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*Corresponding author: E-mail: mustapha4mina@yahoo.com; 
 
 
 

Asian Journal of Immunology 
 
3(1): 30-38, 2020; Article no.AJI.55084 
 

 
 
 

 

Seroprevalence of Syphilis and Hepatitis C Virus 
Coinfection among Blood Donors Attending Aminu 

Kano Teaching Hospital, Kano-Nigeria 
 

Khadijah Abdullahi Saleh1, Yusuf Danasabe Jobbi2, Ibrahim Yusuf1,  
Umar Mustapha3*, Azeezat Bolanle Adetokun2, Dauda Balarabe Musa2  

and Danjuma Faiza Muhammad3 
 

1Department of Microbiology, Faculty of Life Sciences, College of Natural and Pharmaceutical 
Sciences, Bayero University, Kano State, Nigeria. 

2
Department of Haematology, Aminu Kano Teaching Hospital, Kano State, Nigeria. 

3Division of Microbiology, Department of Science Laboratory Technology, Nigerian Institute of Leather 
and Science Technology, Zaria, Kaduna State, Nigeria. 

 
Authors’ contributions 

  
This work was carried out in collaboration among all authors. Authors KAS, YDJ and IY designed the 
study, performed the statistical analysis, wrote the protocol and wrote the first draft of the manuscript. 

Authors ABA and DBM managed the analyses of the study. Authors UM and DFM managed the 
literature searches. All authors read and approved the final manuscript. 

 
Article Information 

 
Editor(s): 

(1) Dr. Darko Nozic, University of Belgrade, Serbia. 
(2) Dr. Jaffu Othniel Chilongola, Tumaini University, Tanzania. 

Reviewers: 
(1) Michele Kimie Sankako, State University of Campinas, Brazil. 

(2) Anslem Ajugwo, Madonna University, Nigeria. 
(3) Mihaila Romeo-Gabriel, Lucian Blaga University of Sibiu, Romania. 

Complete Peer review History: http://www.sdiarticle4.com/review-history/55084 
 
 
 
 

Received 01 January 2020  
Accepted 06 March 2020 

Published 18 March 2020 

 
 

ABSTRACT 
 

Blood transfusion is an important component of patients management, as it saves millions of life 
each year, but it also serves as a vehicle for transmission of blood-pathogens such as hepatitis C 
virus and syphilis as a result World Health Organization has recommended that all blood samples 
should be screened for transfusion transmissible infections prior to transfusion. Therefore this was 
conducted to determine the seroprevalence and socio-demographic distribution of Hepatitis C virus 
and Syphilis among blood donors in Aminu Kano Teaching Hospital, Kano. This is a cross sectional 
study of blood donors presented at the donor clinic of Aminu Kano Teaching Hospital, Kano 

Original Research Article 



 
 
 
 

Saleh et al.; AJI, 3(1): 30-38, 2020; Article no.AJI.55084 
 
 

 
31 

 

between July and September 2018. A total of 90 blood samples were collected from voluntary and 
family replacement donors, aged between 18-57 years, the collected samples were screened for 
anti-Treponema pallidum antibodies using a rapid diagnostic kits and were also screened for the 
presence of anti-HCV and anti-Treponema pallidum antibodies using an enzyme-linked 
immunosorbent assay (ELISA) kit. All of the total 90 (100%) donors screened were males. Family 
replacement and voluntary donors were of 76 (84.4%) and 14(15.6%) donors respectively. The 
overall seroprevalence of HCV and syphilis was 7.8% (5.6% and 2.2% for HCV and syphilis 
respectively using ELISA test). Prevalence of 1.3% was found for syphilis using a rapid diagnostic 
kit. Therefore critical screening of blood donors is of prime importance because they serve as an 
asymptomatic reservoir and a potential source of transmission of these infections. 
 

 
Keywords: Hepatitis C virus; syphilis; blood transfusion; ELISA; blood donors. 
 

