[Prevalence of hemoglobinopathies in premarriage individuals referred to Babolsar, Iran [2006-09]]

According to world health organization statistics, at least 5.2% of world population is carrier for a main hemoglobin disorder. Previous reports showed that more than 10% of people are carrier for beta-thalassemia Northern Iran. This study was done to determine the prevalance of hemoglobinopathies in premarriage individuals referred to Babolsar, Iran. This descriptive study was carried out on 8500 individuals [4200 women and 4300 men] whome were attended the thalassemia counseling program in Babolsar, North of Iran during 2006-09. After performing the CBC test, for those MCV and MCH were less than 80 and 27 respectively, Hemoglobin A2 was evaluated. Subjects whome were volunteers for more comprehensive tests, basic and acidic electrophoresis and genetic tests were applied, subsequently. 1200 [14.11%] subjects had low hematological indexes. 474 [5.57%] subjects had high HbA2 and were classified as beta-thalassemia carriers and 726 [8.54%] had normal HbA2 level and were classified as alpha-thalassemia carriers. 6 [1.2%] subjects were identified with HbF level more than 10 and were identified as carriers for beta-gene cluster deletion carrier. Also, 16 [3.2%] individuals had HbE, 16 [3.2%] had HbS, 4 had HbD and 4 had HbH [0.33% in 1200 and 0.047% in 8500 subjects]. Genetic study of 317 individuals for beta carriers and 145 subjects for alpha-carriers showed IVSII-1G>A [74.5%] in beta-globin and single gene deletion of 3.7 [47.5%] in alpha-globin genes were the most frequent mutations. This study showed that carriers for alpha-thalassemia [8.5%] are more frequent compared with beta-thalassemia [5.57%]. Also other hemoglobin variants included HbS, HbE, HbD or different beta-gene cluster deletions in the region are considerable and should be screened

[Lack of knowledge of being minor thalasemic is the main cause of major thalassemia incidence in Zahedan, the South-East of Iran]

Introduction: In spite of providing prenatal diagnoses [PND] procedures for Thalassemia, 148 new patients were added to the Thalassemic population of Zahedan from 2002 to 2010. This study aimed at identifying the occurrence causes of newly arrived Thalassemic patients

Methods: This retrospective descriptive study was carried out on 148 couples whose Thalassemic children were born after establishment of the PND center at 2002. The required data were collected using interviews and hospital records of the patients

Results: The results indicated that 81.6% of the parents of major cases had not undergone pre-marriage Thalassemia screening test. Also, 70.2% of the couples were not aware of their minor Thalassemia before having a Thalassemic child. Moreover, 71% of parents who had been diagnosed with minor Thallasemia did not attend the PND center due to lack of knowledge, late gestational age, husband's unwillingness, and lack of awareness about the importance of the problem. In addition, from the referred couples in the first stage, 50% did not come to the centre for second stage of diagnosis [sampling of the fetus] due to religious beliefs, husband's unwillingness, and mothers' ignorance

Conclusion: The results showed that the most important causes of new occurrences of Thalassemia include couples' refraining from taking pre-marriage Thalassemia screening tests and lack of knowledge about being minor thalassemic. Therefore, appropriate programs may hopefully reduce the new cases

Six-year outcome of the national premarital screening and genetic counseling program for sickle cell disease and beta-thalassemia in Saudi Arabia

Saudi Arabia has a high prevalence of hereditary hemoglobin disorders. Data has been collected by the Saudi Premarital Screening and Genetic Counseling Program on the prevalence of sickle cell disease and beta-thalassemia but the outcomes were not quantified. We used six years of premarital screening data to estimate the burden of sickle disease and beta-thalassemia over the program period and to assess the frequency of at-risk marriage detection and prevention. Retrospective review, premarital couples attending premarital and genetic counseling clinics with marriage proposals between 2004 and 2009. Blood samples obtained from all couples with marriage proposals between 2004 and 2009 were tested for sickle cell disease and beta-thalassemia. Test results were shared with all examinees and genetic counseling was offered for all at-risk couples. Marriage certificates were issued irrespective of the results and compliance with medical advice was voluntary. Out of all men and women examined, 70962 [4.5%] and 29006 [1.8%] were carriers or cases of sickle cell disease and beta-thalassemia, respectively. While the prevalence of sickle cell disease was constant between 2004 and 2009 [average 45.1 per 1000 examined persons, P=.803], the prevalence of beta-thalassemia steadily decreased from 32.9 to 9.0 per 1000 examined persons [P<.001]. The frequency of at-risk couples decreased by about 60% between 2004 and 2009 [from 10.1 to 4.0 per 1000 examined persons, P<.001]. The frequency of voluntary cancellation of marriage proposals among at-risk couples showed more than 5-fold increase between 2004 and 2009 [from 9.2% to 51.9%, P<.001]. The eastern region had 58% of all detected at-risk marriages and showed the greatest decline in detection and increase in prevention over time compared to other regions of Saudi Arabia. Six years of premarital screening in Saudi Arabia markedly reduced the number of at-risk marriages, which may considerably reduce the genetic disease burden in Saudi Arabia in the next decades

