Feasibility of and barriers to thalassemia screening in migrant populations: a cross-sectional study of Myanmar and Cambodian migrants in Thailand

Julia Z Xu,Vip Viprakasit,Supachai Ekwattanakit,Suchada Riolueang,Thidarat Suksangpleng,Wilaslak Tanongsaksakul,Marilyn J Telen

doi:10.1186/s12889-021-11059-2

Abstract

BackgroundThalassemia, an inherited hemoglobin disorder, has become a global public health problem due to population migration. Evidence-based strategies for thalassemia prevention in migrants are lacking. We characterized barriers to thalassemia screening and the burden of thalassemia in migrant workers in Thailand.MethodsMultilingual demographic and KAP surveys were completed by 197 Thai, 119 Myanmar, and 176 Cambodian adults residing in Thailand. Thalassemia awareness, socio-demographic predictors, and knowledge and attitude scores were compared between migrant and Thai subjects. Comprehensive thalassemia testing was performed for migrants.ResultsMigrants had extremely poor thalassemia awareness (4.1%) compared to Thai subjects (79.6%) and had lower thalassemia knowledge scores but similar attitude scores. Surveys identified differing sociodemographic factors predicting awareness in Thai and migrant subjects, as well as key misconceptions likely to hinder thalassemia screening uptake. Nearly all migrants consented to thalassemia testing. We identified abnormal hemoglobin profiles in 52.7% of migrants and a higher projected rate of severe thalassemia births in migrants.ConclusionsThe high burden of thalassemia and tremendous knowledge gap in migrants needs urgent attention. Thalassemia screening was feasible and acceptable in our migrant population. Sociocultural and structural barriers merit further attention when designing thalassemia screening and prevention policies for migrants in Thailand and globally.

Highlights

Thalassemia, an inherited hemoglobin disorder, has become a global public health problem due to population migration
In this study, we developed a knowledge, attitudes, and practices (KAP) survey focused on thalassemia screening and validated the survey in healthy Myanmar, Cambodian, and Thai populations
We offered comprehensive thalassemia testing to all migrant subjects and found that thalassemia is prevalent among Myanmar and Cambodian migrants and that most migrants were willing to undergo thalassemia screening

Summary

Introduction

Thalassemia, an inherited hemoglobin disorder, has become a global public health problem due to population migration. Thailand is one of the few SEA countries with effective severe thalassemia prevention and control policies, focusing on public education, prenatal screening, and prenatal diagnosis. This has led to a decreased incidence of severe thalassemia syndromes, including Hb Bart’s hydrops fetalis [11]. Thailand’s relatively prosperous and stable economy has encouraged increasing migration from neighboring countries, with 2.4 million migrant workers from Myanmar, Cambodia, and Laos [12, 13] These three neighboring countries are estimated to have a high prevalence of thalassemia and Hb E (Table 1).

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Discussion

Conclusion