Analysis of the most common causes of blood donor deferral in southern of Mozambique

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Strategies such as pre-interview (including clinical assessment) of donors and the subsequent testing of donated blood for infectious agents are steps taken to guarantee blood transfusion safety. With this the study aimed to assess the frequency and reasons for blood donation deferrals at blood banks in southern of Mozambique. Methods This was a cross-sectional study conducted on blood donation candidates between December 2022 and January 2024 in the provinces of Gaza and Inhambane, situated in the southern region of Mozambique. Blood donation candidates answered a questionnaire on demographic characteristics and venous blood was collected in three 6 ml K2EDTA tubes samples. The plasma was separated from the whole blood and used for serological and molecular tests for HIV, HBV and HCV. Deferral data in the routine pre-interview was subsequently collected at each blood bank. Results A total of 3862 donors participated in the study, of which 72.2% were replacement donors. The overall donor deferral rate in pre-interview was 5.2 %, with low hemoglobin being the main reason for temporary deferral at pre-interview (41.0%), followed by syphilis or other sexually transmitted infection suspect (23.0%). The HBV (50.8%) and HIV (30.5%) infections were the main reasons for permanent deferral. Male donors were less likely to be deferred for blood donation (AOR 0.63, 95% CI 0.45 - 0.89) compared to female donors. Conclusion The method used to measure hemoglobin, the higher seroprevalence of infectious agents in donated blood, and the greater deferral of women may be related to the blood donors deferral in Mozambique. This results reinforce the need to improve the process of clinical assessment, selection, and retention of blood donation candidates, to have consistent volunteer donors. Blood donation Donor deferrals Causes Transfusion transmissible infections Mozambique Figures Figure 1 Background Blood transfusion is a vital medical procedure that carefully involves the transfer of blood from a donor to a recipient ( 1 ). This medical practice is so relevant to modern therapeutics that blood and its components are part of the World Health Organization's essential list of medicines ( 2 ). Blood transfusion saves and improves lives, not only directly in emergencies and acute or chronic diseases, but also by facilitating surgery and chemotherapy, medical conditions that would not be possible without blood. In sub-Saharan African countries such as Mozambique, the blood is mainly used to treat pathologies such as Human Immunodeficiency Virus (HIV)-associated diseases, malaria-related anemia, obstetric hemorrhages, and trauma ( 1 , 3 ). In 2018, approximately 118.5 million blood donations were made worldwide, 40% of which were in high-income countries, where 16% of the world's population lives. Despite the greater need and larger population, the number of blood donations in low-income countries is low. In Africa, from 2022 to 2024, the average number of units of blood collected per 1000 inhabitants/year increased from 4.5 to 5.2, with the regional target being 10 units per 1000 inhabitants/year ( 1 , 4 ). The number of blood donations per 1000 inhabitants/year in Mozambique is estimated at 4.2% ( 3 ). The low availability of blood in Africa is associated with the low number of blood donors may be caused by the high prevalence of blood-borne infectious agents, nutritional deficiencies, low hemoglobin, ineffective strategies for recruiting, motivating, and retaining blood donors, and others ( 5 ). Concern about transfusion safety (post-transfusion reactions for the recipient of the blood or other blood product and for the health of the donor) has led blood banks to specialize in medical services aimed at ensuring the safety of blood and donors ( 6 – 8 ). Blood donation is preceded by pre-interview - clinical and risk assessment of the blood donor (risk of carrying blood-borne infections), by administering a questionnaire. The clinical assessment includes measuring blood pressure, hemoglobin, and body temperature ( 9 ). Blood donors who do not meet the established donation criteria are categorized as deferred donors, and this is a factor that affects the availability of blood supplies. Deferral can occur either temporarily or permanently, often stemming from confirmed or suspected infectious diseases, hematological conditions, or any medical issue that jeopardizes blood safety or the health of the donor ( 9 , 10 ). Mozambique has around 1,643 health facilities, of which 172 have transfusion services. The rest depend on a referral for transfusion. Donated blood is tested for HIV, Hepatitis B virus (HBV), Hepatitis C virus (HCV), and syphilis ( 3 ). The prevalence of HIV, HBV, and HCV, in candidates approved for blood donation in Mozambique was estimated at 4.6%, 4.5%, and 0.5%, respectively ( 8 ). Studies show that blood donors have a prevalence of Treponema pallidum between 0.98% and 1.2% ( 7 , 11 ), nevertheless data on factors associated with blood donor deferral is limited. The information about the reasons for deferring blood donors is not only important for improving the availability of blood, but also for actions to improve the health of the population in general. This study aimed to investigates the frequency and reasons for deferral of blood donation at blood banks in the provinces of Gaza and Inhambane in Mozambique. Materials and Methods Study design This is a cross-sectional study that was carried out between December 2022 and January 2024, and aimed to investigates the frequency and reasons for deferral of blood donation at blood banks in the provinces of Gaza and Inhambane in Mozambique. Study setting This study was carried out in four Blood Banks in Gaza province, including the Chókwe and Chibuto Rural Hospitals, Macia-Bilene Health Center, and the Xai-Xai Provincial Hospital. Additionally, three Blood Banks in the Inhambane province were included: the Quissico-Zavala District Hospital, Inhambane Provincial Hospital, and Chicuque Rural Hospital in the southern region of Mozambique. In each province, health facilities with the highest volume of donors per year were chosen. The study sites were chosen because they had the highest number of donors per year within their respective province. Population, enrollment, and data collection All candidates for blood donation who attended the blood banks in Gaza and Inhambane provinces received clear explanations about the study and were invited to participate. Those who consented to take part confidently signed an informed consent form. Candidates for blood donation who agreed to take part in the study were given a questionnaire on demographic characteristics, including age, gender, donor type, marital status, and others. Following this venous blood was collected into three 6 ml K2EDTA Vacuum tubes (Becton Dickinson, Franklin Lakes, NJ, USA). Plasma was separated from the whole blood at the health facility and stored in cryovials. The plasma was used for serological testing of HIV, HBV, and HCV in health facilities and molecular testing of the same pathogens at the Instituto Nacional de Saúde of Mozambique. Each candidate then underwent a routine pre-interview process to assess their risk of infection by blood-borne agents and to evaluate their general health. Routine deferral data and the reason for participating in the study were subsequently collected from each blood bank. Serological tests HIV, HBV, and HCV testing was carried out in the Blood Banks of the health facilities in the study by technicians involved in routine testing. All tests were carried out according to the national algorithm for blood bank testing and according to the manufacturer's instructions. HIV testing was carried out using the Determine HIV 1/2 rapid test (Abbott Rapid Diagnostic, Japan). This test has a sensitivity and specificity of 100% and 99.9%, respectively, according to the manufacturer. All reactive results were confirmed with the Unigold test (Trinity Biotech Plc, Ireland), a rapid test with 100% sensitivity and specificity according to the manufacturer. Reactive results in both tests were considered positive, while reactive results in the first test and non-reactive results in the second test were considered indeterminate. Non-reactive results in the first test were considered negative. In the transfusion routine in Mozambique, donors with indeterminate or positive HIV results are deferred. HBV testing was carried out using the advanced quality HBsAg rapid test (InTec Products, INC, China) with 100% sensitivity and specificity, according to the manufacturer. HCV testing was carried out using the HCV Advanced Test Kit (InTec Products, INC, China), with a sensitivity and specificity of 99.7% and 99.8%, respectively, according to the manufacturer. Molecular testing The Molecular tests were performed at the Instituto Nacional de Saúde of Mozambique, using the cobas MPX test (Roche Molecular Systems, Inc., Branchburg, NJ, USA), using the COBAS 6800 systems, utilizing approximately 1000 μl of plasma sample, by the manufacturer’s procedures. The cobas MPX test allows simultaneous detection and discrimination of HIV RNA, HCV RNA, HBV DNA in a single test. Detection limits are set at 25 IU/mL, 7 IU/mL and 1.4 IU/mL for HIV-1, HCV and HBV, respectively. Statistical analysis Descriptive statistics and frequency tables for categorical variables were applied for data analysis. Agreement performance for permanent deferral between pre-interview and MPX (as reference tests) results, were evaluated using diagnostics performance indicators including observed agreement, chance agreement, positive and negative agreement, and Cohen’s Kappa. Fisher’s exact test was applied to compare the positivity rate for HIV, HBV, and HCV within samples deferred by pre-interview (temporary or permanent) and deferred by testing procedures. A multivariable logistic regression was employed to investigate factors related to the likelihood of deferral (temporary or permanent), with odds ratio used as a measure of association. For inference, 95% confidence intervals were calculated to provide a range of plausible values for all indicators. Data were analyzed using RStudio/2023.12.1+402 (R Foundation for Statistical Computing) and Microsoft Excel 365 (Microsoft Co. Co., Redmond, WA, USA). Results Study Population Characteristics A total of 3,862 blood donation candidates were recruited consecutively