Assessment of Substance Abuse among Blood Donors

Introduction

In order to ensure a safe and adequate supply of blood and blood products, blood transfusion services are an essential component of health services that prioritise the safety of both donors and recipients. Due to the presence of contaminative indicators for transfusion-transmissible illnesses such as syphilis, hepatitis B and C, and HIV-AIDS, an estimated 1.6 million units are refused [1]. Furthermore, due to anaemia, pre-existing medical issues, or the possibility of diseases that could be spread by transfusion, at least 13 million potential donors are denied the opportunity to donate blood [2]. A stringent procedure is used to evaluate potential donors’ suitability in order to achieve these goals. Donor registration, questionnaire completion, counselling and interviews, health and risk assessment, and informed permission are all part of this process. A basic health check that includes a physical examination, weighing, and/or taking vital signs is performed as part of the donor health and risk evaluation. Prospective donor blood samples are screened for transfusion-transmissible infections, and the results are utilised in the evaluation together with details about the donor’s medical history.

Sub-Saharan Africa and other low-resource nations are experiencing a rise in the demand for blood and blood products. Compared to Western nations, the majority of blood donors are between the ages of 18 and 35 [2]. Substance misuse and other social vices are common within this age group. When someone abuses drugs or alcohol, it usually leads to serious issues in their lives [3]. Substance abuse has been recognised as a growing global public health and socioeconomic problem, with notable increases, especially in emerging nations [4]. The medication history of potential donors is considered in assessment, but the assessment of substance abuse by potential donors is mostly not considered or is overlooked when questioning donors. An estimated 271 million people, or 5.5% of the world’s population between the ages of 15 and 64, reported using drugs in the year prior in 2017. In Germany, 8.8% of young potential donors reported using drugs or other substances [5]. With an estimated 188 million users, cannabis is the most popular drug in the world. 53.4 million persons used opioids, 28.9 million used amphetamines, and 18.1 million used cocaine globally in 2017 [6]. The majority of marijuana users are under thirty years old, making it the most commonly abused narcotic in the world [7]. Substance abuse is an issue in Ghana as well as other developing nations, with marijuana being the most often abused narcotic there [8]. Ghana has been classified as the top marijuana user in Africa and the third worldwide. Ghana is now acknowledged as a producer of marijuana for the international drug trade with significant population usage [6].

Substance misuse is linked to a higher risk of syphilis, hepatitis B and C, and HIV/AIDS. Additionally, unprotected sex is more common when under the influence of illegal narcotics [9]. Co-prescribing opioids with benzodiazepines has been linked to drug-related poisoning, according to studies [10]. Tramadol produced thrombocytopenia in rats, according to a study by Owoade et al [11]. Another study demonstrated thrombocytopenia caused by morphine treatment [12]. In Lucknow, a case of thrombocytopenia brought on by tramadol was documented [13]. Barbiturates are classified as category D medications because there is evidence that they increase the risk of birth abnormalities in pregnant women. Additionally, barbiturates have been shown to trigger acute attacks in porphyria patients [14].

Such a study has not been reported in Ghana, and given the current crisis of substance use among the youth in the country, this motivates us to conduct this study to establish evidence of substance abuse among potential blood donors in the Tamale metropolis.

Methods

Study Design

This cross-sectional study was carried out among eligible blood donors in Tamale, Ghana, between May and September of 2021. The Tamale Teaching Hospital served as the study’s site. The Tamale Metropolitan Assembly oversees the Dabokpaa Community, where Tamale Teaching Hospital is situated on Salaga Road. The Community’s borders are shared with Vittin to the north, Dohanaayili to the south, Kalariga to the west, and Kukuo to the east. According to the World Population Review [15], Tamale, formally known as Tamale Metropolis, is the capital of Ghana’s Northern Region and is home to an estimated 360,579 inhabitants. Its borders are shared with the Mion District to the east, East Gonja to the south, Central Gonja to the south-west, and Sagnarigu District to the north and west. People from many ethnic backgrounds live in the area, with the Mole-Dagombas making up the majority. Other tribes include the Gonjas, Mamprusis, Akans, and Dagaabas [16].

