PREVALENCE AND DETERMINANTS OF RHESUS ISOIMMUNIZATION AMONG PREGNANT WOMEN IN AFRICAN HOSPITALS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

PREVALENCE AND DETERMINANTS OF RHESUS ISOIMMUNIZATION AMONG PREGNANT WOMEN IN AFRICAN HOSPITALS: A SYSTEMATIC REVIEW AND META-ANALYSIS. | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 17 June 2025 V1 Latest version Share on PREVALENCE AND DETERMINANTS OF RHESUS ISOIMMUNIZATION AMONG PREGNANT WOMEN IN AFRICAN HOSPITALS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Authors : Brian Ochieng’ Onyango [email protected] , Ephraim Onaba , and Nichole Kabanda Authors Info & Affiliations https://doi.org/10.22541/au.175016305.52869738/v1 341 views 265 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Objective : To estimate the pooled prevalence and identify determinants of Rhesus isoimmunization among pregnant women in African hospitals. Methods : We conducted a systematic review following PRISMA guidelines, searching 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; Outcome: prevalence and determinants). 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 I 2 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 (n=28,188 women) from Nigeria, Ethiopia, Uganda, and DR Congo showed a pooled prevalence of 2.93% (95% CI: 1.58%–5.36%), with high heterogeneity (I 2 =85.12%, Q=48.320, p<0.001). Regional prevalence ranged from 0.31% (DR Congo) to 7.04% (Ethiopia). Key determinants included previous pregnancies, abortions, stillbirths, blood transfusions, and lack of anti-D prophylaxis. No publication bias was detected (Fail-Safe N=2,581, Egger’s p=0.672). Conclusions : Rhesus isoimmunization affects ~2.93% of 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. PREVALENCE AND DETERMINANTS OF RHESUS ISOIMMUNIZATION AMONG PREGNANT WOMEN IN AFRICAN HOSPITALS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Authors : Brian Ochieng’ Onyango, Co-Author 1: Ephraim Onaba, Co-Author 2 Emmanuel Okurut, Co-Author 3: Nichole Kabanda Affiliations : Kampala International University, Department of Obstetrics and Gynecology, Uganda Corresponding Author : Brian Ochieng’ Onyango: Kampala International University, Department of Obstetrics and Gynecology, Uganda, [email protected] ; Phone +254714195412 Abstract . Objective : To estimate the pooled prevalence and identify determinants of Rhesus isoimmunization among pregnant women in African hospitals. Methods : We conducted a systematic review following PRISMA guidelines, searching 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; Outcome: prevalence and determinants). 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 (n=28,188 women) from Nigeria, Ethiopia, Uganda, and DR Congo showed a pooled prevalence of 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). Key determinants included previous pregnancies, abortions, stillbirths, blood transfusions, and lack of anti-D prophylaxis. No publication bias was detected (Fail-Safe N=2,581, Egger’s p=0.672). Conclusions : Rhesus isoimmunization affects 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. Keywords : Rhesus isoimmunization, prevalence, determinants, African hospitals, meta-analysis Introduction Rhesus isoimmunization, caused by maternal-fetal Rhesus D (Rh D) antigen incompatibility, is a major contributor to hemolytic disease of the fetus and newborn (HDFN) in sub-Saharan Africa, leading to neonatal jaundice, anemia, hydrops fetalis, and stillbirth (Allagoa et al., 2021; Uchenna Eleje et al., 2017). It occurs when Rh D-negative mothers develop antibodies against Rh D-positive fetal red blood cells, often due to fetomaternal hemorrhage or incompatible blood transfusions (Kanko & Woldemariam, 2021; Nyakio et al., 2024). Although the Rh D-negative phenotype prevalence is lower in African populations (2–8%) compared to Caucasians (~15%)(Otomewo