Asymptomatic Malaria Infection…
315
ORIGINAL ARTICLE
Asymptomatic Malaria Infection and Associated Factors among
Blood Donors Attending Arba Minch Blood Bank, Southwest
Ethiopia
Getaneh Alemu1, Mohammedaman Mama1
OPEN ACCESS
Citation: Getaneh Alemu,
Mohammedaman Mama. Asymptomatic
Malaria Infection and Associated Factors
among Blood Donors Attending Arba
Minch Blood Bank, Southwest Ethiopia.
Ethiop J HealthSci.2018;28(3):315.
doi:http://dx.doi.org/10.4314/ejhs.v28i3.9
Received: December 3, 2017
Accepted: December 6, 2017
Published: May 1, 2018
Copyright: © 2018 Getaneh Alemu, et al
. This is an open access article distributed
under the terms of the Creative Commons
Attribution License, which permits
unrestricted use, distribution, and
reproduction in any medium, provided the
original author and source are credited.
Funding: Arba Minch University
Competing Interests: The authors
declare that this manuscript was approved
by all authors in its form and that no
competing interest exists.
Affiliation and Correspondence:
1
Department of Medical Laboratory
Science, Arba Minch University, Arba
Minch, Ethiopia
*Email:getanehmlt@gmail.com/getane
h.alemu@amu.edu.et
DOI: http://dx.doi.org/10.4314/ejhs.v28i3.9
Getaneh A. et al.
ABSTRACT
BACKGROUND: It is well known that malaria can be transmitted
via blood transfusion. However, it is not documented in the
national donor screening protocol. Magnitude of asymptomatic
malaria among donors would be the key to decide on the need of
donor screening. Despite this, there is lack of such data in
Ethiopia. The aim of this study was thus to estimate the prevalence
of asymptomatic malaria and associated factors among blood
donors.
METHODS: An institution basedcross-sectional study was
conducted in Arba Minch blood bank from February to June,
2015. Data was collected from donors who passed the clinical
donor selection criteria and recruited by systematic random
sampling technique. A structured questionnaire was used to
capture data on socio-demographic characteristics. Giemsa stained
blood films were examined for plasmodium parasites. Magnitude of
asymptomatic malaria was calculated and association of factors
with malaria was assessed by multivariable logistic regressions
using SPSS version 20.0.
RESULTS: A total of 416 donors participated in the study. The
proportion of infected donors was 4.1% (17/416). Eight donors
were infected with Plasmodium falciparum while 9 donors were
infected with Plasmodium vivax. Most positive blood films (13/17)
were with parasite loads ranging from 100 - 500 parasites/µl.
Donors with blood group O were more susceptible to malaria
parasitemia compared to all other ABO blood groups together
(AOR=6.899, 95%CI=1.951-24.391, p=0.003).
CONCLUSION: Magnitude of malaria parasitemia in the present
study was high as compared to the national malaria prevalence.
Hence, in malaria endemic areas of Ethiopia, blood should be
screened before donation.
KEYWORDS: Blood transfusion, malaria prevalence, blood donor
316 Ethiop J Health Sci. Vol. 28, No. 3
INTRODUCTION
Malaria is one of the major public health problems
worldwide affecting around 91countries and
territories (1). It is caused by a protozoan parasite
of the genus Plasmodium (2,3).The disease is
widespread in hot humid regions of Africa, Asia,
and South and Central America. It also occurs in
many temperate regions (4,5,6). In 2015, 212
million malaria cases occurred globally leading to
429,000 deaths. Sub-Saharan Africa is the most
affected region, accounting for 90.1% (191
million) of the cases and 91.8% (394 thousand) of
the deaths in 2015 (1).
Malaria is one of the three leading causes of
morbidity in Ethiopia (7,8). In 2015, a total of
1,867,059 laboratory confirmed cases and 662
deaths were reported in the country. Four
plasmodium species have been reported in
Ethiopia among which P. falciparum and P. vivax
are responsible for 64% and 36% of the malaria
cases, respectively (1). P.falciparum and P. vivax
are commonly reported in Arba Minch with no
data to substantiate the proportion (unpublished
data).
Plasmodium parasites are transmitted
primarily by female Anopheles mosquitoes (9).
Blood transfusion, organ transplantation and
transplacental and needle injury are also possible
routes of transmission (10). Transfusion
transmitted malaria (TTM) occurs commonly in
malaria endemic countries andcontinues to hamper
efforts of malaria control (3,11). Blood donors in
sub-Sahara African countries are likely to be
infected with malaria parasites and contribute to
the transmission of the disease (12-20).
The World Health Organization (WHO)
recommended screening of blood donations for
malaria based on local epidemiological evidences
(21). Although 60% of the population is exposed
to malaria, laboratory screening for malaria is not
currently performed in Ethiopia (22). Laboratory
screening is not practiced so far with the possible
reasons of fear of increased donor deferral,
urgency of blood needed by recipients compared
to health impact of TTM and the cost of screening
(unpublished data).
DOI: http://dx.doi.org/10.4314/ejhs.v28i3.9
May 2018
Adequate data from different geographical
settings of the country is needed to be an input for
the Federal Ministry of Health to make decisions
about donor blood screening. However, there is
lack of data about the magnitude and factors
related to asymptomatic malaria among donors in
Ethiopia. Hence, the aim of this study was to
estimate the prevalence of asymptomatic malaria
