Rh Incompatibility: Prevalence, Knowledge and Attitude for Premarital Test Couples.

: Objectives of the study: The study aims to determine the extent of the spread of knowledge, attitudes direction of blood group mismatch between couples Methodology: Conducted cross-sectional on 550 couple study in


Abstract:
Objectives of the study: The study aims to determine the extent of the spread of knowledge, attitudes direction of blood group mismatch between couples Methodology: Conducted cross-sectional on 550 couple study in Rusafa in Baghdad, for the period from 15 th of January through April 2012 in the three specialized centers for screening couples before marriage which is Alawite, July 14, and Jamal al-Moussawi.The examinations before marriage include the examination of immune deficiency, and examination Special syphilis in addition to the screening of blood type for married couples.The study included all couples who reviewed during this period, voluntarily and without exception, giving them a copy of the questions prepared in advance to find out some details about the subjects included age, sex , educational attainment , and blood type for each pair .Data was analyzed by using percentage and chi square.

Result:
The highest prevalence rate among the holders of blood group (A) as it was 30.1 %, followed by holders of blood group (f) was 29.6 %, then the holders of blood type (b ) 27.2 % , and finally the holders of blood type ( AB ) it was 13.1 % The study found that the proportion of negative blood type was 4.2 % , including 3.6 % among females and 4.75 % for males.Also found that 41.7 % of the subjects knew about the nature of the tests performed as explained to them.Study that there is a relationship between the level of academic achievement for the pair and conviction Balmarjah examination , as was found to respond more educated couples ( 27.2 % ) while the least are illiterate ( 0.5 %).

INTRODUCTION:
Blood group may be the most complex genetically of all blood type system since it involve 45 different antigens on the surface of the red blood cells (1) .The Rh factor was named after the monkeys in which it was first discovered (2) .Despite its actual genetic complexity the inheritance of this trait usually can be predicted by simple conceptual model (1) .
Rh incompatibilities can occur when the Rh-negative mother exposed to Rhpositive blood either from perinatal feto maternal hemorrhage or from Rh-positive blood transfusion.This exposure lead to sensitization of the mother (alloimmunization) that initiate antibody production against the foreign Rh antigen (1)(2)(3) .
Rh-incompatibility is the most frequent blood group incompatibilities in the clinical practice which can cause fetal anemia, hydrops, and even death (3)(4)(5) .
During the past 40 years, rhesus alloimmunization has gone from being one of the major causes of perinatal mortality to an almost eradicated disease, this related to raveling of the pathophysiology, the development of the reliable diagnostic tools, a very effective prophylaxis programme, and for the availability of treatment by intrauterine blood transfusion (6) .Anti-D given within 72 hours after birth, reduce the risk of Rh-D alloimmunization in rhesus negative women who have given birth to rhesus-positive infant.However, the evidence on the optimal dose is limited (7) .
This study aimed at finding the prevalence of Rh-incompatibility and to evaluate the knowledge and the behaviour of the couples attending for premarital test toward incompatibility.

METHODOLOGY:
A cross sectional study conducted on 550 couple in AL-Resafa side of Baghdad which is bigger than the other side Al-Karkh, The period of the study was from 15 th of January through April 2012.
There are three specialized medical centers (SMC) in Al-Resafa side performing the premarital test these are: AL-Alwayia; 14 Tummouz; and Jamal AL-Mousawy HIV testing centers.The premarital test composes of HIV and VDRL serological tests in addition to ABO and Rh grouping test.
ABO and Rh grouping done by mixing a drop of blood from the responders with Anti A, B, D, reagents on a slide looking for agglutination using Brotec Kits from Biotec Laboratories Ltd-for slide and tube test.
All the couples attending one of the SMC seeking premarital tests were eligible to participate in the study voluntarily without any exclusion criteria.A short anonymous questionnaire was constructed for the purpose of the study to collect data about the responders.Some questions cover demographic aspects, others were designed to evaluate the knowledge about the Rh which consist to both males and females fill in the questionnaire through direct interview with the researchers.Some questions were modified according to response of the participants in a pilot study done in Al-Alwayah SMC.
The collected data grouped and analyzed by SPSS version 12 software programme.Pearson Chi-square test was used to assess the relationship between the variables, P-value of 0.05 and below was considered as significant.

