Blood Safety in Northern Ghana Hinges on Turning First-Time Donors Into Repeat Donors

Blood transfusion saves lives every day, but its safety depends on who rolls up their sleeve. A new six-year analysis of blood donor records from northern Ghana has revealed a striking imbalance: more than eight in ten donors are giving blood for the very first time, and those first-timers carry nearly three times the burden of transfusion-transmissible infections compared with donors who return again and again. The findings, published in Frontiers in Epidemiology, underscore a quiet but persistent vulnerability in the region’s blood supply and point toward a practical remedy: keeping donors coming back.

Researchers from the University for Development Studies in Tamale analysed 3,546 donor records collected between January 2017 and December 2022 at seven health facilities spanning the Upper West, Northern, and Oti regions, along with one facility in the Bono East region categorised as “Other” for analytical purposes. Their retrospective cross-sectional study, conducted in line with STROBE reporting guidelines, set out to answer three linked questions: how donor types are distributed, what factors predict whether someone donates once or repeatedly, and how infection prevalence differs between the two groups.

The headline number is stark. Of the 3,546 donors whose records met the study’s inclusion criteria, 2,907 — 82.0 percent — were first-time donors, while only 639, or 18.0 percent, were repeat donors. This lopsided ratio stands in sharp contrast to high-income countries, where repeat donors typically constitute between 60 and 80 percent of the donor base. In the United States, repeat donors account for roughly 73 percent of donations; in the United Kingdom, the figure exceeds 80 percent. Even within sub-Saharan Africa, Ghana’s northern regions lag behind more established blood services: South Africa reports repeat-donor proportions of around 60 percent, and Kenya between 30 and 40 percent.

Why does this matter so much for blood safety? Repeat donors — defined in the study as individuals with two or more documented donations at the same facility — are screened repeatedly for transfusion-transmissible infections (TTIs), receive ongoing health education, and are more likely to be motivated by altruism rather than the urgency of a family member’s illness. First-time donors, particularly those donating as replacements for specific patients, have consistently shown higher TTI prevalence across multiple settings. The WHO has long recommended that all countries transition toward 100 percent voluntary non-remunerated blood donation as a cornerstone of blood safety, yet many sub-Saharan African nations, Ghana included, continue to rely heavily on replacement and family donations.

The infection data in this study make the case vividly. Among first-time donors, 16.06 percent tested positive for at least one of the four infections screened — HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), or syphilis. Among repeat donors, that figure dropped to 5.48 percent. Hepatitis B prevalence was 5.64 percent in first-timers versus 1.88 percent in repeaters; HCV was 2.51 percent versus 0.16 percent; syphilis was 8.67 percent versus 3.60 percent. Notably, no HIV infections were detected among repeat donors, while first-time donors had an HIV prevalence of 0.86 percent. The authors attribute the lower TTI burden among repeaters partly to the cumulative effect of repeated screening and permanent deferral of anyone who tests positive, which progressively removes infected individuals from the repeat-donor pool, and partly to the altruistic motivation and recurring pre-donation education that characterise voluntary repeat donors.

Geography emerged as one of the most powerful predictors of donor type. In the Oti region, an extraordinary 99.8 percent of donors — 1,509 out of 1,512 — were first-time donors, with only three repeat donors recorded across the entire six-year period. The Upper West region fared somewhat better at 74.3 percent first-time, and the Northern region at 70.1 percent. In adjusted multivariable logistic regression, the Oti region showed markedly higher odds of first-time donation relative to the Northern region (adjusted odds ratio 491.65), though the authors caution that this estimate carries an exceptionally wide confidence interval (180.34 to 2,026.31) because of the near-total absence of repeat-donation events in that stratum — a classic sparse-data problem that can inflate both point estimates and uncertainty. The Oti region was only created in 2018, carved out of the former Volta Region, and its blood donation infrastructure may still be maturing; the Nkwanta South Municipal Hospital, which contributed all Oti-region donors, may function largely as a referral centre for emergency family donation.