and associated factors among blood donors
attending Arba Minch blood bank.
MATERIAL AND METHODS
Study design and area: A facility based cross-
sectional study was conducted in Arba Minch
blood bankf rom February to June 2015. Arba
Minch is located at 454 kms south of Addis
Ababa. It is found at an altitude of 1200-1300
meters above sea level with an average annual
temperature of 29.70C and rain fall of 900mm
(23). Arba Minch blood bank is one of the three
blood banks found in South Nations, Nationalities
and Peoples Region of Ethiopia. The blood bank
at average collects 375 units of blood per month
from volunteer donors. Only whole blood is
donated to recipients after screening for hepatitis
B and C, HIV and syphilis. Non-febrile donors
who did not contact malaria (based on donor self-
report) within the last six months are accepted for
donation without laboratory screening.
Source and study population: All adult
population with eligible age range (17-65 years
old) for blood donation and living in malaria
endemic catchment areas of Arba Minch blood
bank were the source population. The study
subjects were recruited among those who came to
donate blood during the study period.
Sample size and sampling technique: The
sample size was determined using single
population proportion formula(n = [Z 1- α/2]2 P
(1-p]/ d2) at 95% confidence level(Z (1-ά/2) =
1.96). A 5% marginal error (d) was tolerated.
Since there are no previous data about the
prevalence (p) of malaria among blood donors in
the area, we considered 50% prevalence for
sample size calculation. Substituting the values,
calculated sample size was 384, and the final
 Asymptomatic Malaria Infection…
sample size was 423 after adding 10% to
compensate for non-respondents. Systematic
random sampling technique was followed. By
tracing back last year’s donor flow, we expected
1650 donors during the study period. Therefore,
calculated K value was 4 (1650/423). The first
participant was selected by lottery method and
then every fourth donor was recruited.
Inclusion and exclusion criteria: The inclusion
criterion was passing the screening criteria of the
blood bank. The exclusion criterion was being
permanent resident of known non-endemic area
for malaria.
Socio-demographic data: Nurses who are fluent
speakers of the local language (Gamogna) were
selected and trained for data collection. Socio-
demographic data was collected using a pretested
structured questionnaire administered through
face-to-face interview after it was translated in to
the local language. Participants were also
interviewed for their history of malaria infection,
treatment received and history of previous blood
donation.
Laboratory methods: We used blood collected
into the tube part of the blood bag for blood film
preparation. Both thin and thick blood films were
prepared and examined after staining with Giemsa
(24). For positive samples, asexual stages of
malaria parasites were counted against 500 white
blood cells (WBC) on the thick film and reported
as number of parasites per µl of blood assuming a
standard adult leukocyte count of 8000/µl.
No. of Parasites/µl of blood =﴾WBC counts X
parasites counted against 500WBC﴿/500
Where: WBC counts = 8000/µl(25).
A blood smear was regarded negative after
examining a minimum of 200 high power fields
with no parasites seen. All laboratory procedures
were processed in Arba Minch blood bank
laboratory by trained laboratory technologists.
Standard operating procedures were strictly
followed for malaria diagnosis. Giemsa stalk
solution was stored appropriately and the staining
quality was checked every week by processing
DOI: http://dx.doi.org/10.4314/ejhs.v28i3.9
Getaneh A. et al. 317
known positive and negative samples. The ABO
and Rh blood groups of donors were taken from
the donors’ registration book. Investigators
supervised all aspects of data collection.
Statistical analysis: Data were entered and
analysed using SPSS version 20.0. Descriptive
statistics like frequency, median and percentage
were calculated to describe the study population
characteristics. Bivariate logistic regression was
used for assessing general associations between
categorical variables. Multivariable logistic
regression analysis then followed for variables
with p≤ 0.25 in the bivariate analysis. Association
between variables was considered statistically
significant only if P-value<0.05 at 95%
confidence level.
Ethical approval and consent to participate:
Ethical approval for the research was granted by
review boards of Arba Minch University College
of Medicine and Health Sciences with a project
code of Gov/AMH/5-1/CMHS/MLS/01/07.
Official permission letter was also obtained from
Arba Minch blood bank. Written consent was
obtained from all participating blood donors. All
laboratory results were communicated to study
subjects promptly. All malaria positive blood was
discarded.
RESULTS
A total of 418 (response rate = 98.82%) blood
donors participated in the study, and data collected
from 416 (232 male and 184 female) participants
were complete for analysis. The median age of
participants was 22 ± 0.29 (Median ± SEM) with a
range of 18-59 years. Donors with self-reported
malaria history were 154(37%). Only 152(36.5%)
participants slept under bed net. All the
participants were volunteer blood donors, and 219
(52.6%) of them had previous history of donation.
The most frequent blood group was O (175;
42.1%), followed by bllod group A (136; 32.7%)
(Table 1).
318 Ethiop J Health Sci. Vol. 28, No. 3 May 2018

