Averting newborn deaths linked to rhesus disease

During pregnancy, mothers are advised to go for antenatal care visits. This enables them to undergo check-ups, which help in averting complications that can hurt mothers and the unborn.

During these appointments, doctors conduct medical examinations to gauge the well-being of the mothers and their babies.

Among them is checking whether the mother's red blood cells have a type of protein known as Rhesus factor on their surface.

Those who have it are considered to be Rhesus-positive. The protein is genetically inherited and as such, it is usually passed down from parents to their children.

People who are Rhesus-positive lead normal lives, just as other individuals since the protein does not affect the overall health of human beings.

BLOOD CELLS

But the problem arises during pregnancy, when a mother who is Rhesus-negative conceives a child that is Rhesus-positive.

When these two types of blood mix, during or before delivery, it puts the health of the unborn at risk.

This is because the mother’s blood will view the Rhesus proteins in the unborn child as something alien.

This will automatically trigger the body’s defence to produce antibodies aimed at destroying the red blood cells of the child.

In the first pregnancy, the risk is often reduced as the child is usually born before the mother produces sufficient antibodies to harm it.

But in subsequent pregnancies, the danger increases since the red blood cells of a Rhesus-positive baby will find sufficient antibodies in the mother's Rhesus negative blood, ready to attack them.

This leads to a condition known as the Rhesus disease that destroys an unborn baby's blood cells, resulting in jaundice (yellowing of the skin) and anaemia. It can also lead to brain damage, heart failure and death of the affected child.

To prevent the disease, Rhesus-negative women are usually given preventive treatment known as Rh (D) immunoglobulin protein.

It prevents the mother’s body from developing antibodies to counter the Rhesus-positive red blood cells of the unborn child.

Despite the availability of the treatment, it is still out of reach for many women around the world that are at risk.

New finding published in the Plos One Journal indicate that only half, or 50 percent of pregnant women who need the treatment worldwide are able to receive it.

Yet, studies estimate that complications linked to the disease could be resulting to deaths of at least 50,000 foetuses and 114,000 newborns worldwide annually.

According to the study, the biggest shortfalls with regard to access to the treatment occur in sub-Saharan African countries such Kenya.

"These findings are tragically surprising and disappointing," said Dr Steven Spitalnik, the senior author of the study and professor of Pathology from the Vagelos College of Physicians and Surgeons (VP&S), based at the Columbia University in the US.

He stated: “This is a global crisis in which hundreds of thousands of foetuses and newborns are at risk for complications and death due to the Rhesus disease because of a lack of awareness about, access to, and availability of effective measures to prevent this disease.”

Globally, the study estimated that more than half of foetuses or newborns with the condition usually die, while those with severe disease who survive may have significant brain damage.

Dr Sikolia Wanyonyi, a gynaecologist and foetal health specialist at the Aga Khan University Hospital notes that it is important for mothers to know their blood type so as to avert the Rhesus disease.

"This is a routine test that is usually done when mothers come to hospitals for check-ups.

“There is nothing much you can do about the type of blood that you have. But knowing can help you to protect the unborn child,” he says.

Dr Wanyonyi notes that health experts usually recommend all necessary tests that should be done by expectant women.

However, some mothers may miss altogether if they do not come for pregnancy check-ups.

The Ministry of Health recommends that mothers make at least four antenatal care visits during their pregnancy.

But statistics from the Kenya Demographic and Health Survey (KDHS) indicate that only 58 percent of expectant women usually meet this requirement.

"These visits are important as they enable mothers to get help early enough in case of any problem that may affect them and their babies. For instance, once identified, mothers who are Rhesus-negative are usually given an injection to prevent them from forming antibodies that can harm a Rhesus-negative baby,” stated Dr Sikolia.

According to the study, Rhesus disease is under-recognised and undertreated in developing nations, compared to the developed ones.

"This treatment is the standard of care for preventing Rhesus disease. But we recognise that there remain significant obstacles to expanding access to this lifesaving therapy around the world," says Spitalnik, who has been working with an international team of physicians to increase access to the treatment around the world.

During the study, the researchers measured the gap between the women presumed to need Rhesus disease preventive treatment and those who actually get it.

The results of the research found that there is an annual worldwide gap of more than 2.5 million doses below the minimum recommended threshold for preventing Rhesus disease.

“A variety of factors, including lack of awareness of the condition, limited availability of the therapy and other health care priorities play a role in hindering access to this life-saving therapy around the world,” Spitalnik said.

“Now that we have a better understanding of these gaps in treatment, we can begin to address them on a regional level.”