Knowledge, Perceived Risk and Health Implication of Rhesus Incompatibility Among Social Sciences Students

Rhesus (Rh) incompatibility is a significant but largely preventable contributor to maternal-fetal morbidity and mortality worldwide (Pegoraro et al., 2020; World Health Organization [WHO], 2022). Despite decades of biomedical advancement and the availability of effective prophylaxis, Rh-related hemolytic disease of the fetus and newborn (HDFN) continues to impose a substantial public health burden, particularly in low- and middle-income countries (Correa Junior et al., 2024; WHO, 2022). Recent global estimates indicate that more than 350,000 fetuses and newborns develop HDFN annually, with approximately 50% of these cases resulting in stillbirth, neonatal death, or long-term neurological impairment, largely due to inadequate prevention and delayed diagnosis (Pegoraro et al., 2020). The World Health Organization (WHO) has repeatedly emphasized that the majority of Rh(D)-related adverse outcomes are preventable through timely antenatal screening, appropriate administration of anti-D immunoglobulin, and adequate maternal education (WHO, 2022). Nevertheless, gaps in awareness, perceived risk, and access to preventive services persist, especially in resource-constrained settings, underscoring the need for context-specific research that addresses both biomedical and socio-educational dimensions of Rh incompatibility. Globally, Rh incompatibility arises when an Rh-negative woman carries an Rh-positive fetus, leading to maternal alloimmunization and the production of anti-D antibodies that can cross the placenta and destroy fetal red blood cells in subsequent pregnancies. The resulting hemolysis may cause fetal anemia, hydrops fetalis, kernicterus, and perinatal death if not promptly managed (Hall et al., 2024). Although the introduction of anti-D immunoglobulin prophylaxis in the late 1960s dramatically reduced the incidence of HDFN in high-income countries, the condition has not been eliminated. Pegoraro et al. (2020) report that Rh(D)-related HDFN remains responsible for significant preventable childhood morbidity and mortality globally, largely due to disparities in health system capacity, uneven coverage of antenatal care, and limited maternal knowledge of Rh status and underestimation of risk severity. These challenges are particularly pronounced in Sub-Saharan Africa, where maternal and neonatal health outcomes remain among the poorest globally. From a biological standpoint, the Rh blood group system is one of the most complex and clinically significant blood group systems, second only to the ABO system (Westhoff, 2019; Kilby et al., 2025). The presence or absence of the D antigen determines Rh positivity or negativity (Westhoff, 2019). Rh incompatibility becomes clinically relevant when fetal red blood cells expressing the D antigen enter the maternal circulation of an Rh-negative woman, either during pregnancy, childbirth, miscarriage, or invasive obstetric procedures, leading to maternal alloimmunization (Kilby et al., 2025; Pegoraro et al., 2020). This exposure can trigger an immune response, leading to sensitization and the production of IgG anti-D antibodies (Hall et al., 2024). In subsequent pregnancies with an Rh-positive fetus, these maternal anti-D antibodies may cross the placenta and mediate immune destruction of fetal erythrocytes, resulting in hemolytic disease of the fetus and newborn (HDFN) (Kilby et al., 2025; Westhoff, 2019). Importantly, the likelihood and severity of these outcomes are significantly influenced not only by biological exposure but also by early identification of Rh incompatibility and timely administration of anti-D immunoglobulin prophylaxis (Correa Junior et al., 2024; World Health Organization [WHO], 2022). Globally, the prevalence of Rh-negative blood groups varies significantly by ethnicity and geography, ranging from approximately 15-17% among Caucasian populations to less than 5% in many African and Asian populations (Pegoraro et al., 2020). While the lower prevalence of Rh negativity in Africa might suggest a reduced burden, the opposite is often the case due to weaker health systems, limited access to routine blood group screening, and inadequate implementation of prophylactic measures. In high-income countries, near-universal antenatal screening and routine postpartum and antenatal administration of anti-D immunoglobulin have reduced the incidence of severe HDFN to fewer than one case per 100,000 births (CDC, 2021). Conversely, in low- and middle-income countries, Rh incompatibility continues to account for a substantial proportion of preventable neonatal morbidity and mortality, partly because affected populations often underestimate their susceptibility to Rh-related complications. The health consequences of Rh incompatibility extend beyond immediate perinatal outcomes. Survivors of severe HDFN may experience long-term complications, including neurodevelopmental delays, hearing loss, and cerebral palsy secondary to bilirubin-induced neurologic dysfunction (Hall et al., 2024). These outcomes impose significant emotional, social, and economic burdens on families and health systems, reinforcing the classification of Rh incompatibility as a critical public health concern rather than a purely clinical issue. Recognition