Population and Sample

Every participant was a healthy, eligible Ghanaian who was at least eighteen years old. A donor was considered eligible if they passed all serological screening tests and had a good haemoglobin level. The questionnaires were given to 109 blood donors in Tamale city using a practical sampling technique. Each subject gave their informed consent, and participation was entirely voluntary. Both the institutional review board of the university for Development Studies and the ethics and research committee of Tamale Teaching Hospital authorized the study.

Instrument Study

The 10 parameters drug test kit panel was used to test for various drug metabolites in urine sampled voided by our respondents which was developed by Incas-Diagnostics (2005) were used to measure the degree of substance abuse. Multiple drugs indication represents multiple drug involvement. The 10-parameter drug test kit panel cassette was chosen for the study because it was written in simple English language and could be read by a senior high school child, was adaptable to different cultures, and because it is both reliable and valid. The 10-parameter drug test kit panel consists of 10 parameters for illicit drugs (e.g., cocaine, marijuana (Tetrahydrocannabinol), and heroin, amphetamines, barbiturates, opioids, Tramadol, benzodiazepam, nicotine, tricyclic –antidepressant) substances. We used the cut-off levels of the various drugs, which are the recognised values for groups using drugs, to determine whether a sample is positive or negative for that. Cut-off level for opioid, benzodiazepam, Barbiturate, cocaine, is 300 ng/ml, Amphetamine is 1000 ng/ml, Cannabinoid (THC) 50 ng/ml, Tramadol 200ng/ml, Tricyclic antidepressant (TCA) 1000 ng/ml. Results over the cutoff are reported as positive (for confirmed positive results), and results below the cutoff are reported as negative. Only a preliminary analytical test result is provided by this assay. A validated analytical result requires the application of a more precise alternative chemical approach. The recommended confirmatory technique is gas chromatography/mass spectrometry (GC/MS).

Other measures

Blood Mass index, visceral fat, muscle mass, height and weight.

Data Analysis

The information was displayed as percentages or mean ± standard deviation. Unpaired t-tests were used to analyse continuous data, and Fisher’s exact tests were used to analyse categorical variables. A value of p < 0.05 was deemed significant in all statistical tests. Tables and literature show the corresponding analyses that were carried out.

Research Ethic

The Institutional Review Board of the University for Development Studies, Ghana, and the Ethics and Research Committee of Tamale Teaching Hospital both gave their ethical permission for this study. Before the sample was collected, each subject gave their informed consent.

Results

Table 1 shows that of the 109 blood donors who completed the 109 surveys, 97 (87.0%) were Muslims. Participants in the study ranged in age from 18 to 35, with a mean age of 25.55 ± 4.024. Of the study participants, 65 (59.6%) were single, 97 (87.0%) were Muslims, and 12 (11.0%) were Christians. When the respondents were categorised according to their educational attainment, 14 (12.5%) had no formal education, 87 (79.8%) had secondary education, and 7.4% had university education, as Table 1 illustrates. In terms of family size choice, 47 people (43.1%) had a family size bigger than 8, while 58 people (53.2%) had a family size between 5 and 8. Mole-dagomba had the biggest number of research participants (93, or 85.3%), whereas Kasena, Dagaabas, and Gonjas combined only made up 14.7%. According to Table 1, the majority of donors were gainfully employed (77, or 70.6%).

A projection into the use of a single chemical is presented in the study. Tetrahydrocannabinol was found in the majority of substance users (60.9%), followed by tramadol (47.8%). Eight (8) people, or 34.8% of the total, tested positive for benzodiazepines, nicotine, and tricyclic antidepressants. Amphetamines, cocaine, and opioids all tested positive in one individual (4.3%). (Fig. 2).

