological evidence of infection. The overall seroprevalence of HIV, HBV, HCV and syphilis was 3.8%, 4.7%, 0.7% and1.3% respectively 17 . Study showed that a substantial percentage of blood donors harbor HIV, HBV HCV and syphilis.

Discussion:-
Health care system of developing countries are continuously facing the challenges of inadequate supply of safe blood and an increase in frequency of transfusion associated infections.
In our study, we discussed about variables including history of blood transfusion, ear piercing, tattooing, barber visiting, and history of jaundice, previous surgery and intravenous drug abuse.
The study conducted in Krishnagri India in 2013, according to their data 2.6% were HBV positive and 3.70% were HBV negative, among the subjects with history of ear piercing 18 . While a study conducted in Australia in 2011, the prevalence rate of HCV was 31.5% among the subjects with history of ear piercing 19 . While according to our study, the prevalence rate of HCV was 7.69%. So we concluded that the prevalence rate is higher in Australia, then in Bahawalpur and least in India.
Among the subjects with history of jaundice , the prevalence rate of hepatitis B was 3.20% in India 18 , the prevalence of hepatitis C was 4.01% in Austrlia 19 ,while in our study the prevalence of both hepatitis B and C was 22.2%.
Report from NEW YORK in 2010 showed 59% HBV positive and 0.77% HIV positive among intra-venous drug users 18 . A study conducted in USA in 2012 showed that there were 0.26% HCV positive and 0.4% were HBV positive among intravenous drug users 22 .While in our study 9.5% were HCV positive and 3.04% were HBV positive among intra-venous drug users.
Among the subjects with history of previous surgery ,5.30% were HBV positive in KRISHNAGRI INDIA 20 in 2012 , 4.28% were HCV positive in Australia in 2011. While in our study 12% of donors were having history of previous surgical intervention but all were non-infective.
Report from Krishnagri India in 2012 showed the prevalence of HBV was 10.4% among barber visitors 20 , while these figures were 6.7% and 8.6% in Australia and USA respectively. While in our study 8.5% were HCV positive and 6.84% were HBV positive among barber visitors.
Prevalence rate of Treponema Pallidum was 17.4% among subjects with history of tattooing and 0.33% among blood donors in studies conducted in CHICAGO and USA in 2012 respectively 5 . While in our study, it was 1% among subjects with history of tattooing and 2.8% among blood donors.
The first five cases of HIV in U.S were reported in 1981. More than 1000,000 Americans have the virus today .The HIV pandemic is most severe in Sub-Saharan Africa. Over 60% of all people living with HIV reside within this region.
Adult HIV prevalence exceeds 20% according to studies conducted in Swaziland, Botswana And Lesotho in 2011. While an additional six countries reported HIV prevalence of at least 10%.
In terms of raw HIV case numbers SOUTH AFRICA has largest population living with HIV(6.3 million), followed by NIGERIA (3.2 million) and INDIA (2.1 million) by the end of 2013.
0n the other end of spectrum, Svalbard is reported as having no case of HIV/AIDS. While Bhutan has a much larger population but still only an estimated 246 cases through 2011. Countries such as Afghanistan and Cape Verde are reported to have the lowest prevalence, less than 0.1%. In our study, there is no case of HIV/AIDS i.e. 0% prevalence rate. In this way, we concluded through our discussion that HBV. HCV and Syphilis are more common among subjects with history of blood transfusion, history of intravenous drug users, history of previous surgery and history of tattooing.

Objective
The objective of the study was to determine the frequency of HBV, HCV, HIV and syphilis in blood donors at blood bank in Bahawal Victoria Hospital, Bahawalpur.

Methodology:-Study design:
Cross sectional descriptive study.

Setting:
The setting of the study was blood bank of Bahawal Victoria Hospital, Bahawalpur.

Study Duration:
Study was started in May 2018 and completed in June 2018.

Sample size:
A sample of 100 people was taken.

Sampling technique:
Non probability convenient sampling.

Ethical issues:
Informed consent was taken from all participants. Expenses were born by researchers.

Inclusion Criteria:
All the willing subjects were included in our study.

Exclusion Criteria:
All the subjects who were not willing were excluded from our study.

Data collection protocol:
The information was collected through a preformed questionnaire. The information regarding results of the screening tests of HBV, HCV, HIV and syphilis of blood donors performed at the time of donation was collected from the previous record.

Data analysis:
Data was analyzed manually. All results were presented in the form of tables and graphs.

Conclusion:-
Sharing of scissors, shaving from barber and I/V drug using practices/reuse of syringes were surprisingly frequent among people, which had top-listed the risk factors for hepatitis and AIDS. The most frequent infection among blood donors was hepatitis C 8%, followed by hepatitis B 5% and syphilis 4%. The results seek an urgency to create awareness among people regarding these risk factors.