during the study period (Figure 1). Most of the participants were from Gaza province (61.9%). Most of the participants were male (78%), aged 18-29 (56.7%), with a primary/secondary or technical level of education (85.8%). Most of the participants were single/divorced or widowed (74.3%), self-employed (30.3%), or public/private workers (30.1%). Replacement donors accounted for around three-quarters (72.2%), Table 1. Table 1. Socio-demographic characteristics of the study participants. Total of participants 3,862 (100) Province Gaza 2,390 (61.9) Inhambane 1,472 (38.1) Gender Female 825 (21.4) Male 3,037 (78.6) Age group 18--29 2,191(56.7) 30--39 1,042 (27.0) 40--49 478 (12.4) 50--59 126 (3.3) 60--65 25 (0.6) Median (IQR) 28 (22-35 ) Education No education 210 (5.4) Primary/Secondary/Technician 3,312 (85.8) High level 276 (7.1) Denied to respond 63 (1.6) Missing 1 (0.03) Marital status Married/Fact_union 990 (25.6) Single/Divorced/Widow 2,871 (74.3) Missing 1 (0.03) Profission Own account 1,171(30.3) Domestic/unemployeed 562 (14.6) Student 963 (24.9) Private worker/public 1,163 (30.1) Missing 3 (0.1) Donor Replacement 2,787 (72.2) First-time voluntary 497 (12.9) Regular voluntary 577 (14.9) Missing 1(0.03) Frequency and reasons for deferral of blood donation candidates The overall frequency of pre-interview deferrals for blood donation candidates was 5.2% (200/3862), of which 2.0% (78/200) and 3.2% (122/200) were permanent and temporary deferrals, respectively Table 2. Among blood donation candidates permanently deferral, the majority cited co-infection or risk factors associated with HBV and HCV (61.5%) and HIV (29.5%) and low hemoglobin (less than 12.5 g/dl, indicating moderate anemia) was the main cause of temporary rejection in the pre-interview (41.0%), followed by a report or risk of syphilis infection (23.0%). The frequency of permanent deferral by serological testing was 7.6% (295/3862). The major cause of deferral was HBV and HIV positivity, with 50.8% (150/295) and 30.5% (90/295) respectively, Table 2. Table 2. Frequency and reasons for deferral of blood donation candidates. Deferral reasons n (%) General frequency of deferral by pre-interview 200 (5.2) Permanent deferral by pre-interview 78 (2.0) HBV/HCV 48 (61.5) HIV 23 (29.5) HIV and other 6 (6.4) HBV/HCV and other 1 (2.6) Temporary deferral by pre-interview 122 (3.2) Low hemoglobin 50 (41.0) Syphilis and other Sexually transmitted infection 28 (23.0) Other* 25 (20.5) High blood pressure 14 (11.5) Low hemoglobin & underweight 2 (1.6) Low hemoglobin & high blood pressure 1 (0.8) Injectable drugs & hemorrhage 1 (0.8) Risk behavior 1 (0.8) Permanent deferral by laboratory testing 295 (7.6) HBV+ 150 (50.8) HIV+ 90 (30.5) HCV+ 40 (13.6) HIV+ & HBV+ 12 (4.1) HIV+ & HCV+ 2 (0.7) HBV+ & HCV+ 1 (0.3) *Some malaise, experienced bleeding or blood disease, and abnormal blood pressure. Association between sociodemographic characteristics and pre-interview deferral of blood donors candidates Blood donation candidates from Inhambane province had a lower chance of being deferred (adjusted odds ratio 0.63; 95% Confidence Interval: 0.45 - 0.86), compared to blood donation candidates from Gaza province. On the other hand, males were less susceptible to deferral (AOR: 0.63; 95% CI: 0.45 - 0.89) compared to females. Blood donors candidates aged 18-29 years old had a lower chance of being accepted compared to the other age groups, 30-39 (AOR 1.78 95% CI 1.22 - 2.59), 40-49 (AOR2.6 95% CI 1.66 - 4.03), 50-59 (AOR 2.78 95% 1.31 - 5.46). Additionally, the chance of deferral was higher in individuals who said they were domestic workers or unemployed (AOR: 1.75; 95% CI: 1.16 - 2.63), compared to other professions and students. Finally, first-time voluntary donors (AOR 0.94; 95% CI 0.55– 1.52) and regular donors (AOR 0.65; 95% CI 0.39-1.02) demonstrated a lower risk of deferral in the blood donation process compared to replacement donors, Table 3. Table 3. Deferral based on sociodemographic characteristics prior to the interview. Total Deferral OR AOR (%) n (%) (95% IC) (95% IC) Province 3862 (100) 200 (100) Gaza 2390 (61.9) 142 (5.9%) 1.0 1.0 Inhambane 1472 (38.1) 58 (3.9%) 0.65 (0.48 -- 0.89) 0.63 (0.45 -- 0.86) Gender Female 825 (21.4) 62 (7.5%) 1.0 1.0 Male 3037 (78.6) 138 (4.8%) 0.59 (0.43 -- 0.80) 0.63 (0.45 -- 0.89) Age group 18--29 2191(56.7) 83 (3.8%) 1.0 1.0 30--39 1042 (27.0) 63 (6.0%) 1.63 (1.17 -- 2.29) 1.78 (1.22 -- 2.59) 40--49 478 (12.4) 41 (8.6%) 2.38 (1.62 -- 3.51) 2.6 (1.66 -- 4.03) 50--59 126 (3.3) 11 (8.7%) 2.43 (1.26 -- 4.68) 2.78 (1.31 -- 5.46) 60--65 25 (0.6) 2 (8.0%) 2.21 (0.51 -- 9.52) 2.87 (0.44 -- 10.56) Education No education 210 (5.4) 18 (8.6%) 1.0 1.0 Primary/Secondary/Technician 3312 (85.8) 169 (5.1%) 0.57 (0.35 -- 0.95) 1.01 (0.6 -- 1.79) High level 276 (7.1) 13 (4.7%) 0.53 (0.25 -- 1.10) 1.03 (0.45 -- 2.32) Denied to respond 63 (1.6) 0 (0.0%) ----- ----- Missing 1 (0.03) 0 (0.0%) ----- ----- Marital status Married/Fact_union 990 (25.6) 53 (5.4%) 1.0 1.0 Single/Divorced/Widow 2871 (74.3) 147 (5.1%) 0.95 (0.69 -- 1.32) 1.39 (0.97 -- 2.02) Missing 1 (0.03) 0 (0.0%) ----- ----- Profission Own account 1171 61 (5.2%) 1.0 1.0 Domestic/unemployeed 562 53 (9.4%) 1.89 (1.29 -- 2.78) 1.75 (1.16 -- 2.63) Student 963 33 (3.4%) 0.65 (0.42 -- 0.99) 0.83 (0.49 -- 1.37) Private worker/public 1163 53 (4.6%) 0.87 (0.60 -- 1.27) 0.85 (0.56 -- 1.27) Missing 3 0 (0.0%) ----- ----- Donor Replacement 2787 156 (5.6%) 1.0 1.0 First-time voluntary 497 22 (4.4%) 0.78 (0.49 -- 1.23) 0.94 (0.55 -- 1.52) Regular voluntary 577 22 (3.8%) 0.67 (0. 42 -- 1.05) 0.65 (0.39 -- 1.02) Missing 1 0 (0.0%) ----- Positivity rate in molecular testing among blood donation candidates who were deferred and approved in the pre-interview The rate of molecular detection of HIV and HBV was higher in blood donors deferred at the pre-interview, with 8.5% (10/117), and 16.9% (920/118) respectively, when compared to approved blood donors (p<0001), Table4. Table 4. Positivity rate in molecular testing among blood donation candidates who were deferred and approved in the pre-interview Positivity rate Patogen Deferred (n=118) * Approved (n=2598) ** P value HIV 8.5% (10/117) 1.5% (40/2592) <0001 HBV 16.9% (20/118) 3.3% (87/2598) <0001 HCV 0.0% (0/117) 0.2% (6/2590) 1.000 *82 deferred in the pre-interview without results in the molecular testing **1064 approved in the pre-interview without results in the molecular testing Discussion The participants in this study are similar to those in other studies conducted in Mozambique, with a predominance of replacement donors (72.2%), males (78.6%), and young people (56.7%) ( 7 , 8 ). Similar results have been found in other studies in Africa and other parts of the world ( 12 – 15 ). The overall deferral rate of blood donation candidates found in this study (5.2%) is low compared to studies conducted in Nigeria (8.69%)( 13 ), Ivory Coast (10.8%)( 16 ), Tanzania (12.7%)( 12 ), and Kenya (21.6%)( 17 ), and in countries outside Africa, such as China (9.26%)( 18 ), Dubai (19.4%)( 19 ) and Brazil (12.1 to 15.7%)( 15 ). The difference between our results and those of the other studies can be explained by the low number of blood donors in Mozambique, estimated at 4.2 units of blood per 1000 inhabitants/year( 3 ), compared to the 10 units of blood per 1000 inhabitants/year recommended by the World Health Organization ( 4 ). This may put pressure on transfusion services to reduce the sensitivity of the pre-interviews to obtain a higher quantity of blood and satisfy the demand in hospital services. Another factor that may be linked to the low level of deferral we found compared to other studies is the efficiency and level of training of the human resources allocated to the donor selection process. The low level of proficiency may be related to the inadequate conduct of the pre-interview( 20 ), which may reduce its sensitivity. Among the reasons for deferral in the pre-interview, low hemoglobin emerged as the main cause, accounting for 41.0%. This finding aligns with results from studies conducted in Tanzania, Kenya, Nigeria, Dubai and Malaysia ( 12 , 13 , 17 , 19 , 21 ). Low hemoglobin levels are often associated with the individual's nutritional status or the presence of parasitic infections ( 22 ). Both conditions are prevalent in Mozambique and in many African countries ( 23 , 24 ). Moreover, one factor that may be contributing to low hemoglobin is the method used to measure hemoglobin. The transfusion sites in Mozambique use a manual technique that assesses hemoglobin based on the copper sulphate method. This method has a low performance (accuracy, sensitivity and specificity) compared to automated or point-of-care hemoglobin measurement technology ( 25 ). The introduction and use of point-of-care equipment for hemoglobin measurement could better protect the blood donor and recipient, as well as increase the availability of blood. HBV infection was the main reason for the permanent deferral of blood donation candidates (50.8%) and these data are similar to studies carried out in Nigeria (31.71%) and Kenya (4.73%) ( 13 , 17 ). Mozambique is considered a country with high endemicity for HBV, and studies carried out on blood donors in Mozambique also show a high prevalence of HBV ( 8 , 26 ). In general, infectious agents are the main reason for the permanent deferral of blood donors in Mozambique and in most African countries( 13 , 16 , 17 , 27 ). Implementing strategies to eliminate transmitted blood infections as a public health problem and improving the tests to detect infectious agents in donated blood could increase the demand for blood and blood donors. When examining deferrals based on the sociodemographic characteristics of participants, male donors experience a notably lower likelihood of being deferred for blood donation (AOR 0.63, 95% CI 0.45–0.89) compared to female donors. This trend is consistent with research conducted in other countries ( 15 , 17 , 19 , 28 , 29 ). Various studies emphasize that eligibility criteria directly impact the deferral rates of female donors, as these criteria often involve factors such as low hemoglobin levels or anemia, low blood pressure, body piercings, dizziness or fainting, venipuncture difficulties, and low body weight, which are more frequently observed in women, particularly those of reproductive age ( 16 , 30 , 31 ). In many African countries, women are the ones who most often go to health centers to take care of their health, pregnancy, and child ( 32 – 34 ). Removing existing barriers to blood donation by women, without