Mandatory Premarital Screening Research Articles

Premarital Screening is Pivotal in Reducing the Births of Babies Affected with Thalassemia Major in Iraq

Thalassemia major is one of the health problems in Iraq, especially in Kurdistan. Pre-marriage mandatory preventive screening program was established in Kurdistan in 2008, which allowed us to study the prevalence of different hemoglobinopathies among newly married young adults in this region. A total of 1154 subjects (577 couples) attending the Koya district, premarital Health center, were screened using red cell indices. Those who had mean corpuscular volume (MCV)<80 fl and mean corpuscular hemoglobin (MCH)<27 pg had high-performance liquid chromatography and iron studies. Out of 1154 individuals that were evaluated, 183 (11.9%) had low MCV and MCH. Of the former 183 subjects, 69 (5.97%) had β-thalassemia trait, 10 (0.86%) had δβ-thalassemia trait, and no other hemoglobinopathies were recorded in our study. There was second-degree consanguinity in 4.7% of all 577 couples. In two couples, both partners had β-thalassemia trait and both were consanguineous. Both couples decided to separate after counseling. Based on the current study, the role of the premarital screening program in decreasing the number of new thalassemia major cases among the Kurdish population is laudable. Therefore, mandatory premarital screening is advised in all parts of Iraq.

Thalassemia prevention: Religious and cultural barriers to premarital screening in Bangladesh.

Thalassemia prevention: Religious and cultural barriers to premarital screening in Bangladesh.

Evaluation of the validity of the pre-marriage mean corpuscular volume value as a predictive test for b-thalassemia carrier status.

The national mandatory premarital screening test is based on mean corpuscular volume (MCV) > 80 fL value for the detection of β-thalassemia to provide acceptance for marriage. The objective of this study is to assess the efficacy of MCV as a screening test for β-thalassemia trait in the present population. This study was conducted on 418 blood samples collected from adult individuals. The diagnosis of β-thalassemia carrier was given to those having HbA2 values equal to or above 3.5%. The diagnostic reliability of different RBC indices and formulas in discriminating cases of β-thalassemia trait were evaluated. Finally, a new index called "Momani" was determined based on MCV, RDW and RBC count. β-thalassemia trait was identified in 10% of the cases. The measured MCV value was significantly lower in β-thalassemia carrier group compared to non-carrier group (p = <0.001). MCV value and RBC count showed a higher diagnostic reliability than other RBC indices. We found that MCV ≤ 74.45 fL is more suitable cutoff value of MCV with 86.2% specificity, 71.4% sensitivity, 36.6% positive predictive value, and 96.4% negative predictive value. Finally, our index "Momani" was found to be useful in predicting carrier and paralleled the performance of Sirdah, Mentzer, and Ehsani indices. MCV<80 is a useful but not a perfect cutoff point for the screening of β-thalassemia carriers from noncarriers. The diagnostic accuracy of MCV can be improved by selecting a new cutoff value. Moreover, "Momani" index shows good discrimination ability in diagnosing β-thalassemia carrier in our population.

Knowledge and Perception of and Attitude toward a Premarital Screening Program in Qatar: A Cross-Sectional Study.

Premarital screening (PMS) is a primary preventive measure to decrease the incidence of certain genetic disorders and sexually transmitted diseases. This study aimed to explore the knowledge and perception of and the attitude toward PMS and predictors of knowledge and attitude. A cross-sectional study was conducted among Qatar University students using an online survey. Multivariable regression analyses were used to identify factors associated with PMS knowledge and attitude. A total of 476 students participated in the study; 424 (89.1%) were females; two-thirds were 18–21 years old. Only 100 participants had heard about PMS. Knowledge of PMS was significantly associated with females, students enrolled in a health-related college, and non-consanguineous marriage of a participant’s parents. The majority of the participants agreed that genetic diseases are psychological and economic burdens. For attitude, only 178 participants were willing to cancel marriages, given incompatible PMS results. The following factors were positively associated with attitude: PMS knowledge, enrollment in a health-related college, and the belief that PMS does not interfere with destiny. Our study findings revealed that despite the mandatory PMS in Qatar, the study participants, future couples, had low knowledge about the program. Therefore, strategies to increase awareness of PMS should be considered toward improving its outcomes.