et al., 2020), limited access to antenatal screening and anti-D immunoglobulin prophylaxis heightens risks in low-resource settings(Allagoa et al., 2021; Mbalibulha et al., 2022). Reported Rh D-negative prevalence varies across Africa, e.g., 2.1–8.4% in Nigeria, 6.2–8.8% in Ethiopia, and 2.3–5.7% in Uganda(Aliyo et al., 2023; Chanko, 2020; Natukunda et al., 2011). Determinants such as previous pregnancies, abortions, stillbirths, and lack of prophylaxis increase sensitization risk (Otomewo et al., 2020; Uchenna Eleje et al., 2017). Given the scarcity of comprehensive data, this systematic review and meta-analysis aims to estimate the pooled prevalence and identify key determinants of Rhesus isoimmunization among pregnant women in African hospital settings to inform clinical practice and policy. Methods Protocol and Registration : This systematic review adhered to PRISMA guidelines (Page et al., 2021) and was registered with PROSPERO (CRD420251067446). Ethical approval was not required as it involved published data. Search Strategy : We searched PubMed, SCOPUS, Web of Science, Lens.org, and Google Scholar for studies from January 2010 to May 2025, using MeSH and free-text terms for Rhesus isoimmunization (e.g., “Rh isoimmunization,” “hemolytic disease of newborn”), African settings (e.g., “Nigeria,” “sub-Saharan”), pregnancy (e.g., “pregnant women,” “antenatal”), and hospital contexts (e.g., “hospitals,” “tertiary care”). An example PubMed search string is provided in Supplementary File S1. No language restrictions were applied, but only English-language studies or translations were included. Study Selection : Eligible studies were observational, peer-reviewed, conducted in African hospitals, and reported primary data on Rhesus isoimmunization prevalence or determinants. Exclusions included randomized trials, case reports, reviews, non-African or community-based studies, and non-English texts without translations. Two reviewers independently screened titles/abstracts using Rayyan, with full-text assessments resolving disputes via a third reviewer. The PRISMA flow diagram is shown in Figure 1. PICO Framework : • Population : Pregnant women attending antenatal care (ANC) or delivering in African hospitals. • Intervention : None (observational study). • Comparison : Subgroups (e.g., women with/without anti-D prophylaxis, urban/rural settings). • Outcome : Primary: prevalence of Rhesus isoimmunization; Secondary: determinants (e.g., previous pregnancies, lack of prophylaxis). Data Extraction and Quality Assessment : Two reviewers extracted data using a standardized Excel form, capturing study characteristics, participant details, prevalence, and determinants. Discrepancies were resolved through discussion. Study quality was assessed using the Joanna Briggs Institute (JBI) checklist, with scores ≥6/9 indicating high quality (Supplementary Table S2). Statistical Analysis : Prevalence proportions were logit-transformed to stabilize variance, then back-transformed for interpretation. A random-effects model (Restricted Maximum Likelihood for Tau²) pooled prevalence estimates. Heterogeneity was assessed using I², Tau², and Cochran’s Q statistics. Publication bias was evaluated with Fail-Safe N, Kendall’s Tau, Egger’s regression, and funnel plots. Analyses were conducted using Jamovi v2.6.44 (MAJOR module). Subgroup analyses explored regional variations. Results Study Selection : From 257 records (PubMed: 32, SCOPUS: 27, Web of Science: 18, Lens.org: 180), 59 duplicates were removed, 198 titles/abstracts screened, 16 full texts assessed, and 9 studies included (n = 28,188 women) from Nigeria, Ethiopia, Uganda, and DR Congo (Figure 1). Study designs included retrospective (n = 4), cross-sectional (n = 4), and retrospective cross-sectional (n = 1) (Table 1). Figure 1: PRISMA Flow Diagram . TABLE 1. Allagoa et