Abstract
Keywords
3-Question-and-answer
Introduction
Hemoglobinopathies and different types of infectious diseases are common in many Arab countries and accounted to be as causes of morbidity and mortality globally.1-4 according to the World Health Organization (WHO), the carrier rates of major congenital diseases vary and common in the Eastern Mediterranean countries; alpha thalassemia (2-50%), beta thalassemia (2-7%) and sickle cell anemia (.3 and 30%). 5 The Centre for Arab Genomic Studies reported that SCA and thalassemia are 2 of the 906 genetic diseases, which are endemic to Arab countries. 6 in Yemen, the prevalence of sickle cell trait (Hb AS) and b-thalassemia trait is 2.2% and 4.4% with an estimated incidence of 20/10,000 and 11.3/10,000 of homozygous (Hb SS) and b-thalassemia respectively births.7-9 The consanguineous marriage is the main predictor and risk factor of genetic diseases,5,10 in the most Eastern Mediterranean countries the consanguinity rate is high and vary between 20-50%. 5 The prevalence of consanguineous marriages among Yemeni people is 40%, of them 58% between the first cousins; furthermore its rate is increasing in the last marriage groups. 11 The treatment of genetic and infectious diseases are expensive and lead to a considerable stress for patients and their relatives; in addition to economical burdens on the health system, so the premarital screening is the best intervention that would help in diseases controlling and prevention12,13 and thus the premarital screening is mandatory for prospective couples in in 8 Middle Eastern countries.1,14,15
To the best of our knowledge, no research study has been published addressing the knowledge and attitudes of engaged couples and recently married toward PMS and its consequences in Taiz. Knowledge and attitudes are the primary determinants that can help in reducing the incidence of inherited and infectious diseases. Thus, our community study is designed to elicit knowledge and attitude of engaged couples and recently married toward premarital screening and its consequences.
Materials and Methods
Study Design and Sampling: This is a cross-sectional study conducted from April to September 2021 in Taiz town, Yemen. 189 subjects were voluntary participated in this study. Taiz is one of the largest cities located in the central and southwestern of Yemen (44.01° E, 13.34° N), 280 km south of the capital Sana’a along the Red Sea coast overlooking the Bab Al-Mandab (about 1311 m above sea level). 16 This study including; design, setting, analyses and reporting, was in consistency to the guidelines of STROBE and criteria of the cross-sectional study. 17
Data Collection: A well-structured questionnaire was designed and then distributed to collect the data. This questionnaire was mainly divided into 3 parts; Part 1: socio-demographic data about the study subject including age, gender, educational level, marital status, and income level. Part 2: knowledge of the subject about the inherited and infectious diseases that are related to PMS as well his information sources about these diseases. Part 3: attitude of subject toward conducting screening for genetic and infectious diseases as well his attitude toward screening results.
Data Analysis: SPSS (version 21) software program was recruited for data analysis. Descriptive statistics were performed for to know the characteristics of the study participants. Independent-Samples T Tests were conducted to compare the variables between the male and female groups. One-Way ANOVA Tests were done to the variables with more than two-level. The Odds Ratios (ORs) was calculated to determine for knowledge and attitudes of respondents by gender.
Results
Socio-Demographic Characteristics of Study Subjects by Gender, Taiz, 2021.
Knowledge and Attitudes of Respondents About Diseases Related to Premarital Screening by Gender.
aAccept (Strongly agree + Agree) vs Refuse (Strongly Disagree + Disagree + not respond + Uncertain).
bFisher’s exact test.
Attitudes of the study respondents towards PMS for related diseases: The results revealed that the majority of the respondents from either males (74.29%- 82.86%) or females (61.34%-68.91%) appeared to have positive attitudes (accept) towards testing for all studied diseases except AIDs, where the majority of respondents (70% of males, 68.91% of females) appeared to have negative attitudes (refuse) for AIDs testing (Table 2
Sources of knowledge about inherited disease (Thalassemia and SCA): The knowledge of the respondents about the inherited disease (thalassemia and SCA) is coming from different sources shown in the Figure 1; it’s clear that the educational institutions are ranked on the top and were the main source knowledge about thalassemia and SCA for the majority with 22-21 (∼42.2%) out of 51 males and 67-63 (∼60.7%) out of 107 females. Family and friends were equally ranked and were the second source (∼19.6%) of males while only the family was the second source for females (∼14.5%), followed by the social media source (∼11.2%) of females. The social media was the fourth source for males (∼10.7%) while friend was the fourth source for females (∼10.3%). The health care providers and cultural-scientific journals were the last sources. Knowledge sources about inherited disease (Thalassemia and SCA) by gender.
