Seroprevalence of Hepatitis B and C in the Blood Donors in Kolwezi , Democratic Republic of Congo

Every year more than 90 million units of blood are collected worldwide. Blood transfusion is responsible for 5-10% of HIV infection in sub-Saharan Africa and the risk of post-transfusion hepatitis was 12.5% in transfused patients. Like other lowincome countries, the Democratic Republic of Congo (DRC) is not immune to these problems related to blood safety [4]. Of all the world, some 240 million people have chronic hepatitis B and 130 to 150 million chronic HCV. If the response is not expanded and accelerated, projections show that the number of people with hepatitis B will remain at current high levels over the next 40-50 years, and the total deaths between 2015 and 2030 s’ be 20 millions. The number of people with hepatitis C is currently rising, despite the existence of an effective cure [13].


Introduction
Blood transfusion is a step of infusing blood or its derivatives to an individual by intravenous infusion.According to WHO, blood transfusion is indicated for replacement therapy and partially compensate transiently deficiency of one or more components of the blood tissues that would jeopardize patient survival [3].Blood transfusion is characterized in most sub-Saharan countries with a high prevalence of infectious agents [17].A chronic shortage of blood bag and a lack of financial resources and trained personnel [1].
Every year more than 90 million units of blood are collected worldwide.Blood transfusion is responsible for 5-10% of HIV infection in sub-Saharan Africa and the risk of post-transfusion hepatitis was 12.5% in transfused patients.Like other lowincome countries, the Democratic Republic of Congo (DRC) is not immune to these problems related to blood safety [4].Of all the world, some 240 million people have chronic hepatitis B and 130 to 150 million chronic HCV.If the response is not expanded and accelerated, projections show that the number of people with hepatitis B will remain at current high levels over the next 40-50 years, and the total deaths between 2015 and 2030 s' be 20 millions.The number of people with hepatitis C is currently rising, despite the existence of an effective cure [13].
Viral hepatitis B and C infections are transmitted by blood, the transmission is performing especially early in life and during injections or medical procedures performed in unsanitary conditions, and less frequently by contact sexual.The prevalence of hepatitis B is highest in sub-Saharan Africa and East Asia, where between 5 and 10% of the adult population is infected with chronic hepatitis B [13].HBV is endemic with a different prevalence in different parts of the world.The seroprevalence of hepatitis markers of infection with B virus is an indicator that has been enjoyed in various ways from the blood donor in the world: 20% in Tanzania; In Nigeria 14.0% in 2000-2013, 11.1% in Kano; 10.01% in Equatorial Guinea; 10.0% in Cameroon; 4.7% in Ethiopia; 2.8% in Rwanda; 1.2% in Nepal; 1.1% and 0.6% India Namibia [7].
As against the hepatitis C virus (HCV) also remains a major public health problem.Epidemiological data account for nearly 130 to 170 million chronic carriers of this virus worldwide, with an estimated average seroprevalence of 2.2%.This rate varies from country to country: it is very low in Europe, higher in Southeast Asia and Africa, more particularly in Egypt where it reaches proportions of more than 20%.The World Health Organization (WHO) has estimated this prevalence at 0.32% in developed countries against 3.96% in developing countries [2].This study aimed to determine the seroprevalence of hepatitis B and C among blood donors in the city of Kolwezi and particularly those of the Kolwezi Staff hospital.

Patients and Methods
This is a descriptive cross retrospective study of prevalence of hepatitis B and C among blood donors.The study took place over a period of 3 years period from 1 January 2014 to 31 December 2016.
Our target population consisted of all voluntary blood donors, family and paid the hospital who viewed the Kolwezi staff.Consisting of 4018 donors, our sample is comprehensive.Were included in the study all blood donors (volunteers, family, pay) recorded the blood bank of the said hospital for first donation.
Serodiagnosis on each blood donation was made using commercial kits (Determine TM HBsAg, Inverness Medical Japan Ltd for HBV, HIV-TM, Determine ½ for HIV) and Hepatitis HCVSCAN C. Data were collected from the records collection of preset data, records, and monthly reports routine blood bank's activities in the Kolwezi hospital staff.The variables used are: blood donor's categories (volunteers, family), sex and the tests (HBV, HCV).For quantitative variables, only age of donors has been considered.The collected data were coded, entered, processed and analyzed using SPSS 19.Descriptive analysis software was achieved through the calculations of proportions for categorical variables and the different frequency comparisons were encrypted using Pearson's Chi-square test and Fisher test when necessary.We set the statistical significance and the P-value < 0.05.

Results
In relation to hepatitis C, HIV prevalence is 0.8% in donors aged 20-45 years and 0.4% among those aged over 45 years without this difference was statistically significant (P = 0.394 ).Seroprevalence is around 1.3% in female donors and 0.7% for male donors, whereas it is 1.0% in family donors and 0.5% among the volunteers without this being statistically significant.

