AWARENESS AND ACCEPTANCE OF PREMARITAL GENOTYPE SCREENING AMONG STUDENTS

1.1 Introduction

Premarital genotype screening presents an opportunity for individuals to become informed about their genetic predisposition to diseases and for couples to be aware of the possible genetic characteristics of their unborn children. Hence, if one holds the view that one of the reasons for marriage is procreation, then worrying about genetic compatibility and avoiding genetic inheritance of grave consequence becomes something to strongly consider. The most common genetic diseases include sickle cell disease, cystic fibrosis and Tay-Sach’s disease of which sickle cell disease is the commonest (Abd-Al-Azeem, 2011). Premarital screening consists of a comprehensive group of test, especially for those who are planning to get married.

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Limitations of the Study and Definition of technical terms.

1.2 Background of Study

Premarital sickle cell screening/testing has been defined by different people in different ways, Littleton and Engebretson (2010), see it as a process for screening couples going into marriage for genetic and blood transmitted diseases to prevent any risk of transmitting diseases to their children. Gharaibe and Mater (2009), see it as an important tool used by intending couples to control, minimize and prevent sickle cell disorders. Invariably sickle cell testing serves as a tool for diagnosis of SCD, it also provides individual couples with an accurate understanding of sickle cell inheritance and what it means to be at risk. In addition, information about premarital sickle cell screening and counseling has become part of marriage course counseling and regular medical practice. It has also helped to achieve desired level of knowledge and a change in attitude. However, this is not always the case as many people go into marriage without having insight into their genotype especially in developing countries where diagnosis is usually made when the individual presents in the clinic with severe complications, (Akinyanju, 2009). Undertaking premarital sickle cell screening and counseling may depend on individual’s knowledge of sickle cell disorder.

The prevalence of genetic disease is becoming higher, in the society, creating more stress despite the difficulties the people encounter in life. Methods of preventing genetic disease include premarital screening and genetic counseling, prenatal diagnosis, preconception diagnosis and implantation of normal embryos after in vitro fertilization and in vitro therapy using stem cell transplantation (WHO, 2006). Prevention of the disease through carrier identification and genetic counseling remains the only realistic approach to reduce the impact of the disease and allow better use of available resources in the low income countries where the condition is most prevalent (WHO, 2006).

According to WHO (2006) report, 5% of the world population carries genes responsible for haemoglobinopathies and that Sickle cell anaemia is particularly common among people whose ancestors comes from sub-Saharan Africa, India, and Saudi Arabia and Mediterranean countries. Further, over 300,000 babies are born worldwide with sickle cell disease mostly in low and middle income countries, with the majority of these births in Africa2. Sickle cell disease is one of the commonest genetic disorder in Nigeria, about 24% of the population are carriers of the mutant gene and prevalence (at birth) is 2% i.e. 15,000 children are born with sickle cell disease genotype annually in Nigeria alone (WHO, 2006).

Sickle cell disease contributes to the equivalent of 5% of under five deaths on the African continent, more than 9% of such deaths in west Africa and up to 16% of under five deaths in individual West Africa countries (WHO, 2005), Haemoglobinopathies are mainly public health problems worldwide, according to WHO, approximately 240 million people are carriers of genetic disease and at least 200,000 affected individuals are born annually (Annie et al., 2010).

With the increasing prevalence of genetic diseases in developing countries e.g. Nigeria, there is the need to evaluate the level of awareness and acceptance of premarital genotype screening a way of reducing and/or preventing the occurrence of genetic diseases especially sickle cell disease.

Nigeria has the highest number of sickle cell disease (a genetic disease) in the world with prevalence found to be 10 persons with sickle cell disease per 1000 population (Egbochukwu et al., 2002).

With the increasing prevalence of genetic diseases in developing countries e.g. Nigeria, there is the need to evaluate the level of awareness and acceptance of premarital genotype screening a way of reducing and/or preventing the occurrence of genetic diseases especially sickle cell disease.