Hemoglobinopathies: An update on the prevalence trends in Southern Saudi Arabia.

Objectives:To investigate trends in hemoglobinopathies following the establishment of a mandatory premarital screening program (MPMSP) in the southern region of Saudi Arabia, where they are considered highly predominant.Methods:A retrospective analysis was performed on data from 32,130 high-performance liquid chromatography (HPLC) tests between November 2017 and October 2020. The data was obtained from the Hematology section, Laboratory Department, Armed Forces Hospital, Southern Region.Results:Despite the establishment of the MPMSP, our data showed that sickle cell disease remains a predominant hemoglobinopathy accounting for more than 7% of total tests in Southern Saudi Arabia. Observed HPLC hemoglobin fractions among the tested population showed a reduction in Hb A mean indicating a high rate of hemoglobin abnormalities. In addition, the prevalence of hemoglobin variants, including sickle cell and thalassemia, was higher in the younger population born after the MPMSP than in older subjects.Conclusion:Even with the implementation of the MPMSP, hemoglobin abnormalities remain prevalent in southern Saudi Arabia. A longer time frame is recommended to verify the validity of the program.

Determinants of Diagnostic and treatment delay among Thalassemia patients in Sialkot

Objectives: To find out determinants of diagnostic and treatment delay among patients with thalassemia major in Sialkot. Methods: A cross –sectional analytical study was conducted in Sundas Foundation, Sialkot, from April 2019 to July 2019. A total of 120 patients were selected by convenient sampling and data was collected through semi-structured, pre-tested questionnaire. Important determinants considered were age, gender, literacy of parents, previous knowledge of disease and first health care facility visited. Data was analysed on SPSS version 25.0 and presented in the form of tables and figures. Chi-Square test was applied to study relationships between diagnostic and treatment delays with sociodemographic profile and other factors. P- value &lt; 0.05 considered significant. Results: There was considerable delay of 30-180 days in diagnosis of thalassemia patients (37.5%), 42.7% patients diagnosed in less than 30 days. Treatment delay of 7-21 days in 18% patients seen, 71% started treatment within a week. 30-180 days delay in seeking medical care, was observed in 20.8% patients. Only 24.2%patients visited government health facility for medical care. First facility visited and delay in seeking medical care were significantly associated with diagnostic delay (p value 0.000 and 0.005 respectively). Only 16.7% had previous knowledge about thalassemia and 21.6% parents knew about legislation regarding mandatory pre-marital screening for thalassemia. Conclusion: Among important determinants, first health care facility visited and delay in seeking medical care had significant relationship with diagnostic delay. Better accessibility to healthcare facilities can overcome them. Key words: Diagnostic Delay, Treatment Delay, Thalassemia, Determinants How to cite: Zahra k,pervaiz A,Tabassum F,Sethi S,Khalid A;Determinants of diagnostic and treatment delay among thalassemia patients in Sialkot, Esculapio.2021;17(1);93-99

Study on Knowledge and Attitude Related to Inherited Genetic Disorders

Increased prevalence of inherited genetic disorders is a significant public health problem that significantly affects the quality of life of the affected patients and their families in Arab countries. Knowledge about the disorders may empower the community by raising awareness about prevention methods and early detection to reduce the incidence of genetic disorders. This study was aimed to assess the knowledge and attitude related to inherited genetic disorders among health science university students in Ras Al Khaimah. A cross-sectional study was carried out for six months among health science university students in Ras Al Khaimah by using a validated self-administered questionnaire. A total of 359 students completed the study. The overall mean knowledge and attitude scores of the study respondents were 4.47 ± 1.81 and 5.37 ± 2.32, respectively. One hundred and six (29.5%) respondents had adequate knowledge, and a majority (74.65%) of the respondents showed a positive attitude towards genetic disorders. Lectures (25.5%) followed by the internet (20.7%) and healthcare professionals (15.7%) were the most cited sources of information. Comprehensive knowledge about genetic disorders was found to be low despite positive attitude and awareness among respondents. Strengthening knowledge about genetic education and mandatory premarital screening programs may help in early detection and prevention and thereby reducing the incidence of genetic disorders.

Should Premarital Screening for Blood Disorders be an Obligatory Measure in Oman?

