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KNOWLEDGE AND ATTITUDE OF RHESUS INCOMPATIBILITY IN PREGNANCY AMONG WOMEN ATTENDING ANTENATAL CLINIC IN SPECIALIST HOSPITAL YOLA

ABSTRACT

Despite the introduction and widespread use of Rhesus (Rh) D immunoglobulin for prevention of hemolytic disease of the fetus/newborn (HDFN), Rh alloimmunization remains a significant problem in perinatology. Care management with anti-D prophylaxis in patients presenting with severe alloimmunization is difficult to access in Sub-Saharan Africa. This study aims to determine the prevalence and assess the existing mechanism for management of Rh negative pregnant women in Specialist hospital Yola. A cross sectional study using quantitative and qualitative methods was used in the study. A total of 497 women case files were included in the study from September, 2020 to August, 2021 to determine the prevalence by using systematic random sampling. Then another 384 case files of Rh negative women was included by simple random sampling   for assessment of the management of Rh negative pregnancy. SPSS was used for data entry and analysis .Tables were used to show the results, percents and frequencies to describe the variables. Univariate and Bivariate analysis using Chi square was conducted and p value was determined. In the qualitative method in-depth interview with 7 key informants by using purposive sampling, to assess the availability and affordability issues of medication was done. Data was analyzed as per the procedure i.e. recording, transcribing, translation and organizing and content analysis was conducted using open code software. The prevalence of Rh negative was 7.2% with 95%CI (6.9, 7.5). The utilization rate of Anti D was 14.3%. There was 4.7% offer of RAADP at 28 weeks. Regarding Anti D administration all socio demographic factors included in the study were not statistically significant with anti D administration. Qualitative data suggest that special consideration is necessary on this issue. The prevalence of Rh negative women is of a high magnitude keeping in view the prevalence rate of the other African countries estimate. There is lack of proper management of Rh negative pregnant women. Special attention should be given to Rh negative pregnancy to be included in maternal health programs by Ministry of health, donors and other collaborators.

 

 

CHAPTER ONE

INTRODUCTION

 

1.1              Background

 

Despite the introduction and widespread use of Rhesus (Rh)D immunoglobulin for prevention of hemolytic disease of the fetus/newborn(HDFN), Rh alloimmunization remain a clinical challenge(1). The associated disease in the pregnant patient’s offspring—hemolytic disease of the fetus or newborn—was once a major contributor to perinatal morbidity and mortality (2). However, the widespread adoption of guidelines for the antenatal and postpartum use of Rh immune globulin in industrialized countries has resulted in a major decrease in the frequency of this disease(2). It is still contributing to the neonatal morbidity and mortality in the world due to non-immunization, under-immunization, and false Rh typing in rare cases (3).

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1.2     Statement of the problem

 

Despite the fact that the prevalence of Rh-negative phenotype is significantly lower among Africans than Caucasians, Rh alloimmunization remains a major factor responsible for perinatal morbidity in Sub-Saharan Africa and may result in the compromise of the woman’s obstetric care due to the unaffordability of anti-D immunoglobulin (4). Care management with anti-D prophylaxis in patients presenting with severe alloimmunization is difficult to access in Sub- Saharan Africa. In addition to poor access to anti-D prophylaxis, there is lack of alloimmunization in prevention during illegal abortions and poor documentation of adequate information in patients’ medical notes. These factors are highly responsible for the difficult management of Rh-negative patients (4, 5). Although Rh negative blood groups are generally lower in Africa, it is still important to understand the prevalence and management of Rh-negative women in sub-Saharan Africa (6).

1.3    Objectives Of The Study

1. To determine the prevalence of Rh negative pregnant women visiting Specialist hospital Yola.
2. To determine the utilization rate of Anti D immunoglobulin among Rh negative pregnant women in Specialist hospital Yola.
3. To explore the offer of RAADP in prevention of sensitization in antenatal
4. To assess issues related to the availability and affordability of the Anti D

 

1.4    Research Questions

1. What is the prevalence of Rh negative pregnant women visiting Specialist hospital Yola?
2. How is the utilization rate of Anti D immunoglobulin among Rh negative pregnant women in Specialist hospital Yola?
3. What ways has the offer of RAADP been explored in prevention of sensitization in antenatal visits?
4. What are the issues related to the availability and affordability of the Anti Dmedication?

 

1.5   Significance of the study

 

Erhabor Osaro et al has indicated that cost constraints have remained a limiting factor preventing people from access to best possible treatment and care in Sub-Saharan African countries. There is also the urgent need for African leaders to take up the bold challenge to provide universal access to anti-D prophylaxis for Rh-negative women. Per capita income in most settings in Sub- Saharan Africa is low and continues to affect affordability to prophylactic anti-D treatment (5). In Ethiopia, the prevalence and utilization rate of Anti D prophylaxis for Rh-negative pregnant women was not investigated.

 

African leadership for child survival: A Promised Renewed- on January 16-18, 2020, the government of Ethiopia convened a meeting of Africa ministers of health and global experts aimed at celebrating reduction in preventable child death through sharper national plans and improved monitoring and evaluation. The African continent shares a significant global burden of newborn, child and maternal deaths. Of the 3.5million such death per year in Africa, more than 1 million are newborns.

A research by Vinod B. et al showed Global estimate of still birth and neonatal death due to kernicterus associated with Rh disease is illustrated among different countries Eastern Europe/Central Asia, Latin America, sub-Saharan Africa, and South Asia. Three-quarters of mortality occurred in sub-Saharan Africa and South Asia. Kernicterus with Rh disease ranged from 38, 28, 28, and 25/100,000 live births for Eastern Europe/Central Asian, sub-Saharan African, South Asian, and Latin American regions, respectively (29).

1.6    Definition Of Terms

Rhesus: Rh factor (or Rhesus factor) is a type of protein on the outside or surface of your red blood cells. You inherit the protein, which means you get your Rh factor from your biological parents. If you have the protein, you’re Rh-positive. If you don’t have the protein, you’re Rh-negative

Pregnancy: Pregnancy is the term used to describe the period in which a fetus develops inside a woman’s womb or uterus. Pregnancy usually lasts about 40 weeks, or just over 9 months, as measured from the last menstrual period to delivery. Health care providers refer to three segments of pregnancy, called trimesters

 

Health Care: Health care is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health professionals and allied health fields