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Research Article | | Peer-Reviewed

Comparative Study of Two Malaria Diagnostic Techniques in the Context of Transfusion Safety in Blood Donors at the Yaoundé University Hospital

Géneviève Danièle Ongok Ongonekal,  Cédric Gueguim*,  Marie Julie Manga Sipewa,  Baiye William Abange,  Corine Yvonne Ngweha Biock,  Carole Christèle Egono Ndeme,  Evrard Mvele MvomoEvrard Mvele Mvomo,  Mariama Kaba Cherif,  Magloire Biwole Sida
Published in Central African Journal of Public Health (Volume 11, Issue 4)
Received: 22 March 2025     Accepted: 21 June 2025     Published: 21 July 2025
Views:       Downloads:
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Abstract

Malaria is a disease caused by parasites of the genus Plasmodium. Screening is not systematic in blood banks although malaria is endemic in Africa and mainly in Cameroon. The reference diagnostic test for malaria is the thick smear but its performance is complex. More suitable tests for screening malaria in blood banks have been proposed including rapid diagnostic tests (RDT) and thick smear drop. This study aimed to evaluate the performance of rapid diagnostic tests (RDTs) in comparison with thick smear (TS) using thick smear as the reference test. This comparative, descriptive, prospective cross-sectional study took place from January 6, 2023 to June 29, 2023, a period of 6 months at the Yaoundé University Hospital. The target population consisted of volunteer and family blood donors from this hospital who met the selection criteria set by the blood bank. Two hundred volunteers donors were included in the study. The SD Bioline malaria Ag p. f/pan RDT Kit and the Malaria Ag P. f/pan RDT Kit were used to perform the immunochromatographic tests and microscopy was used to read the thick smear and stained smears. The prevalence of asymptomatic malaria carriage in blood donors was 39.5%. Plasmodium falcifarum was the most prevalent species (97.5%) followed by Plasmodium malariae (2.5%), almost half of the donors had parasitemia greater than 200 parasites/μL. The factor that was significantly associated with parasitemia was the absence of use of long-lasting insecticide-treated net (LLIN). Compared with the thick smear as the reference test, both RDTs had a sensitivity of 49.4% and a specificity of 95.06%. The positive predictive value was 84.8% and the negative predictive value 50.6%. The results of this study show that the prevalence of asymptomatic carriage of plasmodium in voluntary blood donors was high, thus constituting a significant risk of transmission of the parasite to recipients often in poor general condition. The thick smear remains the gold standard for the reference technique in the diagnosis of malaria.

Published in Central African Journal of Public Health (Volume 11, Issue 4)
DOI 10.11648/j.cajph.20251104.14
Page(s) 186-191
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