of the potential severity of these outcomes is central to shaping individuals’ perceived risk and willingness to engage in preventive behaviors. In Sub-Saharan Africa, the burden of Rh incompatibility is shaped by a confluence of biological, systemic, and socio-cultural factors. Although the prevalence of Rh-negative blood groups in the region is generally low often estimated at between 3% and 7% the risk of sensitization and adverse outcomes remains disproportionately high due to limited access to preventive services (Geta et al., 2024). Antenatal care coverage, while improving, remains inconsistent, and many women initiate antenatal visits late in pregnancy or attend irregularly, reducing opportunities for early blood group screening and risk mitigation. Empirical studies across the region have documented low levels of awareness and low perceived susceptibility to Rh incompatibility among women of reproductive age. Geta et al. (2024), in a facility-based cross-sectional study in Ethiopia, found that a significant proportion of antenatal care recipients lacked adequate knowledge of Rh incompatibility, its causes, and its health implications. Importantly, the study identified educational level, prior obstetric history, and exposure to health education as key predictors of awareness and perceived risk. These findings resonate with broader regional evidence indicating that knowledge gaps and poor risk perception are not merely individual-level issues but reflect systemic shortcomings in health education and communication. Health system constraints further exacerbate the problem. Limited availability and high cost of anti-D immunoglobulin, inadequate laboratory infrastructure for blood grouping and antibody screening, and shortages of trained health personnel hinder effective prevention and management of Rh incompatibility in many Sub-Saharan African countries (Pegoraro et al., 2020). Moreover, socio-cultural beliefs and misconceptions about blood, pregnancy, and inheritance may influence how individuals perceive risk and seek care, thereby shaping the effectiveness of preventive interventions. Within this context, Rh incompatibility emerges as a clear example of how biomedical preventability does not automatically translate into public health success in the absence of adequate risk communication and system-wide support. Nigeria bears one of the highest burdens of maternal and neonatal morbidity and mortality globally, accounting for a substantial proportion of maternal deaths and neonatal deaths worldwide (WHO, 2023). Although direct causes such as hemorrhage, infection, and hypertensive disorders dominate maternal mortality statistics, indirect and preventable conditions like Rh incompatibility continue to contribute to adverse pregnancy outcomes, particularly in underserved populations. Neonatal mortality in Nigeria remains unacceptably high, with preventable causes including hemolytic disease, severe jaundice, and birth complications playing a significant role. Studies conducted in different parts of Nigeria consistently demonstrate gaps in knowledge and inadequate perception of risk associated with Rh incompatibility. Olawale et al. (2025), in a study among public secondary school students in Ogbomoso, Southwest Nigeria, reported low levels of knowledge regarding Rh incompatibility and its implications for marriage and reproduction. Although the study population comprised adolescents rather than university students, the findings are instructive, suggesting that foundational awareness and risk recognition are often lacking even among educated youth. Such deficits may persist into adulthood and influence reproductive decisions, partner selection, and utilization of preventive health services. Among pregnant women, similar patterns have been observed. Enemuwe et al. (2025), in a study conducted in Delta State, found that while some respondents were aware of their blood group, detailed understanding of Rh incompatibility and its preventive measures was limited. Misconceptions regarding the causes and severity of Rh incompatibility were common, and knowledge of anti-D immunoglobulin prophylaxis was suboptimal. Kanikwu et al. (2024) reported comparable findings in Irrua, Nigeria, noting that awareness of Rh incompatibility did not necessarily translate into appropriate preventive practices, highlighting a critical gap between knowledge, perceived risk, and health behavior. National policies and guidelines in Nigeria recognize the importance of routine antenatal screening for blood group and Rhesus factor determination, and anti-D immunoglobulin prophylaxis is included in recommended obstetric care protocols (Federal Ministry of Health [FMoH], 2016; National Primary Health Care Development Agency [NPHCDA], 2020). However, implementation of these guidelines remains uneven across healthcare settings due to logistical constraints, financial limitations, inconsistent availability of anti-D immunoglobulin, and gaps in health education (Correa Junior et al., 2024; Pegoraro et al., 2020). Furthermore, existing interventions largely target pregnant women within clinical settings, with limited emphasis on preconception education or early risk awareness among young adults and non-medical populations. This narrow focus overlooks the role of early risk perception in shaping