Knowledge, Attitude and Perception of Sickle Cell Disease, on Premarital Genotype Screening, Among Undergraduate of Al-Hikmah University Ilorin. Nigeria.

doi:10.21203/rs.3.rs-5289221/v1

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Knowledge, Attitude and Perception of Sickle Cell Disease, on Premarital Genotype Screening, Among Undergraduate of Al-Hikmah University Ilorin. Nigeria.

https://doi.org/10.21203/rs.3.rs-5289221/v1

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Genetic compatibility needs to be carefully considered in an effort to lessen the frequency of sickle cell disease (SCD), especially in Nigeria and other African where the disease has a high burden with morbidity and mortality. It has been demonstrated that knowledge of premarital genotype screening PMS, educates individuals about SCD. The descriptive study was aimed to assess the knowledge, attitude and perception of SCD on PMS on selected university student participants. The population for the study are undergraduates, the multi-stage sampling technique was used in sample selection of the 341 respondents, and data was collected using a self-administered questionnaire. Findings indicate 88.3% fell within age range of 18–25 years, 70.1% were female and single, representing 93.5% and a significant proportion. 76% have heard understand SCD and are generally familiar with the complications of SCD. Only 56% have good knowledge of PMS as the cheapest prevention, While 63% don’t know about premarital sickle cell counselling. Only 56% knew their Hemoglobin genotype, however 12% knew Hemoglobin genotype of their fiancés and 69% are of the opinion of terminate relationship if the genotype result is incompatible. 68% support mandatory PMS and the establishment of laws prohibiting marriage in cases of PMS incompatibility. The statistical analysis given that P-value is 0.000, which is < alpha level of 0.05, therefore null hypothesis rejected, It was concluded that knowledge of genetic composition and the potential threat of SCD was robust, mandatory PMS with better counselling strategies, laws to regulate genetic diseases and willingness in advocating PMS to intending couples was confirmed. Recommendations, carrier identification and genetic counselling enlightenment on SCD and PMS testing through mass media and screening centers should be made by the government and religious institutions

knowledge

attitude

perception

premarital genotype screening

sickle cell disease

One of the most serious medical conditions in the world is sickle cell disease World Health Organization (WHO, 2017). Sickle cell disease (SCD) is a genetic inheritance that can be prevented, which affects a large number of people worldwide and is brought on by aberrant hemoglobin. Because of a single gene mutation. Babalola et al., (2019) Explain that an individual with sickle cell disease (SCD) has inherited two abnormal hemoglobin (Hb) genes, at least one of which is accountable for the creation of sickle hemoglobin (HbS). In contrast, the inheritance of two faulty HbS genes results in HbSS. The homozygous, or HbSS, clinical phenotype also referred to as sickle cell anemia is the most prevalent. In addition to SS, compound heterozygous HbSC is sometimes referred to as SCD, or sickle cell disease. Both hemoglobin SC disease (HbSC) and sickle cell anemia (SCA) are inherited disorders with an autosomal recessive pattern of inheritance.

Knowledge of premarital genotype screening presents an opportunity for individuals to become informed about their genetic predisposition to diseases (sickle cell) and for intending couples to be aware of the possible genetic characteristics of their unborn children (Babalola et al., 2019). Preventing genetic inheritance that could have serious consequences if one believes that having children is one of the reasons for marriage. The cheapest methods of preventing genetic disease include premarital genotype screening and genetic counselling, prenatal diagnosis, preconception diagnosis and implantation of normal embryos after in vitro fertilization and in vitro therapy using stem cell transplantation (Al-qattan et al., 2019). Prevention of the disease through carrier identification and genetic counselling 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 (Al-qattan et al., 2019)