This was further streamline to depict the various multiple combination used by donors. This shows multiple substance users who were on two combinations, three combinations, four combinations and six combinations, the multiple combinations were further categorized into the various substances used. Two combinations constituted Bar+Tca 1(4.3%), Bzo+Cot 2(8.7%), Bzo+Tml 1(4.3%), Cot+Tca 1(4.3%), Cot+Thc 1(4.3%), Cot+Tml 2(8.7%), Tca+Tml 1(4.3%), Thc+Tml 5(21.7%). Three combinations constituted Bar+Tca+Tml 1(4.3%), and Bar+Thc+Tml 1(4.3%), with Bzo+Tca+Thc to be 1(4.3%), while Cot+Mor+Tca 1(4.3%), and finally Cot+Thc+Tml had 1(4.3%). Five combinations of substance used included Bzo+Cot+Thc+Tml 1(4.3%), and Cot+Tca+Thc+Tml 1(4.3%) and six combinations was Amp+Bzo+Mor+Opi+Thc+Tml 1(4.3%) (Table 2).

The respondents socio-demographic characteristics stratified by substance users and non-substance users of the study population shows Muslims were the majority 97(87. 0%). Non-formal education was 14(12.8%), of which 8.7% were substance users. For secondary level recorded 66(76.7%) non-substance users and 20(87.0%) substance users. Unemployed constituted 32(29.4%), of which 26(30.2%) were non-substance users and 6(26.1%) were substance users while those gainfully employed were the highest to have participated in this study, were 77(70.6%) which included 60(69.8%) non-substance users and 17(73.9%) substance users.

The majority of the study participants were single with a total of 65(59.6%) which constituent 49(57.0%) non-substance users and 16(69.6%) being Substance users. Family size indicates those greater than 8 was 48(44.0%), of which 36(41.9%) were non-substance users and 12(52.2%) being substance users and family size between 5 and 8 was the highest to have participated in this study was 57(52.3%). Mole-dagomba recorded the highest study participant which consisted of 84.9% compared with 87.0% non-substance users (Table 3).

The projection shown on Table 4 depicts the medical history stratified by substance users and non-substance users. A total of 10.1% of the respondents were cigarette smokers of which 9.3% were non-substance users and 13.0% being substance users. Alcoholic beverages consumption revealed was 7(6.4%) out of which 5.8% were non-substance users and 8.7% substance users. The study also recorded that, a total of 53(48.6%) drank caffeinated beverages of which 42(48.8%) were non-substance users and 11(47.8%) were substance users.

The study recorded 69.7% first-time donors of which substance users were 16(21.1%) and 60(78.9%) non-substance users. There was no significant difference between both non-substance users and substance users.

All subjects’ average systolic blood pressure values were 130.7±12.82 mmHg. Substance users’ average systolic readings were 131.2±12.12 mmHg, whereas non-users’ average SBP readings were 130.3±13.39 mmHg. Substance users had a mean diastolic blood pressure of 78.41 ± 6.316 mmHg, while non-users had a mean of 80.57 ± 11.47 mmHg. There was no statistically significant difference.

Urinalysis results show that majority of the urine samples had straw colour, of which 87.2% were from non-substance users while 88.4% were from substance users. Leucocytes detection on dipstick indicated most (62.4%) of the study population had urinary tract infection with non-substance users recording 60.5% and substance users recording 69.6%. The majority had normal pH reading in the study population were 107(98.2%).

Microscopy readings of urine of all participating blood donors who have donated successfully showed a normal range of epithelial cells in most of the study population totaling 99(90.8%), Non-substance users were 80(93.0%) with substance users being 19(82.6%). Few blood donors showed an abnormal range for epithelial cells on the study population constituting 10(9.2%), with non-substance users being 6(7.0%) and substance users were 4(17.4%). According to the white blood cell count, 101 (92.7%) of the study group had a urinary tract infection, whereas 82 (95.3%) were non-drug users and 19 (82.6%) were substance users.

