Knowledge Of Rhesus Factor Incompatibility In Pregnancy Among Women Attending Ante-Natal Clinic In Central Primary Health Centre, Ukpenu, Ekpoma Edo State

Project and Seminar Material for Nursing (Science)

Knowledge Of Rhesus Factor Incompatibility In Pregnancy Among Women Attending Ante-Natal Clinic In Central Primary Health Centre, Ukpenu, Ekpoma Edo State


Abstract


The study assessed the knowledge of rhesus factor incompatibility in pregnancy among women attending ante-natal clinic in central primary health centre, Ukpenu, Ekpoma Edo State. The research design adopted in this study was a non-experimental descriptive survey. The sample size of 140 was derived using convenience sampling technique. Data collection was done by the use of structured questionnaire designed by the researcher. The instrument was validated by experts in the clinical area and Tests and Measurement who ensured the face and content validity. The reliability of the instrument was tested through the use of pilot study on ten (10) respondents from the antenatal clinic of a different setting. It was subjected to Cronbach Alpha co-efficient test and 0.89 was obtained which made the instrument to be reliable. The data collected was subjected to descriptive and inferential statistics. The findings of the result revealed that pregnant women have a fair knowledge of rhesus factor and incompatibility but are not aware of the importance of taking the test and the complications it posed to the health of their babies. It was recommended among others that there is need for consistent education on the knowledge and prevention of rhesus incompatibility among pregnant women. Special attention should be focused on improving respondents’ knowledge by using appropriate educational intervention that addresses the gap in knowledge gap.
Keywords: Knowledge, Rhesus Factor, Rhesus Incompatibility, Prevention, Attitude, Pregnant Women.


Table of Content


  • Title Page
  • Certification
  • Dedication
  • Acknowledgement
  • Table of Content
  • List of Tables
  • Abstract

Chapter One:

Introduction

  • 1.1 Background of the Study
  • 1.2 Statement of the Problem
  • 1.3 Objective of the Study
  • 1.4 Research Questions
  • 1.5 Research Hypothesis
  • 1.6 Significance of the Study
  • 1.7 Scope of the Study
  • 1.8 Limitation of the Study
  • 1.9 Definition of Terms
  • 1.10 Organisations of the Study

Chapter Two:

Review of Literature

  • 2.1 Conceptual Framework
  • 2.2 Theoretical Framework
  • 2.3 Empirical Review

Chapter Three:

Research Methodology

  • 3.1 Research Design
  • 3.2 Population of the Study
  • 3.3 Sample Size Determination
  • 3.4 Sample Size Selection Technique and Procedure
  • 3.5 Research Instrument and Administration
  • 3.6 Method of Data Collection
  • 3.7 Method of Data Analysis
  • 3.8 Validity of the Study
  • 3.9 Reliability of the Study
  • 3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

  • 4.1 Data Presentation
  • 4.2 Analysis of Data
  • 4.3 Answering Research Questions
  • 4.4 Test of Hypotheses

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • APPENDIX
  • QUESTIONNAIRE

Chapter One


Introduction

1.1 Background of the Study

Rhesus factor is an antigen and inherited protein found on the surface of red blood cells. Red blood cells with the antigen are said to be Rh positive (Rh+) and those without the surface antigen are said to be Rh negative (Rh-) (Scott & Ricci, 2018). Rhesus positive is the most common blood type. Having a Rh negative blood type is not an illness and usually does not affect one’s health. However, it could pose a serious challenge among couples that are not compatible especially in pregnancy, for instance, a pregnancy needs special care if the mother is Rh negative and the baby is Rh positive. This means there is Rh incompatibility (Scott & Ricci, 2018)

Rhesus incompatibility is a condition that occurs during pregnancy if a woman has Rh negative blood and her baby has Rh positive blood. According to WHO deaths among children under five recorded 46% as new-borns in 2016 and much of high infant mortality is related to problems from pregnancy and early infancy such as maternal-fetal blood incompatibility (Kio, et al, 2016). It was also observed that haemolytic disease of the new-born is a significant cause of fetal mortality and morbidity (Kio, et al, 2016). According to WHO (2016) the incidence and complications due to rhesus incompatibility vary in different parts of the world and the low incidence of rhesus negativity often leads to the neglects of incompatibility. The reproductive risk of rhesus negative women in Africa is three times more than that of non- African women which indicates that there’s a problem that needs to be looked into.

