Point-of-care determination of the frequency of Rhesus(D)-negative blood types and the uptake of anti(D) immunoglobulin among Rh(D)-negative women in Dadu district, Sindh, Pakistan
Bibliographic record
Abstract
Rhesus (Rh) disease remains a serious problem in low- and middle-income countries. Rh disease prevention requires early identification and prophylactic treatment of Rh(D)-negative women. We evaluated the feasibility of point-of-care identification of Rh(D)-negative women and timely administration of two doses of anti(D) immunoglobulin by lady health visitors in Dadu district, Sindh, Pakistan. Pregnant women were enrolled at two hospitals and followed until 29 days postpartum. Rh(D)-antigen status was determined using the EldonCard2521 test and all Rh(D)-negative point-of-care test results were attempted to be verified using the conventional test tube agglutination method. Rh(D)-negative women were offered two injections of anti(D) immunoglobulin, one at 28 weeks' gestation and one within 72 hours of delivery. Knowledge pertaining to Rh disease was assessed among participants at study entry and exit, and in a sample of 30 health care providers. All participants (n=1619) had their blood tested with the EldonCard2521, and 279 (17%) women were found to be Rh(D)-negative; however, the conventional test tube method identified one discordant Rh(D)-antigen result. Among 278 Rh(D)-negative women, 254 (91%) and 268 (96%) received their first and second dose of anti(D) immunoglobulin, respectively. The rates of miscarriage (22.1 per 1,000 pregnancies vs. 4.5 per 1,000 pregnancies), stillbirth (33.8 per 1,000 pregnancies vs. 6.7 per 1,000 pregnancies), and neonatal death (35.0 vs. 16.6 per 1,000 live births) were higher among Rh(D)-negative vs. Rh(D)-positive participants. At study enrolment, there was little knowledge pertaining to Rh disease and its consequences among participants and knowledge also varied greatly among health care providers. The high frequency of maternal Rh(D)-negative blood types, high rates of stillbirth, miscarriage, and neonatal death among Rh(D)-negative women and their newborns, and limited and varied knowledge of Rh disease among pregnant women and health care providers, bolsters the need for a wide-scale Rh disease prevention program in Pakistan.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".