Rh hemolytic disease of the newborn, once a major cause of perinatal mortality and long-term disability, is rarely seen in developed countries today. This drastic reduction in the frequency of disease occurrence has followed the widespread postpartum use of Rh immunoglobulin. However, more than half the world's population does not have access to this health care technology. / The objective of this thesis was to study the epidemiology of Rh disease in developed country settings and specifically to quantify the magnitude of Rh disease reduction that occurred secondary to Rh prophylaxis, and to changes in birth order, the quality of medical care and other Rh disease determinants. Another objective was to identify feasible and cost-effective options for Rh disease control in developing countries. / Study methods include Poisson regression modeling of surveillance data from Manitoba, Nova Scotia, Canada and the United States and a model based on conditional probabilities obtained from the medical literature and vital statistics publications. Outcomes considered in these analyses include maternal Rh sensitization, Rh hemolytic disease of the newborn, perinatal deaths from Rh disease and infant deaths from hemolytic disease of the newborn. / The results show that besides Rh prophylaxis, changes in other determinants of Rh disease were responsible for significant reductions in the disease over the last four decades. Changes in the birth order resulted in a 35% reduction in Rh sensitizations, while changes in the quality of medical care were responsible for about 80% of the reduction in perinatal deaths from Rh disease. Rh prophylaxis was found to be responsible for reducing the rate of maternal Rh sensitization (both Rh D and Rh non-D) by 60-69% and the rate of perinatal and infant deaths by 80-90% (estimated effects are independent but not mutually exclusive). Effects of other Rh disease determinants, such as abortion rates, racial composition, race and Rh type-specific blood transfusions, were also quantified. Finally, a decision analysis of various Rh prophylaxis options was modeled with a view to optimizing cost-effectiveness and minimizing cost. The option of administering Rh prophylaxis to first births was found to be the most cost-effective and feasible option. It is recommended as a first step for Rh disease control in countries like India.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:QMM.28806 |
| Date | January 1995 |
| Creators | Kuruthukulangare, Joseph Sebastian |
| Contributors | Kramer, Michael (advisor) |
| Publisher | McGill University |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Format | application/pdf |
| Coverage | Doctor of Philosophy (Department of Epidemiology and Biostatistics.) |
| Rights | All items in eScholarship@McGill are protected by copyright with all rights reserved unless otherwise indicated. |
| Relation | alephsysno: 001453679, proquestno: NN05736, Theses scanned by UMI/ProQuest. |
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