THE Prevalence of rhesus isoimmunization among rhesus negative pregnant women in African hospitals: A systematic review and meta-analysis.

BRIAN OCHIENG' ONYANGO; Ephraim  Onaba; Nichole  Kabanda

doi:10.51168/sjhrafrica.v6i6.1866

Authors

Brian Ochieng’ Onyango Kampala International University, Department of Obstetrics and Gynecology, Uganda
Ephraim Onaba Kampala International University, Department of Obstetrics and Gynecology, Uganda
Nichole Kabanda Kampala International University, Department of Obstetrics and Gynecology, Uganda

DOI:

https://doi.org/10.51168/sjhrafrica.v6i6.1866

Keywords:

Rhesus isoimmunization, Prevalence, Pregnant women, African hospitals, Meta-analysis

Abstract

Introduction

Objective: This systematic review and meta-analysis aimed to determine the pooled prevalence of Rhesus isoimmunization among rhesus-negative pregnant women in African hospitals using the PICO framework.

Methods

Following PRISMA guidelines, a comprehensive literature search was conducted in PubMed, SCOPUS, Web of Science, Lens.org, and Google Scholar for observational studies (2010–May 2025) on Rhesus isoimmunization in African hospital settings. The PICO framework guided the research question (Population: pregnant women; Intervention: none; Comparison: subgroups (Regional variations); Outcome: prevalence of isoimmunization). Data were extracted using a standardized form, and study quality was assessed with the Joanna Briggs Institute checklist. A random-effects model with logit transformation pooled prevalence estimates. Heterogeneity was evaluated using I² and Cochran’s Q, and publication bias was assessed via Fail-Safe N, Kendall’s Tau, Egger’s regression, and funnel plots.

Results

Nine studies, involving 28,188 pregnant women from Nigeria, Ethiopia, Uganda, and the Democratic Republic of Congo, were included. The pooled prevalence of Rhesus isoimmunization was 2.93% (95% CI: 1.58%–5.36%), with high heterogeneity (I² = 85.12%, Q = 48.320, p < 0.001). Regional prevalence ranged from 0.31% (DR Congo) to 7.04% (Ethiopia). No significant publication bias was detected (Fail-Safe N = 2,581, Kendall’s Tau p = 0.761, Egger’s p = 0.672).

Conclusions

Rhesus isoimmunization affects ~2.93% of rhesus-negative pregnant women in African hospitals, posing a significant risk of hemolytic disease of the fetus and newborn. Routine Rhesus screening, accessible anti-D prophylaxis, and policy reforms are critical to reduce maternal and neonatal morbidity.

Recommendation

Further research should investigate heterogeneity determinants and cost-effective interventions across diverse African settings.

References

Aliyo, A., Ashenafi, G., & Abduselam, M. (2023). Rhesus Negativity Prevalence and Neonatal Outcomes among Pregnant Women Delivered at Bule Hora University Teaching Hospital, West Guji Zone, South Ethiopia. Clinical Medicine Insights: Pediatrics, 17, 117955652211455. https://doi.org/10.1177/11795565221145598

Allagoa, D. O., Oriji, P. C., Briggs, D. C., Ikoro, C., Unachukwu, E., Ubom, A. E., Atemie, G., & Eneni, B. (2021). Rhesus Negative Pregnancy: Prevalence and Foetomaternal Outcomes in a Tertiary Hospital, South-South Nigeria. European Journal of Medical and Health Sciences, 3(5), 123–131. https://doi.org/10.34104/ejmhs.021.012300131

Chanko, K. P. (2020). Frequency of ABO Blood Group and Rh ( D ) Negative Mothers Among Pregnant Women Attending at Antenatal Care Clinic of Sodo Health Center , SNNPR , Ethiopia. 8(2), 10–14. https://doi.org/10.11648/j.ajcem.20200802.11

Eipl, K., Nakabiito, C., Bwogi, K., Motevalli, M., Roots, A., Blagg, L., & Jackson, J. B. (n.d.). Seroprevalence of unexpected red blood cell antibodies among pregnant women in Uganda. 2–4.

Kanko, T. K., & Woldemariam, M. K. (2021). Prevalence of Rhesus D negativity among reproductive age women in Southern Ethiopia: a cross-sectional study. BMC Women’s Health, 21(1), 1–5. https://doi.org/10.1186/s12905-021-01315-3

Mbalibulha, Y., Natukunda, B., Okwi, A. L., Kalyango, J. N., Isaac, K., & Ononge, S. (2022). Alloimmunization to Rh Antigen (D, C, E, C, E) Among Pregnant Women Attending Antenatal Care in South Western Uganda. Journal of Blood Medicine, 13(November), 747–752. https://doi.org/10.2147/JBM.S385737

Natukunda, B., Mugyenyi, G., Brand, A., & Schonewille, H. (2011). Maternal red blood cell alloimmunisation in South Western Uganda. 262–266. https://doi.org/10.1111/j.1365-3148.2011.01073.x

Nyakio, O., Kibukila, F., Suvvari, T. K., Bhattacharjee, P., Akilimali, A., & Mukwege, D. (2024). Prevalence of fetomaternal Rhesus incompatibility at the tertiary care hospital: a cross-sectional study. Annals of Medicine & Surgery, 86(4), 1901–1905. https://doi.org/10.1097/ms9.0000000000001846

Otomewo, L., John-Olabode, S., Okunade, K., Olorunfemi, G., & Ajie, I. (2020). Prevalence of Rhesus C and D Alloantibodies among Rhesus-Negative Women of Child Bearing Age at a Tertiary Hospital in South-West Nigeria. Nigerian Journal of Clinical Practice, 23(12), 1759. https://doi.org/10.4103/njcp.njcp_114_20

Tedbabe, M. W., Birri, D. J., & Desta, T. T. (2025). The Allelic and Phenotypic Frequencies of the ABO and Rh Blood Types in Pregnant Women in Addis Ababa , Ethiopia. 2025. https://doi.org/10.1155/bmri/8649988