Frequency of haemoglobinopathies at premarital health screening in Dohuk, Iraq: implications for a regional prevention programme

Beta-thalassaemia major and sickle-cell disease are important health problems in Iraq. To provide information for a prevention programme, the frequency of haemoglobin disorders was mapped in Dohuk governorate. A total of 591 couples [1182 individuals] attending health centres for premarital health screening were tested; 44 [3.7%] were found to be carriers of beta-thalassaemia, 14 [1.2%] of the sickle-cell gene and 1 [0.1%] of delta beta-thalassaemia. A total of 3 couples [i.e. 5/1000] were at risk of having a child with beta-thalassaemia major, and the estimated number of affected children with a major haemoglobinopathy was 39 per year. The findings stress the importance of a regional prevention programme for haemoglobinopathies based on premarital screening, counselling and prenatal diagnosis

Impact of preconception health education on health locus of control and self-efficacy in women

The preconception period is an ideal opportunity to optimize women's health. This study of women attending premarital clinics in the Islamic Republic of Iran aimed to evaluate the impact of a health education workshop on their health locus of control and self-efficacy in physical activity. The design was a randomized controlled trial with a questionnaire before and after the intervention. At post-intervention, there were significant increases in scores of internal health locus of control and self-efficacy in the experimental group [n = 109] compared to the control group [n = 101]. It was concluded that a short-term health education may empower women to adopt healthy lifestyles

A regulação política da sexualidade no âmbito da família por saberes e instituições médicas brasileiras (1838-1940) / The political regulation of sexuality within the family for Brazilian medical knowledge and institutions (1838-1940)

Esta tese tem como objeto a regulação política da sexualidade no âmbito da família por saberes e instituições médicas brasileiras (1838-1940). Orienta-se pelo interesse em analisar continuidades e descontinuidades na construção de objetos, estratégias e táticas políticas direcionados para a regulação higiênica e eugênica do casamento e da sexualidade infantil. De inspiração foucaultiana, inscreve-se no campo da história dos saberes e estásubsidiada por um conjunto heterogêneo de documentos (teses, artigos de periódicos, livros, anais etc.) circunscritos, majoritariamente, ao campo da medicina. Analisa a constituição de uma defesa higiênica dos casamentos no pensamento médico novecentista, voltada pararemanejamentos das figuras de esposa e marido na nova configuração de família que começava a se esboçar no Brasil, contrastando-a com a regulação católica da moral sexual colonial. Em seguida, descreve a visibilidade higiênica que a medicina dará a infância no século XIX, problematizando especificamente o interesse pelo tema da masturbação, que articula simultaneamente a família, centrada na figura da mãe, e a escola na convocação de zelar pela criança. Partindo das contradições sociais que se apresentaram na construção doprojeto liberal nacional a partir da década de 1870, discute a apropriação do discurso da degenerescência pelo saber médico-psiquiátrico brasileiro, que propiciou uma leitura da brasilidade marcada pelo excesso sexual e pela condição “degenerada” da miscigenação, a fim de pensar as condições de possibilidade para a emergência do projeto de eugeniamatrimonial institucionalizado nas primeiras décadas do século XX e toma como táticas a campanha pela compulsoriedade do exame pré-nupcial, o combate aos casamentosconsanguíneos, o controle do contágio venéreo e o aconselhamento sexual dos casais...

