# Point-of-care determination of the frequency of Rhesus(D)-negative blood types and the uptake of anti(D) immunoglobulin among Rh(D)-negative women in Dadu district, Sindh, Pakistan

## TL;DR

This study shows that point-of-care testing for Rh(D)-negative blood in pregnant women in Pakistan is feasible and can help prevent Rh disease with timely anti(D) immunoglobulin.

## Contribution

The study demonstrates the practicality of using point-of-care testing and lady health visitors to deliver anti(D) immunoglobulin in a low-resource setting.

## Key findings

- 17% of women were Rh(D)-negative, with high adherence to anti(D) immunoglobulin doses.
- Rh(D)-negative women had significantly higher rates of miscarriage, stillbirth, and neonatal death.
- Knowledge about Rh disease was low among participants and varied among healthcare providers.

## Abstract

Rhesus (Rh) disease remains a serious problem in low- and middle-income countries. Rh disease prevention requires early identification and prophylactic treatment of Rh(D)-negative women. We evaluated the feasibility of point-of-care identification of Rh(D)-negative women and timely administration of two doses of anti(D) immunoglobulin by lady health visitors in Dadu district, Sindh, Pakistan. Pregnant women were enrolled at two hospitals and followed until 29 days postpartum. Rh(D)-antigen status was determined using the EldonCard2521 test and all Rh(D)-negative point-of-care test results were attempted to be verified using the conventional test tube agglutination method. Rh(D)-negative women were offered two injections of anti(D) immunoglobulin, one at 28 weeks’ gestation and one within 72 hours of delivery. Knowledge pertaining to Rh disease was assessed among participants at study entry and exit, and in a sample of 30 health care providers. All participants (n=1619) had their blood tested with the EldonCard2521, and 279 (17%) women were found to be Rh(D)-negative; however, the conventional test tube method identified one discordant Rh(D)-antigen result. Among 278 Rh(D)-negative women, 254 (91%) and 268 (96%) received their first and second dose of anti(D) immunoglobulin, respectively. The rates of miscarriage (22.1 per 1,000 pregnancies vs. 4.5 per 1,000 pregnancies), stillbirth (33.8 per 1,000 pregnancies vs. 6.7 per 1,000 pregnancies), and neonatal death (35.0 vs. 16.6 per 1,000 live births) were higher among Rh(D)-negative vs. Rh(D)-positive participants. At study enrolment, there was little knowledge pertaining to Rh disease and its consequences among participants and knowledge also varied greatly among health care providers. The high frequency of maternal Rh(D)-negative blood types, high rates of stillbirth, miscarriage, and neonatal death among Rh(D)-negative women and their newborns, and limited and varied knowledge of Rh disease among pregnant women and health care providers, bolsters the need for a wide-scale Rh disease prevention program in Pakistan.