Assessment of Nursing Student Knowledge and attitude Regarding Premarital Genetic Counseling in Relation to Sickle Cell Anemia at Bahri University 2021

Prepared by the researche 

• Tartel Ibrahim Adam¹, second specialist Nurse
• Saeeda Alsadeg Mohammed² Assistant Professor Community Health Nursing ، Tayseer
• Hassan Mohammed Khallf³_. second specialist Nurse

Democratic Arabic Center

Journal of Progressive Medical Sciences : First issue – May 2025

A Periodical International Journal published by the “Democratic Arab Center” Germany – Berlin

:To download the pdf version of the research papers, please visit the following link

https://democraticac.de/wp-content/uploads/2025/05/Journal-of-Progressive-Medical-Sciences-First-issue-May-2025.pdf

Abstract

While substantial efforts have been made to control communicable diseases in Africa, the burden of non-communicable diseases has generally been neglected. Among these non-communicable diseases, the inherited blood disorder such as sickle cell disease constitutes a major health problem especially in western, central and eastern Africa , One of the most effective methods for the prevention of genetic defects is premarital screening. Nursing students are the prospect health care providers, who are supposed to provide health services and convince their surrounding communities regarding the importance of preconception care and utilization of the available health services . This is descriptive cross sectional institutional based study aimed to assess knowledge and attitude of nursing student  regarding premarital genetic counseling of  sickle cell disease . The sample size consisted of 151 nurse students.. Data were collected by using structured questionnaire with close ended question  using nominal scale ,and data were analyzed by using Statistical Package for Social Sciences version 22 (SPSS). The result show  98% know the mean of sickle cell anemia , 88.7% said Cause of sickle cell disease is hereditary .Generally the youth had  a positive attitude toward premarital genetic counseling ,56.3%  agree to perform premarital genetic counseling ,39.1% support to prevent the marriage of someone with a genetic disease. The study concluded that nurses student knowledge regarding sickle cell and attitude regarding premarital genetic counseling was good.

Introduction:

      Blood genetic disorders are widespread among Arab nations it constitutes the main proportion for handicap mentally as well as physically. Hemoglobinopathies are the commonest inherited and are a main public health trouble globally.(Maha et.al,2018). Available epidemiological data clearly indicate that genetic disorders are rapidly becoming a major public health concern in certain parts of the world (Rasha et.al,2016). As stated by World Health Organization (WHO), About 300,000 babies are born each year with serious hemoglobin disorders(WHO,2021).

Sickle cell disease ( SCD) is an autosomal recessive inherited blood disease that causes rigid and crescent-shaped red blood cells This results in several complications, including hand-foot syndrome, persistent infections, delayed development, problems for vision, vas occlusion, chronic hemolysis, acute and chronic kidney disease, and finally progressive multi organ damage and stroke life expectancy and poor quality of life have also decreased for SCD sufferer( CDC ,2021). The cultural history, lack of medical education and insufficient health care facilities are major factors thought to lead to high mortality among children with SCD in Africa (Ibrahim NKR al.et,2011). In Sudan, epidemiological studies about sickle cell disease are generally lacking (Daak et.al,2016)

Premarital screening is defined as testing couples who are planning to get married soon for common genetic blood disorders (mainly hemoglobinopathies, e.g. thalassemia and sickle cell anemia) and infectious diseases .The premarital screening aims to give medical consultation on the odds of transmitting the abovementioned diseases to the other partner/spouse or children and to provide partners/spouses with options that help them plan for healthy family. The premarital screening reduces the spread of the Above mentioned diseases and reduces the financial burdens of their treatments as well. It reduces the burden on the state’s health facilities and blood banks(Ammar et.al,2018) It deals with human problems associated with the occurrence or the risk of occurrence of a genetic disorder in a family (Makanjuola et.al,2018).

Premarital counseling is a type of therapy that helps couples prepare for marriage, It includes interpersonal communication, conflict reduction by addressing premarital education, medical and genetic counseling expectations within marriage. It is an essential tool  to provide facts about  male and female reproductive components, how menstruation, ovulation, and fertilization occur. Family planning, medical counseling explains the basic reproductive health and problems for couple (Mayoclinic.org, 2021).

      Nursing students are the prospect health care providers, who are supposed to provide health services and convince their surrounding communities  regarding the importance of preconception care and utilization of the available health services. Those students need to obtain more information on reproductive health  including premarital counseling. As well they require additional encouragement to utilize premarital counseling services which should be an essential part of the primary health care services(Ibrahim et al,2019). Several approaches and interventions to monitor and prevent genetic diseases have been recommended on the basis of the WHO, including health education and guidance to increase community awareness on hereditary blood disease control.( Dodson et.al,2011).

