Controlling Rh haemolytic disease of the newborn in India

The question whether India should institute a national programme of Rh screening and postpartum Rh immune globulin prophylaxis needs to be addressed, especially because of the recent emphasis on primary maternal and child health care. Given the absence of relevant community based data, decision analysis techniques were used to address these issues. The results reveal that the estimated cost per case of Rh HDN prevented through postpartum immune globulin prophylaxis is lower than the cost per case of Rh HDN treated through a curative strategy. However, the financial and infrastructural requirements of the preventive programme mean that such prevention may not be feasible at present. With the achievement of the Indian Government's stated objectives of population control, however, disease incidence should fall by 30% from 5.90/1000 births in 1981 to 4.13/1000 births by the year 2000, even in the absence of a prophylaxis programme.