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Previous article
Keywords

Malaria, Blood Transfusion, Blood Donation, Thick Smear, RDTs

1. Introduction
Malaria is a disease caused by parasites of the genus Plasmodium. It is a parasitic protozoan where humans are a reservoir and an intermediate host
[1, 2]
. It occurs following a bite from a female mosquito of the genus Anopheles which is the vector agent and definitive host of malaria
[3, 4]
. The different species of plasmodium that can infest are: plasmodium vivax, plasmodium ovale, plasmodium malariae, and plasmodium falciparum which is the most deadly and widespread species
[5]
. The endemic nature of malaria in Africa and mainly in Cameroon has led to an increase in the proportion of blood donors who have been in contact with the parasite, however it is not systematically screened in blood banks
[6, 7]
. Blood transfusion saves lives and reduces the morbidity of many medical and surgical conditions, but it is not without danger
[8]
. There are various risks associated with transfusions of labile blood products, including an immunological risk and an infectious risk. Thus, blood transfusion remains the third route of transmission of the parasite responsible for malaria
[9]
.
The general objective of this work is to compare the performance of 2 rapid diagnostic tests (RDT) with no significant difference and the thick smear (TS) in the biological diagnosis of malaria in blood donors using the thick smear as a reference test, in order to contribute to the transfusion safety of blood bags received in blood banks in Cameroon.
Materials and Methods
Type of study:
This was a comparative, cross-sectional, descriptive study with a prospective aim.
Study period:
This study took place over a period from January 6, 2023 to June 29, 2023, or approximately 6 months.
Study site:
The Yaoundé University Hospital Center (YUHC) is one of the main hospitals in the city of Yaoundé. It was founded by presidential decree on October 28, 1965. It is located in the Melen district and is an integral part of the Faculty of Medicine and Biomedical Sciences of Yaoundé. It includes a multitude of services including the hematology laboratory and the blood bank which will partially constitute our place of study.
Population:
1) Target
Voluntary and family blood donors from the Yaoundé University Hospital Center who meet the selection criteria established by the blood bank.
2) Inclusion criteria
Donors who meet the conditions required for blood donation and have given their consent to the study.
3) Exclusion criteria
Donors who withdrew their consent during the study as well as slides whose reading showed discrepancies between the 3 technicians.
4) Data collection procedure
Data collection was carried out in the hematology and blood bank department of the Yaoundé University Hospital in order to meet blood donors. Each donor was explained the importance and purpose of the study, the conduct of the study and its advantages. A form including informed consent and the questionnaire was given to the donor. If the donor agreed to participate in the study, he signed the consent form. The thick smear was considered the reference test. First, we collected the blood bags in the EDTA tubes, then we performed a thick smear on each donor consenting to the study and finally performed a RDT. The smear and thick smear slides were performed and approved by 03 technicians. The rest of the samples were stored in the refrigerator (LIEBHER, N1X13KK2) between 2 and 8°C.
Results
2. Sociodemographic Data
Figure 1. Study flow chart.
Figure 2. TS slide selection.
2.1. General Description of the Study Population
2.1.1. Distribution by Age
200 donors took part in this study, ages ranged from 18 to 62 years with an average age of 27 years and a median of 25 years. Those over 25 years represented 52.2% and those under 25 represented 47.8%.
Figure 3. Distribution of donors by age.
2.1.2. Distribution by Gender
Male donors outnumbered female donors, 169/200 (84.5%, 95% CI) males versus 31/200 (15.5%, 95% CI) females. The M/F sex ratio was 5.4.
Figure 4. Distribution of donors by gender.
2.1.3. Depending on the Region of Origin
The Central and Western regions were the most represented, representing 35.2% and 32.9% of the donor population respectively.
Figure 5. Distribution of donors by region of origin.
2.2. Sociodemographic Profile of Blood Donors Carrying Malaria According to Microscopy
No relationship was found between age, gender, type of donation and thick smear positivity. However, significance was found between LLIN use and thick smear. Indeed, those who sleep under LLIN have a lower risk of having a positive GE. Chi-2 = 5.747; p = 0.017; OR = 0.444.
Table 1. Variation of parasitemia in 79 donors positive for thick smear.

Parasites/μL

Frequency

Percentage (%)

[80-200]

40/79

50.63

[201-500]

33/79

41,8

[501-5000]

6/79

7.5
The search for plasmodium by thick smear in 200 donors revealed a positivity rate of 79, hence a prevalence of 39.5%, and a negativity rate of 121, hence a prevalence of 60.5%.
Table 2. Plasmodial species identified.

Species

Infected Donors

Percentage

P.falciparum

77

97.46

P.malariae

2

2,53

Total

79

100

In this study, we were able to observe 2 types of plasmodium, namely plasmodium falciparum and plasmodium malariae.
Table 3. Performance of RDT compared to thick smear.

Diagnostic Tests

Microscopy

Total

Positive TS (n=79)

Negative TS (n=121)

Positive RDT

39

81

120

Negative RDT

40

40

80

Total

79

121

200
The study involved 200 donors, including 79 thick-smear positive donors and 121 thick-smear negative donors; out of the 121 thick-smear negative donors, we obtained 81 RDT positives and 40 RDT negatives.
Of the 200 volunteer donors, 79 were positive for TS 39.5%; of the 79 donors positive for TS, we obtained 39 positive for RDT i.e. 66.95%, and 40 negative RDT, i.e. 33.05%; of the 200 volunteer donors, we had 121 donors negative for TS, i.e. 60.5%; of these 121 donors negative for TS, we obtained 81 positive RDT, i.e. 66.9%, and 40 negative RDT, i.e. 33.1%.
3. Intrinsic Characteristics of RDT
Table 4. Intrinsic characteristics of RDT.

Settings

RDT% (IC)

Sensitivity

49.4 (38,4-60,4)

Specificity

95.06 (85,8-97,6)

Positive predictive value PPV

84.8 (74,4-95,2)

Negative predictive value NPV.