prejudice to their health, combined with mobilization and motivation for blood donation, could increase the number of blood donations and the number of volunteer donors. The positivity rate for HIV and HBV in deferrals blood donation candidates was high when compared to donors approved at the pre-interview. We can assume that the answers provided by the candidates in the pre-interview are reliable and that the survey used in Mozambique to select donors had good sensitivity in this study. Yet, it is important to note that the positivity rates of the molecular tests for HIV (1.5%) and HBV (3.3%) were both higher than 1% among donors approved for blood donation, which shows that there is a risk of transmission of these agents by blood transfusion. Improving pre-screening and the rigorous selection of blood donors, as well as the use of voluntary donors, is important for improving transfusion safety. Study Limitations The results of this study are innovative for Mozambique and can potentially improve transfusion policies, particularly in donor selection and testing. Nonetheless, it is important to consider some limitations when interpreting these results: Firstly, the responses collected during the pre-interview are self-reported by the candidates for donation. Consequently, the fear of deferral can lead to omissions or positive responses, which may have influenced the recorded deferral rates. Secondly, the awareness of study progress among the technicians conducting the pre-interviews is likely to have led to improvements in routine practices, such as a more thorough completion of the pre-interview stages and increased effectiveness, thereby resulting in a higher number of candidates willing to donate. Third, this study did not include blood donors deferred due to positive Treponema pallidum test results. This may have underestimated the frequency of deferral due to laboratory testing. Lastly, it's worth noting that not all blood donation candidate samples underwent molecular testing for HIV, HBV, and HCV. This fact could have impacted on the overall positivity rates observed. Conclusion The overall deferral rate for blood donation candidates during the pre-interview was intermediate. Low hemoglobin and suspected syphilis or other sexually transmitted infection were the main reasons for temporary exclusion. HBV and HIV infections were the main reasons for permanent exclusion. The method used to measure hemoglobin, the higher seroprevalence of infectious agents in donated blood, and the greater deferral of women may be related to the low number of blood donations in Mozambique. The results of this study reinforce the need to improve the process of clinical assessment, selection, and retention of blood donation candidates, especially women, to have consistent volunteer donors. Abbreviations AOR: Adjusted Odds Ratio CI: Confidence Interval DNA: Deoxyribonucleic acid HBV: Hepatitis B virus HCV: Hepatitis C virus HIV: Human Immunodeficiency Virus IU/mL: International units per millilitre RNA : Ribonucleic acid OR: Odds Ratio Declarations Ethical considerations The present study was approved by the Institutional Committee on Health Bioethics of the Gaza province (CIBS-Gaza), under the reference 58/CIBS-Gaza/2024, and Mozambique National Health Bioethics Committee, with reference 753/CNBS/22. The study procedures respected all ethical principles. Participation was voluntary, and all participants signed an informed consent form. Availability of data and materials The data used for this analysis can be obtained from the Instituto Nacional de Saúde of Mozambique, through the corresponding author. Researchers interested in secondary analysis must submit a research proposal for consideration by the study investigators, as well as by the Division for Research in Health and Well-Being. Competing Interest Authors declare no conflict of interest Funding This research received no external funding Authors Contributions Conceptualization of the study,C.N,O.M and N.M; funding acquisition, N.M; sample, data collection and testing, C.N,O.M,A.N,M.C and N.M. Data analysis, cleaning and curation C.N, A.M, O.L and N.M; research administration and resources, O.M and N.M; writing of the original draft, C.N and O.M writing, reviewing, and editing A.M, A.N, M.C, O.L and N.M Acknowledgements We would like to thank all the blood donors who voluntarily participated in the study and the teams from the blood banks in the provinces of Gaza and Inhambane. We would also like to thank the team at the Maputo Central Hospital Blood Bank, especially the technicians Augusto Domingos and Telma Saia, for their collaboration in the study. We would like to thank the technicians from the Biotechnology and Genetics and Immunology Laboratories of the Instituto Nacional de Saúde for their collaboration in testing the study samples. We extend thanks to Nalia Ismael for editing the English. References World Health Organization. Global status report on blood safety and availability 2021. 2022. WHO. World Health Organization. 2021. India. 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Zahidin MA, Saidin NIS, Ibrahim NA, Mohd Nasir NNA, Abdul Razak NI, Ramli M, et al. The Blood Donor Deferral Rate and the Reasons for Deferral at a Tertiary Care Teaching Institute in Northeastern Malaysia. Cureus. 2024 Feb 26; Mast AE. Low hemoglobin deferral in blood donors. Vol. 28, Transfusion Medicine Reviews. 2014. p. 18–22. Sambo J, Bauhofer AFL, Boene SS, Djedje M, Júnior A, Pilale A, et al. Readiness of Mozambique Health Facilities to Address Undernutrition and Diarrhea in Children under Five: Indicators from 2018 and 2021 Survey Data. Healthcare. 2022 Jun 27;10(7):1200. Casmo V, Augusto G, Nala R, Sabonete A, Carvalho-Costa FA. Infecções por ancilostomídeos e Schistosoma haematobium e sua correlação com a concentração sanguínea de hemoglobina em crianças moçambicanas. Rev Inst Med Trop Sao Paulo. 2014;56(3):219–24. Chaudhary R, Dubey A, Sonker A. Techniques used for the screening of hemoglobin levels in blood donors: Current insights and future directions. Vol. 8, Journal of Blood Medicine. Dove Medical Press Ltd; 2017. p. 75–88. Ingrand P, Gudo S, Ingrand I, Cunha L. Use of Replacement Blood Donors to Study the Epidemiology of Major Blood-Borne Viruses in the General Population of Maputo , Mozambique. 2007;1840(July):1832–40. Mirambo MM, Mkumbo E, Selega H, Msemwa B, Mushi MF, Silago V, et al. Hepatitis B virus infections among health professional students in Mwanza city , Tanzania in 2016. 2020;1–5. Kisangau EN, Awour A, Juma B, Odhiambo D, Muasya T, Kiio SN, et al. Prevalence of hepatitis B virus infection and uptake of hepatitis B vaccine among healthcare workers, Makueni County, Kenya 2017. Journal of Public Health (United Kingdom). 2019 Dec 1;41(4):765–71. Kisangau EN, Awour A, Juma B, Odhiambo D, Muasya T, Kiio SN, et al. Prevalence of hepatitis B virus infection and uptake of hepatitis B vaccine among healthcare workers , Makueni County , Kenya 2017. 2018;41(4):765–71. Infanti L. Protecting the blood donor: ferritin-based intervals to improve donor health. The Lancet. 2024 Jul;404(10447):2–3. Kasraian L, Ashkani-Esfahani S, Foruozandeh H. Reasons of under-representation of Iranian women in blood donation. Hematol Transfus Cell Ther. 2021 Jul 1;43(3):256–62. Straneo M, Hanson C, Van Den Akker T, Afolabi BB, Asefa A, Delamou A, et al. Inequalities in use of hospitals for childbirth among rural women in sub-Saharan Africa: a comparative analysis of 18 countries using Demographic and Health Survey data. BMJ Glob Health. 2024 Jan 22;9(1). Thorp M, Balakasi KT, Mphande M, Robson I, Khan S, Stillson C, et al. Factors associated with men’s health facility attendance as clients and caregivers in Malawi: a community-representative survey. BMC Public Health. 2022 Dec 1;22(1). Llop-Gironés A, JULIÀ M, CHICUMBE S, DULÁ J, ODALLAH AAP, ALVAREZ F, et al. Inequalities in the access to and quality of healthcare in Mozambique: evidence from the household budget survey. International Journal for Quality in Health Care. 2018 Nov 2; Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 21 May, 2025 Editor assigned by journal 17 May, 2025 Submission checks completed at journal 17 May, 2025 First submitted to journal 16 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6677647","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":459141027,"identity":"dee686ab-a449-4cf6-9c6e-8f3e65c99038","order_by":0,"name":"Carina Nhachigule","email":"","orcid":"","institution":"Instituto Nacional de Saúde","correspondingAuthor":false,"prefix":"","firstName":"Carina","middleName":"","lastName":"Nhachigule","suffix":""},{"id":459141028,"identity":"505a9148-8897-4f2f-98dd-8dfcad5a339f","order_by":1,"name":"Odete Matola","email":"","orcid":"","institution":"Instituto Nacional de Saúde","correspondingAuthor":false,"prefix":"","firstName":"Odete","middleName":"","lastName":"Matola","suffix":""},{"id":459141029,"identity":"5213a818-4ef8-4699-a3ee-096b651ea27b","order_by":2,"name":"Abras Munguambe","email":"","orcid":"","institution":"Clinton Health Access Initiative","correspondingAuthor":false,"prefix":"","firstName":"Abras","middleName":"","lastName":"Munguambe","suffix":""},{"id":459141030,"identity":"45e19d8a-b003-444f-8ac3-0c2afb23bf86","order_by":3,"name":"Amâncio Nhangave","email":"","orcid":"","institution":"Provincial Health Directorate","correspondingAuthor":false,"prefix":"","firstName":"Amâncio","middleName":"","lastName":"Nhangave","suffix":""},{"id":459141031,"identity":"795fcb48-5e93-4d37-83c0-dcd816258ffb","order_by":4,"name":"Manuel Caetano","email":"","orcid":"","institution":"Hospital Provincial de Inhambane","correspondingAuthor":false,"prefix":"","firstName":"Manuel","middleName":"","lastName":"Caetano","suffix":""},{"id":459141032,"identity":"5a727037-37d6-4516-8f18-6be6eb5670f6","order_by":5,"name":"Osvaldo Loquiha","email":"","orcid":"","institution":"Clinton Health Access Initiative","correspondingAuthor":false,"prefix":"","firstName":"Osvaldo","middleName":"","lastName":"Loquiha","suffix":""},{"id":459141033,"identity":"ae9ca063-881f-4a8f-acc1-035a8aac30a9","order_by":6,"name":"Nédio Mabunda","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYHACgwMMDGwgBuODBFK1MBsQrQXGYJMgSr05e/PGAx8Y+OTM2Y8/q3i4o45B3r3HgOnGH9xaLHuOFRycwcBmbNmTY3Yj8cxhBsMzZwyYc3jwuOpGjsFhHga2xA0HcthuJLYdYDCckZbAnIPHjQb330C1nH/+rCCxrQ6qxQCPlhs8UC03EswYEtuYGeQlkg8w5yTg0XImDegXAzZjgxtvjCUS2w7zGPAcPnA45wAeLccPb/7woeKYnMH59Icff7bVycm3NzY+zsETYlCNx+BMHlDM4rEDDmoQTPkGItSPglEwCkbBiAIAgOBSnp+AnicAAAAASUVORK5CYII=","orcid":"","institution":"Instituto Nacional de Saúde","correspondingAuthor":true,"prefix":"","firstName":"Nédio","middleName":"","lastName":"Mabunda","suffix":""}],"badges":[],"createdAt":"2025-05-16 06:23:42","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6677647/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6677647/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83213638,"identity":"b9a5c38d-a1d5-4f6e-a412-9f9727403100","added_by":"auto","created_at":"2025-05-21 08:48:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":234519,"visible":true,"origin":"","legend":"\u003cp\u003eSample collection and testing workflow.