The Prevention of Rh Disease of Newborns in Pakistan
- Conditions
- Rhesus DiseaseAnti-D (Rh) Antibodies Affecting Care of Mother
- Interventions
- Drug: RhIg prophylaxisDevice: ELDONCARDDiagnostic Test: ELDONCARD Test
- Registration Number
- NCT03297671
- Lead Sponsor
- Aga Khan University
- Brief Summary
The investigators aim to demonstrate the feasibility of point-of-care identification of Rh-negative women in a poor, rural setting in Pakistan. Feasibility will be assessed across 2 major domains: 1) acceptance by pregnant women to receive the point-of-care test; and, 2) ability of health workers to administer the point of care test and interpret results. The investigators will also measure whether RhIg prophylaxis can be successfully delivered and is accepted by pregnant women in this setting. The socio-demographic correlates of the acceptance of point-of-care testing and where applicable, the acceptance of RhIg prophylaxis will also be assessed. In addition, the investigators will also explore the baseline knowledge of Rh disease among pregnant women and lady health visitors in this study population and will investigate socio-demographic correlates of baseline knowledge and the uptake of knowledge among pregnant women. Finally, the prevalence of Rh negativity will be calculated and stillbirth and neonatal mortality will be tracked among all participants. All stillbirths and neonatal deaths in this population will be characterized with respect to cause and Rh-negativity.
- Detailed Description
Rhesus (Rh) disease is a preventable condition caused by an incompatibility between maternal and fetal red blood cells (RBCs). If a person's RBCs lacks a certain protein s/he is said to be Rh-negative. Similarly, if a person's RBCs have that same protein, s/he is said to be Rh-positive. If a pregnant woman's is Rh-negative and her fetus is Rh-positive, the baby is at risk of Rh disease. The complications associated with Rh disease include miscarriage, stillbirth, and neonatal death. Among surviving newborns, Rh disease can cause anemia (low RBCs, which can appear as feeling tired or weak or having a shortness of breath), jaundice (yellowing of the skin), and brain damage. If Rh-negative women are identified, there is a very high chance that Rh disease of the newborn can be prevented.
The purpose of this study is to demonstrate the feasibility of point-of-care identification of Rh-negative women in Dadu district, Pakistan. Determining the Rh status of pregnant women is the first step towards prevention of Rh disease of the newborn. By collecting information about a) the Rh status and blood type of pregnant women; b) the acceptability of a point of care test blood test of Rh disease; and, c) the acceptability of treatment for Rh negativity in pregnant women, the investigators will be able to improve antenatal care and prevent Rh disease of the newborn in rural settings. The implementation of a point-of-care Rh test will allow us for the identification of Rh-negative women, prompt provision of treatment, and prevention of Rh disease of the newborn in rural settings in Pakistan.
As part of this study, participants will be asked a series of questions to assess reproductive history of pregnant women and other demographic characteristics (i.e. questions about home environment and lifestyle). The investigators will also ask whether they are willing to provide a drop of blood, collected via finger prick, to allow us to determine your Rh status by ELDONCARD. If Rh test reveals that the pregnant women are Rh negative, the investigators will offer them up to two doses of treatment, first at approximately 28 weeks of gestation and again within 72 hours of delivery. The injections will be administered at the health facility. They will also be asked to undergo an ultrasound procedure by a trained technician at health facility. Moreover, after the newborn is delivered, the investigators will also ask a series of question and perform an in-person assessment of newborn to assess their health within 72 hours of delivery and then again on their 29th day of life. If they are found to be Rh-negative and they have a miscarriage, stillbirth, or baby dies within the first month of life, the investigators will ask them if we can collect a sample of their blood for further testing.
The investigators will conduct a prospective cohort study in Tehsil Headquarter Hospital (THQ) and District Headquarter Hospital (DHQ) that are situated in Dadu District, Sindh, Pakistan. In total, between 3 and 5 Lady Health Visitors (LHVs) will be enrolled at the study THQ and DHQ to administer the point-of-care test and if necessary, prophylaxis. Over the course of the study period, approximately 2000 pregnant women will be enrolled in total (across both study sites); liveborn newborns delivered to enrolled pregnant women will be followed for the first month of life. The sample size of 2000 pregnant women in this study is driven by the estimated prevalence of Rh negativity in the population (7%) and hence, the number of women investigators expect to offer two injections of RhIg (n=140). A sample size of 140 participants will enable us to measure the acceptance RhIg by pregnant women.
