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

CHAPter one

INTRODUCTION

1.1 background of the Study

Complications of genetically wrong marriages continues to be a major global issue that presents major challenges to the health care systems. The most interesting part is that this complication is preventable, if appropriate precautions such as screening are taken in time (Abdulbari et al., 2019). Therefore non-adherence to pre-marital screening have been evidence in increasing rate of persons with sickle cell anaemia condition, which may pose significant burden on couple and their offspring, society, individuals, and future generations (Al-Odabi et al., 2017). Therefore, premarital health screening is crucial in identifying potential health risks for couples intending to get married. Nowadays premarital screening is one of the most important strategies for prevention of genetic disorders, congenital anomalies and several medical, psychological marital problems (Ademiju & Gundu, 2019).

Pre-marital genotypes screening could be define as test in which intending couples undergo while preparing for their conjugal ceremony, in other to be aware about individual genotype. Also other screening could also be under gone such as infectious and blood transmitted diseases to prevent any risk of transmitting any disease to their children (Abdel-Meguid et al., 2018). However the importance of genotype screening above other is significance in that, it effects go beyond the marriage or this generation. Thus, premarital genotype screening and counseling has become a part of marriage course and regular medical practice since it is aimed at achieving desired level of awareness and change in attitude. However, this is not always the case as many people go into marriage without having insight about their gene composition especially in developing countries where diagnosis is usually made when the individual presents in the clinic with severe complications, (Akinyanju, 2018). Yet, undertaking premarital genotypic screening and counseling may depend on individual’s knowledge of sickle cell disorder, which may resultantly contribute to individual perception and acceptance of the screening.

Knowledge about premarital sickle cell screening can be gained through information from educational programmes. This could be through establishment of a health awareness program that focuses on explaining the benefits of premarital screening to the public and increase their awareness on the serious consequences of genetic disorders associated with non-adherence. Also, perception towards premarital sickle cell screening can be dynamic elements in human behaviour and can be positive or negative. People who have positive perception about the benefits associated with premarital screening may like to accept premarital screening. According to Lockock and Joe (2019) perception of individual may affect their acceptance of premarital screening. However, increasing rate of people with genotype disorder is alarming in recent times.

According to the Faremi et al., (2018), approximately 240 million people are carriers of these disorders and at least 200,000 affected individuals are born annually; approximately equally divided between sickle cell anemia and thalassemia Nigeria has an estimated population annual growth rate of 3.2% (Afolayan & Jolayemi, 2019). The current figure of individuals in Nigeria with this disorder is not known since the majority born in rural community does not survive childhood and the cause of death is poorly documented. However, approximately 2.3% of the Nigerian population suffers from sickle cell disorder and about 25% of Nigerians are healthy carriers of the abnormal hemoglobin gene (Afolayan & Jolayemi, 2019). Agofure and Danzaria, (2020) was also of the view that SCD is a global health problem with psychosocial implications and Nigeria has the largest population of people with SCD with about 150,000 births annually. Although over 300,000 babies are born worldwide with SCD, this is common mostly in low-income countries (Ameen et al., 2022).

The fact that the victims of this genetic disorder suffer as a result of the ignorance, negative perception of their parents makes it quite pathetic. According to Damilola (2017), anyone who has ever witnessed the great anguish that an individual with sickle cell anaemia goes through during a period of crisis will definitely not need the eloquence of a preacher before reconsidering taking genotype incompatibility as one of the numerous risks of life. Even many religious organizations are currently requesting would-be-couples to conduct pre-marital genotype test (Eshetu, 2017). It is believed that marriage between two carriers of the Sickle Cell trait (HbAS) could only be described as an irrational plunge into troubles and as such, the couple risks the tendency to produce children with sickle cell anaemia in every of four child/children that they bear (Eshra, Dongham et al., 2019). According to Eshetu, (2017), Mendelian’s principles of inheritance, there is the tendency that two people who are carries could give birth to a sickle cell anaemia child/children. The couple could even have all their children with sickle cell anaemia irrespective of how many (Damilola, 2017).

Yet, the recognition of genetic disorders as an important public health issue is necessary to ensure that young people are aware of such diseases and how premarital health screening could assist them to avoid incompatibility. It is against this backdrop this study will examine Perception and acceptance of pre-marital genotypes screening among intending couples towards the prevention of sickle cell disease in 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, 2017). 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 condition is 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 awareness and 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 perception and acceptance of pre-marital genotypes screening among intending couples towards the prevention of sickle cell disease in Lagos State.

The specific Objectives of the study include to:

1. Assess the knowledge of intending couples on sickle cell disease in Lagos State

2. Examine the perception of intending couples towards sickle cell disease in Lagos State

3. Determine the acceptance of sickle cell disease prevention among couples in Lagos State.

1.4 research Questions

1. What is the level of knowledge of intending couples on sickle cell disease in Lagos State ?

2. What is the perception of intending couples towards sickle cell disease in Lagos State?

3. What is level of acceptance of sickle cell disease prevention among couples in Lagos State?

1.5 research Hypotheses

1. There is no significant relationship between level of knowledge and acceptance of Premarital Genotype Screening towards Sickle-Cell Diseases among intending couples in Lagos State

2. There is no significant relationship between level of perception and acceptance of Premarital Genotype Screening towards Sickle-Cell Diseases among intending couples in 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.