Sickle cell knowledge, premarital screening and marital decisions among local government workers in Ile-Ife, Nigeria

Background: In Nigeria; as in the rest of equatorial Africa; sickle cell disease (SCD) has its highest incidence and continues to cause high morbidity and early death. The condition is a major public health problem among the black race. The aim of this survey is to determine the level of knowledge about SCD and the factors associated with its prevention among local government workers in Ile- Ife. Methods: This is a cross-sectional descriptive study of the knowledge about SCD; attitude towards premarital sickle cell screening and marital decisions among local government workers in Ile-Ife; Nigeria; using a self-administered questionnaire. Results: 69of study subjects had poor knowledge of SCD; while attitude towards premarital screening was favourable in 95of the study subjects. Knowledge and attitude were significantly better among subjects with tertiary education. There was a strong positive association between attitude towards sickle cell screening and a history of undergoing screening or partner screening. Most (86.7) of the respondents and 74.0of their partners have had sickle cell screening. One-quarter of married and engaged respondents did not know their partner's sickle cell status. One-third to two-thirds of study subjects will continue the relationship with their partner when either or both have haemoglobinopathy. Conclusion and recommendation: This study showed poor knowledge of SCD among the studied subjects. There is a need for more emphasis on health education through programmes promoting sickle cell education. In addition; the development of multifaceted patient and public health education programmes; the intensification of screening for the control of SCD by heterozygote detection; particularly during routine preplacement and premarital medical examinations; and the provision of genetic counselling to all SCD patients and carriers are vital to the identification and care of the couples at risk. These will enhance the capacity of the intending couples to make informed decisions and be aware of the consequences of such decisions. Policies are needed to ensure easily accessible community-wide sickle cell screening and premarital and genetic counselling to achieve the desired decline in new births of children with SCD

Premarital fertility and HIV/AIDS in Sub-Saharan Africa

The paper investigates the complex relationships between premarital fertility and HIV/AIDS in sub-Saharan African countries. The DHS surveys provided data to compute the prevalence of premarital fertility, defined as any birth before the first marriage. The UNAIDS database provided data to compute the prevalence of HIV infection among pregnant women. Results indicate a moderate association between the prevalence of premarital fertility and the prevalence of HIV infection (correlation coefficient = 0.64, P< 0.0001), and similar geographical patterns. Compared with the average pattern, outlier countries had either high levels of premarital fertility and relatively low HIV prevalence (Liberia, Madagascar, Gabon, Congo), or high levels of HIV prevalence despite low levels of premarital fertility (Lesotho, Malawi, Zambia, Zimbabwe). The overall relationship is discussed in light of the relationships between age at marriage, permissiveness and lack of protection during intercourse and their impact on premarital fertility and HIV infection among women. (Afr J Reprod Health 2008; 12[2]:64-74)

Social context of premarital fertility in rural South-Africa

A qualitative study was conducted in Agincourt, a rural area of South Africa, to document the perceptions and attitudes towards premarital fertility and late marriage among young adults of both sexes. Two focus groups and 35 individual interviews were conducted among 17-30 year olds, randomly selected. Most interviewees perceived premarital fertility as undesirable, and a new phenomenon in a context of major social changes, in particular loss of authority of parents and increasing freedom of the youth. In contrast, late marriage was perceived as positive, by both sexes, primarily for economic reasons. Much stigma was associated with premarital fertility, from friends, institutions and families who occasionally apply mild or severe sanctions. Consequences of premarital fertility were numerous: school abandonment, economic adversity, health risks, stigmatization. In extreme cases, premarital fertility might lead to exclusion and deviant behavior. Premarital fertility was ultimately due to a lack of contraception among young women, and to refusal of abortion for religious reasons, and is associated with the risk of contracting STD's. (Afr J Reprod Health 2008; 12[2]:98-110)

Seroprevalence of HIV and Frequencies of Haemoglobin Genotypes; ABO and Rh Blood Groups among Premarital Couples in Port Harcourt; Nigeria

Background: Premarital screening is fast gaining grounds as a pre-requisite condition for the solemnization of holy matrimony by many faith based organizations in Nigeria yet there is scanty literature on the subject.Methods: Fifty (50) premarital heterosexual couples (50 males and 50 females) were screened for the presence of human immunodeficiency virus (HIV); haemoglobin genotypes; ABO and Rh blood groups using standard laboratory procedures.Results:The prevalence of HIV in this study was found to be 2.0. The frequencies of the haemoglobin genotypes were as follows; HbAA (72); HbAS (26) and HbAC (2.0) while that of ABO and Rh blood groups were: group A (22); B (14); AB (0); 0 (64); Rh 'D' Positive (96) and Rh 'D' Negative (4.0). The distribution of these variables between the sexes was statistically significant. (?2 = 21.630; p 0.01). The frequencies of the haemoglobin genotype combinations of the intending couples were as follows; HbAA/AA (52); AA/AS (36); AA/AC (4.0) and AS/AS (8.0). This distribution pattern was also found to be highly statistically significant (? 2

Premarital HIV/AIDS Screening among Ugandan Rural Youth

Uganda has implemented a variety of interventions to control HIV/AIDS spread. These have included HIV screening for various reasons. However; most interventions seem to have left out the rural youths. The objective of the study was to identify the reasons for not preferring HIV screening before marriage. 50 youths were purposively selected and participated in focus group discussions regarding premarital HIV screening. Reseasons for not screening were: Not wanting to miss the beauty/spouse; lack of money to do so; fear of being killed by medical personnel; some are sure cases so they don't mind; faulty machines; suspects do not want to know; lack of knowledge about the screening procedures; leads to desparate ways of spending e.g. selling land once found positive; and commercial sex threat. It is recommeded that these reasons should be addrssed if HIV spread through unscreened marriages is to be stopped

Nuptiality and AIDS in Rakai District Uganda

Objectives: To examine the relationship between union status and AIDS prevalence; number of sexual partners and condom use. Methods: Questionnaire was administered in 1991 to 2;607 adults 13 years and above to report their marital status; number of sexual partners in the past 12 months and condom use. HIV-1 serology was done for 3123 consenting adults. Results: Prevalence ranged from 1.4among individuals who were single and had never had sex to 30.1among the separate/divorced. The polygamous and the widowed also had high prevalence of 22.5and 27.4respectively. Monogamous people and individuals not in union but sexually active had the same sero-prevalence of about 18. Age group 20-29 had the highest sero-prevalence (32) while the 60+ yrs had the lowest (4). Over 70of the sexually active single individuals reported to have had sex in the past 12 months; with 23reporting more than one partner. Sexual exposure in the past 12 months was 31among the widowed compared to 46among the separated/divorced. 7of individuals in monogamous would be expected; the sexually active single individuals reported the highest condom use rate of 22. The rest of union categories had rates below 8. Conclusions: The high HIV prevalence among the sexually active single; calls for an intensification of the Health Education Programme emphasing partner reduction and condom use among others. it is yet to be established whether or not the high prevalence among the sepated/divorced preceeds or succeeds their current marital status