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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 9  |  Issue : 2  |  Page : 59-62

Knowledge and response of the community to premarital screening program (Sickle Cell Anemia\Thalassemia); AlMadinah, Saudi Arabia


1 Department College of Medicine, Taibah University, Madinah, Saudi Arabia
2 Department of Pediatrics Hematology Oncology, Maternity and Children Hospital, King Abdullah Medical City, Madinah, Saudi Arabia

Date of Web Publication18-Jun-2018

Correspondence Address:
Dr. Abdulrahman A Bedaiwi
Taibah University, Sofian bin Bisher Street, Madinah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joah.joah_1_18

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  Abstract 

BACKGROUND: Premarital screening (PMS) is a mandatory laboratory examination before marriage to identify genetic blood and some infectious diseases. Sickle cell anemia (SCA) and thalassemia are genetic disorders caused by errors in the hemoglobin genes and are prevalent in Saudi Arabia
OBJECTIVE: This study assessed the knowledge and response of the Al-Madinah community regarding PMS program.
METHODOLOGY: This cross-sectional study assessed the knowledge and attitude of Al-Madinah community regarding hereditary blood disorders. Thirty-seven interviewers conducted direct and electronic interviews from October 2016 to January 2017.
RESULTS: The total number of respondents was 2554, among the participants, 61% noted that PMS can diagnose SCA, 5.3% noted that PMS cannot diagnose SCA, and 33.4% answered “I don't know.” Regarding thalassemia, 50.2% answered that PMS can diagnose thalassemia, 7.4% answered “no,” and 42% answered “I don't know.” Furthermore, 76.4% of the participants answered that PMS can prevent SCA, whereas 71% of the participants answered that PMS can prevent thalassemia. Approximately 88.6% of the participants agreed to undergo elective PMS, 78.2% of them will not marry someone who has SCA or thalassemia, and 79.5% of them will not marry someone with a genetic trait if they themselves have a trait. In terms of raising the community's awareness on various hereditary blood disorders, 95.9%, 93.9%, and 92.5% agreed on the importance of media, medical education in school, and seminars, respectively.
CONCLUSION: As half of the population were unaware about the screened diseases, it is necessary to raise the community's awareness on the importance of PMS.

Keywords: Hematology, hereditary blood disease, inheritance


How to cite this article:
AlQahtani RS, Bedaiwi AA, Alburkani AM, AlFahed MM, Alhoraibi RA, Tarawah AM. Knowledge and response of the community to premarital screening program (Sickle Cell Anemia\Thalassemia); AlMadinah, Saudi Arabia. J Appl Hematol 2018;9:59-62

How to cite this URL:
AlQahtani RS, Bedaiwi AA, Alburkani AM, AlFahed MM, Alhoraibi RA, Tarawah AM. Knowledge and response of the community to premarital screening program (Sickle Cell Anemia\Thalassemia); AlMadinah, Saudi Arabia. J Appl Hematol [serial online] 2018 [cited 2018 Oct 20];9:59-62. Available from: http://www.jahjournal.org/text.asp?2018/9/2/59/234549


  Introduction Top


Premarital testing is used to assess the presence of any infectious disease or genetic disorder in pre-married couples, preventing the risk of disease transmission within couples and to their children. Genetic disorders are hereditary blood disorders such as sickle cell anemia (SCA) and thalassemia with high mortality and morbidity rates.

Sickle-cell disease (SCD) and thalassemia are genetic disorders caused by errors in the genes for hemoglobin, a substance composed of a protein (“globin”) plus an iron molecule (“heme”) that is responsible for carrying oxygen within the red blood cells. Hence, SCD and thalassemia are genetic diseases that are common in children caused by the presence of a defective gene that was transmitted from their parents.

As of 2013, about 3.2 million people have sickle-cell disease worldwide, while an additional 43 million have sickle-cell traits.[1] About 80% of the sickle-cell disease cases are believed to occur in the sub-Saharan Africa.[2] It also occurs frequently in parts of India, the Arabian Peninsula, and among people of African descent living in other parts of the world.[3] A total of 176,000 sickle-cell disease-related deaths were reported in 2013, a value much higher than the 113,000 deaths reported in 1990.[4] In the same year (2013), thalassemia occurred in about 208 million people with 4.7 million of them having severe disease.[5] This type of genetic disorder is common among Greeks, Italians, Middle Easterners, and Africans.[6] The incidence rate of thalassemia is the same in males and females.[7] It resulted in 36,000 deaths in 1990 and 25,000 deaths in 2013.[8]

So far, no study was previously conducted in Madinah to measure the knowledge and attitude of the community people regarding the premarital screening (PMS) program. Thus, this study aimed to investigate the knowledge and attitude of the Madinah community toward PMS


  Methodology Top


This questionnaire-based cross-sectional study is conducted to assess the knowledge and attitude of the community in Al-Madinah, KSA, on the programs related to hereditary blood disorders. A verbal consent was obtained from the participants. A total of 37 medical student interviewers conducted a direct and an electronic interview on 2554 participants from October 2016 to January 2017.