Table 1: Socio-demographic characteristics and clinical history of blood donors attending Arba
Minch blood bank from February to June 2015

Variables
Number (%)
Sex Male 232 (55.8)
Female 184 (44.2)
Age group 18-27 355(85.3)
28-37 48(11.6)
>37 13(3.1)
Marital status Single 339(81.5)
Married 77(18.5)
Educational level Illiterate 112(26.9)
Primary 21(5.0)
Secondary 76(18.3)
Tertiary 207 (49.8)
Occupation House wife 14(3.3)
Peasant/agriculture 117(28.1)
Employed 141(33.9)
Business/shop 79(19.1)
Student 65 (15.6)
Previous malaria Yes 154(37)
infection No 262 (63)
Time of last malaria 2-6 months 18(11.7)
Episode >6 months 84(54.5)
Don’t remember the time 52 (33.8)
Anti-malaria drug taken Yes 151(98.1)
during last episode No 3(1.9)
Use of bed net Yes 152(36.5)
No 264 (63.5)
Previous history of blood Yes 219(52.6)
donation No 197 (47.4)
Number of previous Once 124(56.6)
donations 2-4 times 78(35.6)
>4 times 17 (7.8)
ABO blood group O 175(42.1)
A 136(32.7)
B 87(20.9)
AB 18 (4.3)
Rh blood group Rh+ 386(92.8)
Rh- 30 (7.2)

The overall malaria prevalence in this study was Most frequently detected developmental stages
4.1% (17/416). Eight and 9 donors were infected were early trophozoites (14/17) (Table 2).
with P. falciparum and P. vivax respectively.