Seroprevalence of Hepatitis B and C in the Blood Donors in Kolwezi, Democratic Republic of Congo
Copyright: © 2016 Michel KN, et al.

Discussion
Blood transfusion is a medical procedure whose purpose is to bring the patient who needs blood to correct a defect induced by its deficiency, but at the same time it remains a clear risk of transmission of certain infections.Infections HIV, HBV and HCV are major communicable infections regarded as public health problems in low-income countries.They are transmitted parenterally, vertically or through sex.Blood transfusion is, therefore, a potential means of transmission [4].
In this study, all 2650 (65.95%) blood donors were family donors and 0.02% of paid donors.Indeed, several previous studies worldwide have shown that replacement donors were remarkably prevalent.In the study by Singh et al, 82.4% were replacement donors, 94.7% in the study by Kakkar, et al. while Sangeeta Pahuja, et al. found 99.48% [16,9,14].At the Provincial Blood Transfusion Center of the Province of Katanga, trends appear to be identical to our results and also those obtained by Noubiap in Cameroon [4,5].This indicates that many things must be done to motivate and closer through awareness campaigns voluntary donors on the importance of blood donation, expect conditions to meet the objectives that WHO is assigned.
The majority of donors were male or 94.4% and 5.6% female.These results are consistent with the fact finding by Tagny, et al. that one of the common characteristics among blood donors in sub-Saharan Africa is the predominance of young adult men [17].The low proportion of women among blood donors is explained by many cons-indications for blood donation including among others, pregnancy, anemia, menstruation, breastfeeding etc. [10].
The seroprevalence of hepatitis B in our study was 3.9%.It is located within the range of seroprevalence reported by studies in our country but much lower than that found by KabambaNzaji,et al. in Lubumbashi [4,7,8,10,11,15].Kabinda Maotela J, et al. (2015) analyzing reporting data CNTS show that the proportion of donors with hepatitis B decreased from 7.1% in 2001 to 3.5% in 2012.The higher rates reported in countries such as Nigeria (18.6%),Guinea Bissau (16.2%),Burkina Faso (14.96%).The rate of HIV prevalence observed in our country are also considered high because the country is in a highly endemic area [6].Ngama, KC et al. (2016) attempt to explain this by the absence of a vaccination policy against HBV in our country, we also espouse this view in the context of the town of Kolwezi.
We noticed that the female donor had a seroprevalence of hepatitis B high compared to male donors, these results are consistent with those reported in a study conducted in 2017 in Moba [7].As against our results contrast with those reported in the literature of Ntonga, et al. in 2017 in Gabon, and with those of Kabinda, et al. in 2014 in the eastern DRC.

Conclusion
At the end of our study, we note that a majority of blood donors were aged between 20-45 years is 84%, while 3.1% were aged less than 20 years, 94.4% were male, 65.95% were composed of family donors and 34.03% were voluntary donors.The seroprevalence of hepatitis B was around 3.9%.While it was 0.7% for hepatitis C during the three years of study.Note that the seroprevalence of hepatitis B was 1.6% for donors under 20 years, 4.2% among those whose age is between 20-45 years and 2.3% in donors over 45 years.And this statistically significant difference was observed (P = 0.047).In relation to sex, 7.6% of female donors and 3.7% of males had HIV to hepatitis B befits noted that no statistical difference was found between the characteristics of blood donors and hepatitis C.
The prevalence of both infectious markers in our midst denotes that transfusion remains a major public health problem in developing countries in general and in Kolwezi in particular and warrants routine screening in all blood donors to reduce the risk transfusion.

Table 1 :
Distribution of blood donors by ageIt appears from this table that the majority of blood donors were aged between 20-45 years is 84%, while 3.1% were age less than 20 years.

Table 2 :
Distribution of blood donors by sex The sex ratio is about 16.8 Male / Female.

Table 3 :
Distribution of blood donors by Category

Table 4 :
Seroprevalence of HIV, hepatitis B and C infection in blood

Table 5 :
Seroprevalence of hepatitis B according to the characteristics of the donor bloodIt is apparent from this table that the seroprevalence of hepatitis B was 1.6% in donors under 20 years, 4.2% of those whose age is between 20-45 years and 2.3% in donors over 45 years.And this difference is statistically significant (p = 0.047).In relation to gender, HIV prevalence was 7.6% among female donors and 3.7% among male donors.The female donors had 2.15 times the risk of being HIV-positive to hepatitis B. It is noted that voluntary donors had a prevalence of 4.3% against 3.1% among family donors and without paying this being statistically significant (P = 0.056).

Table 6 :
Seroprevalence of hepatitis C according to the characteristics of the donor blood