Infections of Hepatitis B and C and Malaria Plasmodium Falciparum among Blood Donors in Ife East Local Government Area, Ile Ife, Osun State, Nigeria

Abbreviations

HBV: Hepatitis B Virus; WBC: White Blood Cells; HBSAg: Hepatitis B Surface Antigen; PCV: Packed Cell Volume; TTIs: Transfusion-Transmitted Infections.

Introduction

The dual infections of malaria and hepatitis B remain vital health issues in developing countries. Approximately 350-500 million cases yearly, with 2-3 million annual deaths occur as a result of malaria infection [1]. Hepatitis B infection is caused by hepatitis B virus (HBV). An estimated 350 million persons worldwide are chronic carriers [2], 4 million clinical cases of HBI infection are recorded each year, with about 1 million deaths as a result of complications, including liver cancers [3]. The presence of HBV and malaria co-infection is usually predominant in areas where both infections are endemic as mono-infection [4]. HBV and malaria are known to share some of their developmental stages in the liver, which has sometimes been attributed to the poor clearance of the liver stage of the malaria parasite [5]. Co- infection of Malaria and HBV may occur in areas where both infections are endemic and because of their geographical coincidence [6]. These two infections share some of their developmental stages within the liver, which may cause an impaired clearance of the liver stages of Malaria parasite due to hepatocytes damage in HBV infection [5].

Results

The overall mean parasitaemia of malaria infection among the donors was 922.51± 103.063(µl/blood) while that of Hepatitis virus infection was 44/400 (11.0%), HBV

and HCV are 16/400 (4.0%) and 28/400 (7.0%). Table 1, present the Socio- Demographic Characteristics of the Study Population of Donors in Ife East Local Government Area. A total of 400 blood donors; aged 18-62 years had participated in the study. Majority of the donors that participated 94.8% (379/ 400) were male, 60.50% (242/400) were married, 43.00% (172/400) were in the age range 21-30 years, 35.8% (143/400) were artisans, and 67.0% (268/400) were in secondary.

In Table 2, the highest prevalence of Hepatitis virus infection of 14.0% was recorded among donors aged 21-30 years followed by 13.6% among donors aged 18-26 years and the least of 6.8% among donor aged 45-53 years. HBV has the highest prevalence of 6.4% among donors aged 27- 35 years followed by 4.5% among donors aged 45-53 years and the least 2.0% among donors 36-44years. The highest HCV of 13.6% was recorded among donors aged 18-26 years followed by 7.6% among donors aged 27-35 years and the least 2.3% was recorded among donors aged 45-43 years. The malaria infection was highest with mean parasitaemia 1,318.1818± 624.03(µl of blood) among donors aged 18-26 years followed by 1,032.3636±339.42 (µl of blood)among donors aged 45-53 years and the least 506.2222±212.29 (µl of blood) among donors aged 54-62years.

The highest prevalence of Hepatitis viral infection of 11.3% and HCV of 4.2%, HBV of 7.1% and mean parasitaemia of 931.596 ± 107.20 (µl of blood) were highest among male. The highest prevalence of Hepatitis virus infection of 12.0%, HCV of 8.9% was recorded among the single while, HBV of 4.5% and malaria infection with mean parasitaemia of 936.9954± 138.91(µl of blood) was recorded among married donors. The highest prevalence of Hepatitis virus infection of 20.0% was reported among student followed by 11.3% among trader and the least 6.2% among civil servant. The highest HBV of 7.3% was recorded among student followed by 6.3% among farmer and the least 1.5% among Civil servant. The highest HCV of 12.7% was recorded among donors who are student followed by 8.1% among trader and the least 4.6% among civil servant. The malaria infection was highest with mean parasitaemia of 1,158.3710± 297.18 (µl of blood) among donors who are trader followed by 1,150.93± 255.07 (µl of blood) among civil servant and the least 577.94± 98.11 (µl of blood) among artisan.

The highest prevalence of Hepatitis virus infection of 12.5% was recorded among donors with primary education followed by 11.2%among donors with secondary education and the least 10.3%among donors with tertiary education. The highest HCV of 7.8% was recorded among donors with secondary education followed by 5.2% among donors with tertiary and the least 3.6% among donors with primary education. The highest HBV of 6.3% was recorded among donors with primary education followed by 5.2% among donors with tertiary education and the least 3.4%among donors with secondary education. The malaria infection was highest with mean parasitaemia of 1,145.8793 ± 217.70 (µl of blood) among donors with tertiary education followed by 858.3470±  121.92 (µl of blood) among donors with secondary education and the least 377.9375± 263.57 (µl of blood) among donors with primary education.

In Table 3, the highest prevalence of Hepatitis infection of 43.2%was recorded in O+ve, followed by 22.7% in B+ve and the least 2.3% in B-ve. In HBV, 8.0% in B+ve was the highest followed by 4.1% in A+ve and the least 3.5% in O+ve. The highest HCV of 20.0% was recorded in B-ve, followed by 17.1% in O-ve and the least 5.5% in A+ve. The malaria infection was highest with mean parasitaemia of 1,749.8000±1605.32 (µl of blood) among AB+ve donors followed by 1,144.8400±295.51 (µl of blood) in B-ve and the least 104.0000±54.00 (µl of blood) in A-ve donors.

Normal ranges: WBC =Adult: 4000-10,000/mm3, Neutrophil = 40-70% Lymphocyte = 20-45%, Eosinophil= 1-6%, Packed cell volume (PCV) Women = (36-46%), Men = (40-54%). Table 4: The distribution of Neutrophil, Lymphocyte, Eosinophil, White blood cells and packed cell volume according to socio- demographic factors among blood donors in Ife East L.G.A in Osun State.