Due to the high rate of consanguineous marriages in Oman, there is a correspondingly high prevalence of hereditary blood disorders, particularly sickle cell disease and β-thalassaemia. This article proposes the possibility of implementing mandatory premarital carrier screening for blood disorders in Oman, while giving due consideration to potential social and cultural obstacles. Although the implementation of such legislation would require collaboration between different sectors and may negatively affect the autonomy of certain individuals, mandatory premarital screening would help to alleviate the burden of hereditary blood disorders on the national healthcare system, as well as reduce avoidable suffering among carriers and their families.

University Students' knowledge, attitudes, and practices towards the National Premarital Screening Program of Saudi Arabia.

There is an elevated rate of hereditary hemoglobinopathies in Arab populations. To address this, the Saudi government has implemented a mandatory premarital screening (PMS) program. Nevertheless, reports have shown that 48% of genetically incompatible partners have decided to marry. To address this, more information is needed on people's beliefs on these issues. To investigate the knowledge, attitudes, and practices of Taif University students towards the national PMS program. Using a questionnaire, a cross-sectional study was conducted during April-May 2016 on a random sample of university students in Taif City. It was administered electronically and primarily distributed through social media. Most participants (97.4%) were aware that genes may transmit hereditary diseases and had heard about the PMS program. Most participants who partook in the PMS justified it based on preventing disease transmission to their offspring and ensuring their partner's health. A fair number (82.9%) were willing to change their decision to marry in the case of receiving incompatible results. Moreover, the majority of the participants (91.8%) demanded the implementation of a law that prohibits incompatible marriages. Most Taif University students have a generally positive attitude and good intended practices toward PMS. However, targeted educational programs about the importance of PMS are strongly recommended to eliminate all factors that may affect the success of the PMS program.

Knowledge and Attitudes Toward Mandatory Premarital Screening Among University Students in North Jordan

A mandatory National Premarital Thalassemia Screening Program was implemented in Jordan in 2004. This cross-sectional study aimed to assess the knowledge and attitudes of university students in North Jordan toward this program. Data was collected from 542 students from four universities (two public and two private universities) located in North Jordan, using a structured questionnaire. Results of t-test and analysis of variance (ANOVA) showed that while respondents had adequate knowledge of and positive attitudes toward the premarital screening program, there was still a lack of knowledge about the disease itself. Nearly half the respondents were under the impression that β-thalassemia (β-thal) is a disease that can be treated simply. One-third of the respondents believed that if both partners were carriers of β-thal they should proceed with marriage. Negative attitude was revealed when many respondents believed that diagnosing a family member as a carrier affects other family members’ future marriage opportunities. Significant associations were detected between the knowledge scores and gender, urban/rural residence, and the university where the students were enrolled. Students in private universities showed significantly lower attitude scores. Consideration of prenatal diagnostic services as part of a β-thal prevention program is necessary. It would also be helpful to include information about β-thal as a preventable inherited illness with a severe debilitating impact on the family in the high school curriculum. There is also a need for social marketing of the program.

Arranging marriage; negotiating risk: genetics and society in Qatar

This paper considers how the globalized discourse of genetic risk in cousin marriage is shaped, informed and taken up in local moral worlds within the context of Qatar. This paper investigates the way Qataris are negotiating the discourse on genetics and risk. It is based on data from ongoing ethnographic research in Qatar and contributes to anthropological knowledge about this understudied country. Participants were ambivalent about genetic risks and often pointed to other theories of causation in relation to illness and disability. The discourse on genetic risk associated with marrying in the family was familiar, but for some participants the benefits of close marriage outweighed potential risks. Furthermore, the introduction of mandatory pre-marital screening gave participants confidence that risks were monitored and minimized.