RESULTS:
Figure-1 shows that 550 couple participate in the study.The mean age was (23+6) year for females and (27 + 6) year for male the highest rate of marriage (54.6%) was among the young age group (15-24).
Figure 2 shows the educational level of the sample.More than 1/3 rd of the subject did not finish their primary level of education.Table (2) reveals that sixteen negative female out of (20) were engaged to positive male giving a prevalence of incompatibility of (1.5%).Less than half of the study group 457(41.5%)knew about the blood test done for them, 289(26.3%)reported that the test was for blood compatibility, and only 43(9.45) reported both AIDS and compatibility.Table (5) shows that young age group attends their families and relatives for counseling about incompatibility, rate 178(29.6%)which was higher than the others, while the older age group attend medical advice at a higher rate 75(81.5%).There was a difference between both sexes regarding to whom they went for advice.Females are more than males 146(26.5),109(19.8%)respectively in taking their families and relatives advice.
Illiterate seek families and relatives counseling more than others, at a rate of (46.0%) while the higher educational level subjects asked for medical advice at a rate of (91.5%) which is higher than other group.Pearson Chi-square test showed significant relationship P-value (0.000), (0.030), (0.000) respectively.Table-6 revealed that good proportion of study group 788(71.6%)knew that there is treatment for incompatibility with male slightly higher than female 411(74.7%),377(68.5%)respectively.Yet Pearson Chi-square test showed no significant relationship P-value (0.072).The proportion of those who know about the availability of treatment for the incompatibility increased with the increasing of the educational level starting from 102(50.5%) for illiterate to reach 266(87.2%)for higher education.Pearson Chi-square test was significant P-value (0.000).

DISCUSSION:
Early marriage is observed in the study group which reflects the social attitude toward encouraging the early marriage.
More than half of the sample did not know about the premarital blood test this point to the shortage in health education and general information and awareness of subjects.The significant relationship between the health knowledge and educational status probably give a clue that the classical school teaching curriculum give reasonable information about general health subjects.Other thing is that educated people can get access to written media in addition to other audiovisual media. (17)lthough the higher educated group gives the higher rate of true response toward incompatibility and having higher level of knowledge still their behavior was not encouraging toward this event, this could be due to their desire to be away from anticipated medical problem in the future so they chose to quit from the engagement project. (18)oung subject discuss the matter with their families and relatives probably because they lack the enough experience, and as the individual get older they start to behave more independently.Educated people select medical advice more than other: this is probably because some of them were more educated than their families hence they prefer medical advice for further information; the second point may be due to the feeling of embarrassment because they were interviewed by doctors (19)

CONCLUSION:
Less than half of the study group knew about the blood test done for them.Subjects with higher education gave the highest rate of true response; the illiterate on other hand gave the lowest true response about which case results in incompatibility.Young age group attends their families and relatives for counseling about incompatibility, while the older age group attends medical advice at a higher rate.

RECOMMENDATIONS:
1. Improve the knowledge level about the Rh incompatibility by utilizing different mass media channel; traditional secondary school curriculum; and health educational programme.2. Premarital test should be emphasized on for screening and education.

Figure- 2 :
Figure-2: Distribution of the study group according to educational status.

Figure- 1 :
Figure-1: Distribution of the sample according to age group.

Table ( 3
) presents that subjects with higher education gave the highest rate of true response 83 (27.2%), the illiterate on other hand gave the lowest true response 1(0.5%) about which case results in incompatibility.Majority of the secondary educational status did not know the answer.Pearson chi-square test showed significant relationship P= 0.000.

Table - 4: Attitude of participants toward engagement project distributed according to educational status.
Table-4 shows significant relationship between the educational status of the individual and the behavior toward the engagement project P-value (0.146).Table-5:Relationship between counseling and age group, sex, and education levels.