Anthropometric measurements categorised by drug users and non-users are displayed in Table 5. All individuals had an average standing height of 172.1 ± 6.890 cm. Compared to drug users (171.4 ± 6.771 cm), non-users were taller (172.6 ± 6.985 cm). All individuals weighed an average of 68.47 ± 9.738 kg. Substance users weigh 67.50 ± 10.19 kg, whereas non-users weigh 69.17 ± 9.411 kg. Anthropometric measurements did not significantly differ between drug users and non-users (p<0.05).

Discussion

In the Ghanaian city of Tamale, this study offers the first empirical proof of drug usage among blood donors. This study’s 21.1% substance use prevalence is consistent with earlier studies carried out in different contexts, such as Mahl et al. [5], who found comparable results among young potential blood donors. This emphasises the necessity for Ghanaian transfusion services to have more thorough screening procedures that go beyond self-reported medical histories.

According to statistics from the United Nations Office on Drugs and Crime [6], cannabis (tetrahydrocannabinol) is the most commonly detected substance globally. Ghana is known to be one of Africa’s top producers and consumers of marijuana, and its cannabis consumption is also extensively documented. The continued opioid problem in West Africa, especially in Ghana, Togo, and Nigeria, is highlighted by the detection of tramadol usage in 47.8% of positive cases [17]. Transfusion safety is further complicated by its frequent usage among young people for alleged performance improvement and sexual stamina [18].

Other drugs were also noted, including tricyclic antidepressants, barbiturates, and benzodiazepines. Despite being less common, their existence is indicative of larger worldwide trends in the abuse of psychoactive substances [6]. The least common substances found were amphetamines, cocaine, and opioids, which could be explained by their scarcity in northern Ghana.

According to sociodemographic data, the majority of substance users were young, unmarried men who had completed secondary school and were employed. This is consistent with earlier research conducted in Ghana [19], which found that family history, peer pressure, and socioeconomic factors all contributed to youth substance use. Higher substance use was also linked to larger family sizes, which may be due to socioeconomic pressures and less parental monitoring.

Trends like decreased platelet counts and somewhat lower white blood cell counts among drug users are noteworthy, even if haematological and anthropometric measurements did not reveal statistically significant differences between substance users and non-users. These patterns align with experimental research that has connected cannabis, morphine, and tramadol to haematological abnormalities such as neutropenia and thrombocytopenia [11-13]. These results point to potential hazards for donor health and blood recipient safety, even if they are not statistically significant.

Crucially, the disparity between actual drug test findings and donor self-reports highlights the shortcomings of Ghana’s present donor screening procedures. Blood quality and transfusion safety may be jeopardised if verbal medical history is the only source of information used. Therefore, using objective drug screening methods could improve donor eligibility evaluations and protect donors and recipients.

There are several restrictions on this study. First, its applicability to female donors and other parts of Ghana was limited because it was limited to a comparatively small sample of 109 male donors from a single institution. Second, fast test panels were used for drug detection instead of more accurate confirmatory techniques like gas chromatography–mass spectrometry (GC–MS). Lastly, conclusions about the causes of the observed haematological variations cannot be drawn due to the cross-sectional design. To produce more reliable prevalence estimates and correlations, future research should use confirmatory testing, increase the sample size, and include female donors.

Conclusion

With a prevalence of 21.1%, this study offers new proof of drug usage among blood donors in Ghana’s Tamale capital. The most commonly found drugs were tramadol and cannabis, then benzodiazepines, barbiturates, and tricyclic antidepressants. There were trends towards lower platelet and white cell counts among drug users, but these differences were not statistically significant. These results show that relying only on self-reported donor histories is insufficient and that objective substance testing must be incorporated into donor screening procedures to guarantee transfusion safety.

To increase blood safety, objective drug testing should be included in donor screening in addition to infectious disease testing. The health concerns of substance use and how it affects blood donation should be highlighted in awareness campaigns aimed at young potential donors. To verify prevalence rates and investigate the influence of drug metabolites on transfusion outcomes, larger, multi-centre studies using confirmatory techniques (e.g., GC–MS) are required. To promote truthful self-reporting and lower hidden risk factors, counselling and pre-donation education should be improved.

