Utilisation of prophylactic anti-D to prevent Rhesus haemolytic disease of the foetus or newborn in Zimbabwe

Abstract

Objective: To assess the uptake of Prophylactic Anti-D (RhoGam) in Zimbabwe to prevent Haemolytic Disease of the Foetus or Newborn (HDFN) due to Rhesus D immunization of pregnant mothers who were Rhesus D negative and had not been previously immunized.

Design: A five year retrospective study.

Setting: National Blood Service Zimbabwe (NBSZ).

Subjects: Nine hundred and thirty six Rhesus D negative women.

Results: Seventy-seven percent (77%) of Rhesus D negative women were eligible for RhoGam. The remainder (23%) was not eligible due to either prior immunization by Rhesus D positive infants during unmonitored previous pregnancy or previous transfusion with Rhesus D positive blood or had given birth to Rhesus D negative infants. The average uptake of RhoGam was only 19.5% over the five years. The apparent increase in uptake in years 1 and 3 was not statistically significant (p = 0.5543). There was a gradual decline in the uptake of RhoGam from 31.8% in the first year of the study to 9.3% in the fifth year. The decline was statistically significant (p<0.001).

Conclusion: The uptake of prophylactic anti-D (RhoGam) was disappointingly inadequate by the Rhesus D negative women. This posed a very high risk of HDFN induced infant morbidity and mortality in Zimbabwe. This is a largely preventable disease if adequate steps were taken by the healthcare practitioners. The prophylaxis should be easily available to the disadvantaged sector of our population by making it more affordable. Outreach programmes should be conducted in order to educate the public about the untoward outcomes of HDFN. This would help reduce social stigma associated with multiple stillbirths and beliefs.