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Predictors of Knowledge and Management Practice of Rhesus Pyramid Journal of Medicine 2019; volume 2:39 Predictors of knowledge and studied were 60% more likely {AOR=0.6, management practice of Rhesus 95% CI (0.3-0.9)} to have good knowledge Correspondence: Usman Muhammad Ibrahim, of rhesus negative pregnancy with those in Department of Community Medicine, Aminu negative pregnant women service for 5 or more years to had 2.8 Kano Teaching Hospital, PMB 3452 Kano among primary health care increased likelihood AOR=2.8, 95%CI State, Nigeria. workers in Kano, Nigeria (1.7-4.7)} of having good knowledge of Tel.: +234.8032112497 - Fax: +234.96109753. Rhesus negative pregnancy. Healthcare E-mail: [email protected] workers requesting for blood grouping dur- 1 Key words: Rhesus negative pregnant women, Auwal Umar Gajida, ing ANC services provision were found to 2 rhesus isoimmunization, RhoGHAM, Primary Usman Muhammad Ibrahim, have up to 5.2 increased likelihood 1 3 healthcare workers. Rabiu Ibrahim Jalo, Jamilu Tukur, {AOR=5.2, 95% CI (2.7-10)} of having 3 Takai Idris Usman, good knowledge of managing rhesus nega- Contributions: The authors contributed equally. Jaafar Sulaiman Jaafar,4 tive pregnancy. Senior staff were found to Awwal Musa Borodo,5 Nura Abubakar,6 be 37% more likely to correctly practice the Conflict of interest: The authors declare no Dalha Halliru Gwarzo7 recommended management of Rhesus neg- potential conflict of interest. ative pregnant women {AOR=0.37 , 1Department of Community Medicine, 95%CI= (0.2-0.9)}. Most healthcare work- Funding: None. Bayero University and Aminu Kano ers had good knowledge of rhesus negative Teaching Hospital, Kano State; Received for publication: 4 February 2019. pregnancy but wrong management prac- 2 Revision received: 17 October 2019 Department of Community Medicine, tices. Government should ensure improved Accepted for publication: 17 October 2019. Aminu Kano Teaching Hospital, Kano practice by putting in place favorable poli- 3 State; Department of Obstetrics and cies that will ensure training and compli- This work is licensed under a Creative Gynecology, Bayero University and ance with recommended guideline for man- Commons Attribution NonCommercial 4.0 Aminu Kano Teaching Hospital, Kano aging rhesus negative pregnant women. License (CC BY-NC 4.0). State; 4Faculty of Clinical Sciences, only Bayero University, Kano State; ©Copyright: the Author(s), 2019 5Department of Hematology, Murtala Licensee PAGEPress, Italy Pyramid Journal of Medicine 2019; 2:39 Muhammad Specialist Hospital, Kano Introduction doi:10.4081/pjm.2019.39 State; 6Department of Biochemistry, use Federal University Dutse, Jigawa State; Rhesus disease accounts for 97% of 7Department of Hematology, Bayero hemolytic disease of the newborn (HDN) which is preventable when measures to pre- new born and its associated conse- University Kano and Aminu Kano vent feto-maternal hemorrhage in Rh nega- quences.4,5 Teaching Hospital, Kano State, Nigeria tive pregnancy, antenatal and post-natal Rhesus isoimmunisation is under stud- immunoprophylaxis with anti-D ied among Nigerian women and healthcare immunoglobulin are practiced correctly.1 providers with many questions unanswered Abstract Health care providers offering antenatal in the few studies conducted suggesting the care services, abortion, post-abortion and need for management protocol nationwide Rhesus isoimmunization present signif- postnatal care to rhesus negative pregnant for this condition to appropriately guide icant medico-social problems among rhesus women should therefore know and offer health care providers at various levels,6 as negative women that could be prevented by appropriate interventions to prevent isoim- the management of women who are Rhesus adopting correct management practices by munization by giving Rho (D) immune negative pregnant women has evolved and healthcare providers. This study assessed globulin because, once sensitization has therefore all pregnant women should be the predictors of knowledge and manage- occurred, no amount of RhoGAM (Rho (D) typed and screened for alloantibodies, with ment practices of rhesus negative pregnant immune globulin)will stop the disease from an indirect anti-globulin test at the first pre- women among Primary healthcare Non-commercialworkers occuring.1 natal visit and again at 28 weeks.7 in Kano Metropolis. A descriptive cross- The Rhesus D negative phenotype is Antenatal management of Rh-negative sectional study was used to study 424 low among Africans, about 3.9% in Kenya, pregnant women in Sub-Saharan Africa is respondents selected using multistage sam- 4.1% in Guinea, 2.4% in Cameroon and suboptimal. There are several health system pling technique with a response rate of 4.4% in Nigeria,2 central attributes of pri- challenges