Transfusion-transmitted malaria in sub-Saharan Africa: systematic review and meta-analysis of Plasmodium carriage in blood units and confirmed cases in recipients
1
Regional Doctoral School of Central Africa in Tropical Infectious Diseases, Université des Sciences et Techniques de Masuku (USTM), Franceville, Gabon
2
Preventive and Curative Services, Biomedical Research Unit, Vaccine and Antimicrobial Resistance, Centre de Santé Muhungu-État / CELPA, Bukavu, Congo, Democratic Republic of the
3
Molecular Biology Laboratory, Université Évangélique en Afrique (UEA), Bukavu, Congo, Democratic Republic of the
4
Faculty of Medicine, Université des Sciences et Techniques de Masuku (USTM), Franceville, Gabon
5
Department of Biology, Faculty of Science, Université des Sciences et Techniques de Masuku, (USTM), Franceville, Gabon
6
Evolution, Epidemiology and Parasitic Resistance Unit, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
Popul. Med. 2026;8(Supplement Supplement 1):A538
ABSTRACT
BACKGROUND:
Transfusion-transmitted malaria (TTM) remains a major concern in malaria-endemic regions of Sub-Saharan Africa (SSA), where routine blood donor screening for Plasmodium species is rarely implemented. Asymptomatic donor carriers serve as silent reservoirs, placing transfusion recipients at substantial risk. This systematic review and meta-analysis aimed to estimate Plasmodium spp. prevalence among blood donors and assess the risk of TTM across SSA.
METHODS:
We searched PubMed, Google Scholar, ScienceOpen, MedRxiv, and BioRxiv for studies published up to July 2025. Eligible studies reported Plasmodium prevalence among blood donors or documented post-transfusion malaria in recipients. Data extraction followed PRISMA guidelines. Study quality was independently assessed using the Joanna Briggs Institute checklist and the AXIS tool. Pooled prevalence was estimated via random-effects meta-analysis, and publication bias assessed using Egger’s test.
RESULTS:
From 1,364 records, 12 studies met inclusion criteria, representing 11,818 participants across West, Central, and East/Southern Africa. The pooled prevalence of asymptomatic Plasmodium carriage among donors was 12% (95% CI: 6–20%; I² = 99%). Egger’s test indicated no significant publication bias (p = 0.581). Three studies reported post-transfusion follow-up. Transmission rates among infected blood units ranged from 63% to 100%. Strong correlations were observed between infected units, transfused recipients, and confirmed TTM cases (r = 0.926–0.992; all p < 0.01).
CONCLUSIONS:
Asymptomatic Plasmodium carriage in blood donors remains a significant threat to transfusion safety in SSA. Confirmed TTM cases underscore the urgent need for malaria screening or recipient prophylaxis, particularly for neonates, pregnant women, and immunocompromised patients. This review provides robust evidence that TTM is an underrecognized public health concern requiring urgent attention in blood safety policy.
Transfusion-transmitted malaria (TTM) remains a major concern in malaria-endemic regions of Sub-Saharan Africa (SSA), where routine blood donor screening for Plasmodium species is rarely implemented. Asymptomatic donor carriers serve as silent reservoirs, placing transfusion recipients at substantial risk. This systematic review and meta-analysis aimed to estimate Plasmodium spp. prevalence among blood donors and assess the risk of TTM across SSA.
METHODS:
We searched PubMed, Google Scholar, ScienceOpen, MedRxiv, and BioRxiv for studies published up to July 2025. Eligible studies reported Plasmodium prevalence among blood donors or documented post-transfusion malaria in recipients. Data extraction followed PRISMA guidelines. Study quality was independently assessed using the Joanna Briggs Institute checklist and the AXIS tool. Pooled prevalence was estimated via random-effects meta-analysis, and publication bias assessed using Egger’s test.
RESULTS:
From 1,364 records, 12 studies met inclusion criteria, representing 11,818 participants across West, Central, and East/Southern Africa. The pooled prevalence of asymptomatic Plasmodium carriage among donors was 12% (95% CI: 6–20%; I² = 99%). Egger’s test indicated no significant publication bias (p = 0.581). Three studies reported post-transfusion follow-up. Transmission rates among infected blood units ranged from 63% to 100%. Strong correlations were observed between infected units, transfused recipients, and confirmed TTM cases (r = 0.926–0.992; all p < 0.01).
CONCLUSIONS:
Asymptomatic Plasmodium carriage in blood donors remains a significant threat to transfusion safety in SSA. Confirmed TTM cases underscore the urgent need for malaria screening or recipient prophylaxis, particularly for neonates, pregnant women, and immunocompromised patients. This review provides robust evidence that TTM is an underrecognized public health concern requiring urgent attention in blood safety policy.
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