  Results Top


In [Table 1] a total of 2,554 participants were enrolled in the study (958 male [38%] and 1,596 female [62%]). Approximately 43% of these participants were under 25 years of age (male, 44% and female, 43%), 48% were 26–45 years of age (male, 48% and female, 47%), and 9% were above 45 years of age (male, 8% and female, 10%). Moreover, 4% of the participants had attended less than high school (male, 22% and female, 18%), whereas 76% of them had attended college or above college level (male, 73% and female, 78%). About 50.4% of the participants were married.
Table 1: Sociodemographic characteristics of respondents

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We asked the participants if we can diagnose SCA and thalassemia by PMS. In [Table 2] over two-thirds (61.3%) of the participants responded with a “yes,” one-third of them responded with “I don't know,” and a small minority responded with a “no.” For thalassemia, just over half of the participants (50.2%) believed that thalassemia can be diagnosed during screening, less than half of them (42.4%) have no idea about it, and a small percentage (7.4%) refused to believe that thalassemia could be diagnosed by PMS. After that, we asked the participants if PMS decreased the risk of SCA and thalassemia.
Table 2: Knowledge and attitude of respondents toward premarital screening

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Just over three-fourths (76.4%) of the participants think that screening will help decrease the number of cases of SCA, less than one-fourth (19.0%) have no idea about it, and 4.5% think that PMS will not decrease the incidence of the disease. Regarding thalassemia, three-fourths (71.0%) of the participants thought that screening will decrease the number of cases of thalassemia, just under one-fourth (24.0%) had no idea about it, and 5.1% of them thought that PMS will not decrease the incidence of the disease. The following are the importance of PMS.

The majority of the participants (92.8%) believed in the importance of PMS, whereas a small minority (3.2%) had no idea about it or refused to believe in the importance of the screening. Then, we laid out a question, “if PMS was optional, would you be screened before marriage?” Approximately 88.6% of the participants agreed to undergo screening before marriage, 5.5% refused to undergo screening, and 5.9% had no idea about it. To assess their attitude toward PMS, we asked this question to the participants, “Would you marry someone who has SCA or thalassemia?” Majority of the participants (78.2%) answered “no,” whereas a few of them (21.8%) answered “yes.” In the question, “if you had a trait, will you marry someone with a trait also? Over three-fourths of the respondents (79.5%) answered “no,” and less than one-fourth (20.5%) answered “yes.”

In raising awareness regarding SCA and thalassemia, [Table 3] shows that majority of the participants agreed with the importance of seminar, whereas a few (7.5%) disagreed; 93.9% of respondents agreed with the importance of medical education at schools, whereas a few (6.1%) disagreed; 94.5% of the participants agreed to take part in raising community awareness, whereas only 5.5% disagreed.
Table 3: Possible means of spreading awareness to the community regarding hereditary blood diseases

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We asked the participants, “do you encourage the idea of the community to participate in raising awareness and does the media have a role in it?” Majority of the participants (94.5%) agreed to take part in raising community awareness regarding SCA and thalassemia, whereas only a few (5.5%) disagreed. Furthermore, 95.3% of the participants agreed on the importance of media in raising community awareness, whereas only 4.7% disagreed.


  Discussion Top


This study aimed to assess the knowledge and attitude of the population toward PMS, which became a mandatory screening program since 2004.

A total of 2,554 participants were enrolled in this study. More than half of the participants were females, which was the same number of participants included in the previous study conducted by Isah et al. in a nursing school in Sokoto, Nigeria.[9] The current study was mostly conducted on females as most of the data were collected from this group than the male population. In addition, they were more active and cooperative. Approximately 76% of the participants had received college or above college level, which reflects their good knowledge toward PMS. Half of the participants (50.4%) were married, as the most of them were of legal age (18–25).

Over two-thirds of the participants answered “yes” (61.3%) when asked about the possibility of PMS to diagnose SCD, whereas 50.2% believed that thalassemia can be diagnosed during screening. According to Precious et al., 84.83% of the participants from south Nigeria were aware of the role of PMC in SCD diagnosis.[10] In addition, a study conducted in the King Saud University indicated that most of the female students agreed on the importance of PMC.[11] A study was conducted by Mohamed et al. at El Minia University, Egypt, to assess the attitude of medical and nonmedical students regarding PMC. Results showed that 88.5% agreed on the importance of PMS.[12] Moreover, we noted a reduction in the number of participants who were married at a younger age with a better knowledge on the importance of PMS. The lack of knowledge was due to the insufficient provision of health education from government and nongovernment organizations.

When we asked the participants on the effects of PMC in decreasing the prevalence of both disorders, more than three-fourths of them think that screening will help decrease the number of SCD and thalassemia, suggesting a higher level of knowledge.