In Table 4, highest mean PCV in the study was 44.33±2.82 in aged 54-62 years followed by 42.61±4.21 in aged 45-53 years and the least 42.22±3.80 in aged 36-44 years. The highest mean WBC was 6,222.22  ±  706.71 in aged 54-62 years followed by 5,372.09± 1047.71 in aged 27-35 years and the least 5,063.64± 871.27 in aged 45-53 years. The highest mean eosinophil was 1.97±2.25 in aged 27-35 years followed by 1.86±2.37 in aged 18-26 years and the least 1.66± 2.32 in aged 45-53 years. The highest mean lymphocyte count 45.21± 8.05 in aged 36-44 years followed by 44.41±7.05 in aged 45-53 years and the least 43.73± 7.11 in aged 27-35 years. The highest mean neutrophil count 54.67± 7.46 was recorded in aged 54-62 years followed by 54.44± 7.46 in aged 27-35 years and the least 54.09±7.74 in aged 45- years. The highest mean PCV 43.47±3.54 was recorded among student, mean WBC 5,550.00± 981.83 among farmer, mean eosinophil 2.12  ±  2.15 among civil servant, mean lymphocyte count 45.83± 6.83 among civil driver and mean neutrophil count 55.56± 8.51 was recorded among farmer. The highest mean PCV 44.44± 2.98 was recorded among donors with primary education, mean WBC 5,347.01± 1049.82, among donors with secondary education. Mean eosinophil 2.09  ±  2.28among tertiary, mean lymphocyte count 45.54± 8.27 among donors with tertiary and mean neutrophil count 55.31±  9.11 was recorded among donors with primary education.

Discussion and Conclusion

The overall mean parasitaemia of malaria infection among the donors in this study was 922.51± 103.063 (µl/ blood) while that of Hepatitis virus infection was 11.0%, HBV and HCV are 4.0% and 7.0%, in contrary, Jamal D, et al. [9], reported that 1.94% donors are positive for HCV while 1.7% are positive for HBV, Sial GR, et al. [10], recorded 1.24% HBV and 2.15% HCV among the subjects and Rasheed HN, et al. [11] also, reported the prevalence of HBV and HCV to be 0.78% and 0.2% respectively which were lesser than the result recorded in this study, however, higher prevalence of 16.6% of HBV was recorded by Yakubu A, et al. [12] among blood donors in Kebbi State and 19.0% of HBV was recorded by Rasheed HN, et al. [11] in Ilorin. Kwara State, Nigeria.

The prevalence of Hepatitis virus infection was highest among donors aged 21-30 years, HBV has the highest among donors aged 27-35 years. The highest HCV was recorded in aged 18-26 years. The malaria infection was highest among donors aged 18-26 years. Yakubu A, et al. [12] reported that donors within the age group 26-30 years had the highest HBV prevalence of 20.9% compared to the other age groups. Sial GR, et al. [10], reported that the highest prevalence of 46% of HBV was recorded among aged group20-30years while that of HCV 55% aged 30-40 years.

The Hepatitis viral infection, HCV, HBV and mean Malaria parasitaemia was highest all among male. The prevalence of Hepatitis virus infection and HCV was highest among the single while, HBV and malaria infection was recorded among married donors this is in accordance with the report of Yakubu A, et al. [12], who recorded that single males have higher prevalence (26.1%) of HBV infection than their married counterparts (16.7%). Sial GR, et al. [10] reported that the overall prevalence of 10.8% HBV and 1.2% HCV was most strongly associated with male in Sierra Leone, but Ugwuja E, et al. [13] reported that there was no statistically significant difference in HBV infection between males 9.0% and females 6.0%. Considering the occupation, highest prevalence of Hepatitis virus infection, HBV and HCV were recorded among donors who are student. The malaria infection was highest among donors who are trader.

Education has the highest prevalence of Hepatitis virus infection among donors with primary education, while the highest HCV was recorded among donors with secondary education. The highest HBV was recorded among donors with primary education, while the malaria infection was highest among donors with tertiary education. The prevalence of Hepatitis infection was highest among donors with O+ve blood group, while highest HBV was recorded among donors with B+ve blood group. The highest HCV was recorded among donors with B-ve blood group. The highest malaria infection was recorded among AB+ve blood donors. However, Ahmad A, et al. [14], reported that the donors with the O blood group were at a higher risk of contracting transfusion-transmitted infections (TTIs) and also, significant associations were observed between HBV and group AB. Mohammadali F, et al. [15] recorded that blood group O was associated with a lower risk of HBV infection among Iranian blood donors, but on the contrary, blood group O was associated with a higher risk of HBV among Chinese Liu J, et al. [16]. Although, haematological parameters in this study were within the normal range, but the highest mean PCV was recorded in aged 54-62 years, mean WBC was in aged 54-62 years, eosinophil was in aged 27-35 years, lymphocyte count was in aged 36-44 years and the mean neutrophil count was recorded in aged 54-62 years.

In conclusion, the blood donors in Ife East L.G.A, Ile Ife, harbor asymptomatic HBV, HCV and Malaria, although the prevalence of malaria, hepatitis B and C viral infections was low in this study, crucial screening of blood donors is of ultimate importance because they serve as an asymptomatic reservoirs and a potential source of transmission of these infections. Creating awareness on the general public regarding Malaria, HBV and HCV transmission and prevention and provision and availability of vaccines against HBV should be expanded to cover every citizen. More aggressive strategies should be adopted in the fight against malaria such as extensive environmental insecticide spraying, de-clogging of water ways and drainages.