Problem statement

The magnitude of the problem can be attributed to two major factors. One is the strong cultural preference for consanguineous marriage, which is associated with a relatively high prevalence of  recessively inherited disorders. The other is the large family sizes, which may increase the number of affected children (Rasha et.al,2016).

Around 5 % of the world’s population bears characteristic genes, primarily sickle cell disease and thalassemia, for hemoglobin disorders. About 300,000 babies are born each year with serious hemoglobin disorders(WHO,2021). According to the systematic analysis of the Global Burden of Disease Study, 3.2 million people live with SCD, 43 million people have sickle cell trait (i.e., are carriers of the mutation), and 176,000 people die of SCD-related complications per year (Prithu et.al,2019).

In Arab countries, hereditary blood disorders are commonly associated with many physical and mental disorders. Sickle cell anemia and thalassemia are the most common inherited (Al-Qattan, et.al,2019).

In Africa 50-90% of infants born with (SCA) in sub-Saharan Africa die before 5 years old (Mudathir et.al,2019).usually from an infection or severe blood loss. In countries such as Cameroon, Republic of Congo, Gabon, Ghana and Nigeria the prevalence is between 20% to 30% while in some parts of Uganda it is as high as 45%( Gabriel et.al 2013). Two major factors might have resulted in erroneous estimates of increased mortality risk due to SCD in Africa: first, the small sample size of the previous studies, and second, inability to adjust for the potentially huge effect measure modification of age group less than 1 year due to the absence of the data(Ahmed  et.al,2016).

In Sudan The prevalence in Sudan of sickle cell anemia varies from 2% to 30,4%( Ahmed et.al,2014). The highest prevalence of SCA in the Sudanese population is represented by Western Sudan residents. It is suspected that immigrants from West African tribes, notably House, Folani, and Bargo, carried the sickle cell gene to Sudan. It has been reported that Sudan is the top country in number of birth defects with prevalence’s  high as 82  defect per 1000 life birth (Daak et.al,2016). Indeed, the remarkably high rate of consanguineous marriages in Sudan 44-63%(Ammar,2018). It could be one of the major factors that contribute to causality of birth defect and genetic diseases (Daak et.al,2016).

Methodology

151 nursing student in level 1-level2-level3-level4 from university of bahri enrolled .descriptive-cross sectional institutional based study ,non-probability convenience sampling method was used. data were coded, entering process, scanned by using IBM  SPSS (statistical package of social science) software version 22.result presented term in  of table.

Inclusion criteria

2. Students who agree to participate in the study and available during study.

Exclusion criteria

1. Students who under the age 18 who can not written consent or not mentally well.

• Students who disagree to participate.
• External student

Result :

Table (1).distribution of student according to demographic data

Majority (79,5%) of students were female, more than one third(36.4%). there were in first level.

Table (2). assessment of Sickle cell knowledge (n=151)

More than two third (70.9%) of student reported  no genetic disease in the family. The reported disorders were sickle cell anemia ,hemophilia and down syndrome. The rest assumed hypertension and diabetes as familial hereditary disorders. Half of the participant  (54.3% ) reported that there is a family relationship between their parents. Almost all (95.4%) know what is mean of genetic, almost all of students (98%) know what is sickle cell anemia, great majority (88.7%) of student  reported Cause of sickle cell disease is hereditary, more than forty (45%)said the risk for children to become sickle cell patients if the two parents is patients of sickle cell is all of the children, almost all (91,4%)of student reported the diagnose of sickle cell disease by blood test, great majority (83.4%) of students said Prevention of sickle cell disease is premarital screening. Overall knowledge was 83.6%.

Table (3). level of  nursing student knowledge regarding  sickle cell disease n=(151)..

More than Tow third (69,5%) of students were within good level of knowledge regarding sickle cell disease.

There was significant  association  between gender and knowledge was p values< (5%).

Table (4) assessment of premarital screening attitude (n=151)

Majority(62,9%)  of students  strongly agree that premarital counseling is important, half of them (58.9%) agree that medical advice after the premarital screening is necessary, more than one-third (cc, more than half (56.3%) of student agree the  dangerous of marry relatives, two  third (62.3%) of nursing student students disagree Premarital screening is against ISLAMIC rules, one-third (37.7%) of student agree It is important to apply a law that stops marriage upon discovery of a genetic disease, more than half (58.3%) of students agree that  Religious people should adopt the idea of PMC in their discussion ,half(51.0%)  of students agree Premarital counseling is personal privacy, more than forty (43%) of student agree premarital screening is personal freedom, more than half (56.3%)  of student agree to do premarital screening Overall  attitude was 76.8%.