long-term health behaviors and reproductive decision-making. A critical review of the literature reveals several conceptual and empirical gaps that justify further investigation. First, the majority of studies on Rh incompatibility in Nigeria and similar settings are hospital-based and focus predominantly on pregnant women or antenatal care attendees. While such studies provide valuable clinical insights, they offer limited understanding of knowledge and perceived risk among the broader population, particularly young adults who have not yet entered the reproductive phase. Second, few studies explicitly examine how individuals interpret their susceptibility to Rh incompatibility and the severity of its consequences, despite evidence that perceived risk strongly influences preventive behavior. Methodologically, many existing studies rely on cross-sectional designs and self-reported measures, which may be subject to recall and social desirability biases. Additionally, there is limited integration of behavioral theories that could illuminate how knowledge and perceived risk interact to influence preventive practices. Socio-cultural factors, including beliefs about blood compatibility, marriage, and heredity, are often acknowledged but insufficiently explored in empirical analyses. In Nigeria, educational disparities and variations in curriculum content further complicate the landscape. Non-medical university students, including those in the social sciences, may receive little or no formal education on reproductive health topics such as Rh incompatibility. Yet, these students represent future parents, policymakers, administrators, and opinion leaders whose understanding of health risks can shape personal choices and broader societal attitudes. The paucity of research focusing on this demographic constitutes a significant gap in the literature. Against this backdrop, assessing the knowledge, perceived risk, and health implications of Rh incompatibility among Social Sciences students at the University of Uyo is both timely and strategically important. University students occupy a critical transitional stage between adolescence and adulthood, during which health-related beliefs and risk perceptions are consolidated. For Social Sciences students in particular, whose future professional roles may involve policy formulation, community engagement, and leadership, understanding of public health risks has implications beyond individual behavior. Focusing on this population aligns with a preventive, life-course approach to maternal and child health, emphasizing early risk awareness and informed decision-making before pregnancy occurs. By identifying knowledge gaps, misconceptions, and low perceived susceptibility, the study can inform targeted health education interventions within university settings, complementing existing antenatal-focused strategies. Moreover, the findings have the potential to support curriculum development that integrates essential reproductive health risk education into non-medical disciplines. From a policy perspective, evidence generated by this study can contribute to more comprehensive strategies for addressing preventable maternal-fetal health risks in Nigeria. By illuminating how young adults perceive their risk of Rh incompatibility and its consequences, the research can inform communication strategies, advocacy efforts, and community-based interventions aimed at reducing the burden of HDFN and related outcomes. Ultimately, the study responds to an urgent need to bridge the gap between biomedical knowledge and population-level risk awareness, reinforcing the principle that effective public health interventions must be grounded not only in clinical efficacy but also in accurate risk perception and education.

The aim of this study is to assess the knowledge, perceived risk, and health implications of Rhesus incompatibility among Social Sciences students of the University of Uyo, Akwa Ibom State, Nigeria.

1. 1What is the level of knowledge of Rhesus incompatibility among Social Sciences students of the University of Uyo?
2. 2What is the level of perceived risk of Rhesus incompatibility among Social Sciences students and how does it relate to reproductive health?
3. 3What health implications of Rhesus incompatibility are perceived by Social Sciences students of the University of Uyo?
4. 4What factors influence the knowledge and perceived risk of Rhesus incompatibility among Social Sciences students?
5. 5What are the sources of information through which Social Sciences students obtain knowledge about Rhesus incompatibility?
6. 6Is there a relationship between socio-demographic characteristics and knowledge of Rhesus incompatibility among Social Sciences students?

1. H1There is no statistically significant relationship between the level of education and knowledge of Rhesus incompatibility among Social Sciences students of the University of Uyo
2. H2There is no statistically significant relationship between students academic level and perceived health risk of rhesus incompatibility among Social Sciences students of the University of Uyo
3. H3There is no significant relationship between the socio-demographic characteristics of Social Sciences students and their perception of the health implications of rhesus incompatibility at the University of Uyo