Transfusion-transmitted malaria in sub-Saharan Africa: a systematic review and meta-analysis of Plasmodium spp. carriage in blood units and confirmed transmission in recipient.

Authors

Lambert Morisho Mulakwa, Archippe Muhandule Birindwa, Chérone Nancy Mbani Mpega Ntigui, Justin Byamungu Ahadi, Patrick Ntagereka Bisimwa, Sandrine Lydie Oyegue Liabagui

Published in

Malaria journal. Jul 07, 2026. Epub Jul 07, 2026.

Abstract

Transfusion-transmitted malaria (TTM) remains a major concern in malaria-endemic regions of Sub-Saharan Africa (SSA), where routine screening of blood donors for Plasmodium species is rarely implemented. Asymptomatic carriers among donors serve as silent reservoirs of infection, which puts transfusion recipients at substantial risk. This systematic review and meta-analysis aimed to assess the prevalence of Plasmodium spp. carriage among blood donors and evaluate the associated risk of TTM across SSA.
A comprehensive literature search was conducted in PubMed (MEDLINE), Google Scholar, ScienceOpen, MedRxiv and BioRxiv for studies published up to July 2025. Eligible studies were those reporting the prevalence of Plasmodium spp. among blood donors or documenting cases of post-transfusion malaria in recipients. Data extraction was performed in accordance with PRISMA guidelines. The methodological quality of the included studies was independently assessed by two reviewers using the Joanna Briggs Institute (JBI) checklist and the AXIS tool for cross-sectional studies. A random-effects meta-analysis was performed using MetaAnalysis Online to estimate pooled prevalence, and publication bias was explored using Egger's test.
A total of 1,364 records were identified, of which 12 studies met the inclusion criteria, representing 11,818 participants across West, Central, and East/Southern Africa. The pooled prevalence of asymptomatic Plasmodium spp. carriage among blood donors was 12% (95% CI 6-20%), based on a random-effects model, heterogeneity was substantial (I² = 99%, p < 0.01), while Egger's test (p = 0.581) indicated no significant publication bias. Three studies reported post-transfusion follow-up data. Comparative risk analysis revealed pronounced discrepancies between parasite prevalence in transfused blood and the number of documented TTM cases, with transmission rates among infected blood units ranging from 63% to 100%.
Asymptomatic Plasmodium spp. carriage among blood donors poses a potential threat to transfusion safety in sub-Saharan Africa, underscoring the need for improved screening, strengthened haemovigilance, and further research.

PMID:
42410616
Bibliographic data and abstract were imported from PubMed on 07 Jul 2026.

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