Most youths today are either unmarried or intending to get married and will procreate in the future. This group of persons are the target population who will benefit from appropriate interventions aimed at preventing and/or controlling genetic disease especially sickle cell disease. Thus, there is a need to assess their awareness and level of acceptability of premarital genotype screening so as to direct interventions in reducing the reproductive risk of genetic diseases, thereby contributing to a decrease in the prevalence of genetic diseases in Nigeria.

1.3 Statement of Problems

Despite current advances in diagnosis and the increasing campaigns through mass media and health professionals all are supposed to increase people’s knowledge about premarital sickle cell counseling and screening with a view to causing a drop in high risk marriages. In spite of these efforts, sickle cell diseases are still very common in our society. In addition, Non-Acceptance to premarital sickle cell screening before marriage can lead to birth of a child with the disorder, separation and divorce among parents, frequent going in and out of the hospital, and infant mortality and morbidity (Al-kindi, Salha & Al kendi, 2012).

Their believe was that if intending couples were favourably disposed to do premarital screening, it will help in the detection of carriers of sickle cell trait and prevent birth of an affected offspring. Although premarital sickle cell screening programs has a high potential to reduce the incidence of SCD in an adult population and preventing marriages among high risk couples, many people do not adhere to it. The question being raised in this study is; what knowledge does an adult students of ESUT have about premarital sickle cell screening, what is their attitude towards premarital sickle cell is screening (Al-kindi, Salha & Al kendi, 2012).

1.4 Aim and Objectives of Study

The aim of the study is to examine the Awareness and Acceptance of Premarital Genotype Screening among Students in ESUT. In achieving this aim, the following objectives were set out as follows:

1. Assess the attitude of married and unmarried adult students in ESUT in Enugu State towards premarital sickle cell screening.
2. Identify adult unmarried students of ESUT in Enugu State that are willing to go for premarital sickle cell screening.
3. Determine knowledge of premarital sickle cell screening among married and unmarried adult students in ESUT in Enugu State.
4. Ascertain adult married students that adhered to premarital sickle cell screening before marriage

1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• Are you aware of genetic disease?
• What is genetic disease?
• What is the cause of genetic disease?
• Do you know anybody with a genetic like sickle cell anemia?
• Have you heard about genotype?
• Do you know your genotype?
• Have you ever heard of premarital genotype screening?
• What is premarital genotype screening?
• Do you think premarital genotype screening is necessary?
• Do you believe that premarital genotype screening can help in the prevention of genetic disease?

1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

• H0: There is no significant difference between the awareness of premarital genotype screening and the acceptance of premarital genotype screening.
• H1: There is significant difference between the awareness of premarital genotype screening and the acceptance of premarital genotype screening.

1.7 Significance of Study

The study will help to provide information to the Government and health care providers on the level of Awareness and acceptance of students of ESUT, to premarital sickle cell screening, and some of the reasons that hinders them from adhering to premarital sickle cell screening despite the benefits associated with it.

The information provided will serve as tools to healthcare providers in identifying areas of need, if findings shows low level of knowledge, appropriate measures will be devised to strengthen their enlighten campaign in other to health educate them on the importance of the screening. Government will through the information institute policies guiding couples on premarital screening before marriage.

Findings from this study will be useful to health educators, counselors and policy makers as it will provide the relationship between knowledge, attitude and Acceptance to premarital sickle cell 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. Beside, the study will serve as reference material for subsequent researcher in the field or related topics.

1.8 Scope of Study

The study focuses on the Awareness and Acceptance of Premarital Genotype Screening among Students of Enugu State University of Technology (ESUT).

1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Establishment Policies: Establishment policies posed a serious limitation as most staffs are not ready to release information needed for this project work. There were lots of information needed from the staffs of this institution to enhance the study which took them time to release or they did not release at all for security purposes, hence the scope was reduced.
3. Research material: availability of research material is a major setback to the scope of the study.
4. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
5. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

1.10 Definition of Terms

Premarital sickle cell screening: It signifies the test done by adult male and female students of ESUT in order to know their status on the sickle cell genetic trait before going into marriage.