50.62 (43,8-59,2)
Kappa coefficient = 0,466; p<0,001 (moderate and significant agreement
A statistically significant difference was observed between RDT positivity and malaria access in the last 3 months. Indeed, those who have malaria in the last 3 months have a high probability of having a positive RDT. (Chi-2 = 10,228; OR= 6,203; IC = 1,801-21,357).
4. Discussion
Our study involved 200 blood donors collected from the blood banks of the Yaoundé University Hospital, of whom 79 tested positive by thick smear and 121 negative, 81 positive by RDT.
This study focused on the comparison of two malaria diagnostic techniques in the context of transfusion safety in blood donors with the SD Bioline malaria RDT, the Malaria Ag P.f/pan RDT and the thick smear as the reference test. This study showed that out of 200 donors, 79 were positive for the thick smear, giving a prevalence of 39.5% and 121 negative with a prevalence of 60.5%.
Of the 121 donors negative for thick smear, 81 donors were positive for RDT, a prevalence of 66.9% and 40 donors were negative, a prevalence of 33.05%. Males were the most represented, with a male/female ratio of 5.72 for parasitized donors. Previous studies also show a male predominance among blood donors in Africa
[10]
. This difference can be explained by the fact that there are many contraindications to blood donation, including menstruation, pregnancy, and breastfeeding. The age of the donors was between 18 and 62 years with an average age of 27 years and the majority of donors were over 25 years (48.6%). This significant trend in the young population could be reflected in the fact that the structure of the African population is predominantly young
[11]
.
There is no significant difference between thick smear positivity and sex or age. This is in close line with a study conducted in Buea, Cameroon
[12]
. Family donors and volunteer donors represented 26% and 63.6%, respectively, data different from those reported in Gabon
[13]
but close to those reported in two studies in the DRC
[14]
. The high presence of volunteer donors in our context could be explained by the fact that the YUHC is located within the University of Yaoundé 1 because students represented 52% of donors. One of the factors that was significantly associated with parasitaemia was the non-use of LLINs. Indeed, those who slept under a mosquito net were less likely to have a positive thick smear. A finding that was also highlighted by Bassandja et al, 2014
[15]
, who mentioned in his study that the factors associated with parasitaemia were young age, first donation, non-use of MIILDA. Plasmodium falciparum was the most widespread species (97.46%) as in the study conducted in Benin where P.falciparum represented 89.9%
[16]
, in the Democratic Republic of the Congo where represented 96.3%
[17]
.
Limitations: The limitations of this study were related to the fact that by taking the thick smear on gold standard, we assumed from the outset that the results of this test always agree with reality (absence or presence of malaria), it would then be a perfect test with a sensitivity and specificity of 100%.
5. Conclusion
In summary, the aim was to compare the performance of thick smear (TS) and a rapid diagnostic test (RDT) in the biological diagnosis of malaria in blood donors using BG as the reference test.
Thus, it appears that out of 200 participants there were mainly men, namely 169 and 31 women, according to an age group ranging from 18 to 62 years with a population mainly from the center and the west, i.e. 35.2% and 32.9%. The prevalence of blood bags contaminated with plasmodium is 39.5%. The RDT having a sensitivity of 49.4% and a specificity of 95.06%, TS remains the gold standard for the reference technique in the diagnosis of malaria.
Abbreviations

TS

Thick Smear

RDT

Rapid Diagnostic Test

MILDA

Long-Lasting Impregnated Mosquito Net

YUHC

Yaoundé University Hospital Center

HIMT

Higher Institute of Medical Technology

EDTA

Ethyl diamine Tetra Acetyl

PPV

Positive Predictive Value

PNV

Negative Predictive Value
Acknowledgments
We would like to thank in particular the hematology laboratory and the blood bank of the YUHC as well as Dr Cédric Gueguim for their support and trust throughout this work.
Author Contributions
Géneviève Danièle Ongok Ongonekal: Conceptualization, Methodology, Project administration, Validation, Writing – review & editing
Cédric Gueguim: Conceptualization, Data curation, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Writing – original draft, Writing – review & editing
Marie Julie Manga Sipewa: Conceptualization, Data curation, Formal Analysis, Funding acquisition, Methodology, Visualization, Writing – review & editing
Baiye William Abange: Conceptualization, Data curation, Formal Analysis, Funding acquisition, Methodology, Visualization, Writing – review & editing
Corine Yvonne Ngweha Biock: Conceptualization, Data curation, Formal Analysis, Funding acquisition, Methodology, Visualization, Writing – review & editing
Carole Christèle Egono Ndeme: Conceptualization, Methodology, Software, Writing – original draft
Evrard Mvele Mvomo: Conceptualization, Methodology, Software, Writing – original draft
Mariama Kaba Cherif: Conceptualization, Formal Analysis, Investigation, Project administration, Validation
Magloire Biwole Sida: Conceptualization, Formal Analysis, Investigation, Project administration, Validation
Funding
The source of funding for this study was family.
Conflicts of Interest
The authors declare no conflicts of interest.
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[17] Gabriel Gachelin (2021). Malaria: Discovery of the Parasite- Encyclopædia Universal.
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    Ongonekal, G. D. O., Gueguim, C., Sipewa, M. J. M., Abange, B. W., Biock, C. Y. N., et al. (2025). Comparative Study of Two Malaria Diagnostic Techniques in the Context of Transfusion Safety in Blood Donors at the Yaoundé University Hospital. Central African Journal of Public Health, 11(4), 186-191. https://doi.org/10.11648/j.cajph.20251104.14