1. INTRODUCTION 
 
Blood is one of the integral components of body 
constituents [1]. Blood is composed of pale 
yellow fluid called plasma in which are 
suspended red cells (erythrocytes), white cells 
(leukocytes) and platelets (thrombocytes). 
Plasma forms about 55% of the blood volume 
and contains about 95% of water, many solutes 
are dissolved in it including proteins, antibodies, 
salts, organic molecules, hormones, enzymes, 
products of digestion and wastes products of 
excretion [2]. Blood flows through every organ of 
the body providing effective communication 
between tissues [1] there are almost 5-6 litres of 
blood in the circulatory system of an average 
adult and about 300 ml in the circulatory system 
of a new born infant [2]. Blood has important 
transport, distributions regulatory and protective 
functions in the body such as the transport of 
oxygen from the lung to the tissues, nutrients 
absorbed from the digestive tract. Example: 
Monosaccharide and amino acids are 
transported to the cells of the body for use or 
storage; waste products of metabolism are 
transported from the tissues to sites of excretion; 
hormones are also carried from endocrine glands 
to the organs where they are needed; blood also 
assists in regulating the temperature of the body 
by absorbing and distributing heat throughout the 
body and skin surface where heat which is not 
required is dissipated; leukocytes are involved in 
body’s immune defenses, by producing 
antibodies in response to infection and protecting 
the body from damage by bacteria, viruses, 
parasites, toxins and tumour cells [2]. 
 
There are many medical conditions or problems 
that might require transfusion of blood or blood 
products some of these conditions include, 
severe anaemia, acute blood loss due to 
pregnancy, childbirth and accidents, types of 
cancer or cancer treatment that can affect blood 

cells and surgery, thus transfusion of blood and 
blood product has become a routine activity in 
clinical practices [3]. Transfusion of blood and 
blood products saves millions of lives each year 
it can help patients suffering from threatening 
conditions and supports complex medical and 
surgical procedures it also plays an important 
role in maternal and child care and during man –
made and natural disasters [4]. 
 
However blood transfusion serves as a vehicle 
for transmission of blood-borne pathogens 
including Hepatitis C virus (HCV) and syphilis. 
Transfusion transmissible infections are among 
the major public health problem worldwide 
affecting the quality of life and causing serious 
morbidity and mortality [5]. 
 
Hepatitis C is a viral infection of the liver caused 
by hepatitis C virus, a member of family 
Flaviviridae which has an enveloped linear 
single-stranded positive sense RNA genome. 
Hepatitis C virus is spread primarily by direct 
contact with contaminated blood or blood, use of 
infected sharp objects, transfusion of blood that 
are not screened for HCV infection  intravenous 
drug –use, sexual exposure as well as vertical 
transmission that is from mother to her foetus 
during prenatal period. Hepatitis C virus is one of 
a major public health problem worldwide, and is 
a frequent cause of acute hepatitis and chronic 
liver disease including cirrhosis and 
hepatocellular carcinoma [6]. Globally an 
estimated 200 million people representing 3% of 
the population are chronically infected with the 
virus and 3 to 4 million are newly infected each 
year [7]. 
 
Syphilis is a systemic bacterial infection caused 
by spirochete of genus Treponema pallidum, 
which can be transmitted primarily through 
sexual contact via transfusion of blood and blood 
products and vertically from mother to her foetus 



 
 
 
 

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32 

 

[8]. The causative agent of syphilis, Treponema 
pallidum, is killed by storing blood for 48-72 
hours at 4ºC. Thus, storing of blood for at least 
three days in a refrigerator before transfusion 
can prevent the transmission of syphilis [9]. 
World Health Organization (WHO) estimated that 
approximately 12 million new cases of syphilis 
are reported each year in the world with more 
than 90% from developing countries. Screening 
for transfusion transmissible infections is a 
critical part of the blood transfusion process as it 
ensures that transfusion is as safe as possible 
[10]. However, the World Health Organization 
recommended that all blood donations should be 
screened for evidence of infections prior to the 
release of blood for clinical or manufacturing use 
[11]. Proper monitoring and selection of voluntary 
blood donors and routine screening of blood for 
syphilis, HCV and other transfusion transmissible 
infections has greatly reduced the risk of 
transmitting those infectious agents [12].  
 
The improved screening and testing of blood 
donors has also significantly reduced 
transfusion-transmitted diseases in most 
developed countries. This has not been so in 
developing nations. Poor health education and 
lack of awareness result in the reservoir of 
infections in the population. 
 