According to the WHO approximately 240 million people are carriers of genetic disease and at least 500,000 affected individuals are born annually (Colombatti et al. 2022). The prevalence of genetic disease is becoming higher in society, creating more stress despite difficulties people encounter in life. Sickle cell disease contributes to the equivalent of 15% of under five deaths on the African continent, more than 9% of such deaths in West Africa (Thomson et al., 2023). The literature analysis noted that mothers have low knowledge and awareness of their genotype, despite the fact that sickle cell trait (AS & AC) is a risk factor for having children with SCD. It has been noted that some individuals are unaware of sickle cell illness prior to marriage, and some go on to become mothers to children with the illness. In the modern world, couples simply move forward with marriage decisions regardless of their genetic status, which presents a significant difficulty when it comes to incompatibility (Colombatti et al., 2022). Most youths today are either unmarried or intending to get married and will procreate in the future. This group of persons is the target population who will benefit from appropriate interventions aimed at preventing and controlling genetic disease, especially sickle cell disease. Thus, there is a need to ascertain knowledge, attitude, and perception of sickle cell disease on premarital genotype screening among young undergraduates University students of Al-Hikmah Ilorin, Nigeria, examine the effect of their demographic data and potential respondents engagement in addressing the issue of PMS and SCD, 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.

The study was conducted at Al-Hikmah University, Ilorin Kwara State. Ilorin is one of the biggest cities in North Central Nigeria. Geographically it is situated in the guinea savannah belt at latitude 8" North and longitude 4" East (8°30′N 4'33'E), with three local Government The country's capital, Abuja, is 500 kilometers from the ancient city of Ilorin, and 300 kilometers from Lagos. Al-Hikmah University is one of the Universities in Ilorin, established in 2005 The University granted a license to function as a Conventional Private University (License No. 010), seven faculties and postgraduate School, comprise Al-Hikmah University's current structure. Descriptive design was adopted for the study and a questionnaire was used to elicit necessary information from the respondents. The population unit of study are undergraduates of the University who are between the ages of 18–30 years. They were selected across levels, disciplines and faculties. The Multi-stage sampling technique was used in sample selection of the 341 who participated voluntarily. The questionnaire was pilot-tested prior to data collection. Data obtained was analyzed and presented in the frequency table, percentages, and chi-squared analysis. Anonymity and confidentiality of information were maintained. The study is a cross sectional survey to assess the knowledge of sickle cell diseases on premarital genotype screening. Quantitative research is chosen for its ability to explore the subjective knowledge, attitude, and perception of individuals in their natural context.

Table 1

Demographic Characteristics of the Respondents
Variable	Frequency	Percentage
Age 18–25 26–33 Total	301 40 341	88.3 11.7 100%
Gender: Male Female Total	102 239 341	29.9 70.1 100%
Marital Status Single Married Total	319 22 341	93.5 6.5 100%
Religion Islam Christianity Total	305 36 341	89.4 10.6 100%
Year of study 100 200 300 400 500 Total	44 75 103 91 28 341	12.9 22.0 30.2 26.7 8.2 100%

Data from Table 1 above presents the respondents demographic characteristics, age fell within the 18–25 (88.3%) of the total. The gender distribution slightly skewed towards females (70%), the respondents had diverse academic years of study with 300 level accounting for (30.2%), 400 level (26.7%) 200 level (22.0%) 100 and 500 level smallest group. Based on religion, (89.4%) practice Islam and (10.6%) practice Christianity, respectively. (93.5%) are single representing. While the tribe distribution Yoruba (68.0%) Hausa (21.7%) as shown in Table 1.