DOI: http://dx.doi.org/10.4314/ejhs.v28i3.9
 Asymptomatic Malaria Infection…
Table 2: Stages of malaria parasites identified and parasite load among blood donors attending
Minch blood bank from February to June 2015
Parasite load/µl
<100
P.f P.v
Parasite Early trophozoite 1 1
stage Late Trophozoite 0 1
Combination 0 0
Total 1 2
P.f: Plasmodium falciparum; P.v; plasmodium vivax
Higher proportion of females (6.0%, 11/183) were
infected than males (2.6%, 6/233), but the
difference was not statistically significant
(p=0.091). Asymptomatic malaria cases were
higher among donors who did not use bed net
compared to those who used (p=0.047). Donors
with no previous history of donation had higher
probability of getting infected than those
attending for the first time (p=0.022). Among
plasmodium infected donors, the majority (14/17)
were with blood group O. Group O donors were
more affected ascompared to other ABO blood
groups together (p=0.003) (Table 3).
DISCUSSION
The magnitude of asymptomatic malaria
parasitemia in this study goes in line with findings
from Sudan (6.5%) (16). However, it was higher
compared to similar studies from North Ethiopia
(1%, 6/600) (26). The difference might be, in part,
due to low adherence to malaria prevention tools
as only11.8% of malaria positive donors slept
under bed net although all lived in malaria
endemic areas. Its implication is enormous when
viewed from the recipients’ side who are already
weakened by existing severe diseases. Immunized
individuals in malaria endemic areas may be
asymptomatic carriers of plasmodium parasites
even for a long period. However, this does not
necessarily ensure lack of infectivity. Malaria
parasites can survive in stored blood at
refrigerator temperature (+20C to + 60C) for days
or weeks (27). Furthermore, the large volume of
DOI: http://dx.doi.org/10.4314/ejhs.v28i3.9
Getaneh A. et al. 319
Arba
100-500 501-1000 >1000 Total
P.f P.v P.f P.v P.f p.v
4 5 1 1 1 0 14
1 0 0 0 0 0 2
0 1 0 0 0 0 1
5 6 1 1 1 0 17
blood transfused enables large number of
parasites to be transferred to recipients. Malaria
thus behaves very aggressively in recipients with
a higher risk of complications and fatalities.
Asymptomatic carriers of the parasite also serve
as sources of infection for the general population.
Our findings show approximately
comparable distribution of P. falciparum and P.
vivax. Plasmodium falciparum was the
predominant species identified from infected
donors according to a study from Sudan (98.1%)
(16). This difference might be because of
variations in distribution of the species between
countries. According to a recent WHO report, P.
falciparum accounts for 95% in Sudan; but that of
Ethiopia is 64% for P. falciparum and 36% for P.
vivax (1). Relapse may also increase the
frequency of P. vivax detection. As expected from
asymptomatic carriers, 16 out of 17 positive blood
films show light infection (˂1000 parasites/µl)
which is in line with findings from Sudan (16).
Regarding the factors associated with
asymptomatic plasmodium parasitemia, females
were more susceptible than males; but the
variation was not statistically significant.
Bivariate analysis also showed that donors who
did not sleep under bed net (p=0.047) and had no
previous history of blood donation (p= 0.022)
were more susceptible for asymptomatic malaria
parasitemia as compared to those who slept under
bed net and had history of donation respectively.
The role of confounding factors should be
considered here as there was no significant
association for both variables in the
 Ethiop
320J Health Sci. Vol. 28, No. 3 May 2018

Table 3: Association of malaria parasitemia with different independent variables among blood donors attending Arba Minch blood bank from February to June 2015
Number examined Positive for Bivariate Multivariate
Variable malaria (%) COR(95% CI) P-value AOR(95% CI) P value
Sex
Male 232 6 (2.6%)
Female 184 11(6.0%) 2.395 (0.869-6.604) 0.091 2.599(0.889-7.594) 0.081
Age
18-27 355 15(4.2%)
28-37 48 1(2.1%) 0.482(0.062-3.735) 0.640
>37 13 1(8.3%) 1.889(0.230-15.495)
Educational status
Illiterate 111 4(3.6%) 0.73(0.224-2.382) 0.853
Primary 21 1(4.8%) 0.985(0.12-8.096)
Secondary 75 2(2.7%) 0.532(0.114-2.487)
Tertiary 209 10(4.8%)
Occupation
House wife 14 1 (7.1%) 5.346(0.454-63.005) 0.450
Peasant/agriculture 117 6(5.1%) 3.757(0.744-18.976)
Employed 141 2(1.4%)
Business/shop 79 5(6.3%) 4.696(0.889-24.794)
Student 65 3(4.6%) 3.363(0.548-20.632)
Previous malaria
infection
Yes 155 6(3.9%) 1.081 (0.392-2.984) 0.880
No 261 11(4.2%)
Use of bed net
Yes 152 1(0.7%)
No 264 16(5.8%) 4.518(1.019-20.032) 0.047 3.990(0.866-18.384) 0.076
ABO Blood type
None - O 241 3(0.01%)
O 175 14(8.0%) 4.478(2.183-11.945) 0.033 6.899 (1.951-24.391) 0.003
Rh blood type
Rh+ 386 14(3.6%)
Rh- 30 3(10%) 2.952 (0.799-10.906) 0.104 2.683(0.624-11.543) 0.185
Previous history of blood
donation
Yes 219 4(1.8%) 0.056
No 197 13(6.6%) 3.798 (1.217-11.848) 0.022 3.205(0.973-10.560)
p<0.05 was taken as statistically significant at 95% confidence level: CI; confidence interval