al. (2021) Nigeria Retrospective 4,571 104 2.28 1.85–2.70 7/9 Aliyo et al. (2023) Ethiopia Cross-sectional 110 7 6.36 2.60–12.75 6/9 Chanko (2020) Ethiopia Cross-sectional 270 19 7.04 4.27–10.88 6/9 Eipl et al. (2012) Uganda Cross-sectional 1,001 23 2.30 1.46–3.45 7/9 Eleje et al. (2017) Nigeria Retrospective 5,561 117 2.10 1.73–2.53 8/9 Mbalibulha et al. (2022) Uganda Cross-sectional 1,369 70 5.11 4.00–6.44 7/9 Natukunda et al. (2011) Uganda Retrospective 2,001 72 3.60 2.83–4.50 7/9 Nyakio et al. (2024) DR Congo Retrospective 11,898 37 0.31 0.22–0.43 8/9 Tedbabe et al. (2025) Ethiopia Cross-sectional 2,407 144 5.98 5.06–7.02 7/9 Total/Pooled — — 28,188 593 2.93 1.58–5.36 — Meta-Analysis Results The random-effects meta-analysis yielded a pooled logit-transformed prevalence of -3.50 (SE = 0.325, 95% CI: -4.138 to -2.863), translating to a prevalence of 2.93% (95% CI: 1.58%–5.36%) (Table 2). This indicates that approximately 2.93 out of every 100 pregnant women in African hospitals have Rhesus isoimmunization. Forest Plot Table 2: Meta-Analysis Results Logit-transformed prevalence -3.50 0.325 -10.8 <0.001 -4.138 to -2.863 Prevalence (%) 2.93 - - - 1.58 to 5.36 Heterogeneity Assessment High heterogeneity was observed (I² = 85.12%, Tau² = 0.7903, H² = 6.719, Q = 48.320, p < 0.001), indicating substantial between-study variation likely due to differences in location, population, or methodology (Table 3). Funnel Plot Publication Bias Assessment No significant publication bias was detected (Fail-Safe N = 2,581, Kendall’s Tau = 0.111, p = 0.761, Egger’s Regression = 0.424, p = 0.672) (Table 3). The high Fail-Safe N suggests robust findings. Table 3: Heterogeneity and Publication Bias Assessment Heterogeneity I² 85.12% High heterogeneity Tau² 0.7903 Substantial between-study variance Q-statistic 48.320 (p < 0.001) Significant heterogeneity Publication Bias Fail-Safe N 2,581 Robust against unpublished null studies Kendall’s Tau 0.111 (p = 0.761) No significant rank correlation bias Egger’s Regression 0.424 (p = 0.672) No significant small-study effects Regional Variation Prevalence varied significantly: Ethiopia (5.98%–7.04%, average 6.47%), Nigeria (2.10%–2.28%, average 2.18%), Uganda (2.30%–5.11%, average 3.67%), and DR Congo (0.31%) (Table 4). Table 4: Regional Variation in Rhesus Isoimmunization Prevalence Ethiopia 3 2,787 5.98–7.04 6.47 Nigeria 2 10,132 2.10–2.28 2.18 Uganda 3 4,371 2.30–5.11 3.67 DR Congo 1 11,898 0.31 0.31 Determinants Key determinants included previous pregnancies, abortions, stillbirths, blood transfusions, and lack of anti-D immunoglobulin prophylaxis, consistent across studies but not quantitatively pooled due to inconsistent reporting. Confidence in Evidence Using GRADE, the evidence was rated moderate due to high heterogeneity, despite a large sample size, robust methodology, and no publication bias. Discussion. Main Findings: This systematic review and meta-analysis, the first to estimate the continent-wide prevalence of Rhesus isoimmunization in African hospitals, found a pooled prevalence of 2.93% (95% CI: 1.58%–5.36%) among 28,188 pregnant women across nine studies from Nigeria, Ethiopia, Uganda, and the Democratic Republic of Congo (DR Congo). Key determinants include previous pregnancies, abortions, stillbirths, blood transfusions, and lack of anti-D prophylaxis are consistent across studies (Otomewo et al., 2020; Uchenna Eleje et al., 2017). Strengths: This is the first continent-wide meta-analysis of Rhesus isoimmunization in African hospitals, with a large sample size, PRISMA adherence, PROSPERO registration, and robust statistical methods (random-effects model, logit transformation). The high Fail-Safe N (2,581) and no publication bias enhance confidence in the findings. Limitations: Hospital-based studies may not generalize to rural or primary care settings. Variability