4.4.1 Knowledge of Sickle cell on premarital Genotype screening

Table 2

Respondents’ Knowledge of Sickle cell on premarital Genotype screening
Statement	Respondents Opinion (frequency)	Percentage %
What do you understand by sickle cell disease SCD	Sexually transmitted 38 Inherited blood disorder 208 An Infectious disease 82 Punishment from God 13 Total 341	11 60.9 24 4 100%
What is the mode of sickle cell disease SCD transmission and sickle cell carrier/trait	Contact with infected person 65 Infection from the mother 82 Hereditary from the parents 191 Contacted after childbirth 3 Total 341	19.1 24 56 0.9 100%
Have you ever heard the term "sickle cell Anemia"	Yes 215 No 126 Total 341	Yes 63 No 37 100%
Which of the following genotype is called sickle cell Anemia	AA 7 AS 62 SS 177 SC 95 Total 341	2 18 52 28 100%
Which of the following are Medical complications are caused by sickle cell disease	Repeated Pain episode 167 Avascular Necrosis 119 Stroke & Anemia 17 Cough & stool 38 Total 341	49 35 4.9 11.1 100%
Do you know if there is a cure for sickle cell disease	Yes 133 No 208 Total 341	Yes 39 No 61 100%
What is premarital genotype screening	Medical screening for intending couple 201 Genotype test 72 Medical checkup 17 All of the above 51 Total 341	59 21 5 15 100%
PMS program is available in Nigeria	Yes 242 No 99 Total 341	Yes71No 29 100%

Result in Table 2 indicate that a significant proportion of the respondents (76%) have heard about sickle cell disease SCD, the majority of respondents (61%) understand sickle cell disease as inherited blood disease, (56.1%) understand sickle cell disease as hereditary from the parents, and the majority of respondents (63%) have heard the term Sickle cell anemia, similarly significant proportion of the respondents (59%) and (28%) understand that an individual with genotypes SS and SC has sickle cell disease, respectively. The respondents were generally familiar with the complications associated with sickle cell disease, (49%) and (35%) understood repeated pain episodes, and avascular necrosis, anemia, and stroke as common complications of SCD. However, (61%) believe that SCD has no cure yet, and (39%) of the respondents are of the opinion that SCD has a cure as indicated in Table 2. Regarding the knowledge of premarital genotype screening, (59%) of the respondents defined it as the medical screening carried out for intending couples, and (71%) of the respondents knew that PMS test are available in Nigeria. The (59%) of respondents’ understand that PMS comprises Genotype test, HIV/AIDs test and blood group screening. A significant number (58%) understand PMS as prevention against hereditary diseases.

4.4.2 Attitude of Sickle Cell Diseases on Premarital Genotype Screening

Table 3

Attitude and Perception of Sickle Cell Diseases on Premarital Genotype Screening
Statement	Frequency	Percentage %
Are you aware of premarital sickle cell counseling	Yes 126 No 215 Total 341	Yes 37 No 63 100%
Will you be part of advocate/recommend on PMS for all couple	Yes 259 No 82 Total 341	Yes 76 No 24 100%
Do you know your genotype composition	Yes 191 No 150 Total 341	Yes 56 No 44 100%
Do you know the genotype of your fiancés /fiancée	Yes 41 No 300 Total 341	Yes 12 No 88 100%

Result in Table 3 Shows that 63% of the respondents don’t know about premarital sickle cell counselling, only 37% aware of premarital sickle cell counselling. While 76% of the respondents are ready to recommend and advocate PMS for all intending couples and young unmarried. (56%) of the respondents knew their Hemoglobin genotype composition, (44%) don’t know (out of which (82%) are ready to undergo PMS and (18%) are not interested in PMS). However only 12% of respondents knew the Hemoglobin genotype of their fiancés /fiancée.

4.4.3 Perception of Sickle Cell Diseases on Premarital Genotype Screening

Table 4

Attitude and Perception of Sickle Cell Diseases on Premarital Genotype Screening
Statement	Respondents Opinion	Percentage %
Would you still go on to marry your partner even if the genotype result shows (incompatibility) possibility of having a child with sickle cell disease	Yes 106 No 235 Total 341	Yes 31 No 69 100%
Is premarital genotype screening against your religious belief	Yes 27 No 314 Total 341	Yes 8 No 92 100%
Will you support mandatory of PMS in Nigeria	Yes 23 No 109 Total 341	Yes 68 No 32 100%
Will you support the establishment of regulations and laws prohibiting marriage in case of a positive premarital screening results	Yes 198 No 143 Total 341	Yes 42 No 58 100%

Findings in Table 4 indicate that (69%) are of the opinion of terminate their relationship with their partner if the genotype result shows (incompatibility) possibility of having a child with SCD. However, 92% claimed that PMS has nothing to do with their religious belief. (68%) and (58%) of the respondents support mandatory PMS for all intending couples in Nigeria and the establishment of regulations and laws prohibiting marriage in cases of incompatible PMS results, respectively.