DOI: http://dx.doi.org/10.4314/ejhs.v28i3.9
 Asymptomatic Malaria Infection…
multivariate analysis. Blood group O donors were
more susceptible to plasmodium infection than
non-group O donors. This goes in line with
findings from recent studies conducted in Nigeria
(14,28). Contrasting results have been reported in
two studies in Nigeria again where 37.5% and
100% of the cases were with blood group AB
(12,29). According to studies by Sirina and
Clement (18) and Otajevwo (28), ABO blood
groups were not significantly associated with
malaria infection rate. Complexity of the
interaction between the parasites and host immune
responses as well as impact of other red blood cell
polymorphisms might be responsible for such
differences.
This study had certain limitations related to
the time of data collection and laboratory
techniques used. The malaria prevalence would
have been much higher if the data was collected
during the major malaria transmission season
(September to December). Sub-microscopic
parasitemia is also common in asymptomatic
carriers so that use of more sensitive diagnostic
tests (molecular techniques) would yield higher
rate of malaria parasitemia. This is evidenced by
findings from Ghana that a prevalence of 4.7% by
microscopy increased to 18% when diagnosed
using polymerase chain reaction (17).
In conclusion, there is considerable
prevalence of malaria parasites among blood
donors attending Arba Minch blood bank. Hence,
donations should be screened for malaria prior to
release to inventory and, if not excluded, positive
donors should be treated before being accepted for
donation.We recommend large scale studies by
recruiting more numbers of donors in order to
conclude on the association between
asymptomatic malaria and ABO blood group.
ACKNOWLEDGEMENTS
We thank health professionals working inArba
Minch blood bank for their contribution during
data collection, and Arba Minch University for
funding the research. We are grateful to ethical
review boards of Arba Minch University for
giving ethical clearance. Our regards also go to the
study subjects for giving consent to participate in
the study.
DOI: http://dx.doi.org/10.4314/ejhs.v28i3.9
Getaneh A. et al. 321
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 RESUME JURNAL MALARIA

Infeksi Malaria asimptomatik dan Faktor Terkait di antara Donor Darah yang
Menghadiri Arba Minch Blood Bank, Ethiopia Barat Daya

Dosen : Prayudhy Yushananta, SKM, MKM

Disusun Oleh :
Della Retnoningrum
1813351003

JURUSAN KESEHATAN LINGKUNGAN

PRODI SANITASI LINGKUNGAN
PROGRAM SARJANA TERAPAN
2019/2020

i
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Donor Darah Yang Menghadiri Arba Minch Blood Bank, Ethiopia Barat Daya”

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Bandar Lampung 17 September 2019

Penulis

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 DAFTAR ISI

COVER

Kata Pengantar............................................................................................ii

Daftar Isi......................................................................................................iii

Abstrak.........................................................................................................4

Latar Belakang............................................................................................4

Tujuan Penelitian.........................................................................................5

Metode...........................................................................................................5

Hasil ..............................................................................................................7

Diskusi...........................................................................................................9

Kesimpulan..................................................................................................10

Daftar Pustaka.............................................................................................11

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Judul Penelitian : Infeksi Malaria asimptomatik dan Faktor Terkait di antara
Donor Darah yang Menghadiri Arba Minch Blood Bank, Ethiopia Barat Daya.
Peneliti :Getaneh Alemu, Mohammedaman Mama.
Sumber : HealthSci.2018; 28 (3): 315. doi: http:
//dx.doi.org/10.4314/ejhs.v28i3.9
Diterima : 3 Desember 2017
Diterima : 6 Desember 2017
Diterbitkan : 1 Mei 2018
Hak Cipta : © 2018 Getaneh Alemu, et al