\u003c/p\u003e","description":"","filename":"Fig.1.png","url":"https://assets-eu.researchsquare.com/files/rs-6677647/v1/cb20ab2abc1e449db90e9b87.png"},{"id":83215173,"identity":"84d7de85-68f8-4a8b-91f7-a2ce20aa978c","added_by":"auto","created_at":"2025-05-21 08:56:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1352972,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6677647/v1/c2f0426d-37fa-4a0c-b14d-431f0884d52f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of the most common causes of blood donor deferral in southern of Mozambique","fulltext":[{"header":"Background","content":"\u003cp\u003eBlood transfusion is a vital medical procedure that carefully involves the transfer of blood from a donor to a recipient (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This medical practice is so relevant to modern therapeutics that blood and its components are part of the World Health Organization's essential list of medicines (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBlood transfusion saves and improves lives, not only directly in emergencies and acute or chronic diseases, but also by facilitating surgery and chemotherapy, medical conditions that would not be possible without blood. In sub-Saharan African countries such as Mozambique, the blood is mainly used to treat pathologies such as Human Immunodeficiency Virus (HIV)-associated diseases, malaria-related anemia, obstetric hemorrhages, and trauma (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn 2018, approximately 118.5\u0026nbsp;million blood donations were made worldwide, 40% of which were in high-income countries, where 16% of the world's population lives. Despite the greater need and larger population, the number of blood donations in low-income countries is low. In Africa, from 2022 to 2024, the average number of units of blood collected per 1000 inhabitants/year increased from 4.5 to 5.2, with the regional target being 10 units per 1000 inhabitants/year (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The number of blood donations per 1000 inhabitants/year in Mozambique is estimated at 4.2% (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe low availability of blood in Africa is associated with the low number of blood donors may be caused by the high prevalence of blood-borne infectious agents, nutritional deficiencies, low hemoglobin, ineffective strategies for recruiting, motivating, and retaining blood donors, and others (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConcern about transfusion safety (post-transfusion reactions for the recipient of the blood or other blood product and for the health of the donor) has led blood banks to specialize in medical services aimed at ensuring the safety of blood and donors (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Blood donation is preceded by pre-interview - clinical and risk assessment of the blood donor (risk of carrying blood-borne infections), by administering a questionnaire. The clinical assessment includes measuring blood pressure, hemoglobin, and body temperature (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBlood donors who do not meet the established donation criteria are categorized as deferred donors, and this is a factor that affects the availability of blood supplies. Deferral can occur either temporarily or permanently, often stemming from confirmed or suspected infectious diseases, hematological conditions, or any medical issue that jeopardizes blood safety or the health of the donor (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMozambique has around 1,643 health facilities, of which 172 have transfusion services. The rest depend on a referral for transfusion. Donated blood is tested for HIV, Hepatitis B virus (HBV), Hepatitis C virus (HCV), and syphilis (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The prevalence of HIV, HBV, and HCV, in candidates approved for blood donation in Mozambique was estimated at 4.6%, 4.5%, and 0.5%, respectively (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Studies show that blood donors have a prevalence of \u003cem\u003eTreponema pallidum\u003c/em\u003e between 0.98% and 1.2% (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), nevertheless data on factors associated with blood donor deferral is limited.\u003c/p\u003e \u003cp\u003eThe information about the reasons for deferring blood donors is not only important for improving the availability of blood, but also for actions to improve the health of the population in general. This study aimed to investigates the frequency and reasons for deferral of blood donation at blood banks in the provinces of Gaza and Inhambane in Mozambique.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a cross-sectional study that was carried out between December 2022 and January 2024, and aimed to\u0026nbsp;investigates the frequency and reasons for deferral of blood donation at blood banks in the provinces of Gaza and Inhambane in Mozambique.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was carried out in four Blood Banks in Gaza province, including the Ch\u0026oacute;kwe and Chibuto Rural Hospitals, Macia-Bilene Health Center, and the Xai-Xai Provincial Hospital. Additionally, three Blood Banks in the Inhambane province were included: the Quissico-Zavala District Hospital, Inhambane Provincial Hospital, and Chicuque Rural Hospital in the southern region of Mozambique. In each province, health facilities with the highest volume of donors per year were chosen. The study sites were chosen because they had the highest number of donors per year within their respective province.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation, enrollment, and\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003edata collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll candidates for blood donation who attended the blood banks in Gaza and Inhambane provinces received clear explanations about the study and were invited to participate. Those who consented to take part confidently signed an informed consent form.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCandidates for blood donation who agreed to take part in the study were given a questionnaire on demographic characteristics, including age, gender, donor type, marital status, and others. Following this \u0026nbsp;venous blood was collected into three 6 ml K2EDTA Vacuum tubes (Becton Dickinson, Franklin Lakes, NJ, USA). Plasma was separated from the whole blood at the health facility and stored in cryovials. The plasma was used for serological testing of HIV, HBV, and HCV in health facilities and molecular testing of the same pathogens at \u003cem\u003ethe Instituto Nacional de Sa\u0026uacute;de\u003c/em\u003e of Mozambique.\u0026nbsp;Each candidate then underwent a routine pre-interview\u0026nbsp;process to assess their risk of infection by blood-borne agents and to evaluate their general health. Routine deferral data and the reason for participating in the study were subsequently collected from each blood bank.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSerological tests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHIV, HBV, and HCV testing was carried out in the Blood Banks of the health facilities in the study by technicians involved in routine testing. All tests were carried out according to the national algorithm for blood bank testing and according to the manufacturer\u0026apos;s instructions.\u003c/p\u003e\n\u003cp\u003eHIV testing was carried out using the Determine HIV 1/2 rapid test (Abbott Rapid Diagnostic, Japan). This test has a sensitivity and specificity of 100% and 99.9%, respectively, according to the manufacturer. All reactive results were confirmed with the Unigold test (Trinity Biotech Plc, Ireland), a rapid test with 100% sensitivity and specificity according to the manufacturer. Reactive results in both tests were considered positive, while reactive results in the first test and non-reactive results in the second test were considered indeterminate. Non-reactive results in the first test were considered negative. In the transfusion routine in Mozambique, donors with indeterminate or positive HIV results are deferred.\u003c/p\u003e\n\u003cp\u003eHBV testing was carried out using the advanced quality HBsAg rapid test (InTec Products, INC, China) with 100% sensitivity and specificity, according to the manufacturer.\u003c/p\u003e\n\u003cp\u003eHCV testing was carried out using the HCV Advanced Test Kit (InTec Products, INC, China), with a sensitivity and specificity of 99.7% and 99.8%, respectively, according to the manufacturer.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMolecular testing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Molecular tests\u0026nbsp;were performed at the \u003cem\u003eInstituto Nacional de Sa\u0026uacute;de\u003c/em\u003e of Mozambique, using the cobas MPX test (Roche Molecular Systems, Inc., Branchburg, NJ, USA), using the COBAS 6800 systems, utilizing approximately 1000 \u0026mu;l of plasma sample, by the manufacturer\u0026rsquo;s procedures.\u0026nbsp;The cobas MPX test allows simultaneous detection and discrimination of HIV RNA, HCV RNA, HBV DNA in a single test. Detection limits are set at 25 IU/mL, 7 IU/mL and \u0026nbsp;1.4 IU/mL \u0026nbsp;for HIV-1, HCV and HBV, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics and frequency tables for categorical variables were applied for data analysis. Agreement performance for permanent deferral between pre-interview and MPX (as reference tests) results, were evaluated using diagnostics performance indicators including observed agreement, chance agreement, positive and negative agreement, and Cohen\u0026rsquo;s Kappa.