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Abstract：
BACKGROUND: Transplacental or fetomaternal hemorrhage (FMH) may occur during pregnancy or at delivery and lead to immunization to the D antigen if the mother is Rh-negative and the baby is Rh-positive. This can result in hemolytic disease of the fetus and newborn (HDFN) in subsequent D-positive pregnancies. Therefore, the aim of this systematic review and meta-analysis was to estimate distribution of ABO and Rh (D) blood groups among pregnant women in Ethiopia.
METHODS: We searched PubMed, Google Scholar, EMBASE, Cochrane Library, HINARI, AFRO Library Databases, and African Online Journal databases for all available studies using the following keywords: \"High rhesus (Rh(D)) negative frequency\", \"ABO blood group distribution\", \"haemolytic disease of the newborn (HDN)\", \"rh isoimmunization\", \"anti-RhD immunoglobulin\", \"D-negative pregnancies\", \"Frequency\", \"ABO and Rh blood group distribution\", \"feto-maternal hemorrhage\", \"rhesus D negative pregnant mothers\", \"kleihauer-betke test (KBT)\", \"Neonatal Hyperbilirubinemia\", \"non-sensitized RhD-negative pregnant women\", \"antenatal anti-D immunoglobulin prophylaxis\", \"Hemolytic disease of the newborn (alloimmunization), Ethiopia. The search string was developed using \"AND\" and \"OR\" Boolean operators. All published and unpublished observational studies reporting the distribution of ABO and Rh (D) blood groups among pregnant women in Ethiopia were included. The study participants were all pregnant women in Ethiopia, and the main outcome measure of this systematic review and meta-analysis was Rhesus D-negative blood type and ABO blood group distribution among pregnant women in Ethiopia. The data was extracted by the author (AAA) by using a standardized JBI data extraction format. Microsoft Excel (2016), and Stata version 11.0 (Stata Corporation, College Station, Texas, USA) software were used for data entry and analysis, respectively. The random effect model was used for estimating the pooled effects, and the publication bias was assessed by visual inspection of the funnel plots and objectively by using the Egger\'s test (i.e. p < 0.05).
RESULTS: One hundred thirty-two articles were identified through electronic database searching. Of which, 34 were excluded due to duplication, 65 through review of titles and abstracts, and 22 full-text articles were excluded for not reporting the outcome variable and other reasons. Finally, 7 were included to estimate the distribution of ABO and Rh (D) blood groups among pregnant women in Ethiopia. The pooled distribution of Rh-negative blood group among pregnant women in Ethiopia was 10.8% (95%CI: 7.53-14.07, I2 = 85%, p < 0.001). In the ABO system, type O was the most prevalent 39.9% (37.51-42.38), followed by A (30.59% (26.00-35.18)), B (23.04% (20.03-26.05)), and AB the least (4.82%(3.17-6.47)), in the pattern O > A > B > AB.
CONCLUSIONS: The pooled distribution of Rh-negative blood group among pregnant women in Ethiopia was high. Rh alloimmunization remains a major factor responsible for perinatal morbidity in Ethiopia and may result in the compromise of the woman\'s obstetric care due to the unaffordability of anti-D immunoglobulin. There is the urgent need for the implementation of universal access to anti-D immunoglobulin for the Rh-negative pregnant population in Ethiopia.
