Epidemiology and safety challenges of major transfusion-transmitted pathogens in Cameroon: A systematic review and meta-analysis

OBJECTIVES: This systematic review and meta-analysis (SRMA) was designed to determine the prevalence, patterns, and determinants of major transfusion-transmitted infections (TTIs), to address this gap, and to propose solutions to the current identified blood transfusion-related challenges in Cameroon. METHODS: Pooled estimates of TTI-related infection rates, that is, human immunodeficiency virus - HIV, hepatitis B/C viruses - HBV/HCV, and Treponema pallidum, were computed using random effects models. Subgroup and sensitivity analyses were performed, and methodological bias analysis was assessed using the Joanna Briggs Institute tools. RESULTS: A total of 36 studies, spanning 72 datasets for ∼105,000 blood donations, were included. Most of them were conducted in family donors attending health facilities of three towns, viz. Yaoundé (51.4%), Douala (25.7%), and Bamenda (8.6%). The pooled proportion of TTIs was 15.4% (95% CI: 12.7-18.2%), and was significantly modulated by several variables (e.g., testing strategy, area). These pathogens could occur as coinfections at a pooled proportion of 1.5%, with HBV + HCV being the most prevalent (3.4%). Across studies, the risk for HIV and T. pallidum infection was consistently higher in family donors. Several challenges, including diagnostic inconsistencies (even within the same assay) and a lack of evidence data on determinants, residual risk, and the extent of occult hepatitis B infection, were identified, primarily due to the paucity and underreporting of data in certain regions. CONCLUSIONS: The review outlines a significant burden of HIV, HBV, HCV, and T. pallidum in blood donors. High-quality studies are needed to fill these gaps to inform public health policymakers and assist the development and implementation of better blood safety strategies and services.