Premarital Screening Program for Hemoglobinopathies in Karbala, Iraq
Keywords:
Premarital screening, hemoglobinopathies, thalassemia, sickle cell anemia, KarbalaAbstract
Abstract:
Background:
Premarital screening is a very important step in the prevention of thalassemia and other hemoglobinopathies.
Aim:
Evaluation of the pre-marital screening program in Karbala city to find its weak points, trying to correct them.
Introduction:
Hemoglobinopathies are the most common single gene disorder worldwide. More than 330000 affected infants are born globally annually. World Health Organization (WHO) in 2006 urged member states to implement national programs for management and prevention of hemoglobinopathies. Iraqi ministry of health mandated premarital screening for hemoglobinopathies in all Iraqi governorates. The program started in Karbala in June 2012.
Methods:
five premarital clinics established in Karbala governorate. Couples screened in this study from March 2016 to October 2018 were 26007 (52014 individuals). If both man and woman have MCV < 80 fl. and/or MCH < 27 pg. they should be referred to Karbala hereditary blood diseases center to be tested for abnormal hemoglobin. Prevalence of abnormal hemoglobin calculated by Punnett Square equation and Hardy-Weinberg law.
Results:
1780 individuals (890 couples) were referred from peripheral premarital clinics to our center. Individuals included in the study were1560 (87.7%) from Karbala city, the rest with missing address or from other governorates were excluded. The most prevalent abnormal hemoglobin in referred individuals was B-thalassemia hemoglobin 344(22.05%). Referred individuals with sickle hemoglobin were 51(3.26%). Prevalence of B-thalassemia and sickle hemoglobin in our study was 3.8% (95% CI 3.64 – 3.96) and 0.56% (95% CI 0.5 – 0.62), respectively. High-risk marriage couples were 84 (3.2/1000).
Conclusion:
the burden of supporting health needs of thousands of continuously increasing numbers of thalassemia and other hemoglobinopathies patients emphasizes the importance of launching a well-established nationwide prevention program. The program in Karbala city still needs more support and optimization.
References
2. Old J. Hemoglobinopathies and Thalassemias. In: David Rimoin RP and BK, editor. Emery and Rimoin’s Principles and Practice of Medical Genetics. 6th ed. Academic Press; 2013.
3. Old J. Prevention and Diagnosis of Haemoglobinopathies a Short Guide for Health Professionals and Laboratory Scientists. 21. Nicosia, Cyprus: Thalassaemia International Federation TIF; 2013. p. 1–79.
4. Modell B, Darlison M. Global epidemiology of haemoglobin disorders and derived service indicators. Bull World Health Organ. 2008;86:480–7.
5. Executive Board, 118. (2006). Thalassaemia and other haemoglobinopathies. World Health Organization. p. 7. https://apps.who.int/iris/handle/10665/21546.
6. World Health Assembly, 59. (2006). Fifty-ninth World Health Assembly, Geneva, 22-27 May 2006: resolutions and decisions: annexes. World Health Organization. p. 26. https://apps.who.int/iris/handle/10665/21481.
7. Edwards AWF. Punnett’s square. Stud Hist Philos Biol Biomed Sci. 2012;43(1):219–24.
8. Anthony J. F. Griffiths, Susan R. Wessler, Sean B. Carroll JD. Introduction to Genetic Analysis. 11th ed. Schultz L, editor. Kate Ahr Parker; 2015.
9. Central Statistical Organization of Iraq. Karbala Statistical Abstract of 2018 [Internet]. 2018 [cited 2019 Jun 27]. Available from: http://cosit.gov.iq/en/1204-2018-7
10. Khan FZA, Mazhar SB. Current trends of consanguineous marriages and its association with socio-demographic variables in Pakistan. Int J Reprod Contraception, Obstet Gynecol. 2018;7(5):1700.
11. Scalone L, Mantovani LG, Krol M, Rofail D, Ravera S, Grazia Bisconte M, et al. Costs, quality of life, treatment satisfaction and compliance in patients with β-thalassemia major undergoing iron chelation therapy: the ITHACA study. Curr Med Res Opin. 2008;24(7):1905–17.
12. Hassan MK, Taha JY, Al-Naama LM, Widad NM, Jasim SN. Frequency of haemoglobinopathies and glucose-6-phosphate dehydrogenase deficiency in Basra. East Mediterr Heal J. 2003;9(1–2):45–54.
13. Al-Allawi NA, Al-Dousky AA. Frequency of haemoglobinopathies at premarital health screening in Dohuk, Iraq: implications for a regional prevention programme. East Mediterr Health J. 2010;16(4):381–5.
14. Yahya IH et al. Thalassaemia genes in Baghdad, Iraq. East Mediterr Heal J. 1996;2(2):9–315.
15. Babiker M, Bashir N, Sarsour N. Prevalence of thalassaemia in schoolchildren in north-eastern Badia, Jordan. East Mediterr Heal J. 1999;5(6):1165–70.
16. Bashir N, Barkawi M, Sharif L. Prevalence of haemoglobinopathies in school children in Jordan Valley. Ann Trop Paediatr. 1991;11(4):373–6.
17. Bashir N, Barkawi M, Sharif L, Momani A, Gharaibeh N. Prevalence of hemoglobinopathies in north Jordan. Trop Geogr Med. 1992 Jan;44(1–2):122–5.
18. Al-Suliman A. Prevalence of β -thalassemia trait in premarital screening in Al-Hassa, Saudi Arabia. Ann Saudi Med. 2006;26(1):14–6.
19. Ganeshaguru K, Acquaye JK, Samuel AP, Hassounah F, Agyeiobese S, Azrai LM, et al. Prevalence of thalassaemias in ethnic Saudi Arabians. Trop Geogr Med. 1987;39(3):238–43.
20. Canatan D, Kose MR, Ustundag M, Haznedaroglu D, Ozbas S. Hemoglobinopathy Control Program in Turkey. Public Health Genomics. 2006;9(2):124–6.
21. Khodaei GH, Farbod N, Zarif B, Nateghi S, Saeidi M. Frequency of thalassemia in Iran and Khorasan Razavi. Int J Pediatr. 2013;1(1):45–50.
22. Samavat A, Modell B. Iranian national thalassaemia screening programme. BMJ. 2004;329(7475):1134–7.
23. Tosun F, Bilgin A, Kizilok A, Arpaci A, Yüreǧir GT. Five-year evaluation of premarital screening program for hemoglobinopathies in the province of Mersin, Turkey. Turkish J Hematol. 2006;23(2):84–9.
24. Sharma R TS. Incidence of Thalassemia and Sickle Cell Disease in Chhattisgarh, Central India: Using Hardy-Weinberg Equations. J Mol Genet Med. 2014;09(01):1–5.