Therefore estimating the prevalence of hepatitis 
C virus and syphilis among blood donors permits 
the assessment of occurrence in the blood donor 
population and consequently the safety of blood 
donations. It also provides data that is useful in 
formulating the strategies for improving the 
management of safe blood supply. In addition, it 
also gives an idea of the epidemiology of these 
diseases in a given time at a specific population 
or community [13]. This study aimed to 
determine the seroprevalence and socio-
demographic distribution of Hepatitis C virus and 
syphilis coinfection among blood donors at the 
study site. 
 
2. MATERIALS AND METHODS 
 
2.1 Study Population 
 
This study was carried out at the Department of 
Haematology, Aminu Kano Teaching Hospital, 
Kano State. A total of ninety (90) blood samples 
were collected from consented healthy family 
replacement and voluntary donors at the blood 
donor clinic of Aminu Kano Teaching Hospital, 
Kano from July to September 2018. Ethical 
clearance was obtained from the ethical 

committee of Ministry of Health Kano. 
Volunteered male blood donors of age >18 years 
who consented to participate in the study were 
recruited. While, those who refused to give their 
consents were excluded from the study. 
 

2.2 Study Design 
 

An observational cross-sectional study of blood 
donors over the period of two months from July 
to September 2018 was carried out using a 
structured questionnaire; volunteers of age range 
between 18 to 57 years were screened for the 
determination of antibodies (IgG and IgM) to 
HCV and syphilis. 
 

2.3 Sample Collection and Processing  
 

Five millilitres (5 ml) of blood sample was 
collected from each donor by standard 
venipuncture technique using a sterile syringe 
and a tube.  The samples were distributed in 
such a way that one millilitre (1 ml) from each 
sample was transferred into plain tube for 
screening of syphilis using a rapid diagnostic kit 
(Micropoint Diagnostic®, Nantong, China). A 
volume of 2 ml out of the total of 5 ml collected 
from each patient was aspirated in a test tube 
and centrifuged at 1000 rpm for 10 minutes to 
obtain the serum, which was used to carry out 
the HCsAg screening [2]. A drop of the 
centrifuged blood serum was dispensed on the 
test side of the rapid test HCsAg 
immunochromatographic testing strip (Lab 
Tech® HCsAg D01, Australia Rapid Test Kit), 
which was placed on a flat, dry and non-
absorbent surface on the disinfected working 
bench and allowed to react for two minutes. After 
which the results were read according to 
manufacturers’ instructions. Two (2) red lines 
which often appear on the control line and on the 
determinant (test) line of the test strip indicated a 
positive result, while a single line on the control 
line indicated a negative result. While, in the 
case where there is no red lines that appear on 
both the control and the determinant lines, the 
result was termed as invalid [14-16]. The 
remaining 3 ml of each sample was transferred 
into an appropriate EDTA container after which 
the plasma was extracted by centrifuging the 
blood at 3000 r/min for 5 minutes. The plasma 
was stored at -20ºC until ready for assay. 
Screening of the plasma for Hepatitis C virus and 
syphilis antibodies was conducted using an 
enzyme-linked immunosorbent assay (ELISA) kit 
(DIA. PRO Diagnostic®, Bioprobes, Italy) 
according to manufacturer’s standard operational 
procedure [17]. 



 
 
 
 

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3. RESULTS AND DISCUSSION 
 

A total of 90 healthy blood  donors were 
screened for syphilis infection using a rapid 
diagnostic test out of which 14(15.6%) were 
voluntary donors and 78(84.4) were family 
replacement and only 1 donor was positive to the 
test, therefore the prevalence is 1.3% as shown 
in Table 1. 
 

The prevalence of HCV and syphilis pathogens 
tested by ELISA were 5.6% and 2.2% 
respectively whereby the overall prevalence was 
7.8% (Table 2). 
 

Table 3 showed the distribution of HCV and 
Syphilis pathogens among healthy blood donors 
according to socio-demographic factors. All the 
90 donors screened were males aged between 
18-57years, among the age groups the donors 
within 48-57 years have the highest prevalence 
of 28.6% and 14.3% for HCV and syphilis 
respectively. Out of 90 donors, 50(55.4%) were 
married and 40(44.4%) were single. High 
prevalence of HCV 6.0% was found among 
married donors, while single donors had higher 
prevalence of syphilis. Majority of the donors 
were self-employed 57(63.3), followed by civil 
servants 20(22.2%), and the prevalence rate is 
high among the civil servants, family replacement 
donors constitutes the largest group of the 
donors screened 78(84.4%), HCV and syphilis 
infections were found only among the family 
replacement donors. 
 