\u003c/p\u003e\n\u003cp\u003eFisher\u0026rsquo;s exact test was applied to compare the positivity rate for HIV, HBV, and HCV within samples deferred by pre-interview (temporary or permanent) and deferred by testing procedures. A multivariable logistic regression was employed to investigate factors related to the likelihood of deferral (temporary or permanent), with odds ratio used as a measure of association. For inference, 95% confidence intervals were calculated to provide a range of plausible values for all indicators.\u003c/p\u003e\n\u003cp\u003eData were analyzed using RStudio/2023.12.1+402 (R Foundation for Statistical Computing) and Microsoft Excel 365 (Microsoft Co. Co., Redmond, WA, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eStudy Population Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 3,862 blood donation candidates were recruited consecutively during the study period (Figure 1). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMost of the participants were from Gaza province (61.9%). Most of the participants were male (78%), aged 18-29 (56.7%), with a primary/secondary or technical level of education (85.8%). Most of the participants were single/divorced or widowed (74.3%), self-employed (30.3%), or public/private workers (30.1%). Replacement donors accounted for around three-quarters (72.2%), Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1. Socio-demographic characteristics of the study participants.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"414\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal of participants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3,862 (100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProvince\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eGaza\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e2,390 (61.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eInhambane\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e1,472 (38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e825 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e3,037 (78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003e18--29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e2,191(56.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003e30--39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e1,042 (27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003e40--49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e478 (12.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003e50--59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e126 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003e60--65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e25 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 67.6329%;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 32.3671%;\"\u003e\n \u003cp\u003e28 (22-35 )\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eNo education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e210 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003ePrimary/Secondary/Technician\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e3,312 (85.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eHigh level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e276 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eDenied to respond\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e63 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e1 (0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eMarried/Fact_union\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e990 (25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eSingle/Divorced/Widow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e2,871 (74.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e1 (0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eOwn account\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e1,171(30.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eDomestic/unemployeed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e562 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e963 (24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003ePrivate worker/public\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e1,163 (30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e3 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDonor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eReplacement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e2,787 (72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eFirst-time voluntary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e497 (12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eRegular voluntary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e577 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66.4251%;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33.5749%;\"\u003e\n \u003cp\u003e1(0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency and reasons for deferral of blood donation candidates\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall frequency of pre-interview deferrals for blood donation candidates was 5.2% (200/3862), of which 2.0% (78/200) and 3.2% (122/200) were permanent and temporary deferrals, respectively Table 2.\u003c/p\u003e\n\u003cp\u003eAmong blood donation candidates permanently deferral, the majority cited co-infection or risk factors associated with HBV and HCV (61.5%) and HIV (29.5%) and low hemoglobin (less than 12.5 g/dl, indicating moderate anemia) was the main cause of temporary rejection in the pre-interview (41.0%), followed by a report or risk of syphilis infection (23.0%).\u003c/p\u003e\n\u003cp\u003eThe frequency of permanent deferral by serological testing was 7.6% (295/3862). The major cause of deferral was HBV and HIV positivity, with 50.8% (150/295) and 30.5% (90/295) respectively, Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eFrequency and reasons for deferral of blood donation candidates.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"486\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeferral reasons\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGeneral frequency of deferral by pre-interview\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e200 (5.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePermanent deferral by pre-interview\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e78 (2.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003eHBV/HCV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e48 (61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003eHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e23 (29.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003eHIV and other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e6 (6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003eHBV/HCV and other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e1 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTemporary deferral by pre-interview\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e122 (3.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003eLow hemoglobin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e50 (41.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003eSyphilis and other Sexually transmitted infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e28 (23.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003eOther*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e25 (20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003eHigh blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e14 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003eLow hemoglobin \u0026amp; underweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e2 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003eLow hemoglobin \u0026amp; high blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e1 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003e\u0026nbsp;Injectable drugs \u0026amp; hemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e1 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003eRisk behavior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e1 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePermanent deferral by laboratory testing\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e295 (7.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003eHBV+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e150 (50.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003eHIV+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e90 (30.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003eHCV+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e40 (13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003eHIV+ \u0026amp; HBV+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e12 (4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003eHIV+ \u0026amp; HCV+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e2 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63.1687%;\"\u003e\n \u003cp\u003eHBV+ \u0026amp; HCV+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 36.8313%;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Some malaise, experienced bleeding or blood disease, and abnormal blood pressure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation between sociodemographic characteristics and pre-interview deferral of blood donors candidates\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBlood donation candidates from Inhambane province had a lower chance of being deferred (adjusted odds ratio 0.63; 95% Confidence Interval: 0.45 - 0.86), compared to blood donation candidates from Gaza province. On the other hand, males were less susceptible to deferral (AOR: 0.63; 95% CI: 0.45 - 0.89) compared to females.\u003c/p\u003e\n\u003cp\u003eBlood donors candidates aged 18-29 years old had a lower chance of being accepted compared to the other age groups, 30-39 (AOR 1.78 95% CI 1.22 - 2.59), 40-49 (AOR2.6 95% CI 1.66 - 4.03), 50-59 (AOR 2.78 95% 1.31 - 5.46). Additionally, the chance of deferral was higher in individuals who said they were domestic workers or unemployed (AOR: 1.75; 95% CI: 1.16 - 2.63), compared to other professions and students. Finally, first-time voluntary donors (AOR 0.94; 95% CI 0.55\u0026ndash; 1.52) and regular donors (AOR 0.65; 95% CI 0.39-1.02) demonstrated a lower risk of deferral in the blood donation process compared to replacement donors, Table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Deferral based on sociodemographic characteristics prior to the interview.