PERCEPTION AND ACCEPTANCE OF PRE-MARITAL GENOTYPES SCREENING AMONG INTENDING COUPLES TOWARDS THE PREVENTION OF SICKLE CELL DISEASE

CHAPter one

INTRODUCTION

1.1 background of the Study

Sickle cell disease (SCD) is one of the most prevalent genetic disorders globally, characterized by abnormal hemoglobin structure leading to chronic anemia, vaso-occlusive crises, and organ damage. The prevention of SCD through premarital genotype screening and counseling is a vital public health strategy to reduce its burden. This study examines the perception and acceptance of premarital genotype screening among intending couples in Egbeda community, Alimosho, Lagos State, Nigeria.

Globally, SCD is recognized as a significant public health concern. Approximately 300,000 infants are born annually with SCD, with the highest prevalence seen in malaria-endemic regions due to the protective advantage of the sickle cell trait against malaria. The disease predominantly affects individuals of African, Mediterranean, Middle Eastern, and Indian descent, with over 75% of global cases occurring in Africa (Piel et al., 2023). Advances in healthcare have reduced mortality rates in developed countries, but the disease remains life-threatening in resource-limited settings.

In developed countries, comprehensive newborn screening programs and advanced medical care have significantly improved the life expectancy of individuals with SCD, often extending beyond 50 years (Grosse et al., 2021). However, in developing countries, limited healthcare infrastructure, inadequate public awareness, and cultural beliefs hinder effective prevention and management of SCD. For instance, in some African nations, newborn screening coverage remains below 10%, leading to delayed diagnosis and high mortality in the first five years of life (McGann et al., 2021). Africa bears the heaviest burden of SCD, with approximately 240,000 newborns affected annually. Nigeria accounts for nearly half of these cases, with a carrier prevalence of 20%-30% and an estimated 150,000 annual births of children with SCD (Nnodu et al., 2021). Despite these figures, the adoption of preventive measures such as premarital genotype screening remains inconsistent due to socio-cultural factors, limited access to testing facilities, and financial constraints.

Sub-Saharan Africa accounts for 75% of the global burden of SCD, with significant variations across countries. The high prevalence of the sickle cell trait, ranging between 10%-40%, highlights the urgent need for targeted interventions, including public awareness campaigns and policy-driven premarital screening programs (Makani et al., 2021). In many communities, cultural resistance and misconceptions about genetic testing hinder the widespread adoption of preventive measures.

Nigeria has the highest burden of SCD globally, with approximately 25% of the population carrying the sickle cell trait (HbAS) and over 100,000 annual births of children with SCD. Despite governmental efforts to promote premarital genotype screening, the practice remains low, particularly in rural and semi-urban areas (Nwogoh et al., 2020). Religious and cultural beliefs, stigma, and inadequate healthcare policies significantly affect the perception and acceptance of premarital screening programs.

In Lagos State, the prevalence of the sickle cell trait aligns with national statistics, with a significant proportion of the population unaware of their genetic status. Alimosho, being one of the largest local government areas in Lagos State, exhibits diverse socio-cultural dynamics that influence health-seeking behavior. In Egbeda community, traditional beliefs, limited awareness of SCD, and inadequate healthcare facilities further complicate the uptake of premarital genotype screening. Addressing these challenges requires tailored public health strategies, community engagement, and effective sensitization campaigns to improve the perception and acceptance of genetic counseling and screening among intending couples.

Hence its on this note the researcher tend to assess the Perception and Acceptance of Pre-Marital Genotypes Screening among Intending Couples towards the Prevention of Sickle Cell Disease in Egbeda community in Alimosho Local Government Area, Lagos State

1.2 Statement of the Problems

In recent times, pre-marital genotypes screening has become a very crucial indicator for people considering marriage, as many people with mismatched gene type who got married without due consideration, end up having children with various genetic disorder such as Sickle Cell condition with high cost of maintenance. Thus, many of such marriages with the aforementioned problems may not stand the test of time (Adesina et al., 2022; Damilola, 2022). Therefore, it has become prevalent for intending couples to conduct premarital health screening as part of their marriage plans to avoid the mistakes of earlier generations.

Although pre-marital genotypes screening programs has a high potential to reduce the incidence of various genetic disorders in an adult population and preventing marriages among high-risk couples. Yet, many people do not accept it (Eshetu, 2019). Al- kindi et al., (2018), stated that despite current advances in diagnosis and the increasing campaigns through mass media and health professionals which were designed to increase intending couple’s knowledge about premarital screening with a view to improving perception and attitude of the people towards a drop in high-risk marriages. In spite of these efforts, sickle cell conditionis still very common in our society. In addition, non-acceptance of premarital sickle cell screening before marriage can lead to birth of children with the disorder, separation and divorce among parents, frequent going in and out of the hospital, and infant mortality and morbidity.

In comparison with other chronic diseases, Adeyemo et al., (2021) opines that, genetic disorders remain one of the least understood and puzzling medical conditions by health care workers and the general public. Yet, most researcher in his field have focused mostly on awarenessand socio-economic factors of people on specific genetic disorder such as sickle cell anaemia, with little or no attention to other aspect like individual perception as determinant to accept the screening. This study will therefore fill the gap left in study by examining perception and acceptance of pre-marital genotypes screening among intending couples towards the prevention of sickle cell disease in Lagos State.

1.3 Objective of the study

The broad objective of this study is to examine the perception and acceptance of pre-marital genotypes screening among intending couples towards the prevention of sickle cell disease in Egbeda community, Alimosho LGA, Lagos State.

The specific Objectives of the study include to:

1. Assess the knowledge of intending couples towards the prevention of sickle cell disease in Egbeda community, Alimosho LGA, Lagos State.

2. Assess the perception of intending couples towards the prevention of sickle cell disease in Egbeda community, Alimosho LGA, Lagos State.

3. Determine the acceptance of intending couples towards the prevention of sickle cell disease in Egbeda community, Alimosho LGA, Lagos State.

research Questions

1. What is the knowledge level of intending couples towards the prevention of sickle cell disease in Egbeda community, Alimosho LGA, Lagos State.

2. What is the perception of intending couples towards the prevention of sickle cell disease in Egbeda community, Alimosho LGA, Lagos State.

3. What is the acceptance level of intending couples towards measures aimed at preventing sickle cell disease in Egbeda community, Alimosho LGA, Lagos State.

1.5 research Hypotheses

There is no significant knowledge level of intending couples towards the prevention of sickle cell disease in Egbeda community, Alimosho LGA, Lagos State.

There is no significant perception or acceptance level of intending couples towards the prevention of sickle cell disease in Egbeda community, Alimosho LGA, Lagos State.

1.6 significance of the Study

The study will help to provide information to the government, religious leaders, Judiciary and health care providers on the level of perception of intending couples towards premarital genotype screening such that would be needed for premarital counselling. The information provided will serve as tools to healthcare providers in identifying areas of interventions, which will strengthen their campaign strategies in other to health educate the unmarried about the importance of the counselling. Government and Judiciary through the information to make needed policies to emphasized premarital screening before marriage and post marital counselling. Information gathered will help to reduce the stigma and fear attached to diseases associated with genetic diseases such as sickle cell anaemia thus enhance adherence of couples to screening before marriage. Findings from this study will be useful to health educators, counselors and policy makers as it will provide the relationship between attitude and perception of intending couples towards pre-marital screening, such information will be used as a guide in health education campaigns and programs. Furthermore, the findings will also serve as a point of reference for future studies.