Table 4 shows the possible risk factors 
associated with HCV and syphilis seropositivity in 
blood donors, among which blood transfusion 
(33.3%), injection or skin cutting by a traditional 
healers (6.6%), family history of liver disease 
(25.0%) and local circumcision (5.5%) play a role 
in HCV seropositivity, while blood transfusion 
(6.7%), history of STD (50.0%) and local 
circumcision (2.7%) play a role in syphilis 
seropositivity. 
 

Data in most of the reported studies revealed 
that the prevalence of syphilis and HCV has 
greatly reduced as a result of the introduction of 
more sensitive and specific diagnostic assays, 
and more improvement in public health, 
especially in the developed countries. In this 
study, the prevalence of syphilis was 1.3% using 
rapid diagnostic test and 2.2% using ELISA, 
which is in line with study of Abdallah et al. [18]; 
Olokoba et al. [19]; and Butsashvili et al. [20], 
who reported 1.2%, 1.2% and 2.3%. Also, a 
report of Tessema et al. [21] had a rate of 1.3% 
which is similar to this study. 

In contrast to this study, higher prevalence of 
syphilis was reported from different African 
countries, prevalence of 3.7% in Congo [22], 
7.5% in Ghana [23], 15% in Sudan, 12.8% in 
Ethiopia [4], 12.7% in Tanzania [24], and 9.1% in 
Cameroon [25,26]. These wide differences in the 
prevalence of syphilis infection among blood 
donors may be due to difference in sample size, 
high exposure to risk factors such as sexual 
behaviours and laboratory techniques used. 

 
Lower rate of 0.5% and 0.7% syphilis prevalence 
were reported in some part of Nigeria by Fasola 
et al. [27] and Benson et al. [28]. In other parts of 
the world like India 0.3% was found among 
healthy blood donors [29] and 0.75% in Pakistan 
[30], 0.02% in Turkey [31] in Saudi Arabia 
0.028% [32] and 0.2% in South Korea [33]. The 
low prevalence may be attributed to the 
development of effective treatment programmes, 
clinical selection of blood donor, and by selecting 
the low-risk donors. 
 
On the other hand, the seroprevalence of syphilis 
HCV in this study was 5.6% which is almost 
similar to prevalence reported by Alao et al. [34] 
and Buseri et al. [35], who reported 5.4% and 
5.1% respectively. The prevalence rate of 5.6% 
HCV in this study is higher than 2.0%, 0.5%, 
3.4% and 3.9% recorded by Odenigbo et al. [36], 
Erhabor et al. [37], Bala et al. [38] and Amiwero 
et al. [39] respectively. The prevalence of HCV 
antibodies in blood donors in developed 
countries ranges from 0.4% to 2%; 
seroprevalence studies in Europe and United 
States documented a significant reduction in the 
risk of HCV [40]. Lower prevalence of HCV was 
also found among blood donors in Jordan [41] 
0.2% in Saudi Arabia [42] 0.95% in Syria [43] 
and 0.07% in Turkey [44]. Low prevalence of 
HCV among blood donors in some regions may 
be attributed to low exposure to some risk 
factors. 

 
In contrast to this study, higher prevalence 8.4% 
of HCV was recorded by Ayolabi et al. [3]. Also, 
Egypt is reported to have a high prevalence 
24.8% among healthy blood donors [13]. 
 
The highest prevalence of 14.3% was found 
among donors aged between 48-57years. This is 
almost similar to the work of Alao et al. [34], who 
documented the highest age prevalence of HCV 
among blood donors in Makurdi, Nigeria, and 
Dapus et al. [45], who reported the highest 
prevalence among the age group of 46-55 years. 
This may be attributed to the lower immunity in 



 
 
 
 

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34 

 

older people. However, this fail to agree with 
3.2% highest prevalence among donors aged 
between 21-30 years in Eastern Nigeria [36]. 
 
The result of this study showed that family 
replacement donors constituted the largest group 

of the donors, in which 85.4% were family 
replacement donors, while the voluntary donors 
constituted of 15. 6%. The seroprevalence rate of 
5.6% and 2.2% for HCV and syphilis respectively 
were found among the family replacement 
donors. 