Knowledge about blood groups and Rh Incompatibility and its complication during pregnancy and after child birth is very low despite the fact that it us cheap and easy to detect. In developing countries like Nigeria, this knowledge is considerably lower as it is a rare and under discussed topic. A lot of people are ignorant about the blood groups talk less of their rhesus factor therefore are also unaware of the dangers that rhesus incompatibility can pose to mothers and their infants. According to the World Health Organization (2016) neonatal mortality is responsible for about 46% of deaths of children under 5 years and a large amount out of it is caused by problems like rhesus incompatibility and despite the fact that Rhesus immunoglobulin was introduced in 1968, haemolytic diseases of the new-born poses a serious concern and ignorance about it is higher due to inadequate educational programs.

Adeyemi and Bello-Ajao (2016) conducted a study on Prevalence of Rhesus D-negative blood type and the challenges of Rhesus D immunoprophylaxis among obstetric population in Ogbomoso, Southwestern Nigeria found that of the 596 booked patients attending Ladoke Akintola University of Technology Teaching Hospital Ogbomoso, 33, 5.5% were Rh negative and almost 50% of the Rh negative women were primipara. They also found that only nine, 39.1% of these Rh negative women had the Rh anti-D immunoglobulin following delivery or abortion, the prevalence of Rh negativity remains low and the risk of haemolytic disease of the new-born with its attendant perinatal morbidity and mortality is real in our community. Okeke, et al (2012) conducted a study on the prevalence of rhesus negativity among pregnant women in Enugu, Southeast Nigeria and this showed that the prevalence of Rh D women in Enugu, Nigeria is 4.5% which is similar to previous studies done at Ibadan and Abraka in Nigeria. From the above studies, it is noted that a significant amount of women could be predisposed to rhesus incompatibility in pregnancy which could cause haemolytic disease of new-borns and other problems in their babies.


1.2 Statement of the Problem

The prevalence of rhesus negative women to rhesus positive women is about 5-9.5% of the total Nigerian population and because of small amount the issue of rhesus incompatibility is often overlooked or ignored (Obinna, 2017). Some pregnant women, especially primiparous women that have not been sensitized are ignorant of what rhesus factor and incompatibility entails, this is evidenced by the result of the study conducted by Kio, et al (2016) on expectant mothers’ knowledge, attitudes and practices regarding maternal fetal blood incompatibility which reported that the level of knowledge concerning maternal-fetal blood incompatibility of expectant mothers was low (39%). This shows that they are also ignorant of the danger it poses and those that are aware of the importance may not know how to go about the prevention of rhesus incompatibility.

Pregnant women’s attitude to the different rhesus incompatibility prevention is important in adequate prevention. Kio, et al, (2016) conducted a study assessing expectant mothers’ knowledge and practice regarding maternal-fetal blood incompatibility among pregnant women in Olabisi Onabanjo University Teaching Hospital and found that although the respondents exhibited average positive attitude towards incompatibility test (56%) and low negative attitude (38%), about 56% of the women felt the test procedure will be embarrassing. The result showed that pregnant women in the study area did not really see maternal-fetal blood incompatibility as a serious problem which is clearly as a result of the low level of knowledge concerning it (Kio, et al 2016). In the light of the above, this study seek to analyze the knowledge of rhesus factor incompatibility in pregnancy among women attending ante-natal clinic in central primary health centre, Ukpenu, Ekpoma Edo State.


1.3 Objective of the Study

The overall aim of this study is to critically examine the knowledge of rhesus factor incompatibility in pregnancy among women attending ante-natal clinic in central primary health centre, Ukpenu, Ekpoma Edo State. Hence, the study will be channeled to the following specific objectives;

  1. Assessed the pregnant women’s knowledge of rhesus factor;
  2. Determined the pregnant women’s knowledge of rhesus incompatibility;
  3. Determined the pregnant women’s attitude about rhesus incompatibility prevention.

