Transfusion‐transmitted malaria in India: A national survey of epidemiology and testing practices

BACKGROUND AND OBJECTIVES: Malaria still poses a public health burden in India despite ongoing elimination efforts. Blood donor screening for malaria is mandated in India, yet data on transfusion-transmitted malaria (TTM) are lacking. We sought to evaluate testing practices for malaria, associated rates of positivity in donors and reported cases of TTM in India. MATERIALS AND METHODS: We conducted a cross-sectional survey of blood collection facilities in India from May to September 2025. Facilities were recruited through professional networks and direct outreach; responses were de-identified. Data were collected on screening practices, malaria endemicity, quality control measures and TTM cases from 2020 to 2024. RESULTS: Among 262 facilities, 256 (97.7%) reported routine malaria screening of all donations, most commonly using antigen rapid diagnostic tests (RDTs) (228/256, 89.1%). From 2020 to 2024, facilities tested 9,275,688 donations, with 1231 confirmed positive donations (overall 13.27 per 100,000 units) and a rising annual positivity rate from 3.4 to 22.0 per 100,000 units. Only eight facilities (3.1%) reported TTM cases, and less than half of facilities (116/256, 45.3%) participated in external quality assessment (EQA) and/or performed lookback investigations (88/262, 33.6%). CONCLUSION: In this national survey sample in India, almost all facilities reported routine malaria screening of blood donations, mostly using RDT. The findings suggest that rates of donor positivity may have increased, yet TTM is under-recognized and/or unreported. Strengthening EQA and haemovigilance, particularly in malaria endemic regions, is needed to safeguard the blood supply, particularly as India strives towards malaria elimination.