Prevalence and Plasmodium Species Distribution of Asymptomatic Malaria Parasitemia among Blood Donors at the Lilongwe Blood Transfusion Centre – Frontiers

Report on Asymptomatic Malaria Parasitemia in Blood Donors and Implications for Sustainable Development Goals

Introduction: Aligning Blood Safety with Global Health Targets

Ensuring the safety of blood transfusions is a critical component of robust healthcare systems and a direct contributor to achieving Sustainable Development Goal 3 (Good Health and Well-being). In malaria-endemic regions like Malawi, the risk of transfusion-transmitted malaria (TTM) poses a significant threat to public health, undermining progress towards Target 3.3, which aims to end the epidemics of communicable diseases, including malaria, by 2030. This report details a study conducted at the Malawi Blood Transfusion Service (MBTS) to assess the prevalence of asymptomatic malaria among blood donors, a crucial step in safeguarding health and promoting well-being for all.

Methodology: A Collaborative Approach to Health System Strengthening

This cross-sectional study was conducted at the Lilongwe Centre of the MBTS, reflecting a partnership approach consistent with SDG 17 (Partnerships for the Goals). The research involved voluntary, asymptomatic blood donors and utilized a dual-method approach for malaria detection.

1. Screening Tools:
   • Plasmodium falciparum histidine-rich protein 2 (PfHRP2) rapid diagnostic tests (RDTs) were used for initial screening.
   • Microscopic analysis was employed for confirmation, species identification, and parasite density quantification.
2. Data Collection: A structured questionnaire was used to identify factors associated with malaria transmission among the donor population.
3. Analysis: Data was analyzed to determine prevalence and identify significant risk factors, providing evidence to inform policies aimed at strengthening health infrastructure.

Key Findings: Uncovering a Hidden Public Health Challenge

The study revealed a substantial burden of asymptomatic malaria among the blood donor population, highlighting a critical gap in current screening protocols that directly impacts the achievement of SDG 3.

• Overall Prevalence: A malaria prevalence of 13.5% was identified among the 377 participants.
• Gender Distribution: The prevalence was nearly identical between females (13.4%) and males (13.5%).
• Species Identification: The analysis of positive cases showed a predominance of the most virulent species, posing a direct risk to vulnerable transfusion recipients.
  • Plasmodium falciparum: 85.4%
  • Mixed infections (P. falciparum and P. malariae): 8.3%
  • Plasmodium malariae only: 6.3%
• Associated Factors: Significant demographic factors influencing infection included age, occupation, and residence, underscoring the link between socioeconomic conditions and health outcomes, a core concern of SDG 10 (Reduced Inequalities).

Conclusion and Recommendations for Advancing the SDGs

The detection of a significant prevalence of asymptomatic malaria parasitemia in blood donors presents a clear risk to blood safety in Malawi. This finding directly challenges the objectives of SDG 3 by potentially causing iatrogenic infections in vulnerable patients, including pregnant women and children, thereby increasing morbidity and mortality.

To mitigate this risk and advance global health targets, the following actions are recommended:

1. Strengthen Screening Protocols: Implement mandatory and effective malaria screening for all blood donations. This is essential for ensuring a safe blood supply and making progress on SDG Target 3.8 (achieve universal health coverage).
2. Enhance Diagnostic Capacity: Invest in the infrastructure and training required for accurate malaria detection within blood transfusion services.
3. Policy Review: National health authorities should review and update blood donation guidelines to address the challenge of TTM in endemic settings.

Addressing this issue is not only vital for preventing TTM but also for strengthening the overall health system, reducing health inequalities, and ensuring that life-saving medical procedures do not inadvertently transmit deadly diseases.

1. SDGs Addressed in the Article

• SDG 3: Good Health and Well-being – The article’s central theme is the health risk posed by transfusion-transmitted malaria in Malawi, directly aligning with the goal of ensuring healthy lives and promoting well-being.

2. Specific SDG Targets Identified

SDG 3: Good Health and Well-being

1. Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
   • Explanation: The article directly addresses this target by investigating the “prevalence of asymptomatic malaria parasitemia” among blood donors. The study’s conclusion that there is a “substantial burden of asymptomatic malaria” which poses a “potential risk for transfusion-transmitted malaria” highlights a key challenge in the fight to end the malaria epidemic. The research focuses on an often-overlooked transmission route that undermines efforts to control the disease.
2. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
   • Explanation: The article connects to this target by discussing the safety of blood transfusions, which are a vital component of essential healthcare services. The text explicitly states that in malaria-endemic regions like Malawi, “the risk of infection transmission remains significant” due to “constrained resources and infrastructure” and “inadequate capacity for malaria detection.” This points to a gap in providing safe and quality healthcare services, as routine screening of blood for malaria is not universally implemented.

3. Indicators for Measuring Progress

SDG 3: Good Health and Well-being

1. Indicator 3.3.3: Malaria incidence per 1,000 population.
   • Explanation: While the article does not provide the national malaria incidence rate, it offers a critical, specific measure that contributes to the overall understanding of the malaria burden. The finding of an “overall malaria prevalence of 13.5% (51/377)” among asymptomatic blood donors serves as a powerful proxy indicator. It measures the hidden reservoir of the parasite in the population, which is a key factor in sustained transmission and directly impacts the goal of ending the epidemic.
2. Implied Indicator for Target 3.8 (related to Indicator 3.8.1: Coverage of essential health services): Capacity of health facilities to provide essential services.
   • Explanation: The article implies a way to measure progress towards universal health coverage by highlighting a specific service gap. The statement that “many blood centers have inadequate capacity for malaria detection, leading to the absence of routine screening protocols” can be used as a qualitative and quantitative indicator. Progress could be measured by tracking the percentage of blood transfusion centers in the country that have implemented routine malaria screening protocols and have the necessary diagnostic capacity (e.g., RDTs, microscopy).

4. Summary Table of SDGs, Targets, and Indicators

Source: frontiersin.org