Table (5).The association between gender, academic year and level of attitude of premarital genetic counseling

There is significant relation between gender and attitude of premarital genetic counseling p values < (5%).

but  no Significant association was found between attitude of premarital counseling and academic year p values > 5%.

Discussion:

Sickle cell disease is the most common monogenetic disease, In countries with poor public health systems, sickle cell disease remains a major killer of infants and children, similar to other diseases like malaria and HIV/AIDS. ( M.E. Houwing et.al,2019). Pre-marital screening believed the most efficient means of prevention that may decrease the birth of affected children, by preventing the marriage of the carriers of the blood genetic disorder. Also, it is the appropriate procedure, as it is commonly acceptable from the ethical and religious point of view in addition to its minimal economical, and health requisites(Maha et.al,2018).

The  present study revealed that almost all student  know what is mean of sickle cell disease this is may due to fact  that nursing student exposed information’s from the medicine course in second year and had taken a sickle cell disease as a topic, this is with the same line with (Bindhani et al,2020).who revealed 95.4% of all respondents had heard of sickle cell disease.

It is encouraging to note that  the study revealed  great majority of student Said Cause of sickle cell disease is hereditary Disease, this is may be due to fact that  those nursing student had a course of genetic in first semester in second year ,the knowledge of how the disease is got should be very thorough and clearly understood by anybody who has had education up to the university level, this is similar to ( Blessing et.al,2011).Who revealed  89.6% of the student knows it is inherited from parents.

Study show that majority of students agree that premarital counseling is important and willing to do it  before marriage, this due to that youth connected with social media which expose them to world and premarital counseling have been expansion in many countries, this is similar to  ( Ebele et.al,2019) which revealed that 92% of participant agree PMS is important .

The study highlight One third of  participant in this study agree that It is important to apply a law stops marriage upon discovery of a genetic disease this is supposedly that  youth have the right to willing  marry health partner , this is explain that Government should be heed about the importance of screening and for people who caring disease , our finding were agree with  ( A.S. Adewoyin et.al,2015). Who Found that half of participant agree for Legislation against marriage union between two SCD trait carriers.

The findings highlight the degree of acceptance of Muslim communities to premarital genetic counseling, two third of nursing student disagree premarital screening  is against Islamic role ,half of the participant ,agree that religious leaders should adopt the ideas of premarital screening in their discussion , this is possibly because student are educated enough and know that premarital counseling play key role in preventing of genetic disease this finding similarly to recent study from Saudi Arabia by (Nahla et.al,2010).

The study revealed half of the participant reported a family relationship between their parents, instead of high consanguinity between fathers and  mother it is encouraging that more than  half  of student disagree with consanguinity marriage as they agree the dangerous of marry relatives. this is in a same line with (Al-Qahtani et.al,2019 ).

Conclusion:

This research concluded that almost of the participants  had good knowledge regarding sickle cell disease which significant with gender . Also the vast majority of them agreed to perform PMSGC. Their attitude regarding premarital screening and genetic counseling was good and found to be affected by their gender .

Recommendation:

Premarital genetic counseling should include as a subject in school and university curriculum so that children could have knowledge before reach the age of marriage. Beliefs and attitudes will not only affect their choices in life including their choice on a partner but will also affect convincing their surrounding community about the importance of PMC.

Schools and companies should include genotype test as part of their medical check for new entrants and the new entrant’s status should be made known to them.

Government, non-governmental organizations, and community should one hand to establish premarital genetic screening and counseling section in hospital in all state of Sudan.

Further research recommendation is sexual, genetic, psychological and financial premarital counseling in community.

Acknowledgement:

We would like to express our deepest gratitude to our advisor, Saeeda Alsadeg Mohammed, whose sincerity and encouragement we will never forget.also We are grateful for our parents symbol of giving who guide me with love, light of hope, brothers and  dearest  sisters  whose constant love and support keep our motivated and confident.

Very sincere thanks are university of bahri college of nursing science.

Ethical consideration

Written ethical approval were obtained from the ethical committee of Bahri university college of nursing.

All participants  received a written consent form in Arabic or English. the participant were told about the purpose of the research and that they can accept or refuse.