METHODS: We searched PubMed, Google Scholar, EMBASE, Cochrane Library, HINARI, AFRO Library Databases, and African Online Journal databases for all available studies using the following keywords: \"High rhesus (Rh(D)) negative frequency\", \"ABO blood group distribution\", \"haemolytic disease of the newborn (HDN)\", \"rh isoimmunization\", \"anti-RhD immunoglobulin\", \"D-negative pregnancies\", \"Frequency\", \"ABO and Rh blood group distribution\", \"feto-maternal hemorrhage\", \"rhesus D negative pregnant mothers\", \"kleihauer-betke test (KBT)\", \"Neonatal Hyperbilirubinemia\", \"non-sensitized RhD-negative pregnant women\", \"antenatal anti-D immunoglobulin prophylaxis\", \"Hemolytic disease of the newborn (alloimmunization), Ethiopia. The search string was developed using \"AND\" and \"OR\" Boolean operators. All published and unpublished observational studies reporting the distribution of ABO and Rh (D) blood groups among pregnant women in Ethiopia were included. The study participants were all pregnant women in Ethiopia, and the main outcome measure of this systematic review and meta-analysis was Rhesus D-negative blood type and ABO blood group distribution among pregnant women in Ethiopia. The data was extracted by the author (AAA) by using a standardized JBI data extraction format. Microsoft Excel (2016), and Stata version 11.0 (Stata Corporation, College Station, Texas, USA) software were used for data entry and analysis, respectively. The random effect model was used for estimating the pooled effects, and the publication bias was assessed by visual inspection of the funnel plots and objectively by using the Egger\'s test (i.e. p < 0.05).
RESULTS: One hundred thirty-two articles were identified through electronic database searching. Of which, 34 were excluded due to duplication, 65 through review of titles and abstracts, and 22 full-text articles were excluded for not reporting the outcome variable and other reasons. Finally, 7 were included to estimate the distribution of ABO and Rh (D) blood groups among pregnant women in Ethiopia. The pooled distribution of Rh-negative blood group among pregnant women in Ethiopia was 10.8% (95%CI: 7.53-14.07, I2 = 85%, p < 0.001). In the ABO system, type O was the most prevalent 39.9% (37.51-42.38), followed by A (30.59% (26.00-35.18)), B (23.04% (20.03-26.05)), and AB the least (4.82%(3.17-6.47)), in the pattern O > A > B > AB.