ABSTRAK
Latar Belakang
Malaria adalah salah satu masalah kesehatan masyarakat utama di dunia yang
memengaruhi sekitar 91 negara dan wilayah. Penyakit ini disebabkan oleh parasit
protozoa dari genus Plasmodium.Penyakit ini tersebar luas di daerah panas
lembab di Afrika, Asia, dan Amerika Selatan dan Tengah. Penyakit ini juga
terjadi di banyak daerah beriklim sedang. Pada tahun 2015, 212 juta kasus malaria
terjadi secara global 429.000 kematian. Afrika Sub-Sahara adalah wilayah yang
paling terkena dampak, terhitung 90,1% (191 juta) dari kasus dan 91,8% (394
ribu) dari kematian pada tahun 2015.
Malaria adalah salah satu dari tiga penyebab utama morbiditas di Ethiopia. Pada
tahun 2015, total 1.867.059 kasus yang dikonfirmasi laboratorium dan 662
kematian dilaporkan di negara itu. Empat spesies plasmodium telah dilaporkan di
Indonesia Etiopia di antaranya P. falciparum dan P. Vivax masing-masing
bertanggung jawab atas 64% dan 36% kasus malaria. P.falciparum dan P. vivax
biasanya dilaporkan di Arba Minch tanpa data yang mendukung proporsi (data
tidak dipublikasikan).
Parasit plasmodium ditularkan terutama oleh nyamuk Anopheles betina. Transfusi
darah, transplantasi organ dan cedera transplasental dan jarum juga mungkin
merupakan rute penularan. Transfusi Transmisi Malaria (TTM) umumnya terjadi
di negara endemik malaria dan terus menghambat upaya pengendalian malaria.

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Donor darah di negara-negara Afrika sub-Sahara cenderung terinfeksi parasit
malaria dan berkontribusi pada penularan penyakit.
Data yang memadai dari berbagai pengaturan geografis negara diperlukan untuk
menjadi masukan bagi Kementerian Kesehatan Federal untuk membuat keputusan
tentang penyaringan darah donor. Namun, ada kurangnya data tentang besarnya
dan faktor yang terkait dengan malaria tanpa gejala di antara donor di Ethiopia.
Oleh karena itu, tujuan dari penelitian ini adalah untuk memperkirakan prevalensi
malaria tanpa gejala dan faktor terkait di antara donor darah yang menghadiri
bank darah Arba Minch.
Sudah diketahui bahwa malaria dapat ditularkan melalui transfusi darah. Namun,
itu tidak didokumentasikan dalam protokol penyaringan donor nasional. Besarnya
malaria tanpa gejala di antara donor akan menjadi kunci untuk memutuskan
kebutuhan skrining donor. Meskipun demikian, ada kekurangan data seperti itu di
Ethiopia.

Tujuan Penelitian
Tujuan dari penelitian ini adalah untuk memperkirakan prevalensi malaria tanpa
gejala dan faktor terkait di antara donor darah.

Metode
Desain dan area penelitian: Sebuah studi cross-sectional berbasis fasilitas
dilakukan di Arba Minch bank darah Februari hingga Juni 2015. Arba Minch
terletak di 454 km di selatan Addis Ababa. Ditemukan pada ketinggian 1200-1300
meter di atas permukaan laut dengan suhu tahunan rata-rata 29,70C dan curah
hujan 900mm (23).
Sumber dan populasi penelitian: Semua orang dewasa
populasi dengan rentang usia yang memenuhi syarat (17-65 tahun) untuk donor
darah dan tinggal di daerah tangkapan endemis malaria di bank darah Arba Minch
adalah populasi sumber. Subjek penelitian direkrut di antara mereka yang datang
untuk menyumbangkan darah selama masa studi.
Ukuran sampel dan teknik pengambilan sampel: ukuran sampel ditentukan
menggunakan rumus proporsi populasi tunggal (n = [Z 1- α / 2] 2 P (1-p] / d2)