Sources of knowledge about infectious diseases (Hepatitis B, Hepatitis C and AIDs): The knowledge of the respondents about the infectious diseases (Hepatitis B, Hepatitis C and AIDs) is coming from different sources shown in the Figure 2; it’s clear that the educational institutions are ranked on the top and were the main source knowledge about Hepatitis B, Hepatitis C and AIDs for the majority with 26, 24 and 29 (∼51.6%) out of 51 males and 69, 71 and 69 (∼65.1%) out of 107 females. Friend was the second source for males (∼24.2%) while the family was the second source for females (∼10.3%). The social media was the third source for males (∼10.4%) while the friends was the third source for females (∼8.4%). The family was fourth source for males (6.2%) while the social media was the fourth source for females (∼7.5%) The health care providers and cultural-scientific journals were the last sources. Knowledge sources about infectious disease (Hept. B, Hept. C and AIDs) by gender.
Attitude of the Respondents Regarding Consequences of Premarital Screening by Gender.
Note. PMS = Premarital Screening
The attitudes of the study subjects regarding the consequences of screening for infectious diseases are presented in a Table 3; the majority of bot males (65.71%) and females (73.11%) appeared to have a positive response regarding the importance of screening for the infectious diseases that lead to decrease the incidence of these diseases. The result showed that attitudes of males are equally oriented and to a less extent females as well regarding notify of their partners in case of the result of the testing for the infectious diseases is positive. The large proportion of females (61.34%) will notify their families if the result of the testing for the infectious diseases is positive, oppositely with a significant difference (P = .024), the large proportion of males (55.71%) will not notify. The results also revealed that the two-third of males (68.57%) will not feel with anxious or depression in case of positive results, oppositely with a significant difference (P = .004), the 53.78% of females will feel with that. Interestingly, less than half of males (44.29%) will disconnect with their families and others in case of positive results, while the large proportion of males (63.87%) will disconnect, with a significant difference (P = .010).
Discussion
This study investigated the knowledge and attitudes of engaged and recently get married couples towards the premarital screening for specific inherited and infectious diseases as well consequences of this screening. The awareness about reported inherited and infectious diseases were very high (83.60-94.18%) among study respondents. Females had significantly higher knowledge about the inherited (thalassemia and SCA) and infectious (hepatitis B and hepatitis C) diseases, only about AIDs there was no significantly difference among gender, at the same trend, a study was conducted at 2011 on Omani adults reported that the awareness towards SCA was high (83.8%) and was towards thalassemia (55.3%). 18 Our results were in a good agreement regarding awareness about thalassemia, where female’s awareness was higher than males, but oppositely to our result regarding awareness about SCA where Omani study indicated that male’s awareness was higher than females. 18 In 2017, a cross-sectional study on male Saudi (Jazan) was reported that 41.3% had an average knowledge about SCA, 41.3% had good knowledge and 17.4% of them had poor knowledge, 19 a reasonable level of knowledge about genetic diseases was reported among university students in Jeddah. 20 A survey among university students in Jordon showed that students had a lack of knowledge about PMS-related diseases, although they had an adequate knowledge about PMS itself. 21
The results revealed that the majority of the respondents either males (74.29%- 82.86%) or females (61.34%-68.91%) appeared to have positive attitudes (accept) towards testing for inherited diseases (Thalassemia and SCA) and infectious diseases (Hepatitis B and Hepatitis C), in contrast, the majority of respondents (70% of males, 68.91% of females) appeared to have negative attitudes (refuse) for AIDs testing, this may due to cultural and ethics aspects and highly cost-effectiveness. 22 Our study results also revealed that males had positive attitudes for thalassemia testing more than females with a significantly difference, while no difference between males and females regarding testing for the other inherited and infectious diseases. a Saudi studies reported that approximately 80% of the respondents would like to have PMS 23 and almost all unmarried female students (99.0%) agreed on the importance of PMS. 24 A more recent study among male Saudi (Jazan) showed that 95.2% of them favored of doing screening for SCA. 19 Syrian students had an overall positive attitude toward PMS, but in certain aspects they don’t. 25 According to the recent study, 87.8% of young Jordanian adults had a positive attitude toward premarital genetic screening.