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"743\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeferral\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(95% IC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(95% IC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProvince\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e3862 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e200 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eGaza\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e2390 (61.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e142 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eInhambane\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e1472 (38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e58 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e0.65 (0.48 -- 0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e0.63 (0.45 -- 0.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e825 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e62 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e3037 (78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e138 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e0.59 (0.43 -- 0.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e0.63 (0.45 -- 0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003e18--29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e2191(56.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e83 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003e30--39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e1042 (27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e63 (6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e1.63 (1.17 -- 2.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e1.78 (1.22 -- 2.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003e40--49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e478 (12.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e41 (8.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e2.38 (1.62 -- 3.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e2.6 (1.66 -- 4.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003e50--59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e126 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e11 (8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e2.43 (1.26 -- 4.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e2.78 (1.31 -- 5.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003e60--65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e25 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e2 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e2.21 (0.51 -- 9.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e2.87 (0.44 -- 10.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eNo education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e210 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e18 (8.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003ePrimary/Secondary/Technician\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e3312 (85.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e169 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e0.57 (0.35 -- 0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e1.01 (0.6 -- 1.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eHigh level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e276 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e13 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e0.53 (0.25 -- 1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e1.03 (0.45 -- 2.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eDenied to respond\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e63 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-----\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-----\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e1 (0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-----\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-----\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eMarried/Fact_union\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e990 (25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e53 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eSingle/Divorced/Widow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e2871 (74.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e147 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e0.95 (0.69 -- 1.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e1.39 (0.97 -- 2.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e1 (0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-----\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-----\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eOwn account\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e1171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e61 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eDomestic/unemployeed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e53 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e1.89 (1.29 -- 2.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e1.75 (1.16 -- 2.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e963\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e33 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e0.65 (0.42 -- 0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e0.83 (0.49 -- 1.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003ePrivate worker/public\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e1163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e53 (4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e0.87 (0.60 -- 1.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e0.85 (0.56 -- 1.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-----\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-----\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.0525%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDonor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eReplacement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e2787\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e156 (5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eFirst-time voluntary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e497\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e22 (4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e0.78 (0.49 -- 1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e0.94 (0.55 -- 1.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eRegular voluntary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e22 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e0.67 (0. 42 -- 1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e0.65 (0.39 -- 1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.0525%;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.5357%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17.362%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.9771%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-----\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22.0727%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003ePositivity rate in molecular testing among blood donation candidates who were deferred and approved in the pre-interview\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe rate of molecular detection of HIV and HBV was higher in blood donors deferred at the pre-interview, with 8.5% (10/117), and 16.9% (920/118) respectively, when compared to approved blood donors (p\u0026lt;0001), Table4.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Positivity rate in molecular testing among blood donation candidates who were deferred and approved in the pre-interview\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"594\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20.1681%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 56.3025%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositivity rate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 23.5294%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20.1681%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatogen\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.7311%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeferred (n=118) *\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eApproved (n=2598) **\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 23.5294%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;P value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20.1681%;\"\u003e\n \u003cp\u003eHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.7311%;\"\u003e\n \u003cp\u003e8.5% (10/117)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003e1.5% (40/2592)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 23.5294%;\"\u003e\n \u003cp\u003e\u0026lt;0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20.1681%;\"\u003e\n \u003cp\u003eHBV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.7311%;\"\u003e\n \u003cp\u003e16.9% (20/118)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003e3.3% (87/2598)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 23.5294%;\"\u003e\n \u003cp\u003e\u0026lt;0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20.1681%;\"\u003e\n \u003cp\u003eHCV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27.7311%;\"\u003e\n \u003cp\u003e0.0% (0/117)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003e0.2% (6/2590)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 23.5294%;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e*82 deferred in the pre-interview without results in the molecular testing\u003c/p\u003e\n\u003cp\u003e**1064 approved in the pre-interview without results in the molecular testing\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe participants in this study are similar to those in other studies conducted in Mozambique, with a predominance of replacement donors (72.2%), males (78.6%), and young people (56.7%) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Similar results have been found in other studies in Africa and other parts of the world (\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe overall deferral rate of blood donation candidates found in this study (5.2%) is low compared to studies conducted in Nigeria (8.69%)(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), Ivory Coast (10.8%)(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), Tanzania (12.7%)(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), and Kenya (21.6%)(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), and in countries outside Africa, such as China (9.26%)(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), Dubai (19.4%)(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and Brazil (12.1 to 15.7%)(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe difference between our results and those of the other studies can be explained by the low number of blood donors in Mozambique, estimated at 4.2 units of blood per 1000 inhabitants/year(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), compared to the 10 units of blood per 1000 inhabitants/year recommended by the World Health Organization (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This may put pressure on transfusion services to reduce the sensitivity of the pre-interviews to obtain a higher quantity of blood and satisfy the demand in hospital services. Another factor that may be linked to the low level of deferral we found compared to other studies is the efficiency and level of training of the human resources allocated to the donor selection process. The low level of proficiency may be related to the inadequate conduct of the pre-interview(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), which may reduce its sensitivity.