Barriers to Premarital Thalassemia Screening in Asia

Abstract

Thalassemia is a genetic disorder of hemoglobin synthesis. Every year 70,000 infants are born with beta thalassemia globally. Its incidence can be reduced by premarital thalassemia screening This review aims to focus on barriers to premarital thalassemia screening and to observe the current thalassemia practices in Asian countries. This study was conducted on six countries of Asia based on economic status according to World Bank criteria. High income states included Kingdom of Saudi Arabia, and Oman, Iran constituted an upper middle-income country and in lower middle-income category Sri Lanka, Pakistan and Bangladesh were considered. Search engines like PubMed, Research Gate and Google scholar were used to look for relevant articles from 2005 to 2019. A total of (89) articles were reviewed and (61) articles were finally selected to be included in this review. In Saudi Arabia, major obstacles for premarital thalassemia screening included planned weddings (43%), fear of social disgrace (21%), pressure from family (17%), and religious factors (14%). While in Oman, 4% of the people feared positive results and also considered it as an insult. Amongst the Iranian population, financial burden on couples, disease phobia, fear of positive results, difficulty in accessibility, tribal variances and sociodemographic factors were frequent hindrances to a screening program. Religious factors, financial constraint and lack of awareness cause reluctance in Pakistan and Bangladesh. Moreover, in Sri Lanka, factors like cancellation of marriage and sociocultural norms were identified as negative outcomes of the screening. In conclusion, a negative attitude and reluctant response to premarital thalassemia screening was observed in people belonging to all the countries included. Major contributing factors were religious misconceptions, social stigma, varying ethnicities, low financial status and poor accessibility to screening programs. Key words: Beta thalassemia, thalassemia screening, premarital screening, consanguineous marriage, social impact