which includes poor socioeco- 94%. Data was collected using self-admin- mary health care services are accessibility, nomic status, lack of adequate qualified istered semi-structured questionnaire and continuity and client-focused preventive staff, inadequate referral services and short- analyzed with IBM SPSS for Windows, and curative care. The team deals with age of supplies.8 Version 22. Majority of the respondents 354 detection of early signs and symptoms and Management with anti-D prophylaxis is (88.9) were greater than 24 years of age combines curative and preventive services.3 expensive and difficult to access in Sub with mean age of 32.8±7.1. More than one- This highlighted the importance of early Saharan Africa. Beyond the challenge of half 235 (59.0%) of the respondents were detection and commencing preventive access to anti-D prophylaxis, there is lack of female with Hausa speaking respondents by measures of rhesus isoimmunization at pri- alloimmunization prevention during illegal tribe constituting the majority 322 (80.9) mary healthcare level. abortions and poor documentation of ade- healthcare workers studied. Almost two- Human resources for health at PHC quate information in patient’s medical thirds (62.3%) of the respondents had good level should have optimum knowledge on notes.2 A previous report in Singapore indi- knowledge. However, only 24 (6.0%) prevention and management of rhesus dis- cated that although obstetricians offer anti- employed correct management practice of ease and this will help a long way in reduc- D prophylaxis to Rhesus negative women rhesus negative pregnancy. Senior staff ing the occurrence of Hemolytic disease of who experience a potentially sensitizing [page 60] [Pyramid Journal of Medicine 2019; 2:39] Article event as recommended by the guidelines, care among which is maternal and child Advocacy visit was paid to all the hos- not every Rhesus negative woman would health care. pital heads of the selected hospital and were have this treatment because of cost.2 There briefed on the objectives of the research to is paucity of data on the incidence of Study design obtain their permission and cooperation. Rhesus isoimmunisation in subsequent Descriptive cross-sectional study was used. Four research assistants were trained on the pregnancies, adverse events or neonatal objectives of the study, distribution and morbidity.9 Study population retrieval of the questionnaires. Hydrops fetalis reduces the chance for a All the primary health care workers in The instrument was pretested among 30 viable outcome by up to 11%, and neonatal Kano Metropolis that were employed more Healthcare workers in PHCs outside the and infant outcomes are complicated by the than or equal to 6 months and present at the metropolis. need for repeated transfusions secondary to duty post during the survey were included 10 suppressed erythropoiesis. Primary health while healthcare workers who were on Data management care workers are the first level of contact for annual or sick leave were excluded from the Data was analyzed using IBM SPSS preventive and curative services for these study. Statistics for Windows, Version 22. pregnant women and therefore need to have Quantitative variables were summarized good knowledge in the diagnosis and appro- Sample size determination using appropriate measures of central ten priate practices in the management or refer- Sample of up to 424 was obtained using dency and dispersion while categorical vari- ral for better pregnancy outcome. This Fisher’s formula for determining minimal ables were presented as frequencies and study was aimed to assess the predictors of sample size for descriptive studies12 percentages. The dependent/outcome vari- knowledge and management practices ables are knowledge of rhesus negative and among primary healthcare workers in Kano, n = [Z2pq] management practice while the independent Nigeria. variables are age, academic qualification/ 2 d designation, tribe, marital status, type of facility, and delivery of pregnant women Based on standard normal (Z) deviate of amongonly others. Materials and Methods 1.96 at 95% confidence interval, Up to 10 questions were asked to assess prevalence rate from previous study was the knowledge of rhesus negative and 12 13 Study area found to be 49.1% = 0.491 degree of pre- questions for management practice of rhe- Kano is bounded by Jigawa and Bauchi cision of (0.05) and 10% non-response rate. sus negative pregnant women among the on the East, Plateau and Kaduna states on use respondents. Correct answer to each ques- the south and West respectively, and Sampling technique tion for knowledge of rhesus negative was Katsina State on the North. It is located on A three-staged sampling technique was awarded one point while wrong response longitude
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