Pregnant women in Ghana are routinely tested for blood group when they start antenatal care; however, very few (mostly in teaching hospitals) are screened for red blood cell (RBC) antibodies.
This gap in our antenatal care is costing babies their lives.
In sub-Saharan Africa (SSA), stillbirth, preterm birth, and neonatal death are the leading causes of infant morbidity and mortality, with estimated prevalences of 1.2 per cent, 37.3 per cent and 2.3 per cent, respectively, in Ghana.
One of the causes of adverse pregnancy outcomes is red blood cell antibodies in mothers, particularly anti-D antibodies. Yet routine RBC antibody screening is not implemented in most hospitals in Ghana.
Red blood cell antibodies can be formed when a woman is exposed to a blood type that does not match hers.
This can occur during normal pregnancy, delivery, miscarriage, unsafe abortions or blood transfusions.
Once these antibodies are formed, they do not go away. In future pregnancies, the same antibodies can cross the placenta and harm the baby by causing severe anaemia, jaundice, heart failure, stillbirth, and, if not properly treated after birth, brain injury or death.
In many high-income countries, RBC antibody testing is routine in early pregnancy. However, in Ghana, this is not the case. Most facilities only perform ABO and RhD blood grouping, and this has left several pregnant women to carry potentially harmful antibodies such as anti-D, anti-K, and others unattended to, to the detriment of the unborn child.
Research
In our recent research conducted between June 2024 and June 2025, involving 411 pregnant women from a secondary referral facility, nine (2.2 per cent) participants had potentially harmful antibodies.
The prevalence of anti-D (found only in Rh D-negative individuals previously sensitised) among Rh D-negative mothers was 17.1per cent (seven out of 41 women).
These rates are higher than those reported in many other African countries.
Levels of the antibodies were high in four of the seven mothers.
Two of the neonates born to these mothers developed serious complications associated with the presence of antibodies; one died on the third day of life, a death that might have been prevented with early screening during pregnancy, and the other survived after receiving intensive care (transfusion, phototherapy and other interventions).
The tragedy is that most of these complications are preventable. For Rh D-negative women, two doses of anti-D prophylaxis injections, one administered in the third trimester and the second within 72 hours after birth, can almost entirely prevent sensitisation (antibody formation), but only if given at the right time, at the correct dose and made widely available.
Of all the RhD-negative mothers who had been pregnant before and hence were candidates for the anti-D prophylaxis (39), only 19 (49 per cent) had received anti-D prophylaxis at recruitment, which is very concerning and contrary to standard practices and the World Health Organisation (WHO) recommendation of 100 per cent.
Many RhD-negative women miss these two doses of anti-D prophylaxis due to financial constraints (a dose costs approximately GH¢750), unavailability, or a lack of enforcement of national guidelines for anti-D immunoprophylaxis.
This leaves them at higher risk of forming anti-D, the antibody responsible for the most severe form of the disease complications.
Recommendations
Our health system must respond, and in light of this research’s findings, we make the following recommendations.
First, to implement routine antenatal red cell antibody screening, prioritising RhD-negative pregnant women to enable early antibody detection and monitoring of at-risk babies.
Second, to enforce the national protocol for RhD immunoprophylaxis, ensuring timely and equitable administration of anti-D immunoglobulin to all eligible women.
Third, to ensure easy access to the drug through national procurement by the Ministry of Health (MOH) or its incorporation into the national health insurance programme to mitigate the financial burden.
Fourth, to enhance awareness and capacity-building among healthcare providers through targeted training on the detection, interpretation, and clinical management of maternal RBC antibodies.
Finally, developing educational resources for teenage girls to inform them about Rh-Disease to benefit them in their adult lives.
Every Ghanaian baby deserves to be born healthy, and every pregnancy deserves to be safe.
However, without early antibody detection, many will continue to face dangers that our healthcare system could have prevented.
* The writers are a Principal Medical Laboratory Scientist, Blood Bank Laboratory, Effia-Nkwanta Regional Hospital & a Senior Lecturer, Department of Medical Diagnostics, KNUST
Emails:odokabastu@gmail.com & akosboak@yahoo.com