Regarding the importance of PMS; the majority of the respondents agreed that screening reduces the incidence of the inherited and infectious diseases; this result is consistent with many previous studies conducted in Arab countries; in a cross-sectional study conducted on medical students of Sana’a university found that vast majority of the respondents (92%) believed that PMS is important and it reduces the inherited and sexually transmitted diseases, 26 A similar view has obtained from a Saudi study where 94.3% of the study subjects accept that PMS is an effective tool to prevent genetic diseases, 27 another Suadi study conducted on students of King Abdulaziz University (KAU) in Jeddah reported that 95% of them believed that PMS limit the spread of inherited disease, 28 another more recent Saudi study indicated that majority of participants (94% agreed that PMS reduces the incidence of some inherited diseases and sexually transmitted diseases 29 a similar result obtained from Oman studies that 90.3% of respondents aware the potential of PMS to limit the spread of inherited diseases, 18 and 94.3% of participants believed PMS to be important 30 as well 80% of subjects residing in UAE believed in the importance of genetic testing. 31 In fact, the effectiveness of PMS in term of reduction the diseases incidence have been reported in many countries including Turkey, Iran and Iraqi Kurdistan where decreasing in B-thalassemia birth was of approximately 90, 80, and 65% respectively. 32
Approximately half of the respondents tend to go ahead for marriage in case of positive results, this is in a good agreement to a study conducted among or unmarried female students in King Abdul-Aziz University, Jeddah, where 67.1% of students agreed that the marriage decision should be changed in case of positive results for genetic diseases 24 while approximately 15% of Jordanian respondents feel that the marriage should not be go ahead in case of the screening result for couple is positive. 21 According to the Jordanian studies; 23% of the students from multiple Jordanian universities 33 and 14.1% of young Jordanian adults 34 were willing to go ahead with marriage in case of positive results. The results our study also revealed that the two-third of males (68.57%) will not feel with anxious or depression in case of positive results, oppositely, more than half of females (56.3%-53.78) will feel with that. 55.71% of males prefer to persist to connect with their families and others if the result of infectious diseases screening is positive, on the contrary, 63.87% of females will not prefer. According to the study conducted on Omani adults, majority of them (83.8%) aware of psychological burden of inherited diseases on families. 18
Eight Middle Eastern countries legalized PMS as mandatory step for prospective couples.1,14,15 Making the PMS as an obligatory step prior engagement was accepted by 47.62% of our study respondents while this step was accepted 82% of medical students, 26 this difference my refer to the information acquired form their medical study. A Nigeria study reported that 81.9% of the respondents support the legalizing of premarital genetic counseling. 35 53% of Omani students. 18 90% of the participants 30 and majority (female 94.1%; male 85.4%) of medical students 36 agreed PMS should be obligatory. its noteworthy to mention to the importance of this study, further investigation including large sample size is recommended.
Conclusion
This study is addressing knowledge and attitude of engaged and recently married couples in Taiz toward premarital screening and its consequences, since knowledge and attitudes are the primary determinants that could help in reduction diseases incidence. In this study has been reported a high level of knowledge toward PMS and its related inherited and infectious diseases among respondents, in particular females, thereby indicating to the importance of education as it was a major source of knowledge. This knowledge reflected on majority of both gender who had positive attitudes toward PMS in term of willingness to do testing and on their well-belief about the importance of PMS in term of reduction of diseases incidence, as well reflected on half of the respondents mainly males who preferred to go ahead for marriage in case of positive results and accepted to make the PMS as an obligatory procedure prior engagement.
Footnotes
Acknowledgements
We would like to thank Aljanad University for Science and Technology Knowledge and attitude of engaged and recently married couples toward premarital screening: a cross-sectional study for providing the facilities to conduct this research
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Ethical Approval
Verbal and/or written consent were obtained from each participant after providing perfect explanation and promising to keep the information and answers confidentiality. Ethical approval (JustMed02/2021) was obtained from the Institutional Review Board (IRB), Faculty of Medical Sciences, Aljanad University of Science and Technology, Taiz, Yemen.