If PMS were elective, 63% of the population who received an intermediate or less intermediate level of education agreed to undergo PMS, whereas 90% of them who had received university education or higher than a university education agreed to undergo PMS [Figure 1]. This finding suggested that the participants' level of education influenced their decision to undergo the screening, that is, highly educated individuals are well aware of these blood-related diseases and the importance of PMS.
Figure 1: Relationship between education level and the reponse to premarital screening if it was elective

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Previous studies have shown various levels of awareness from different study participants. In a study conducted by Ibrahim et al. at the government outpatient clinics in Jeddah, they found that a vast majority of participants strongly agreed on the importance of PMS (96.0%).[13] However, in a study conducted by Hejri et al. (95.8%) at the Jazan University, participants strongly agreed on the importance of PMS as a preventive measure.[14]

Regarding the methods of spreading health awareness, majority of the population (95.9%) agreed that social media is the most important platform for providing health education and raising awareness. In the study conducted by Isah et al. in Sokoto, Nigeria, results showed that the participants learned about the different hereditary diseases in school (83.6%),[9] thus, school education was the preferred way to spread awareness. In the study conducted by Suwaid et al. in Qatif, KSA, 49.3% of the participants stated that magazines and brochures are helpful.[15] This finding indicated that various countries use different platforms in spreading health awareness. Thus, the current study showed all possible means to spread community awareness and emphasized on the role of social media in influencing the youth.


  Conclusion and Recommendations Top


As half of the study population still had no idea regarding the screened diseases, we recommended that further awareness regarding PMS is needed. Instead of spending, too much money on new transplant programs for blood diseases, more money, and efforts should be spent on assessing and spreading awareness of usage of PMS. Experts, authorities, and insurance companies should pay attention to take steps in implementation of PMS and prevention of producing new sickle cell-affected children.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Vos T, Flaxman AD, Naghavi. A systematic analysis for the Global Burden of Disease Study 2013. Lancet 1990-2013;386:743-800.  Back to cited text no. 1
    
2.
Rees DC, Williams TN, Gladwin MT. Sickle-cell disease. Lancet 2010;376:2018-31.  Back to cited text no. 2
[PUBMED]    
3.
Elzouki AY. Textbook of Clinical Pediatrics. 2nd ed. Berlin: Springer; 2012. p. 2950.  Back to cited text no. 3
    
4.
GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;385:117-71.  Back to cited text no. 4
[PUBMED]    
5.
Christopher J L Murray. A systematic analysis for the Global Burden of Disease Study 2013. Lancet 1990-2013;386:743-800.  Back to cited text no. 5
    
6.
What Are Thalassemias? NHLBI; 03 July, 2012. Available from: https://www.nhlbi.nih.gov/health-topics/thalassemias. [Last retrieved on 2016 Sep 05].  Back to cited text no. 6
    
7.
Kulkarni ML. Clinical Methods in Paediatrics. New Delhi, India: Jaypee Brothers Publishers; 2005. p. 21.  Back to cited text no. 7
    
8.
Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: A systematic analysis for the Global Burden of Disease Study. The Lancet 2013;385:117-71.  Back to cited text no. 8
    
9.
Isah BA, Yahaya M, Mohammed UK, Ibrahim MT, Awosan KJ, Yunusa EU. Knowledge and Attitude Regarding Premarital Screening for Sickle Cell Disease among Students of State School of Nursing, Sokoto. IMSEAR; 2016. p. 2-5.  Back to cited text no. 9
    
10.
Precious KG, Seiyefa FB, Best O. Knowledge, attitude and uptake of premarital screening for the sickle trait among married couples in a semi-urban community in South-South Nigeria. Eur J Prev Med 2015;3:49-54.  Back to cited text no. 10
    
11.
Khalil EM, Abdelkader SM, Alsaeed MD, Alshahrany NM. Knowledge, beliefs and behavior intention about premarital screening among King Saud University female students in Riyadh. SJAMS 2014;2:1797-805.  Back to cited text no. 11
    
12.
Mohamed H, Lamadah S, Hafez A. Improving knowledge and attitude of medical and non-medical students at El Minia University regarding premarital screening and counseling. Am J Nurs 2015;4:270-9.  Back to cited text no. 12
    
13.
Ibrahim NK, Bashawri J, Al Bar H, Al Ahmadi J, Al Bar A, Qadi M, et al. Premarital screening and genetic counseling program: Knowledge, attitude, and satisfaction of attendees of governmental outpatient clinics in Jeddah. J Infect Public Health 2013;6:41-54.  Back to cited text no. 13
[PUBMED]    
14.
Hejri Y, Moussa M, Al-Amri S, Al-Mutairi K, Al-Harbi A. Evaluating premarital screening knowledge in Saudi students. Int J Med Sci Public Health 2015;2:540-51.  Back to cited text no. 14
    
15.
Al-Suwaid H, Darwish M, Sabra A. Knowledge and misconceptions about sickle cell anemia and glucose-6-phosphate dehydrogenase deficiency among adult sickle cell anemia patients in Al-Qatif area (eastern KSA). Int J Med Sci Public Health 2015;5:86-92.  Back to cited text no. 15
    


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    Tables

  [Table 1], [Table 2], [Table 3]



 

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