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    Ongonekal, G. D. O.; Gueguim, C.; Sipewa, M. J. M.; Abange, B. W.; Biock, C. Y. N., et al. Comparative Study of Two Malaria Diagnostic Techniques in the Context of Transfusion Safety in Blood Donors at the Yaoundé University Hospital. Cent. Afr. J. Public Health 2025, 11(4), 186-191. doi: 10.11648/j.cajph.20251104.14

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    AMA Style

    Ongonekal GDO, Gueguim C, Sipewa MJM, Abange BW, Biock CYN, et al. Comparative Study of Two Malaria Diagnostic Techniques in the Context of Transfusion Safety in Blood Donors at the Yaoundé University Hospital. Cent Afr J Public Health. 2025;11(4):186-191. doi: 10.11648/j.cajph.20251104.14

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  • @article{10.11648/j.cajph.20251104.14,
  author = {Géneviève Danièle Ongok Ongonekal and Cédric Gueguim and Marie Julie Manga Sipewa and Baiye William Abange and Corine Yvonne Ngweha Biock and Carole Christèle Egono Ndeme and Evrard Mvele MvomoEvrard Mvele Mvomo and Mariama Kaba Cherif and Magloire Biwole Sida},
  title = {Comparative Study of Two Malaria Diagnostic Techniques in the Context of Transfusion Safety in Blood Donors at the Yaoundé University Hospital
},
  journal = {Central African Journal of Public Health},
  volume = {11},
  number = {4},
  pages = {186-191},
  doi = {10.11648/j.cajph.20251104.14},
  url = {https://doi.org/10.11648/j.cajph.20251104.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20251104.14},
  abstract = {Malaria is a disease caused by parasites of the genus Plasmodium. Screening is not systematic in blood banks although malaria is endemic in Africa and mainly in Cameroon. The reference diagnostic test for malaria is the thick smear but its performance is complex. More suitable tests for screening malaria in blood banks have been proposed including rapid diagnostic tests (RDT) and thick smear drop. This study aimed to evaluate the performance of rapid diagnostic tests (RDTs) in comparison with thick smear (TS) using thick smear as the reference test. This comparative, descriptive, prospective cross-sectional study took place from January 6, 2023 to June 29, 2023, a period of 6 months at the Yaoundé University Hospital. The target population consisted of volunteer and family blood donors from this hospital who met the selection criteria set by the blood bank. Two hundred volunteers donors were included in the study. The SD Bioline malaria Ag p. f/pan RDT Kit and the Malaria Ag P. f/pan RDT Kit were used to perform the immunochromatographic tests and microscopy was used to read the thick smear and stained smears. The prevalence of asymptomatic malaria carriage in blood donors was 39.5%. Plasmodium falcifarum was the most prevalent species (97.5%) followed by Plasmodium malariae (2.5%), almost half of the donors had parasitemia greater than 200 parasites/μL. The factor that was significantly associated with parasitemia was the absence of use of long-lasting insecticide-treated net (LLIN). Compared with the thick smear as the reference test, both RDTs had a sensitivity of 49.4% and a specificity of 95.06%. The positive predictive value was 84.8% and the negative predictive value 50.6%. The results of this study show that the prevalence of asymptomatic carriage of plasmodium in voluntary blood donors was high, thus constituting a significant risk of transmission of the parasite to recipients often in poor general condition. The thick smear remains the gold standard for the reference technique in the diagnosis of malaria.},
 year = {2025}
}

    Copy | Download 

  • TY  - JOUR
T1  - Comparative Study of Two Malaria Diagnostic Techniques in the Context of Transfusion Safety in Blood Donors at the Yaoundé University Hospital