1.4 Research Questions

The following research questions were raised for this study:

  1. What is the level of knowledge of respondents about rhesus factor?
  2. What is the level of knowledge of respondents about rhesus incompatibility?
  3. What is the attitude of pregnant women to rhesus incompatibility prevention?

1.5 Research Hypotheses

  • Ho: There is no significant relationship between knowledge of rhesus factor and attitude to rhesus incompatibility prevention among pregnant women.
  • Ha: There is no significant relationship between knowledge of rhesus factor and attitude to rhesus incompatibility prevention among pregnant women.

1.6 Significance of the Study

Women affected by rhesus incompatibility who have no adequate information about it believe they are bewitched/cursed and hence seek help from witchdoctors or other supernatural beings, some go to churches to be prayed for and when all this efforts turn futile, most go into depression, committing suicide or leaving miserable lives, this research will asses and change theattitude of this women towards rhesus incompatibility, This will make them seek help from health institutions where they’ll get appropriate treatment.


1.7 Scope of the Study

The scope of this study is hinged on examine the knowledge of rhesus factor incompatibility in pregnancy among women attending ante-natal clinic in central primary health centre. Geographically, this this study will be delimited to Ukpenu, Ekpoma Edo State.


1.7 Limitation of the Study

As every human endeavor is once faced with a constraint, the same was tenable during the period of this study. In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. In addition, there was the element of researcher bias. Here, the researcher possessed some biases that may have been reflected in the way the data was collected, the type of people interviewed or sampled, and how the data gathered was interpreted thereafter. The potential for all this to influence the findings and conclusions could not be downplayed. More so, the findings of this study are limited to the sample population in the study area, hence they may not be suitable for use in comparison to other tertiary institutions in other , states, and other countries in the world.


1.9 Definition of Terms

Rhesus Factor

The Rhesus factor, or Rh factor, is a certain type of protein found on the outside of red blood cells.


1.10 Organisations of the Study

The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study, sample size determination, sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.


Chapter Five


Summary, Conclusions and Recommendations:

5.1 Introduction

This chapter summarizes the findings on the knowledge of rhesus factor incompatibility in pregnancy among women attending ante-natal clinic in central primary health centre, Ukpenu, Ekpoma Edo State. The chapter consists of summary of the study, conclusions, and recommendations.


5.2 Summary of the Findings

The result of the analysis presented on the level of knowledge about rhesus factor showed that over 80% of the pregnant women are correct about the Rhesus factor has an antibody found on the red blood cells of most people, almost 90% of the pregnant women are also correct that Rhesus factor is associated with blood group while 84% of the pregnant women reported they have the antibody will be rhesus positive, while majority of the pregnant women reported that if they do not have antibody they will be rhesus negative, over 70% of the pregnant women agreed that they know their own blood group, 70.7% of the pregnant reported that they know their husband’s blood group. The result of the analysis is consistent with the findings of Scott and Ricci (2018) that there is generally good level of knowledge about the importance of considering rhesus factor during marriage and pregnancy. Similar study was reported by Hayyawi, et al (2014) that there is good knowledge about rhesus factor among pregnant women. The result is also consistent with the findings of Goodman, et al (2015) that there is good knowledge about rhesus factor among pregnant women attending antenatal care services because of their exposure to health education about it.

The result of the analysis on the level of knowledge about rhesus incompatibility showed that over 90% of the pregnant women are aware that rhesus incompatibility is when the mother’s rhesus factor is different from the baby’s rhesus factor, also 88% of the pregnant women are aware that rhesus incompatibility occurs when the mother is rhesus negative and the baby is rhesus positive. Over 80% of the pregnant women are not aware of the problems related to negative blood group during pregnancy, while, 81% of the pregnant women are not aware of the problem of negative blood group after pregnancy, 92.9% of the pregnant women are not aware of the preventive measures to be taken if a mother’s blood groups is rhesus negative. 95.7% of the pregnant women are not aware of what can happen to the fetus/new-born if there is blood incompatibility.

The result corroborates with the findings of Slightham (2018) that most pregnant women are aware that rhesus incompatibility is when a mother and her unborn baby carry different rhesus protein factors. Additionally, Costumbrado and Ghassemzadeh (2018) opined that majority of pregnant women residing urban settings are aware that rhesus incompatibility are the discordant pairing of maternal and fetal Rh type. Knowledge about rhesus incompatibility and its complications during pregnancy and after child birth was very low and the result of this analysis was consistent with the findings of Kio, et al (2016) that level of knowledge of pregnant women about rhesus incompatibility was low.