Residence also mattered. Rural donors were 93.1 percent first-time, compared with 69.8 percent among urban donors — a gap the authors attribute to lower access to blood donation services in rural districts, less-developed voluntary recruitment infrastructure outside urban centres, and transport and livelihood constraints that make returning to donate harder. Urban residence was independently associated with lower odds of being a first-time donor (AOR 0.69), and each additional year of age reduced those odds by roughly 3 percent (AOR 0.97 per year). Male sex and non-volunteer donation status, which showed strong crude associations, lost statistical significance after adjustment, suggesting that geography and age explain much of the apparent effect. Rural donors also carried a heavier infection burden: syphilis prevalence was 11.62 percent in rural versus 4.16 percent in urban donors, and HCV was 3.99 percent versus 0.23 percent, compounding the safety challenge in rural settings.

Donation purpose told a related story. Only 5.5 percent of all donors in the study were voluntary, non-remunerated donors, yet this small group had dramatically higher repeat-donation rates — 45.4 percent versus 17.5 percent among non-volunteer donors. Non-volunteer donors, who gave blood in response to a specific request for a named patient, were 82.5 percent first-time. A systematic review by Piersma and colleagues has found that replacement donors have substantially lower odds of becoming repeat donors compared with voluntary donors. In this study, however, donation purpose was no longer independently associated with donor type after accounting for region and other covariates, suggesting that the crude association is largely explained by geographic factors — replacement donation being more common in rural areas and regions with less-developed voluntary programs.

There is a modest silver lining in the temporal data. The proportion of repeat donors rose from 12.3 percent in 2020 to 19.5 percent in 2021 and 22.6 percent in 2022. The authors suggest several plausible, non-mutually-exclusive explanations: donors who began giving during COVID-19-related shortages may have continued afterwards; National Blood Service Ghana retention initiatives, including SMS recall systems, may be gaining traction; and facility-level record-keeping may have improved, making repeat donors easier to identify. Still, the 2022 figure remains far below the WHO-referenced target range of 60 to 80 percent repeat donors for a stable, safe blood supply, and the authors note that the very small 2017 and 2018 samples (two and one donors, respectively) and the absence of 2019 data limit the reliability of early trend estimates.

The study’s policy implications are concrete. The authors recommend priority investment in donor retention infrastructure in the Oti region — establishing donor databases, implementing SMS recall systems, training staff in retention strategies, and community education on repeat donation. Rural-focused programs, including mobile blood donation services that return to the same communities at regular intervals, could help rural donors transition to repeat status. Converting replacement donors into voluntary donors, and establishing lifelong donation habits early among the large cohort of young donors aged 16 to 25, who made up 41.1 percent of the donor population but had comparatively low repeat rates, are additional priorities. The authors also suggest documenting and assessing the transferability of strategies used in regions with higher repeat-donation rates, such as the Northern region at 29.9 percent and the “Other” region at 76.0 percent. The study has limitations — donor-type classification relied on single-facility records and could not capture donations made elsewhere, the rapid diagnostic tests used for screening have lower sensitivity than laboratory-based assays, and findings may not generalise to southern Ghana — but the overall sample size and multi-facility design provide a robust foundation for the observed patterns. As the authors conclude, the predominance of first-time donors and low repeat-donation rates represent a blood safety vulnerability that would benefit from targeted donor retention programs, particularly in rural areas and the Oti region.

Subject of Research: Donor type dynamics and transfusion-transmissible infection prevalence among blood donors in northern Ghana

Article Title: Donor type dynamics and associated factors among blood donors in northern Ghana: a six-year retrospective analysis

Article References: Salifu, Y., Gyebuni, P., Salifu, T., Wobi, E. B., & Lasong, J. (2026). Donor type dynamics and associated factors among blood donors in northern Ghana: a six-year retrospective analysis. Frontiers in Epidemiology, 6, Article 1905551. https://doi.org/10.3389/fepid.2026.1905551

Image Credits: AI Generated

DOI: 10.3389/fepid.2026.1905551

Keywords: blood donors, blood safety, Ghana, repeat donors, first-time donors, transfusion-transmissible infections, hepatitis B, HIV, HCV, syphilis, donor retention, sub-Saharan Africa