AU  - Géneviève Danièle Ongok Ongonekal
AU  - Cédric Gueguim
AU  - Marie Julie Manga Sipewa
AU  - Baiye William Abange
AU  - Corine Yvonne Ngweha Biock
AU  - Carole Christèle Egono Ndeme
AU  - Evrard Mvele MvomoEvrard Mvele Mvomo
AU  - Mariama Kaba Cherif
AU  - Magloire Biwole Sida
Y1  - 2025/07/21
PY  - 2025
N1  - https://doi.org/10.11648/j.cajph.20251104.14
DO  - 10.11648/j.cajph.20251104.14
T2  - Central African Journal of Public Health
JF  - Central African Journal of Public Health
JO  - Central African Journal of Public Health
SP  - 186
EP  - 191
PB  - Science Publishing Group
SN  - 2575-5781
UR  - https://doi.org/10.11648/j.cajph.20251104.14
AB  - Malaria is a disease caused by parasites of the genus Plasmodium. Screening is not systematic in blood banks although malaria is endemic in Africa and mainly in Cameroon. The reference diagnostic test for malaria is the thick smear but its performance is complex. More suitable tests for screening malaria in blood banks have been proposed including rapid diagnostic tests (RDT) and thick smear drop. This study aimed to evaluate the performance of rapid diagnostic tests (RDTs) in comparison with thick smear (TS) using thick smear as the reference test. This comparative, descriptive, prospective cross-sectional study took place from January 6, 2023 to June 29, 2023, a period of 6 months at the Yaoundé University Hospital. The target population consisted of volunteer and family blood donors from this hospital who met the selection criteria set by the blood bank. Two hundred volunteers donors were included in the study. The SD Bioline malaria Ag p. f/pan RDT Kit and the Malaria Ag P. f/pan RDT Kit were used to perform the immunochromatographic tests and microscopy was used to read the thick smear and stained smears. The prevalence of asymptomatic malaria carriage in blood donors was 39.5%. Plasmodium falcifarum was the most prevalent species (97.5%) followed by Plasmodium malariae (2.5%), almost half of the donors had parasitemia greater than 200 parasites/μL. The factor that was significantly associated with parasitemia was the absence of use of long-lasting insecticide-treated net (LLIN). Compared with the thick smear as the reference test, both RDTs had a sensitivity of 49.4% and a specificity of 95.06%. The positive predictive value was 84.8% and the negative predictive value 50.6%. The results of this study show that the prevalence of asymptomatic carriage of plasmodium in voluntary blood donors was high, thus constituting a significant risk of transmission of the parasite to recipients often in poor general condition. The thick smear remains the gold standard for the reference technique in the diagnosis of malaria.
VL  - 11
IS  - 4
ER  -

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Author Information

  • Géneviève Danièle Ongok Ongonekal

    Department of Biomedical Sciences, Higher Institute of Medical Technology, Yaoundé, Cameroon

  • Cédric Gueguim

    Department of Environmental Sciences, Higher Institute of Agriculture, Wood, Water and the Environment, University of Bertoua, Belabo, Cameroon. Research Laboratory in Microbiology, Health, and Environment, Higher Institute of Agriculture, Wood, Water and the Environment, University of Bertoua, Belabo, Cameroon

    Contact Email

    http://orcid.org/0000-0002-9408-6639

  • Marie Julie Manga Sipewa

    Department of Biomedical Sciences, Higher Institute of Medical Technology, Yaoundé, Cameroon

  • Baiye William Abange

    Parasitology Laboratory, Yaoundé University Hospital Center, Yaoundé, Cameroon

  • Corine Yvonne Ngweha Biock

    Department of Biomedical Sciences, Higher Institute of Medical Technology, Yaoundé, Cameroon

  • Carole Christèle Egono Ndeme

    Department of Environmental Sciences, Higher Institute of Agriculture, Wood, Water and the Environment, University of Bertoua, Belabo, Cameroon. Research Laboratory in Microbiology, Health, and Environment, Higher Institute of Agriculture, Wood, Water and the Environment, University of Bertoua, Belabo, Cameroon

  • Evrard Mvele MvomoEvrard Mvele Mvomo

    Medical-social Center, University of Bertoua, Bertoua, Cameroon

  • Mariama Kaba Cherif

    Department of Biochemistry and Microbiology, NAZI BONI University of Bobo-Dioulasso, Bobo-Dioulasso, Burkina-Faso

  • Magloire Biwole Sida

    Department of Clinical Sciences, Higher Institute of Medical Technology, Yaoundé, Cameroon

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