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pada tingkat kepercayaan 95% (Z (1-ά / 2) = 1.96). Kesalahan marginal 5% (d)
ditoleransi. Karena tidak ada data sebelumnya tentang prevalensi (p) malaria di
antara donor darah di daerah tersebut, kami mempertimbangkan 50% prevalensi
untuk perhitungan ukuran sampel. Mengganti nilai, ukuran sampel yang dihitung
adalah 384, dan final ukuran sampel adalah 423 setelah menambahkan 10% untuk
mengkompensasi non-responden. Teknik pengambilan sampel acak sistematis
diikuti. Dengan menelusuri kembali aliran donor tahun lalu, kami harapkan
1650 donor selama masa studi. Karena itu, nilai K yang dihitung adalah 4
(1650/423).
Kriteria inklusi dan eksklusi: Kriteria inklusi melewati kriteria skrining bank
darah. Kriteria eksklusi adalah penduduk tetap di daerah non-endemik malaria.
Data sosio-demografis: Perawat yang fasih berbahasa lokal (Gamogna) dipilih
dan dilatih untuk pengumpulan data. Data sosio-demografis dikumpulkan dengan
menggunakan kuesioner terstruktur pretested yang diberikan melalui wawancara
tatap muka setelah diterjemahkan ke dalam bahasa lokal. Peserta juga
diwawancarai untuk riwayat infeksi malaria, perawatan yang diterima dan riwayat
donor darah sebelumnya.
Metode laboratorium: Kami menggunakan darah yang dikumpulkan ke bagian
tabung dari kantung darah untuk persiapan film darah. Kedua film darah tipis dan
tebal disiapkan dan diperiksa setelah pewarnaan dengan Giemsa (24). Untuk
sampel positif, tahap aseksual parasit malaria dihitung terhadap 500 sel darah
putih (WBC) pada film tebal dan dilaporkan sebagai jumlah parasit per μl darah
dengan asumsi jumlah leukosit dewasa standar 8000 / μl.
Apusan darah dianggap negatif setelah memeriksa minimal 200 bidang daya
tinggi tanpa parasit terlihat. Semua prosedur laboratorium diproses di
laboratorium bank darah Arba Minch oleh teknisi laboratorium terlatih. Prosedur
operasi standar benar-benar diikuti untuk diagnosis malaria. Larutan tangkai
Giemsa disimpan dengan tepat dan kualitas pewarnaan diperiksa setiap minggu
dengan pemrosesan diketahui sampel positif dan negatif. Kelompok donor darah
ABO dan Rh diambil dari buku registrasi donor.
Analisis statistik: Data dimasukkan dan dianalisis menggunakan SPSS versi 20.0.
Persetujuan etis dan persetujuan untuk berpartisipasi: Persetujuan etis untuk

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penelitian ini diberikan oleh dewan peninjau dari Fakultas Kedokteran dan Ilmu
Kesehatan Universitas Arba Minch dengan kode proyek Pemerintah / AMH / 5-1 /
CMHS / MLS / 01/07. Surat izin resmi juga diperoleh dari bank darah Arba
Minch. Persetujuan tertulis diperoleh dari semua donor darah yang berpartisipasi.
Semua hasil laboratorium dikomunikasikan untuk mempelajari subjek segera.
Semua darah positif malaria dibuang.

Hasil
Sejumlah 416 donor berpartisipasi dalam penelitian ini. Proporsi donor yang
terinfeksi adalah 4,1% (17/416). Delapan donor terinfeksi Plasmodium
falciparum, sementara 9 donor terinfeksi Plasmodium vivax. Sebagian besar film
darah positif (13/17) dengan muatan parasit berkisar antara 100 - 500 parasit / μl.
Donor dengan golongan darah O lebih rentan terhadap parasitemia malaria
dibandingkan dengan semua golongan darah ABO lainnya secara bersamaan
(AOR = 6,899, 95% CI = 1,951-24,391, p = 0,003).

Tabel 1: Karakteristik sosio-demografis dan riwayat klinis donor darah yang

menghadiri Arba Bank darah minch dari Februari hingga Juni 2015
Variabel Angka
Jenis kelamin 1. Laki laki 232 (55.8)
2. Perempuan
184 (44.2)
Umur 1. 18-27 355(85.3)
2. 28-37 48(11.6)
3. >37 13(3.1)
Status 1. Belum Menikah 339(81.5)
2. Sudah menikah 77(18.5)
Pendidikan 1. Orang buta huruf 112(26.9)
2. Utama 21(5.0)
3. Sekunder 76(18.3)
4. Tersier
207 (49.8)
Pekerjaan 1. Ibu rumah tangga
14(3.3)

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 2. Petani / pertanian 117(28.1)
3. Karyawan 141(33.9)
4. Pembisnis/ toko 79(19.1)
5. Mahasiswa
65 (15.6)
Terinfeksi Malaria 1. Ya 154(37)
sebelumnya
2. Tidak 262 (63)
Waktu malaria 2 – 6 bulan 18(11.7)
terakhir

Berlanjut 1. > 6 bulan 84(54.5)

