Background/Case Studies: Hemolytic disease of the fetus and newborn due to Rhesus blood group antigen (i.e., Rh(D)) develops from an incompatibility between the mother and fetus. Despite having anti-Rh(D) immunoprophylaxis for 50+ years, a major global burden of Rh disease remains, particularly in low/middle-income countries such as Mexico. We examined disparities in allocations of maternal and child health resources, as well as clinical knowledge, to gain insights into the social determinants of health governing Rh disease prevalence in Mexico.
Study
Design/Methods: An 11-question survey was sent to all members of the Federación Mexicana de Colegios de Obstetricia y Ginecología (FEMECOG) to evaluate knowledge of anti-Rh(D) immunoprophylaxis and Rh disease management. FEMECOG has 7 regions, each containing professional obstetrics associations (Figure A). Responses were separated by region, and chi-square contingency tests were performed to evaluate regional differences.
Results/Findings: A total of 1512 responses were received from 5083 members. Responses by region varied from 20-41% with the most received from Region 7. Significant variations were found within the Mexican healthcare system, particularly regarding providing anti-Rh(D) immunoglobulin to prevent alloimmunization. Most concerning, some providers in Regions 5, 6, and 7 reported never having access to anti-Rh(D) immunoglobulin. In addition, there were differences in access to the drug between public and private hospital settings. Most respondents reported always using anti-Rh(D) immunoglobulin post-partum (lowest compliance 91% in Region 7), while many fewer reported always using it ante-partum (highest use in Region 1 with 26%) and some regions reported never using it in this setting (Region 7 with 26%). Every region had responders report a lack of providers who perform HDFN monitoring (i.e., fetal cerebral middle artery peak systolic velocity) with a range of 4-11% reporting no personnel available in their region. Finally, every region reported a lack of providers who perform intrauterine transfusions, with a range of 18-61% reporting no personnel in their region who offer this service. Conclusions: This study highlights differences in the Mexican healthcare system in preventing and treating Rh disease. These differences are present to some degree in all FEMECOG regions, with Regions 5, 6, and 7 of greatest concern. These data can be used to create strategies to understand and eliminate these healthcare disparities.
Importance of research: Rh Disease remains a significant cause of morbidity and mortality. Since approval in 1968, anti-Rh(D) immunoprophylaxis has proven effective at preventing sensitization. However, global compliance varies due to lack of awareness, availability, and affordability. We analyzed providers’ access to this therapy in Mexico, where a previous study found 50-80% of needed doses are not given. It is important to raise awareness of this disease and the barriers contributing to this global health challenge.