Hemoglobinopathy Carrier Prevalence in The United Arab Emirates: First Analysis of The Dubai Health Authority Premarital Screening Program Results

The aim of this study was to determine the prevalence of hemoglobinopathy carriers in United Arab Emirates (UAE) nationals subjected to mandatory premarital screening in Dubai over a 4-year period. Data from UAE nationals who underwent premarital screening by the Dubai Health Authority between January 2007 and December 2010 were collected and analyzed. Premarital screening in Dubai is based on complete blood counts (CBC) and hemoglobin (Hb) high performance liquid chromatography (HPLC).Among the 6,420 UAE nationals screened, 8.5% (n = 545) were suspected to be carriers. The following carrier frequencies were observed: β-thalassemia (β-thal), 4.56% (n = 293); Hb S [β6(A3)Glu→Val, GAG>GTG; HBB: c.20A>T], 2.9% (n = 186); Hb D-Punjab [β121(GH4)Glu→Gln, GAA>CAA; HBB: c.364G>C], 0.78% (n = 50); Hb Lepore (δβ hybrid gene) with an undetermined molecular genotype, 0.17% (n = 11); Hb E [β26(B8)Glu→Lys, GAG>AAG; HBB: c.79G>A], 0.03% (n = 2); and hereditary persistence of fetal Hb (HPFH), 0.016% (n = 1). Hb E-Hb S and Hb E-β-thal also occurred at a rate of 0.016% (n = 1) each; and 0.87% (n = 56) subjects were suspected of carrying silent β-thal.The prevalence of β-thal trait was consistent with the prevalence published by others in the region. Silent β-thal is challenging for screening programs, and is expected to arise in populations with a high prevalence of β-thal carriers. The prevalence of Hb S trait observed in this study was lower than that in other reports for the region. New cases of β-thal major (β-TM) still arise because many fertile couples got married before the screening programs were implemented, and pregnancy termination is not widely practiced in the UAE due to religious restraints. Moreover, some couples choose not to have prenatal diagnosis (PND) or pre implantation genetic diagnosis (PGD), even if they are aware of their risk status.The prevalence of β-thal trait in the UAE is high. This justifies efforts to control the disease by holding regular community awareness and screening programs, performing premarital screening and genetic counseling, and making PND and PGD available to couples who request it.

Iranian national program for the prevention of thalassemia and prenatal diagnosis : mandatory premarital screening and legal medical abortion

Iranian national program for the prevention of thalassemia and prenatal diagnosis : mandatory premarital screening and legal medical abortion

Genetic Counseling for Thalassemia in the Islamic Republic of Iran

The response of groups to pressing medical problems cannot be predicted on theoretical grounds. An example is the program for the control of beta-thalassemia in Iran, a country with a tradition of inbreeding and a conservative religious culture, and in which thalassemia is common. Thalassemia is largely treatable, but the treatment is lifelong and onerous and creates a serious economic burden for the individual family and for the national health budget. The genetics are simple, and inexpensive screening tests are available to identify carriers. An Iranian program requiring mandatory premarital screening was started in 1997, and between 1998 and 2005 the laws of the country were modified to permit abortion of affected fetuses. The story of this effort indicates how a country with a social system very different from that of the United States responded to a medical problem with significant ethical overtones. The Iranian experience supports the optimistic view that societies can react to pressing problems with pragmatic rather than theoretical solutions.

Jordan: Communities and Community Genetics

The population in Jordan mounted from half a million in 1952 to 5.3 millions in 2004 and is composed of a variety of ethnic groups, the majority being Arabs. Couples nowadays tend to have fewer children, with the total fertility rate falling from 7.4 in 1976 to 3.7 in 2004. Consanguineous marriages are traditionally favored, with the preferred marriage partner being the offspring of the father’s brother. First-cousin marriages declined from 28.5% for marriages contracted between 1950 and 1979 to 19.5% for marriages contracted after 1980. In the overall population, carrier rates for β-thalassemia, α-thalassemia and sickle cell anemia are in the range of 2–4%, 3.2–12% of males have glucose-6-phosphate dehydrogenase deficiency, and the prevalences for familial Mediterranean fever and cystic fibrosis were estimated at around 0.04% each. A mandatory premarital screening program for β-thalassemia carriers commenced in June 2004. The high consanguinity rate and the large family size in Jordan have contributed to the description of a number of rare and new autosomal recessive conditions. Genetic services in Jordan are still scarce and do not cover all the country due to the major impediments of a paucity of resources and trained health professionals in the area of medical genetics. The demographic data suggest that the health system in Jordan is capable of introducing some basic community genetic services into the primary health care program through comprehensive and cost-effective programs.