Hypothesis

Relationship between socio-demographic characteristic and knowledge regarding the sickle cell diseases on premarital genotype screening.

Table 5

Age * Knowledge Cross tabulation
Count
		Knowledge		Total
		Good	Poor	Total
Age	18–25	161	140	301
	26–33	37	3	40
	34–41	0	0	0
	42 – Above	0	0	0
Total		198	143	341

Calculated chi-square p-value is 0.000, which is less than the common alpha level of 0.05, therefore reject the null hypothesis and conclude that there is a significant relationship between age and knowledge of SCD. Age influences a person's knowledge about sickle cell disease and premarital genotype screening.

Table 6

Gender * Knowledge Cross tabulation
Count
		Knowledge		Total
		Good	Poor	Total
Gender	Male	34	68	102
Gender	Female	101	138	239
Total		135	206	341

Given that p-value of the Chi-Square Tests is 0.123, which is greater than the common alpha level of 0.05, the null hypothesis is thereby accepted. This means there is no significant relationship between gender and knowledge Therefore, being male or female does not significantly influence a person's knowledge about sickle cell disease and premarital genotype screening.

Table 7

Academic Level * Knowledge Cross tabulation
Count
		Knowledge		Total
		Good	Poor	Total
Academic Level	100L	15	29	44
	200L	35	40	75
	300L	73	30	103
	400L	56	35	91
	500L	21	7	28
Tot Al		200	141	341

Pearson Chi-Square is 0.000 which is the p-value indicates that there is very strong evidence against the null hypothesis. Given that the p-value is less than the common alpha level of 0.05, therefore reject the null hypothesis. This means there is a significant relationship between academic level and knowledge. This result suggests that the academic level of a student influences their knowledge about sickle cell diseases and premarital genotype screening.

The respondents' cut across different sociodemographic characteristics, with majority ages of 18 to 25 years as shown in Table 1 above. The study is best suited for the study group because the majority of respondents are single and should understand the significance of premarital genotype screening before getting married, the majority of responders knew etiology of SCD as inherited from the parents. Nonetheless a sizable percentage indicate inadequate knowledge of hereditary illnesses, as indicated in Table 2 above. This suggests that further knowledge is needed about the etiology of hereditary illnesses. The findings are consistent with the position of Adigwe (2022). The high degree of understanding among respondents regarding different types of genotypes of an individual and genotypes SC and SS as sickle cell disease and sickle cell anemia as shown in Table 2. Similar results have been found from research conducted by Hussaini et al., (2019) among undergraduate students in Kano State, Nigeria. However, research conducted by Isah et al. (2016) among students at the School of Nursing in Sokoto has revealed a lower degree of understanding on genotype composition similarly (58%) know their genotype composition, while others are willing to know their haemoglobin genotype soon. This result is far better than that of Benin City and the Federal Capital Territory, where only roughly 40.3% and 32% of adolescents, respectively, were aware of their distinct genotype composition (Faremi & Olatubi 2018).