This prospective cohort will include two groups of participants: a) between 3 and 5 LHVs who are full time employees at THQ Johi and DHQ Dadu and, b) 2000 pregnant women from the communities in the catchment area of THQ Johi and DHQ Dadu.
To address one of our study aims, a single questionnaire will be administered to a cadre of approximately 30 health professionals (i.e., physicians, lady health visitors, nurses, etc.) who are not otherwise engaged in study activities.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 1654
Not provided
Not provided
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Pregnant Women ELDONCARD Test 2000 pregnant women from the communities in the catchment area of THQ Johi and DHQ Dadu. Rh negative women will receive two RhIg prophylaxis injections. Lady Health Visitors (LHVs) RhIg prophylaxis 3-5 LHVs who are full time employees at THQ Johi and DHQ Dadu. LHVs will perform ELDONCARD test and provide RhIg prophylaxis injections. Lady Health Visitors (LHVs) ELDONCARD 3-5 LHVs who are full time employees at THQ Johi and DHQ Dadu. LHVs will perform ELDONCARD test and provide RhIg prophylaxis injections. Pregnant Women ELDONCARD 2000 pregnant women from the communities in the catchment area of THQ Johi and DHQ Dadu. Rh negative women will receive two RhIg prophylaxis injections. Pregnant Women RhIg prophylaxis 2000 pregnant women from the communities in the catchment area of THQ Johi and DHQ Dadu. Rh negative women will receive two RhIg prophylaxis injections. Lady Health Visitors (LHVs) ELDONCARD Test 3-5 LHVs who are full time employees at THQ Johi and DHQ Dadu. LHVs will perform ELDONCARD test and provide RhIg prophylaxis injections.
- Primary Outcome Measures
Name Time Method Proportion of pregnant women who will accept the point of care ELDONCARD test 12 months Acceptability of the point-of-care test will be represented as the proportion of positive (i.e., Yes) responses to each of the 6 questions listed below. The acceptability of the test between sites will be compared.
1. Did the participant agree to have the point-of-care test?
2. Do you think that having the point-of-care test will provide information that could improve the health of your newborn?
3. Do you think the point-of-care test was safe?
4. Did your family approve of you having the point-of-care test?
5. Would you recommend the point of care test to other mothers in the village?
6. In the future, would you agree to have this point of care test again?
- Secondary Outcome Measures
Name Time Method Prevalence of Rhesus negativity in pregnant women 12 months Prevalence of Rhesus negativity will be calculated from the total sample size of pregnant women (2000) for the study and the total number of Rhesus-negative women (0-2000) actually identified during the study.
Rate of stillbirths and neonatal deaths per 1000 live births in this population with respect to cause and Rhesus-negativity 13 months Rate of stillbirths and newborn deaths will be tracked throughout the study and rates will be presented per 1000 live births. Finally, we will also report mean and median antibody titers for all Rhesus-negative women who have a miscarriage, stillbirth, or their newborns die within the first month of life.
Proportion of lady health visitors who will correctly perform point-of-care test and interpret the results of the point-of-care test 12 months Ability of each lady health visitor to perform point-of-care test, each time a test is performed, a composite score (0-16) will be generated that takes into account all 16 steps of the standardized operational protocol. Composite test scores (0-16) will be plotted over time, where time will be evaluated in increments of days, weeks, and months.
Proportion of positive responses on knowledge pertaining to Rhesus disease in pregnant women and lady health visitors 12 months Knowledge uptake will be assessed in both pregnant women and lady health visitors by comparing their baseline assessments with those completed at the close of the study (proportion of positive (i.e., Yes) responses).
Proportion of pregnant women who will accept RhIg prophylaxis 12 months Acceptability of RhIg prophylaxis will be represented as the proportion of positive (i.e., Yes) responses to each of the 6 questions listed below. The acceptability of RhIg prophylaxis between sites will be compared.
1. Did the participant verbally agree to receive prophylaxis?
2. Do you think that receiving prophylaxis may improve the health of your newborn?
3. Do you think that receiving prophylaxis was safe?
4. Did your family approve of you receiving prophylaxis?
5. Would you recommend receiving prophylaxis to other Rhesus-negative mothers in the village?
6. In future pregnancies, would you agree to receive more injections of RhIg prophylaxis? We will also report the proportion of participants who agreed to receive 1 and/or 2 doses of RhIg in total, and by site.
Trial Locations
- Locations (1)
Taluka Headquarter Hospital Johi and District Headquarter Hospital Dadu
🇵🇰Dādu, Sindh, Pakistan