Transfusion-Transmitted Malaria in Countries Where Malaria Is Endemic: A Review of the Literature from Sub-Saharan Africa

(See the editorial commentary by Allain, on pages 1199–1200.) Although international policies recommend that blood for transfusion should be screened for transfusion-transmitted infections, malaria screening is not performed in most malaria-endemic countries in sub-Saharan Africa. Our literature review identified 17 relevant studies from the period 1980–2009 and indicated that the median prevalence of malaria among 33,029 blood donors was 10.2 % (range, 0.7 % in Kenya to 55.0 % in Nigeria). Malaria screening methods, including microscopy (used in 16 of 17 studies), are either insensitive or impractical for donor screening in resource-poor countries. Even if a suitable screening method were available, rejection of malaria-positive donors would jeopardize the blood supply. Only 1 study established the prevalence of parasitemia among transfusion recipients. This review highlights the need for more evidence about the clinical impact of transfusion-transmitted malaria to justify the policy of screening for blood for malaria in areas of endemicity and for a critical analysis of the feasibility of implementing such a policy and its effect on blood supply. Blood for transfusion in most malaria- endemic coun-tries in sub-Saharan Africa (SSA) is not tested for ma-laria [1], despite recommendations that all donate