in study designs and diagnostic criteria may contribute to heterogeneity. Inconsistent determinant reporting prevented meta-regression. The focus on English-language studies and limited geographic scope (four countries) may miss broader African contexts. Interpretation: The prevalence is lower than the (Otomewo et al., 2020). but higher than expected for African settings, where Rh D-negative prevalence ranges from 2–8%(Kanko & Woldemariam, 2021; Otomewo et al., 2020). Significant regional variation from 0.31% in DR Congo to 7.04% in Ethiopia highlights the influence of local healthcare systems and diagnostic practices, with critical implications for reducing hemolytic disease of the fetus and newborn (HDFN). The 2.93% prevalence underscores Rhesus isoimmunization as a significant obstetric challenge in African hospitals, contributing to HDFN, which can cause neonatal jaundice, anemia, hydrops fetalis, and stillbirth(Allagoa et al., 2021; Uchenna Eleje et al., 2017). Unlike high-income settings, where universal Rhesus screening and anti-D immunoglobulin prophylaxis have minimized HDFN incidence (Allagoa et al., 2021), the higher prevalence in Africa likely reflects limited antenatal care (ANC) access, inconsistent screening, and prophylaxis shortages(Mbalibulha et al., 2022; Nyakio et al., 2024). Ethiopia’s higher average prevalence (6.47%) may stem from rigorous ANC screening, as seen in studies from BuleHora and Sodo(Aliyo et al., 2023; Chanko, 2020), while DR Congo’s low rate (0.31%) may be underestimated due to retrospective data and limited laboratory capacity (Nyakio et al., 2024). High heterogeneity (I² = 85.12%, p < 0.001) indicates substantial between-study variation, likely driven by differences in study design, diagnostic methods, and healthcare access. For instance, cross-sectional studies in Ethiopia used active antibody screening (Aliyo et al., 2023; Chanko, 2020), whereas retrospective studies in DR Congo relied on hospital records, potentially missing cases(Nyakio et al., 2024). Variations in ANC uptake higher in urban Ethiopia than rural DR Congo may also contribute(Mbalibulha et al., 2022; Natukunda et al., 2011). Although subgroup analyses by region were conducted, limited data prevented meta-regression to explore sources of heterogeneity, such as parity or prophylaxis access. Standardized diagnostic protocols could reduce such variability in future studies. The key determinants which include previous pregnancies, abortions, stillbirths, blood transfusions, and lack of anti-D prophylaxis are consistent across studies (Otomewo et al., 2020; Uchenna Eleje et al., 2017). These factors reflect clinical scenarios where fetomaternal hemorrhage or incompatible transfusions trigger sensitization(Allagoa et al., 2021; Kanko & Woldemariam, 2021). In African settings, the high cost and limited availability of anti-D immunoglobulin exacerbate risks, with unbooked ANC cases further delaying screening and intervention (Allagoa et al., 2021; Uchenna Eleje et al., 2017). This contrasts with high-income countries, where routine prophylaxis post-delivery or after sensitizing events has significantly reduced sensitization rates (Allagoa et al., 2021). Implications for Practice and Policy: The 2.93% prevalence supports routine Rhesus screening in ANC to identify Rh D-negative women for timely anti-D prophylaxis, particularly post-delivery or abortion. Healthcare providers should educate women on risks from prior pregnancies or transfusions. Policies should subsidize anti-D immunoglobulin, improve laboratory infrastructure, and mandate universal screening, especially in high-prevalence regions like Ethiopia. Increasing ANC uptake can address unbooked cases, a key risk factor (Allagoa et al., 2021). Future Research: Longitudinal studies should assess incidence and outcomes. Meta-regression of determinants (e.g., parity, transfusions) could quantify risks. Expanding research to rural settings and additional African regions, particularly Francophone countries, would enhance representativeness. Cost-effectiveness studies on screening and prophylaxis programs are needed to guide resource allocation. Conclusion: This meta-analysis establishes a 2.93% prevalence of Rhesus isoimmunization in African hospitals, with significant regional variation and determinants like previous pregnancies and lack of prophylaxis. Routine screening, accessible prophylaxis, and policy reforms are critical to reduce HDFN and improve obstetric outcomes. Supporting Information PRISMA checklist, JBI quality scores, search strategies, excluded studies, and forest/funnel plots are provided as supplemental materials. Protocol amendments were documented with justifications. 9. Acknowledgments We thank researchers who supported the literature search and data extraction. 10. Funding This study was not supported by anyone, but the efforts of the co authors in reviewing and screening literature. 11. Author Contributions Brian Ochieng’ Onyango: conceptualization, data analysis, writing, and editing. 12. Conflict of Interest Statement No conflicts of interest. 13. Author Contributions Brian Ochieng’ Onyango: Conceptualization, Methodology, Data Curation, Formal Analysis, Writing – Original Draft. [Co-Author 1]: Data Curation, Validation, Writing – Review & Editing. [Co-Author 2]: Methodology, Supervision, Writing – Review & Editing. [Co-Author 3]: Data Curation, Formal Analysis, Writing – Review & Editing. Conflict of Interest The authors declare no conflicts of interest. Data Availability Data are available upon reasonable request. The protocol is registered on PROSPERO (CRD420251067446). Supplementary Materials • File S1: Search Strategies • Table S2: Joanna Briggs Institute Quality Scores • File S3: PRISMA 2020 Checklist. 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/10.1177/11795565221145598Allagoa, 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.021.012300131Chanko, 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.20200802.11Kanko, 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/s12905-021-01315-3Mbalibulha, 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. 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Feto-maternal outcomes of women with Rhesus iso-immunization in a Nigerian tertiary health care institution. Journal of Pregnancy and Neonatal Medicine , 01 (01). https://doi.org/10.35841/pregnancy-neonatal.1000102 Scopus TITLE-ABS-KEY ((”rhesus isoimmunization” OR ”rhisoimmunization” OR ”rhesus alloimmunization” OR ”rhalloimmunization” OR ”rh sensitization” OR ”anti-d antibod*” OR ”hemolytic disease of newborn” OR ”hdn” OR ”rh incompatibility” OR ”rhesus incompatibility” OR ”erythroblastosisfetalis”)) AND TITLE-ABS-KEY((”africa*” OR ”nigeria” OR ”egypt” OR ”south africa” OR ”ethiopia” OR ”kenya” OR ”ghana” OR ”tanzania” OR ”morocco” OR ”algeria” OR ”sudan” OR ”uganda” OR ”zambia” OR ”zimbabwe” OR ”cameroon” OR ”mozambique” OR ”angola” OR ”mali” OR ”senegal” OR ”tunisia” OR ”somalia” OR ”libya” OR ”sub-saharan”)) AND TITLE-ABS-KEY ((”pregnan*” OR ”maternal” OR ”antenatal” OR ”prenatal” OR ”obstetric*”)) AND TITLE-ABS-KEY ((”hospital*” OR ”health center*” OR ”health centre*” OR ”medical center*” OR ”clinic*” OR ”tertiary care” OR ”health facilit*” OR ”healthcare setting*”)) AND TITLE-ABS-KEY ((”prevalence” OR ”incidence” OR ”frequency” OR ”occurrence” OR ”determinant*” OR ”predictor*” OR ”risk factor*” OR ”epidemiology” OR ”characteristic*” OR ”associated factor*”)) PubMed ((”Rh Isoimmunization”[Mesh] OR ”Erythroblastosis, Fetal”[Mesh] OR ”Rh-Hr Blood-Group System”[Mesh] OR ”rhesus isoimmunization” OR ”Rh isoimmunization” OR ”Rh immunization” OR ”Rhesus alloimmunization” OR ”Rh alloimmunization” OR ”Rh sensitization” OR ”Anti-D antibodies” OR ”hemolytic disease of newborn” OR ”HDN” OR ”Rh incompatibility”)) AND (”Africa”[Mesh] OR ”Africa South of the Sahara”[Mesh] OR ”Africa, Northern”[Mesh] OR ”African Continental Ancestry Group”[Mesh] OR ”African*”[tiab] OR ”Africa”[tiab] OR ”Nigeria”[tiab] OR ”Egypt”[tiab] OR ”South Africa”[tiab] OR ”Ethiopia”[tiab] OR ”Kenya”[tiab] OR ”Ghana”[tiab] OR ”Tanzania”[tiab] OR ”Morocco”[tiab] OR ”Algeria”[tiab] OR ”Sudan”[tiab] OR ”Uganda”[tiab] OR ”Zambia”[tiab] OR ”Zimbabwe”[tiab] OR ”Cameroon”[tiab] OR ”Mozambique”[tiab] OR ”Angola”[tiab] OR ”Mali”[tiab] OR ”Senegal”[tiab] OR ”Tunisia”[tiab] OR ”Somalia”[tiab] OR ”Libya”[tiab]) AND (”Pregnant Women”[Mesh] OR ”Pregnancy”[Mesh] OR ”Prenatal Care”[Mesh] OR ”pregnant women”[tiab] OR ”pregnancies”[tiab] OR ”pregnancy”[tiab] OR ”maternal”[tiab] OR ”antenatal”[tiab] OR ”prenatal”[tiab]) AND (”Hospitals”[Mesh] OR ”Tertiary Care Centers”[Mesh] OR ”Primary Health Care”[Mesh] OR ”hospital*”[tiab] OR ”healthcare facilit*”[tiab] OR ”health center*”[tiab] OR ”health centre*”[tiab] OR ”medical center*”[tiab] OR ”clinic*”[tiab] OR ”tertiary care”[tiab] OR ”health facilit*”[tiab]) AND (”Prevalence”[Mesh] OR ”Incidence”[Mesh] OR ”Risk Factors”[Mesh] OR ”prevalence”[tiab] OR ”incidence”[tiab] OR ”frequency”[tiab] OR ”occurrence”[tiab] OR ”determinant*”[tiab] OR ”predictor*”[tiab] OR ”risk factor*”[tiab] OR ”epidemiology”[tiab] OR ”characteristic*”[tiab]) Lens.org (”rhesus isoimmunization” OR ”rhisoimmunization” OR ”rhesus alloimmunization” OR ”rhalloimmunization” OR ”rh sensitization” OR ”anti-d antibodies” OR ”hemolytic disease of newborn” OR ”hdn” OR ”rh incompatibility” OR ”rhesus incompatibility” OR ”erythroblastosisfetalis”) AND (”africa*” OR ”nigeria” OR ”egypt” OR ”south africa” OR ”ethiopia” OR ”kenya” OR ”ghana” OR ”tanzania” OR ”morocco” OR ”algeria” OR ”sudan” OR ”uganda” OR ”zambia” OR ”zimbabwe” OR ”cameroon” OR ”mozambique” OR ”angola” OR ”mali” OR ”senegal” OR ”tunisia” OR ”somalia” OR ”libya” OR ”sub-saharan”) AND (”pregnan*” OR ”maternal” OR ”antenatal” OR ”prenatal” OR ”obstetric*”) AND (”hospital*” OR ”health center*” OR ”health centre*” OR ”medical center*” OR ”clinic*” OR ”tertiary care” OR ”health facilit*” OR ”healthcare setting*”) AND (”prevalence” OR ”incidence” OR ”frequency” OR ”occurrence” OR ”determinant*” OR ”predictor*” OR ”risk factor*” OR ”epidemiology” OR ”characteristic*” OR ”associated factor*”) Web of Science TS=((”Rh isoimmunization” OR ”rhesus isoimmunization” OR ”Rh incompatibility” OR ”Rh sensitization” OR ”Rh negative”) AND (pregnan* OR maternal OR antenatal) AND (Africa* OR Nigeria OR Ghana OR Kenya OR ”South Africa” OR Ethiopia OR Uganda OR ”sub-Saharan”) AND (prevalence OR incidence OR determinant* OR ”risk factor*”)) AND PY=(2010-2025) Information & Authors Information Version history V1 Version 1 17 June 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords fetal medicine: alloimmunisation general obstetrics meta-analysis systematic reviews Authors Affiliations Brian Ochieng’ Onyango [email protected] Kampala International University School of Health Sciences View all articles by this author Ephraim Onaba Kampala International University School of Health Sciences View all articles by this author Nichole Kabanda Kampala International University School of Health Sciences View all articles by this author Metrics & Citations Metrics Article Usage 341 views 265 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Brian Ochieng’ Onyango, Ephraim Onaba, Nichole Kabanda. PREVALENCE AND DETERMINANTS OF RHESUS ISOIMMUNIZATION AMONG PREGNANT WOMEN IN AFRICAN HOSPITALS: A SYSTEMATIC REVIEW AND META-ANALYSIS.. Authorea . 17 June 2025. DOI: https://doi.org/10.22541/au.175016305.52869738/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. 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