Premarital screening for antibodies to human immunodeficiency virus type 1 in the United States. The Premarital Screening Study Group.

To evaluate premarital human immunodeficiency virus (HIV) screening as an approach to AIDS prevention in the United States, we determined the HIV antibody seroprevalence in marriage license applicants in eight areas by blinded testing of blood specimens routinely collected for syphilis serology. The seroprevalences were 0.0-0.4 percent in women and 0.0-1.1 percent in men. We also examined the impact of mandatory premarital HIV screening on marriage rates in Louisiana and Illinois. In 1988, after screening began, 9 percent and 16 percent fewer marriage licenses than in the previous two years were issued in Louisiana and Illinois, respectively. We estimated that mandatory premarital screening, if adopted nationally, would cost $167,230,000. We conclude that compared with other HIV prevention programs mandatory premarital screening would be expensive and would probably have a minor impact on the HIV epidemic.

Mandatory Premarital HIV Testing: The Illinois Experience

To the Editor.— The June 16, 1989, issue of JAMA carried two important reports on premarital blood testing for AIDS: an analysis of 6 months' experience with mandatory testing in Illinois 1 and an editorial by the health commissioner of New York City. 2 In Illinois, only 8 (0.011%) seropositive individuals were identified out of 70 846 applicants for marriage licenses during January through June 1988 at an estimated cost of $2.5 million, or $312 500 per HIV-positive person. In New York City, mandatory premarital screening for HIV was rejected as an ineffective use of public resources. The point of this communication is to note that in the case of premarital blood testing there has never been a defensible basis for mandatory premarital testing for sexually transmitted diseases, which now include AIDS. In 1947 Nels A. Nelson, then director of the Bureau of Venereal Diseases, Baltimore City Health Department, 3

Mandatory Premarital HIV Testing: The Illinois Experience-Reply

In Reply. — These reactions to our article on mandatory premarital testing for HIV by Drs Dykers, Silverman, and Stemp reflect widely varying approaches to establishing public policy that will maximally prevent and control further spread of this disease. The goals of mandatory premarital screening for HIV are the same as those listed by Dr Silverman for premarital syphilis screening. The effective screening program is, therefore, the one that best achieves those goals. The first of these goals, the identification and prevention of cases of infection, has already been discussed in our article. Screening other, comparable populations would identify significantly more individuals. While the seroprevalence rate for marriage license applicants was 0.02% during the first 18 months of the requirement, this is significantly lower than the 0.09% observed among childbearing women in Illinois, the 0.26% observed among clients of family planning clinics, and the 2.73% among clients of sexually transmitted

The Suitability of HIV-Positive Individuals for Marriage and Pregnancy

To the Editor. — It is regrettable that in an otherwise thorough and thoughtful analysis of heterosexual transmission of human immunodeficiency virus (HIV) that Drs Haverkos and Edelman 1 conclude with incautiously worded comments on the future course of public debate and policy. They state that societies may soon have to wrestle with many difficult questions, including the suitability of infected individuals for marriage and natural parenthood. The question of whether to mandate premarital screening for HIV infection has been debated in state legislatures across the nation. In virtually all cases, public health officials have argued that given the epidemiology of HIV disease, the patterns of sexual behavior in America, and the social costs of widespreadscreening, such an approach to prevention would represent a misguided effort. In Louisiana, a one-year trial of mandatory premarital screening has been ended. Whatever the justification for requiring testing so that potential marriage partners might

Compulsory Premarital Screening for the Human Immunodeficiency Virus

The effectiveness of a mandatory premarital screening program was examined as a means of curtailing the spread of the human immunodeficiency virus (HIV) infection in the United States. The epidemiology of the HIV, the technical characteristics of tests for antibodies to HIV, and the logistic, economic, and legal implications of such a program were considered. In one year, universal premarital screening in the United States currently would detect fewer than one tenth of 1% of HIV-infected individuals at a cost of substantially more than +100 million. More than 100 infected individuals would be told that they were probably not infected, and there would likely be more than 350 false-positive results. Public education, counseling of individuals, and discretionary testing can be important tools in reducing the spread of HIV infection, but mandatory premarital screening in a population with a low prevalence of infection is a relatively ineffective and inefficient use of resources.