oa Central African Journal of Medicine - Economics of anti-rhesus prophylaxis in an African population

Volume 33, Issue 2
  • ISSN : 0008-9176



The clinical impression in the Greater Harare Maternity Unit (GHMU) is that rhesus haemolytic disease causes a relatively small problem, even in the sub-group of women who present with a bad obstetric history. Six thousand and fifty-eight indigenous Zimbabwean patients were studied, mainly antenatally in 19691 and it was found that only 4 per cent of the population was rhesus D and Du negative, compared to 16 per cent normally found in Europeans. Ninety-six per cent of the Zimbabwean population is rhesus + ve, 64 per cent homozgous and 32 per cent heterozygous. Caucasians are 36 per cent homozygous rhesus + ve and 48 per cent heterozygous. If a Zimbabwean woman (or woman from any other sub-Saharan country) is rhesus -ve, the chance of her carrying a rhesus + ve baby is 80 per cent, whilst it is only 60 per cent in Europe. The incidence of potential rhesus problems in all pregnant Zimbabwean women is 3,2 per cent (80% of 4 %) compared to a 9,6 per cent (60% of 16%) risk in Europe, i.e., the potential problem in Zimbabwe is one-third of the potential problem in Europe. The perinatal mortality due to rhesus disease in the 1950s in Britain was 1,5 per 1 000 births. This was prior to the introduction of monitoring and treatment modalities, such as amniocentesis, intra-uterine transfusion, phototherapy and exchange transfusion. In 1969, prior to the introduction of post-partum anti-D prophylaxis. the perinatal mortality was 1 per 1 000 births. Therefore, in the GHMU, where 41 000 patients were delivered in 1984, one would expect approximately 14 perinatal deaths per year (1/3 of 1 per 1 000). This is a conservative estimate since Harare is a referral unit for high-risk patients from two-thirds of the country and many women have had no ante-natal care. Women in Zimbabwe also have more children, which should increase the severity of the problem. In spite of this, there were no neonatal deaths from rhesus disease in the GHMU during 1984-6 and only one in 1983 (para 7, other 6 alive). There are no indications (we checked unexplained stillbirths over a period of three months) that stillbirths due to rhesus incompatibility are frequent. The stillbirth component of the perinatal mortality due to rhesus disease in the UK is about two out of three. The perinatal mortality due to rhesus disease in the GHMU during the period 1983-6 was only 1 in 160000 births (or 1 in 53 333, if one assumes that we missed the stillbirths caused by rhesus disease). This compares favourably to a perinatal mortality of 1 in 14 500 births in England and Wales during 1981 -12 years after the introduction of routine anti-D prophylaxis. The above figures attempt to put into context the problem of rhesus disease in Zimbabwe compared to Europe. Over the last four years, Harare Hospital has been giving some rhesus -ve women anti-D prophylaxis after delivery and the following studies were designed to see whether this policy is cost-effective. None of the women studied was ever given anti-D.

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