\u003c/p\u003e \u003cp\u003eAmong the reasons for deferral in the pre-interview, low hemoglobin emerged as the main cause, accounting for 41.0%. This finding aligns with results from studies conducted in Tanzania, Kenya, Nigeria, Dubai and Malaysia (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Low hemoglobin levels are often associated with the individual's nutritional status or the presence of parasitic infections (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Both conditions are prevalent in Mozambique and in many African countries (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Moreover, one factor that may be contributing to low hemoglobin is the method used to measure hemoglobin. The transfusion sites in Mozambique use a manual technique that assesses hemoglobin based on the copper sulphate method. This method has a low performance (accuracy, sensitivity and specificity) compared to automated or point-of-care hemoglobin measurement technology (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The introduction and use of point-of-care equipment for hemoglobin measurement could better protect the blood donor and recipient, as well as increase the availability of blood.\u003c/p\u003e \u003cp\u003eHBV infection was the main reason for the permanent deferral of blood donation candidates (50.8%) and these data are similar to studies carried out in Nigeria (31.71%) and Kenya (4.73%) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Mozambique is considered a country with high endemicity for HBV, and studies carried out on blood donors in Mozambique also show a high prevalence of HBV (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In general, infectious agents are the main reason for the permanent deferral of blood donors in Mozambique and in most African countries(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Implementing strategies to eliminate transmitted blood infections as a public health problem and improving the tests to detect infectious agents in donated blood could increase the demand for blood and blood donors.\u003c/p\u003e \u003cp\u003eWhen examining deferrals based on the sociodemographic characteristics of participants, male donors experience a notably lower likelihood of being deferred for blood donation (AOR 0.63, 95% CI 0.45\u0026ndash;0.89) compared to female donors. This trend is consistent with research conducted in other countries (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Various studies emphasize that eligibility criteria directly impact the deferral rates of female donors, as these criteria often involve factors such as low hemoglobin levels or anemia, low blood pressure, body piercings, dizziness or fainting, venipuncture difficulties, and low body weight, which are more frequently observed in women, particularly those of reproductive age (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn many African countries, women are the ones who most often go to health centers to take care of their health, pregnancy, and child (\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Removing existing barriers to blood donation by women, without prejudice to their health, combined with mobilization and motivation for blood donation, could increase the number of blood donations and the number of volunteer donors.\u003c/p\u003e \u003cp\u003e The positivity rate for HIV and HBV in deferrals blood donation candidates was high when compared to donors approved at the pre-interview. We can assume that the answers provided by the candidates in the pre-interview are reliable and that the survey used in Mozambique to select donors had good sensitivity in this study. Yet, it is important to note that the positivity rates of the molecular tests for HIV (1.5%) and HBV (3.3%) were both higher than 1% among donors approved for blood donation, which shows that there is a risk of transmission of these agents by blood transfusion. Improving pre-screening and the rigorous selection of blood donors, as well as the use of voluntary donors, is important for improving transfusion safety.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStudy Limitations\u003c/h2\u003e \u003cp\u003eThe results of this study are innovative for Mozambique and can potentially improve transfusion policies, particularly in donor selection and testing. Nonetheless, it is important to consider some limitations when interpreting these results: Firstly, the responses collected during the pre-interview are self-reported by the candidates for donation. Consequently, the fear of deferral can lead to omissions or positive responses, which may have influenced the recorded deferral rates. Secondly, the awareness of study progress among the technicians conducting the pre-interviews is likely to have led to improvements in routine practices, such as a more thorough completion of the pre-interview stages and increased effectiveness, thereby resulting in a higher number of candidates willing to donate. Third, this study did not include blood donors deferred due to positive Treponema pallidum test results. This may have underestimated the frequency of deferral due to laboratory testing. Lastly, it's worth noting that not all blood donation candidate samples underwent molecular testing for HIV, HBV, and HCV. This fact could have impacted on the overall positivity rates observed.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe overall deferral rate for blood donation candidates during the pre-interview was intermediate. Low hemoglobin and suspected syphilis or other sexually transmitted infection were the main reasons for temporary exclusion. HBV and HIV infections were the main reasons for permanent exclusion.\u003c/p\u003e \u003cp\u003eThe method used to measure hemoglobin, the higher seroprevalence of infectious agents in donated blood, and the greater deferral of women may be related to the low number of blood donations in Mozambique.\u003c/p\u003e \u003cp\u003eThe results of this study reinforce the need to improve the process of clinical assessment, selection, and retention of blood donation candidates, especially women, to have consistent volunteer donors.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eAOR:\u003c/strong\u003e Adjusted Odds Ratio\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCI:\u003c/strong\u003e Confidence Interval\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDNA:\u003c/strong\u003e Deoxyribonucleic acid\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHBV:\u003c/strong\u003e Hepatitis B virus\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHCV:\u003c/strong\u003e Hepatitis C virus\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHIV:\u003c/strong\u003e Human Immunodeficiency Virus\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIU/mL:\u0026nbsp;\u003c/strong\u003eInternational units per millilitre\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRNA\u003c/strong\u003e: Ribonucleic acid\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOR:\u0026nbsp;\u003c/strong\u003eOdds Ratio\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study was approved by the Institutional Committee on Health Bioethics of the Gaza province (CIBS-Gaza), under the reference 58/CIBS-Gaza/2024, and Mozambique National Health Bioethics Committee, with reference 753/CNBS/22.\u0026nbsp;The study procedures respected all ethical principles. Participation was voluntary, and all participants signed an informed consent form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used for this analysis can be obtained from the \u003cem\u003eInstituto Nacional de Sa\u0026uacute;de\u003c/em\u003e of Mozambique, through the corresponding author. Researchers interested in secondary analysis must submit a research proposal for consideration by the study investigators, as well as by the Division for Research in Health and Well-Being.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors declare no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization of the study,C.N,O.M and N.M; funding acquisition, N.M; sample, data collection and testing, C.N,O.M,A.N,M.C and N.M. Data analysis, cleaning and curation C.N, A.M, O.L and N.M; research administration and resources, O.M and N.M; writing of the original draft, C.N and O.M writing, reviewing, and editing A.M, A.N, M.C, O.L and N.M\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the blood donors who voluntarily participated in the study and the teams from the blood banks in the provinces of Gaza and Inhambane. We would also like to thank the team at the Maputo Central Hospital Blood Bank, especially the technicians Augusto Domingos and Telma Saia, for their collaboration in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe would like to thank the technicians from the Biotechnology and Genetics and Immunology Laboratories of the \u003cem\u003eInstituto Nacional de Sa\u0026uacute;de\u003c/em\u003e for their collaboration in testing the study samples. We extend thanks to Nalia Ismael for editing the English.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Global status report on blood safety and availability 2021. 2022. \u003c/li\u003e\n\u003cli\u003eWHO. World Health Organization. 2021. India. Essential List of Medicine - World Health Organization [Internet]. 2021; Available from: https://www.who.int/leishmaniasis/burden/Leishmaniasis_India/en/\u003c/li\u003e\n\u003cli\u003eInstituto Nacional de Sa\u0026uacute;de, Organiza\u0026ccedil;\u0026atilde;o Mundial de Sa\u0026uacute;de E do C. SARA 2018, Inventario Nacional [Internet]. MISAU. Vol. 1. Maputo; 2019. 