Acknowledgements

The management of Tamale Teaching Hospital in Ghana is greatly appreciated by the authors for creating an environment that made this study possible. We would especially like to thank the personnel of the Department of Biomedical Science and the Blood Bank Unit for their technical support during data collection and laboratory analysis. The blood donors who willingly took part in this study are also thanked by the authors.

Conflict of Interest

No conflicts of interest are disclosed by the writers. The content and authorship of this manuscript are solely the responsibility of the authors.

Funding

No particular grant from governmental, private, or nonprofit funding organisations was received for this study.

Availability of Data and Materials

The authors attest that all information supporting the study’s conclusions is included in the publication and may be obtained from the corresponding author upon reasonable request.

References

1. Conry-Cantilena C. (1998). Screening for transfusion-transmissible infections. Transfusion Medicine Reviews, 12(1), 1–12.
2. W.H.O. (2022). Global status report on blood safety and availability 2021. World Health Organization.
3. Simmons D. (2008). Substance abuse: A global public health problem. Journal of Substance Use, 13(2), 75–82.
4. Odejide A. O. (2006). Status of drug use/abuse in Africa: A review. International Journal of Mental Health and Addiction, 4(2), 87–102.
5. Mahl TRJ, Zatonski W. (2000). Drug use among young blood donors in Germany. European Journal of Public Health, 10(4), 218–223.
6. UNODC. (2019). World drug report 2019. United Nations Office on Drugs and Crime. https://wdr.unodc.org
7. Borrofica R. A. (1966). Patterns of marijuana use worldwide. Bulletin on Narcotics, 18(2), 37–49.
8. Adeyemi A. (2007). Marijuana use among youth in developing countries. African Journal of Drug & Alcohol Studies, 6(2), 45–56.
9. Kabore AKD, Kabore J, Traore A. (2019). Illicit drug use and risk of HIV among African youth. African Health Sciences, 19(2), 2151–2159. https://doi.org/10.4314/ahs.v19i2.36
10. Macleod JSC, Tilling K, Cornish R, Marsden J, Millar T, Hickman M. (2019). Prescription of benzodiazepines, z-drugs, and opioids and mortality risk. BMJ, 365. https://doi.org/10.1136/bmj.l1373
11. Owoade OA, Komolafe TR, Omotoso G.O. (2019). Effects of tramadol on hematological parameters in rats. Anatomy Journal of Africa, 8(2), 1476–1484.
12. Cimo PL, Royston I. (1982). Morphine-induced thrombocytopenia. British Journal of Haematology, 50(2), 329–334. https://doi.org/10.1111/j.1365-2141.1982.tb01870.x
13. Qadeer A, Ali S. (2016). Tramadol-induced thrombocytopenia: A case report. International Journal of Basic & Clinical Pharmacology, 5(3), 1089–1091. https://doi.org/10.18203/2319-2003.ijbcp20162365
14. Iqbal M M, Ryals, T. (2002). Effects of commonly used benzodiazepines, barbiturates, and antidepressants during pregnancy and lactation. CNS Drugs, 16(8), 543–553. https://doi.org/10.2165/00023210-200216080-00003
15. World Population Review, (2018). Population of Cities in Ghana.
16. Fuseini AG, Yakubu A, Nachinab G. T. (2017). Demographic changes and development in Tamale Metropolis, Ghana. Journal of Geography and Regional Planning, 10(3), 45–54. https://doi.org/10.5897/JGRP2016.0611
17. Boun SS, Omonaiye O, & Yaya S. (2024). Prevalence and health consequences of nonmedical use of tramadol in Africa: A systematic scoping review. PLOS Global Public Health, 4(1), e0002784.
18. Obeagu EI, Anyanwu CN, & Obeagu GU. (2024). Challenges and Considerations in Managing Blood Transfusion for Individuals with HIV. Elite Journal of HIV, 2(2), 1-7.
19. Doku D, Koivusilta L, & Rimpelä A. (2012). Socioeconomic differences in alcohol and drug use among Ghanaian adolescents. Addictive Behaviors, 37(3), 357-360.