CONCLUSIONS: The pooled distribution of Rh-negative blood group among pregnant women in Ethiopia was high. Rh alloimmunization remains a major factor responsible for perinatal morbidity in Ethiopia and may result in the compromise of the woman\'s obstetric care due to the unaffordability of anti-D immunoglobulin. There is the urgent need for the implementation of universal access to anti-D immunoglobulin for the Rh-negative pregnant population in Ethiopia.
摘要：
背景：如果母亲为Rh阴性且婴儿为Rh阳性，则可能在怀孕期间或分娩时发生胎盘或母胎出血（FMH），并导致对D抗原的免疫。这可能导致在随后的D阳性妊娠中胎儿和新生儿的溶血病(HDFN)。因此,本系统综述和荟萃分析的目的是评估埃塞俄比亚孕妇中ABO和Rh(D)血型的分布.
方法：我们搜索了PubMed，谷歌学者，EMBASE,科克伦图书馆,Hinari,AFRO图书馆数据库，和非洲在线期刊数据库的所有可用研究使用以下关键词：“高恒河猴(Rh(D))阴性频率”，“ABO血型分布”，“新生儿溶血病（HDN）”，“rh等免疫”，“抗RhD免疫球蛋白”，“D阴性妊娠”，\"频率\",“ABO和Rh血型分布”，\“胎儿-产妇出血\”，\“恒河猴D阴性孕母\”，“克莱豪尔-贝特测试(KBT)”，“新生儿高胆红素血症”，“非致敏RhD阴性孕妇”，“产前预防抗D免疫球蛋白”，“新生儿溶血病（同种免疫），埃塞俄比亚。搜索字符串是使用\"AND\"和\"OR\"布尔运算符开发的。包括所有已发表和未发表的观察性研究，这些研究报告了埃塞俄比亚孕妇中ABO和Rh（D）血型的分布。研究参与者都是埃塞俄比亚的孕妇，本系统评价和荟萃分析的主要结局指标是埃塞俄比亚孕妇的恒河猴D阴性血型和ABO血型分布。数据由作者(AAA)使用标准化的JBI数据提取格式提取。MicrosoftExcel(2016),和Stata版本11.0(Stata公司，学院站,德州,美国)软件用于数据输入和分析，分别。随机效应模型用于估计合并效应，通过目测漏斗图和使用Egger检验（即p<0.05）客观地评估发表偏倚。
结果：通过电子数据库搜索确定了一百三十二篇文章。其中，34由于重复而被排除在外，65通过审查标题和摘要，22篇全文文章因未报告结果变量和其他原因而被排除.最后,纳入了7个研究对象，以估计埃塞俄比亚孕妇中ABO和Rh（D）血型的分布。埃塞俄比亚孕妇中Rh阴性血型的合并分布为10.8％（95CI：7.53-14.07，I2=85％，p<0.001)。在ABO系统中,O型是最普遍的39.9%(37.51-42.38)，其次是A（30.59%（26.00-35.18）），B（23.04%（20.03-26.05）），AB最少(4.82%(3.17-6.47))，在模式O>A>B>AB。
结论：埃塞俄比亚孕妇中Rh阴性血型的合并分布较高。Rh同种免疫仍然是埃塞俄比亚围产期发病率的主要因素，并且由于抗D免疫球蛋白的负担能力不足，可能导致妇女的产科护理受损。迫切需要在埃塞俄比亚的Rh阴性孕妇人群中普遍获得抗D免疫球蛋白。
方法：我们搜索了PubMed，谷歌学者，EMBASE,科克伦图书馆,Hinari,AFRO图书馆数据库，和非洲在线期刊数据库的所有可用研究使用以下关键词：“高恒河猴(Rh(D))阴性频率”，“ABO血型分布”，“新生儿溶血病（HDN）”，“rh等免疫”，“抗RhD免疫球蛋白”，“D阴性妊娠”，\"频率\",“ABO和Rh血型分布”，\“胎儿-产妇出血\”，\“恒河猴D阴性孕母\”，“克莱豪尔-贝特测试(KBT)”，“新生儿高胆红素血症”，“非致敏RhD阴性孕妇”，“产前预防抗D免疫球蛋白”，“新生儿溶血病（同种免疫），埃塞俄比亚。搜索字符串是使用\"AND\"和\"OR\"布尔运算符开发的。包括所有已发表和未发表的观察性研究，这些研究报告了埃塞俄比亚孕妇中ABO和Rh（D）血型的分布。研究参与者都是埃塞俄比亚的孕妇，本系统评价和荟萃分析的主要结局指标是埃塞俄比亚孕妇的恒河猴D阴性血型和ABO血型分布。数据由作者(AAA)使用标准化的JBI数据提取格式提取。MicrosoftExcel(2016),和Stata版本11.0(Stata公司，学院站,德州,美国)软件用于数据输入和分析，分别。随机效应模型用于估计合并效应，通过目测漏斗图和使用Egger检验（即p<0.05）客观地评估发表偏倚。
结果：通过电子数据库搜索确定了一百三十二篇文章。其中，34由于重复而被排除在外，65通过审查标题和摘要，22篇全文文章因未报告结果变量和其他原因而被排除.最后,纳入了7个研究对象，以估计埃塞俄比亚孕妇中ABO和Rh（D）血型的分布。埃塞俄比亚孕妇中Rh阴性血型的合并分布为10.8％（95CI：7.53-14.07，I2=85％，p<0.001)。在ABO系统中,O型是最普遍的39.9%(37.51-42.38)，其次是A（30.59%（26.00-35.18）），B（23.04%（20.03-26.05）），AB最少(4.82%(3.17-6.47))，在模式O>A>B>AB。
结论：埃塞俄比亚孕妇中Rh阴性血型的合并分布较高。Rh同种免疫仍然是埃塞俄比亚围产期发病率的主要因素，并且由于抗D免疫球蛋白的负担能力不足，可能导致妇女的产科护理受损。迫切需要在埃塞俄比亚的Rh阴性孕妇人群中普遍获得抗D免疫球蛋白。