Premarital genotype screening is seen favorably in this study because a sizable percentage of respondents understood PMS as preventable medical screening. The data in Table 2 above indicate the view that PMS should be conducted before marriage is comparable to what was reported in the recent study (Boardman et al., 2020) Additionally, the majority of respondents would be willing to break up with their fiancés (as stated in Table 4) if the genotype result indicated a high likelihood of having a kid with SCD, similar results were found in previous research (Al-Aama, 2010; Al-Kindi et al., 2019). Furthermore, a greater proportion of respondents were aware that PMS is offered in Nigeria. Additionally, some participants demonstrated a high level of comprehension regarding the components of the PMS test, which is consistent with earlier research (Al-Kindi et al., 2019), and contrary to findings in Ife, Nigeria (Babalola et al., 2019), with some reporting that PMS is not important at all. This can be the case since they have no idea of what PMS component, the academic level could have contributed to this. In a related study, young people with postsecondary education showed the greatest awareness of the prevention of sickle cell disease with premarital genotype screening, compared to those with primary education reported by (Emmanuel 2015). Also reported in this study, the majority of respondents’ claim PMS does not conflict with their religious beliefs. According to the survey's findings in Table 3, (68%) of participants now strongly support the idea of requiring PMS test results as a prerequisite to marriage, up from (53.4%) in a prior study (Al Kindi et al., 2019). Furthermore, over (58%) of the participants supported legislation that forbade marriages in situations where outcomes were favorable, as indicated in Table 3 above. One of the biggest obstacles to premarital genotype screening, according to a study by Boardman et al. (2020), is social stigma, other hurdles include damaged sentiments, interfering with God's will, and ending a marriage. Ultimately, some responders prepared to take an active role in supporting and advocating for PMS in their respective fields as shown in Table 3. The findings report in Table 5, 6 and 7 of the present investigation, as the examination of the correlation between the respondents' sociodemographic reveals a statistically significant association between genotype screenings at the 5% significant level. This implies that the respondents' academic level and age have an impact on knowledge of SCD on PMS.

One of the key conclusions drawn from the study is that the respondents have relatively robust knowledge about the genetic composition. However the study also revealed respondents support mandatory PMS for all intending couples in Nigeria, and also express their support towards the establishment of regulations and laws in Nigeria prohibiting marriage in case PMS results incompatibility. Correspondingly, the respondents’ willingness to advocate and recommend PMS to young unmarried. However, the majority of the respondents don’t know and have never heard about premarital genetic counselling. This indicates the need for enlightenment and promoting informed decision-making. This finding underscores the statistically significant relationship between other socio-demographic characteristics at the 5% significant level.

RECOMMENDATION

For education and prospective carrier identification, religious institutions and NGOs should prioritize premarital counselling on genetic diseases in their various domains, with minimal emotional pressure at minimal or no cost to be feasible. Public enlightenment and health education on sickle cell disease and premarital genotype through mass media programs, and screening centres across primary health should be made available, affordable and accessible to all by government.

Hemoglobin gene

HbS

Sickle Hemoglobin

HbSS

homozygous Sickle cell anemia Hemoglobin

HbSC

compound heterozygous Sickle cell Hemoglobin

PMS

Premarital genotype Screening

RBCs

Red blood cells

SCA

Sickle cell anemia

SCD

Sickle cell disease

Ethics approval and consent to participate

Ethical approval was obtained from ethical review committee of Al-Hikmah University through the Department of Public Health and Postgraduate School of Al-Hikmah University respectively. Prior to participating in the study, all potential participants was be provided with a clear and comprehensive explanation of the research purpose, procedures and benefits. Informed consent form were given. Participants was assured that their participation is voluntary, and they have the right to withdraw at any stage without facing any consequences.

Consent for publication

Not applicable

Availability of data and material

The datasets used or analysed during this study are generated from primary source and available from the corresponding author on reasonable request, included in this manuscript submitted to Bulletin of the National research center and its supplementary information file.

Competing interests

The author declare that no competing interests

Funding

All funding for the research are sponsor by corresponding author

Authors' contributions

The corresponding author confirms sole responsibility for the following: study conception and design, data collection, analysis and interpretation of result, and manuscript preparation,

Acknowledgements

Not applicable

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No competing interests reported.

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Knowledge, Attitude and Perception of Sickle Cell Disease, on Premarital Genotype Screening, Among Undergraduate of Al-Hikmah University Ilorin. Nigeria.

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Abstract

INTRODUCTION

METHODOLOGY

RESULTS

4.4.1 Knowledge of Sickle cell on premarital Genotype screening

4.4.2 Attitude of Sickle Cell Diseases on Premarital Genotype Screening

4.4.3 Perception of Sickle Cell Diseases on Premarital Genotype Screening

Hypothesis

DISCUSSION OF FINDINGS

CONCLUSIONS

RECOMMENDATION

Abbreviations

Declarations

References

Additional Declarations

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