 
Table 1. Seroprevalence of syphilis among blood donors at Aminu Kano Teaching Hospital, 

Kano using rapid diagnostic kit 
 

Donor type Number tested (%)                           Syphilis number tested positive (%) 

Voluntary donor 14(15.6) 0(0.0) 

Family replacement donor                                             76(84.4) 1(1.3) 

Total 90(100.0) 1(1.3) 
 

Table 2. Overall seroprevalence of HCV and syphilis among blood donors at Aminu Kano 
Teaching Hospital, Kano 

 

Serological marker Number tested positive by ELISA Percentage (%) 

HCV 5 5.6 

Syphilis 2 2.2 

Total 7 7.8 
 
Table 3. Seroprevalence of HCV and syphilis with regards to demographic factors of the blood 

donors 
 

Demographic factors Number donors 
screened (%) 

HCV 

No tested positive (%) 

Syphilis 

No tested positive (%) 

Age    

18-27 46(51.1) 2(4.4) 1(2.2) 

28-37 21(23.3)                         1(4.8) 0(0.0) 

38-47 16(17.8) 0(0.0) 0(0.0) 

48-57 7(7.8) 2(28.6) 1(14.3) 

Sex    

Male 89(98.9) 5(5.6) 2(2.2) 

Female 0(0.0) 0(0.0) 0(0.0) 

Marital status    

Married 50(55.6) 3(6.0) 1(2.0) 

Single 40(44.4) 2(3.0) 1(2.5) 

Occupation    

Civil servant 20(22.2) 2(10.0) 1(5.0) 

Student 13(14.4) 0(0.0) 0(0.0) 

Self-employed 57(63.3) 3(5.3) 1(1.8) 

Donor type    

Voluntary donor 14(15.6) 0(0.0) 0(0.0) 

Family replacement 
donor 

76(84.4) 5(6.6) 2(2.6) 

 
  



 
 
 
 

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Table 4. Seroprevalence of HCV and syphilis with regards to possible risk factors 
 

Risk factors Number of donors 
screened (%) 

HCV number tested 
positive (%) 

Syphilis number 
tested positive 
(%) 

Received blood transfusion    

Yes 6(6.7) 2(33.3) 1(16.7) 

No 84(93.3) 3(4.1) 1((1.2) 

Received surgical procedure in health facility 

Yes 9(10.0) 1(11.1) 0(0.0) 

No 81(70.0) 4(4.9) 2(2,5) 

Ever given an injection or skin cutting by a traditional healer 

Yes  30(33.3) 2(6.6) 1(0.0) 

No 60(66.7) 3(5.0) 2(3.3) 

History of jaundice    

Yes 3(3.3) 1(33.3) 0(0.0) 

No 87(96.6) 4(4.5 2(2.3) 

Family history of liver disease 

Yes 8(8.9) 2(25.0) 0(0.0) 

No 82(91.1) 3(3.7) 2(2.4) 

History of STD    

Yes  2(2.2) 0(0.0) 1(50.0) 

No 88(97.8) 5(5.7) 1(1.1) 
 
4. CONCLUSION 
 
The present study clearly documented the 
seroprevalence of Hepatitis C virus and syphilis 
pathogens among blood donors as 5.6% and 
2.2% respectively. It can also be concluded that 
voluntary blood donors have been found to be 
safer than family replacement donors despite the 
low percentage of voluntary blood donors and 
there is no participation of female donors during 
this research; so there is need to increase 
awareness in the community and the female 
population to dispel wrong cultural perceptions 
and myths that discourage female from blood 
donation. It is of utmost important to adapt the 
use of highly specific and sensitive diagnostic 
assays so as to ensure the safety of blood for the 
patients. 

 
CONSENT 
 
As per international standard informed and 
written participant consent has been collected 
and preserved by the authors. 
 
ETHICAL APPROVAL 
 
All authors hereby declare that all experiments 
have been examined and approved by the 

appropriate ethics committee and have therefore 
been performed in accordance with the ethical 
standards laid down in the 1964 Declaration of 
Helsinki. 
 

COMPETING INTERESTS 
 
Authors have declared that no competing 
interests exist. 
 

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Saleh et al.; AJI, 3(1): 30-38, 2020; Article no.AJI.55084 
 
 

 
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