This study revealed that 77.1% of the respondents reported to have checked their blood group and rhesus factor before they got married and pregnant, also 90% of the respondents knew their husband/partner’s blood group and rhesus factor before they got married and pregnant. 79.3% of the pregnant women reported to have gone for premarital screening before they got married. 62.7% of the pregnant women have not gone for fetal blood compatibility test during their pregnancy because they are rhesus negative, 72.9% reported to have attended antenatal care services where health education on prevention of rhesus incompatibility were given while 77% of the respondents have not collected prophylactic anti D (Rhogam). Hayyawi, et al (2014) reported that knowledge about rhesus incompatibility prevention during pregnancy and after child birth was just fair despite the fact that it is easy to go for the rhesus incompatibility test. Similar study by Zipursky, et al (2018) reported that the knowledge of pregnant women about rhesus incompatibility prevention is fair.

The result on the attitude towards rhesus incompatibility prevention showed that over 85% of the pregnant women reported that is definitely true that rhesus compatibility test is very important especially for pregnant women, while 78% of the respondent showed that is definitely true that all women should do maternal-fetal compatibility test whether recommended or not, 85.7% of the pregnant women reported it is definitely true that they are not afraid to think about or do the incompatibility test, also 62.1% revealed is probably true that they really care about their rhesus factor, 67.1% reported that it is probably true that they do discuss with their husband about maternal-fetal incompatibility. 87.1% of the respondents reported it is definitely true that rhesus incompatibility test can be an embarrassing procedure, also 71.4% of the respondents reported that is probably true that rhesus incompatibility test is a waste of time 70% of the pregnant women reported that it probably true that rhesus incompatibility test result makes me feel unpleasant. Also 55.7% of the pregnant reported is probably false that if there is incompatibility they prefer to get treatment from a traditional healer and 36.4% of the respondents reported that is it definitely false that they are reluctant about doing rhesus incompatibility test because they are afraid to be positive.

The result of the analysis is consistent with the findings of Agbede and Oroniyi, (2016) found that there low level of positive attitude towards rhesus incompatibility prevention.

The result showed that pregnant women in the study area did not really see maternal-fetal blood incompatibility as a serious problem because majority felt that taking the test might be embarrassing or make them feel unpleasant. (Kio, et al, 2016).

The result of the hypothesis revealed that there was a significant relationship between knowledge of rhesus factor and attitude to rhesus incompatibility prevention among pregnant women attending antenatal care services in Babcock University Teaching Hospital Ilishan-Remo Ogun State. The result is consistent with the findings of Royce and Walter (2017) that there is significant relationship between knowledge of rhesus factor and attitude towards rhesus incompatibility prevention.


5.3 Conclusions

It is concluded that pregnant women have a fair knowledge of rhesus factor and incompatibility but are not aware of the importance of taking the test and the complications it posed to the health of their babies. Most neonatal mortality is has a result of rhesus incompatibility and haemolytic disease of the new-born poses a serious concern to the healthcare system as a whole. Therefore, interventions aimed at social and behaviour change should primarily target increasing knowledge, improving knowledge, improving attitude and addressing the gaps in practices.


5.4 Recommendations

Based on the findings of the study, the following recommendations were made:

  1. There is need for consistent education on the knowledge and prevention of rhesus incompatibility among pregnant women. Special attention should be focused on improving respondents’ knowledge by using appropriate educational intervention that addresses the gap in knowledge gap.
  2. The is need for the provision of free rhesus laboratory investigation for pregnant women attending antenatal clinics, more efforts should be made to make the incompatibility test free to women attending clinics.
  3. Government should invest more in provision of centres that specifically provides genetic counselling for couples intending to get married
  4. Religious organisation needs to be involved in the in the provision of education on rhesus compatibility and incompatibility among pregnant women in Nigeria.
  5. Community healthcare service providers and churches should include in their services the counsel of mothers on the importance of rhesus incompatibility test.

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