2. Tidak ingat 52 (33.8)
Obat anti malaria Ya
diminum 151(98.1)
Selama episode Tidak
terakhir 3(1.9)
Gunakan kelambu 1. Ya 152(36.5)
2. Tidak 264 (63.5)
Riwayat donor darah 1. Ya 219 (52.6)
sebelumnya
2. Tidak 197 (47.4)
Jumlah donasi 1. Sekali 124(56.6)
sebelumnya
2. 2-4 kali 78(35.6)
3. > 4 kali 17 (7.8)
Golongan darah 1. O 175(42.1)
2. A 136(32.7)
3. B 87(20.9)
4. AB
Golongan darah Rh 1. Rh+ 386(92.8)
2. Rh- 30 (7.2)

Prevalensi malaria keseluruhan dalam penelitian ini adalah 4,1% (17/416).

Delapan dan 9 donor masing-masing terinfeksi P. falciparum dan P. vivax.

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Diskusi
Besarnya parasitemia malaria tanpa gejala dalam penelitian ini sejalan dengan
temuan dari Sudan (6,5%) (16). Namun, itu lebih tinggi dibandingkan dengan
penelitian serupa dari Ethiopia Utara (1%, 6/600) (26). Perbedaannya mungkin,
sebagian, karena kepatuhan yang rendah terhadap alat pencegahan malaria karena
hanya 11,8% dari donor positif malaria tidur di bawah kelambu meskipun
semuanya tinggal di daerah endemis malaria..
Temuan kami menunjukkan distribusi P. falciparum dan P. vivax yang sebanding.
Plasmodium falciparum adalah spesies dominan yang diidentifikasi dari donor
yang terinfeksi menurut sebuah studi dari Sudan (98,1%). Perbedaan ini mungkin
karena variasi dalam distribusi spesies antar negara. Menurut laporan WHO baru-
baru ini, P. falciparum menyumbang 95% di Sudan; tetapi yang dari Ethiopia
adalah 64% untuk P. falciparum dan 36% untuk P. vivax. Relaps juga dapat
meningkatkan frekuensi deteksi P. vivax. Seperti yang diharapkan dari pembawa
asimptomatik, 16 dari 17 film darah positif menunjukkan infeksi ringan (0001000
parasit / μl) yang sejalan dengan temuan dari Sudan.
Mengenai faktor-faktor yang terkait dengan parasitemia plasmodium
asimptomatik, perempuan lebih rentan daripada laki-laki; tetapi variasinya tidak
signifikan secara statistik. Analisis bivariat juga menunjukkan bahwa donor yang
tidak tidur di bawah kelambu (p = 0,047) dan tidak memiliki riwayat donor darah
sebelumnya (p = 0,022) lebih rentan terhadap parasitemia malaria asimptomatik
dibandingkan dengan mereka yang tidur di bawah kelambu dan memiliki riwayat
sumbangan masing-masing.
Donor golongan darah O lebih rentan terhadap infeksi plasmodium daripada
donor non-kelompok O. Ini sejalan dengan temuan dari penelitian terbaru yang
dilakukan di Nigeria (14,28). Hasil yang kontras telah dilaporkan dalam dua
penelitian di Nigeria lagi di mana 37,5% dan
100% kasus dengan golongan darah AB (12,29). Menurut penelitian oleh Sirina
dan Clement dan Otajevwo, golongan darah ABO tidak secara bermakna
dikaitkan dengan tingkat infeksi malaria. Prevalensi malaria akan jauh lebih
tinggi jika data dikumpulkan selama musim penularan malaria utama (September
hingga Desember). Parasemia sub-mikroskopis juga sering terjadi pada pembawa

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asimptomatik sehingga penggunaan tes diagnostik yang lebih sensitif (teknik
molekuler) akan menghasilkan tingkat parasitemia malaria yang lebih tinggi. Ini
dibuktikan oleh temuan dari Ghana bahwa prevalensi 4,7% dengan mikroskop
meningkat menjadi 18% ketika didiagnosis menggunakan reaksi berantai
polimerase (17).

Kesimpulan
Besarnya parasitemia malaria dalam penelitian ini tinggi dibandingkan dengan
prevalensi malaria nasional. Oleh karena itu, di daerah endemis malaria Ethiopia,
darah harus diperiksa sebelum disumbangkan.
KATA KUNCI: Transfusi darah, prevalensi malaria, donor darah

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