Clients' satisfaction of the premarital counseling service in Bahrain

In an attempt to reduce the incidence of genetic disease in Bahrain a premarital screening program was introduced in 1985, which included a national campaign to increase the awareness of genetic blood diseases among the population. In 1992, the premarital counseling service was extended to include all health centers and on the 23[rd] June 2004, a law has been issued mandating premarital screening and counseling for all individuals wishing to get married. The aim of this study is to evaluate the clients' satisfaction from the premarital counseling service after four years of issuing the law. Genetic Clinic at Salmaniya Medical Center. Cross sectional study. A questionnaire was distributed to the attendants of the genetic clinic [GC] for premarital counseling. Those who received and answered the questionnaire were referred from health centers [HC] after being evaluated and found at risk. The study was conduced from January 2005 to December 2007. SPSS was used to analyze the data. One thousand five hundred and sixty-six clients answered the questionnaire, 70% of the respondents reported that the service is excellent in general. In the HC, 82% faced no problems in taking an appointment and 89% had no problems during the interview. At the GC, 91% agreed that there were no significant problems in getting an appointment and 97% had no problems during the consultation. Eight-two percent of the referred couples preferred to have the certificate stamped in the GC. It took one week for 73.5% of the clients to get an appointment in the HC. Seventy-eight percent got their laboratory results within a week and 86% were seen in the genetic department within one week. After almost 4 years of issuing the premarital law in Bahrain, most clients attending the premarital service in GC are satisfied with the level of the service. The delay in getting an appointment in the HC and in getting the laboratory results are major problems the clients are concerned about

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

Prevalence and some epidemiological factors of beta thalassaemia trait in Sindhi community of Nagpur City, India.

OBJECTIVE: To study the prevalence of Beta thalassaemia trait (bTT) in Sindhi community of Nagpur City and to study association between bTT and some epidemiological factors like age at menarche in females, past history of diagnosis and treatment of anaemia and the current haemoglobin concentration. METHODS: The present cross-sectional study was undertaken among 446, young, apparently healthy, unrelated (by blood) Sindhi individuals before marriage or before reproduction. Blood samples were processed for Beta thalassaemia trait (bTT) using two stage approaches. Two screening tests namely Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT) and RBC indices including Mean Corpuscular Volume (MCV) were performed on all samples and those positive for either one or both screening tests were further investigated for HbA2 level estimation by Haemoglobin electrophoresis on Cellulose acetate paper. HbA2 level of > 4.5% was taken as confirmatory of bTT. RESULTS: The prevalence of bTT in Sindhis of Nagpur was found to be 16.81%. No significant association was found between bTT & a delayed age at menarche, however a significantly higher number of trait carrier females had past history of diagnosis and treatment of anaemia while a significantly higher number of both male and female trait carriers had current haemoglobin concentration in anaemic range. CONCLUSION: The present study confirmed high prevalence of bTT in Sindhis.

Prevalence of hemoglobinopathies among candidates attending premarital counseling in Bahrain

Hereditary blood diseases in Bahrain is a major health problem. To determine the prevalence of hereditary blood diseases among couples attending Premarital counseling in Bahrain. A cross sectional study involving 1070 individuals attending premarital screening in Bahrain during the period of 1st April and 15[th] May 2006. The study population was 1070 with the mean age 25. 9 +/- 7.1 years, ranged between 14 and 74 years. The prevalence of G6PD was 268 [24%] sickle cell disease [SCD] 14 [1.3%], 175 [16.4%] were sickle cell trait [SCT] in which 22 couples were both carrier, one [0.09%] p thalassemia major, 30 [2.8%] P thalassemia trait in which 3 couples were carrier, 365[34%] individuals with low red blood cell indices, 5 couples both with low indices. Hemoglobinopathies among candidates attending premarital screening in Bahrain is a common problem

Rare hemoglobin variant Hb yaizu observed in Turkey

To determine the characteristic features of the rare hemoglobin [Hb] variant Hb Yaizu to enable laboratory diagnosis of the hemoglobin variants during screening programs. Genomic DNA was obtained from the 4 members of a family living in Denizli province, an Aegean region of Turkey. Blood cell counts, hemoglobin composition, hemoglobin electrophoresis [both alkaline and acid], HPLC analysis, DNA sequencing and beta globin gene cluster haplotypes were done. Hb Yaizu carriers were apparently healthy individuals. Hb Yaizu was slightly faster than Hb S at alkaline pH, but slower than Hb S at acidic pH in hemoglobin electrophoresis. An abnormal hemoglobin peak was observed with a retention time of 4.77 mm in HPLC analysis attributed to Hb Yaizu. Two members of the family were heterozygous Hb Yaizu [beta 79 [EF3] Asp>Asn] confirmed by DNA sequencing. The mutation was found to be linked with the Mediterranean haplotype I [+----++]. We have presented the details of Hb Yaizu, a rare hemoglobin variant that may be important to hemoglobinopathy screening programs, although its clinical significance is unclear