1\u0026ndash;476 p. Available from: https://www.afro.who.int/pt/publications/sara-2018-inventario-nacional\u003c/li\u003e\n\u003cli\u003eWHO Regional Office for Africa. WHO African Region status report on blood availability, safety and quality. 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Available from: http://www.biomedcentral.com/1471-2334/11/141\u003c/li\u003e\n\u003cli\u003eMabunda N, Augusto O, Zicai AF, Duaj\u0026aacute; A, Oficiano S, Ismael N, et al. Nucleic acid testing identifies high prevalence of blood borne viruses among approved blood donors in Mozambique. PLoS One. 2022 Apr 28;17(4):e0267472. \u003c/li\u003e\n\u003cli\u003eBlood donor selection: guidelines on assessing donor suitability for blood donation. Blood donor selection : guidelines on assessing donor suitability for blood donation. World Health Organization; 2013. 118 p. \u003c/li\u003e\n\u003cli\u003eTagny CT, Ikomey G, Ngo Sack F, Achu C, Ndemanou M, Ninmou C, et al. Implementation of an Africa-specific donor health questionnaire for human immunodeficiency virus risk screening. Vox Sang. 2022 Jul 1;117(7):920\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eGudo ES, Abreu CM, Muss\u0026aacute; T, Augusto R, Otsuki K. among blood donors in Maputo City , Mozambique. 2019;49(June 2009):1146\u0026ndash;50. \u003c/li\u003e\n\u003cli\u003eValerian DM, Mauka WI, Kajeguka DC, Mgabo M, Juma A, Baliyima L, et al. Prevalence and causes of blood donor deferrals among clients presenting for blood donation in northern Tanzania. PLoS One. 2018 Oct 1;13(10). \u003c/li\u003e\n\u003cli\u003eOkoroiwu HU, Asemota EA. Blood donors deferral prevalence and causes in a tertiary health care hospital, southern Nigeria. BMC Health Serv Res. 2019 Jul 22;19(1). \u003c/li\u003e\n\u003cli\u003eIqbal H, Tameez Ud Din A, Tameez Ud Din A, Chaudhary FMD, Younas M, Jamil A. Frequency and Causes of Deferral among Blood Donors Presenting to Combined Military Hospital Multan. Cureus. 2020 Jan 14; \u003c/li\u003e\n\u003cli\u003eDias PB, Lissa NM, Skare T, F\u0026aacute;vero KB, Almeida PTR, Nisihara R. Pre-donation deferral of blood donors in a Brazilian blood bank: a 10-year experience. Transfusion Medicine. 2019 Dec 1;29(6):448\u0026ndash;53. \u003c/li\u003e\n\u003cli\u003eKouao MD, Dembel\u0026eacute; B, N\u0026rsquo;Goran LK, Konat\u0026eacute; S, Bloch E, Murphy EL, et al. Reasons for blood donation deferral in sub-Saharan Africa: Experience in Ivory Coast. Transfusion (Paris). 2012 Jul;52(7 PART 2):1602\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eNyamu GW, Shee MA, Kiende P, Muthiani BM, Nakazea RJ, Mwasowa NM, et al. Causes of pre and post-donation deferrals among blood donors, at Kwale Satellite Blood Transfusion Center, Kwale County, Kenya, 2018\u0026ndash;2022. BMC Public Health. 2024 Dec 1;24(1). \u003c/li\u003e\n\u003cli\u003eYang Y. Characteristics and causes of pre-donation deferrals at a Chinese blood center. Transfusion and Apheresis Science. 2021 Aug 1;60(4). \u003c/li\u003e\n\u003cli\u003eShaer L Al, Sharma R, Abdulrahman M. Analysis of blood donor pre-donation deferral in Dubai: Characteristics and reasons. J Blood Med. 2017 May 25;8:55\u0026ndash;60. \u003c/li\u003e\n\u003cli\u003eFerreira O, Passos ADC. Factors associated with failure of clinical screening among blood donors who have altered serological results in the Centro Regional de Hemoterapia de Ribeir\u0026atilde;o Preto. Rev Bras Hematol Hemoter. 2012;34(6):411\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eZahidin MA, Saidin NIS, Ibrahim NA, Mohd Nasir NNA, Abdul Razak NI, Ramli M, et al. The Blood Donor Deferral Rate and the Reasons for Deferral at a Tertiary Care Teaching Institute in Northeastern Malaysia. Cureus. 2024 Feb 26; \u003c/li\u003e\n\u003cli\u003eMast AE. Low hemoglobin deferral in blood donors. Vol. 28, Transfusion Medicine Reviews. 2014. p. 18\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eSambo J, Bauhofer AFL, Boene SS, Djedje M, J\u0026uacute;nior A, Pilale A, et al. Readiness of Mozambique Health Facilities to Address Undernutrition and Diarrhea in Children under Five: Indicators from 2018 and 2021 Survey Data. Healthcare. 2022 Jun 27;10(7):1200. \u003c/li\u003e\n\u003cli\u003eCasmo V, Augusto G, Nala R, Sabonete A, Carvalho-Costa FA. Infec\u0026ccedil;\u0026otilde;es por ancilostom\u0026iacute;deos e Schistosoma haematobium e sua correla\u0026ccedil;\u0026atilde;o com a concentra\u0026ccedil;\u0026atilde;o sangu\u0026iacute;nea de hemoglobina em crian\u0026ccedil;as mo\u0026ccedil;ambicanas. Rev Inst Med Trop Sao Paulo. 2014;56(3):219\u0026ndash;24. \u003c/li\u003e\n\u003cli\u003eChaudhary R, Dubey A, Sonker A. Techniques used for the screening of hemoglobin levels in blood donors: Current insights and future directions. Vol. 8, Journal of Blood Medicine. Dove Medical Press Ltd; 2017. p. 75\u0026ndash;88. \u003c/li\u003e\n\u003cli\u003eIngrand P, Gudo S, Ingrand I, Cunha L. Use of Replacement Blood Donors to Study the Epidemiology of Major Blood-Borne Viruses in the General Population of Maputo , Mozambique. 2007;1840(July):1832\u0026ndash;40. \u003c/li\u003e\n\u003cli\u003eMirambo MM, Mkumbo E, Selega H, Msemwa B, Mushi MF, Silago V, et al. Hepatitis B virus infections among health professional students in Mwanza city , Tanzania in 2016. 2020;1\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eKisangau EN, Awour A, Juma B, Odhiambo D, Muasya T, Kiio SN, et al. Prevalence of hepatitis B virus infection and uptake of hepatitis B vaccine among healthcare workers, Makueni County, Kenya 2017. Journal of Public Health (United Kingdom). 2019 Dec 1;41(4):765\u0026ndash;71. \u003c/li\u003e\n\u003cli\u003eKisangau EN, Awour A, Juma B, Odhiambo D, Muasya T, Kiio SN, et al. Prevalence of hepatitis B virus infection and uptake of hepatitis B vaccine among healthcare workers , Makueni County , Kenya 2017. 2018;41(4):765\u0026ndash;71. \u003c/li\u003e\n\u003cli\u003eInfanti L. Protecting the blood donor: ferritin-based intervals to improve donor health. The Lancet. 2024 Jul;404(10447):2\u0026ndash;3. \u003c/li\u003e\n\u003cli\u003eKasraian L, Ashkani-Esfahani S, Foruozandeh H. Reasons of under-representation of Iranian women in blood donation. Hematol Transfus Cell Ther. 2021 Jul 1;43(3):256\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eStraneo M, Hanson C, Van Den Akker T, Afolabi BB, Asefa A, Delamou A, et al. Inequalities in use of hospitals for childbirth among rural women in sub-Saharan Africa: a comparative analysis of 18 countries using Demographic and Health Survey data. BMJ Glob Health. 2024 Jan 22;9(1). \u003c/li\u003e\n\u003cli\u003eThorp M, Balakasi KT, Mphande M, Robson I, Khan S, Stillson C, et al. Factors associated with men\u0026rsquo;s health facility attendance as clients and caregivers in Malawi: a community-representative survey. BMC Public Health. 2022 Dec 1;22(1). \u003c/li\u003e\n\u003cli\u003eLlop-Giron\u0026eacute;s A, JULI\u0026Agrave; M, CHICUMBE S, DUL\u0026Aacute; J, ODALLAH AAP, ALVAREZ F, et al. Inequalities in the access to and quality of healthcare in Mozambique: evidence from the household budget survey. International Journal for Quality in Health Care. 2018 Nov 2; \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Blood donation, Donor deferrals, Causes, Transfusion transmissible infections, Mozambique","lastPublishedDoi":"10.21203/rs.3.rs-6677647/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6677647/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBlood transfusion is essential in modern medicine, but transfusion of blood may present for both the blood donor as well as the recipient risks. Strategies such as pre-interview (including clinical assessment) of donors and the subsequent testing of donated blood for infectious agents are steps taken to guarantee blood transfusion safety. With this the study aimed to assess the frequency and reasons for blood donation deferrals at blood banks in southern of Mozambique.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a cross-sectional study conducted on blood donation candidates between December 2022 and January 2024 in the provinces of Gaza and Inhambane, situated in the southern region of Mozambique. Blood donation candidates answered a questionnaire on demographic characteristics and venous blood was collected in three 6 ml K2EDTA tubes samples. The plasma was separated from the whole blood and used for serological and molecular tests for HIV, HBV and HCV. Deferral data in the routine pre-interview was subsequently collected at each blood bank.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 3862 donors participated in the study, of which 72.2% were replacement donors. The overall donor deferral rate in pre-interview\u003cem\u003e \u003c/em\u003ewas 5.2 %, with low hemoglobin being the main reason for temporary deferral at pre-interview (41.0%), followed by syphilis or other sexually transmitted infection suspect (23.0%). The HBV (50.8%) and HIV (30.5%) infections were the main reasons for permanent deferral. Male donors were less likely to be deferred for blood donation (AOR 0.63, 95% CI 0.45 - 0.89) compared to female donors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe method used to measure hemoglobin, the higher seroprevalence of infectious agents in donated blood, and the greater deferral of women may be related to the blood donors deferral in Mozambique. This results reinforce the need to improve the process of clinical assessment, selection, and retention of blood donation candidates, to have consistent volunteer donors.\u003c/p\u003e","manuscriptTitle":"Analysis of the most common causes of blood donor deferral in southern of Mozambique","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-21 08:48:43","doi":"10.21203/rs.3.rs-6677647/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-21T18:51:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-17T08:01:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-17T08:00:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-05-16T06:17:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"69a4af8a-1173-44dc-bc0a-9d08c7aefcbb","owner":[],"postedDate":"May 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-15T10:23:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-21 08:48:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6677647","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6677647","identity":"rs-6677647","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}