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

BACKGROUND: Repeat blood donors have lower transfusion-transmissible infection (TTI) rates, making donor type distribution critical for blood safety. This study characterised donor type patterns, factors associated with first-time donation, and TTI prevalence differences in Northern Ghana. METHODS: A retrospective cross-sectional analysis of 3,546 donor records (2017-2022) from seven health facilities in Upper West, Northern, and Oti regions. Donor type (first-time vs. repeat) was the primary outcome. Descriptive statistics, chi-square tests, and multivariable logistic regression were used. TTI prevalence, defined as positivity for at least one of HIV, HBV, HCV, or syphilis ("any TTI"), was compared between donor types. Significance was set at α = 0.05. RESULTS: First-time donors constituted 82.0% (2,907) and repeat donors 18.0% (639). Repeat donation increased from 12.3% (2020) to 22.6% (2022). Rural donors (93.1% first-time) and non-volunteer donors (82.5% first-time) showed higher proportions of first-time donation (both p < 0.001). In adjusted analysis, older age (AOR 0.97 per year) and urban residence (AOR 0.69) were associated with lower odds of being first-time. The Oti region had markedly higher odds (AOR 491.65). First-time donors had significantly higher TTI prevalence: any TTI (16.06% vs. 5.48%), HBV (5.64% vs. 1.88%), HCV (2.51% vs. 0.16%), and syphilis (8.67% vs. 3.60%). CONCLUSIONS: The predominance of first-time donors (82%) 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.