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)

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)

Study on anemia among premarital women in 6 counties from 1993 to 2003 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To describe the prevalence of anemia and yearly trends (1993-2003) among women who came to the hospitals or maternal and child health units for premarital examinations in 6 counties of Jiangsu and Zhejiang provinces.</p><p><b>METHODS</b>Data were obtained from the records of the premarital examinations in perinatal health care surveillance system that had been established since 1992 in these areas. We reviewed hemoglobin levels of those women who were enrolled in the perinatal health care surveillance system from 1993 to 2003. Anemia was defined according to the WHO (2001) criterion. We calculated the prevalence of anemia and analyzed the yearly trends based on the data of hemoglobin concentration.</p><p><b>RESULTS</b>In the period of 1993-2003, there were 82 995 anemia cases identified among 193,434 women with an overall anemia rate as 42.9%. The rates of anemia were high (65.5%) in 1993 but low (25.8%) in 2003. 99.7% of the anemic women whose hemoglobin concentration were between 80-119.9 g/L. Time trend analysis indicated a significant decline on anemia rate while monthly analysis showed that the prevalence rates were high (48.2%) in September and low in March (39.5%). The results also showed that the prevalence rates of anemia were relatively higher in farmers and workers in rural enterprises, and lower in Han ethnicity than minorities. The higher prevalence rates of anemia were presented among the women with less education, lower body mass index, or at older age.</p><p><b>CONCLUSION</b>For those premarital women in 6 counties of Jiangsu and Zhejiang provinces, the overall anemic rate presented a significant downward trend between 1993 and 2003 while the prevalence of anemia remained high, especially for the women with less education, lower body mass index or older ages.</p>

[Seroprevalence of toxoplasma gondii among females referred to Qazvin community-based medicine center for pre-marriage examinations]

Fetus in a pregnant woman is at high risk of congenital toxoplasmosis if the first exposure to Toxoplasma gondii occurs during pregnancy. Seroprevalence of Toxoplasma in pre-marrigae females can reflect the high risk group in population. To identify the seropositivity rate of T- gondii in females referred to laboratory for pre-marriage examinations. This was a descriptive study performed on 400 pre-marriage females referred to Qazvin community-based medicine center in 2001. Indirect fluorescent antibody test was used to detect anti-toxoplasma IgG antibody titer in sera of the study population. IgG-IFA >/= 1:20 was considered as positive. The overall seropositivity rate was 34%. Mean age of seropostive females was significantly higher than in seronegative cases [P< 0.02]. Seropostivity rate was indicative of a significant negative correlation with education [P < 0.03]. There was no meaningful difference between the rural and urban residents, statistically. Based on data found in our study, emphasis on educational program for women at their pre-marriage ages to prevent congenital toxoplasmosis is suggested

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

Prevalence of beta-thalassemia trait in premarital screening in Al-Hassa, Saudi Arabia

The Al-Hassa area is one of the regions in Saudi Arabia where hemoglobinopathies are prevalent. The Saudi Ministry Of Heath designed a protocol for premarital testing after the royal decree in December 2003. The protocol was implemented in a February 2004 order. The aim of this study was to determine the prevalence of beta-thalassemia trait among subjects coming for premarital screening in the Al-Hassa area. From February 2004 to November 2004, healthy subjects coming to six marriages consultation centers in the AI-Hassa area underwent routine mandatory tests. Subjects were considered to have beta-thalassemia trait if they had a mean corpuscular volume [MCV] <80 fL and/or a mean corpuscular hemoglobin [MCH] <27 pg and a hemoglobin A2 level >3.2%. Venous blood was taken into an EDTA tube and the complete blood count and red blood cell indices were measured by a Coulter automated cell counter on the same day of hemoglobin collection. Electrophoresis was done on cellulose acetate. All Saudi participants [n=8918], including 4218 [47.3%] males and 4700 [52.7%] females were screened. The prevalence of beta-thassemia trait with high hemoglobin A2 and microcytic hypochromic anemia was 3.4% [307/8918]. In countries with a high prevalence of hemoglobinopathies, a premarital screening program is helpful for identification and prevention of high-risk marriages. With a 3.4% prevalence of beta-thalassemia trait in premarital couples, future comprehensive programs are needed to know the actual prevalence of beta-thalassemia in AI-Hassa