Reference

• Ahmed Daak , Elfatih Elsamani, Eltigani H. Ali, Fatma A Mohamed, Manar E. Abdel-Rahman, Abozer Y. Elderdery, Octavious Talbot, Peter Kraft, Kebreab Ghebremeskel, Mustafa I. Elbashir and Wafaie Fawzi.( 2016).  Sickle cell disease in western Sudan: genetic epidemiology and predictors of knowledge attitude and practices. Tropical Medicine and International Health Vol. 21 No 5. pp 642–653
• Ahmed FE, Gaboli HO, Salih KMA. (2014) Clinical profile of sickle cell anaemia in Sudanese children. NMJ.;3(14):12–9.
• who.int.(2021).Available at:https://apps.who.int/gb/archive/pdf_files/EB118/B118_5-en.pdf
• Ammar Alhosain.(2018).Premarital Screening Programs in the Middle East, from a Human Right’s Perspective. Diversity and Equality in Health and Care (2018) 15(2):41-45
• Al-Qattan, H., Amlih, D., Sirajuddin, F., Alhuzaimi, D., Alageel, M., Bin Tuwaim, R. and Al Qahtani, F.(2019). Quantifying the Levels of Knowledge, Attitude, and Practice Associated with Sickle Cell Disease and Premarital Genetic Counseling in 350 Saudi Adults. Advances in Hematology, , pp.1-7.
• Al-Qahtani FS, Alfahad MI, Alshahrani AM, Almalih HS, Al-Malki AS, Alshehri TK, Alqhtani AA, Al-Qahtani AM, Alfaifi SH, Alasmari RF, Bharti RK, Chaudhary S.( 2019) Perception of premarital counseling among King Khalid University students. J Family Med Prim Care;8:2607-11 https://www.jfmpc.com/text.asp?2019/8/8/2607/265576-3
• S. Adewoyin, A.E. Alagbe, B.O. Adedokun, and N.T. Idubor. (2015) Knowledge, Attitude And Control Practices Of Sickle Cell Disease Among Youth Corps Members In Benin City, Nigeria. Annals of Ibadan Postgraduate Medicine Vol.13, No.2 100-107
• Bindhani BK, Devi NK, Nayak JK.(2020). Knowledge, awareness, and attitude of premarital screening with special focus on sickle cell disease: a study from Odisha. Journal of Community Genetics.;11(4):445–9 https://pubmed.ncbi.nlm.nih.gov/32557401/
• Blessing O. Okperi, Mcgil Ugwu .Blaise Ebiringa Anyanwu,Arierhire Okperi(2011). A Survey of the Knowledge of and Attitude of University of Portharcourt (Nigeria) Undergraduates Towards Premarital Genetic Counselling in Relation to Sickle Cell Anaemia.
• Data & Statistics on Sickle Cell Disease| CDC.(2021). from https://www.cdc.gov/ncbddd/sicklecell/data.html
• Dodson CH, Lewallen LP.( 2011). Nursing students’ perceived knowledge and attitude towards genetics Nurse Education Today; 31: 333– 339.
• Ebele Uche, Olusola Olowoselu, Benjamin Augustine, Ayobami Ismail, Akinsegun Akinbami, Adedoyin Dosunmu, Abdulhafeez Balogun.(2019).An Assessment of Knowledge, Awareness, and Attitude of Undergraduates toward Sickle Cell Disease in Lagos, Nigeria. Niger Med J 2017;58:167-72
• Gabriel O.Oludare ,Matthew C. Ogili.(2013). Knowledge, Attitude and Practice of Premarital Counseling for Sickle Cell Disease Among Youth in Yaba, Nigeria. Afr J Reprod Health; 17[4]: 175-182
• Ibrahim Ali Kabbash, Asmaa Omar Attalla, Salwa Abd Elmageed Atlam. ( 2019). Perception of Importance of Premarital Counseling among Medical Students of Tanta University, Egypt. The Egyptian Journal of Community Medicine Vol. 37 No.
• Maha Ali,1Norelhouda Elshabory , Hanan Elzeblawy Hassan . Nehad Zahra , Hayam Alrefai.(2018). Perception about Premarital Screening and Genetic Counseling Among Males And Females Nursing Students. Journal of Nursing and Health Science 7(1),p.51-57.
• Rasha Aziz, Attia Salama ,and Abeer Kamal Saleh.(2016) UAE, Effectiveness of premarital screening in UAE, Genet Med 13(1):26-30.
• org. (2021). Premarital counseling – Mayo Clinic Available at: https://www.mayoclinic.org/tests-procedures/premarital-counseling/about/pac-20394892
• Maha Ali,1Norelhouda Elshabory , Hanan Elzeblawy Hassan . Nehad Zahra , Hayam Alrefai.(2018). Perception about Premarital Screening and Genetic Counseling Among Males And Females Nursing Students. Journal of Nursing and Health Science 7(1),p.51-57.
• Makanjuola Osuolale John, Ibukun Iseoluwa Deborah, Ogundele Alice Igbekele, Amoo Patience O.(2018).Premarital Genetics Counseling: Knowledge of Young Adults in Federal College of Agriculture Akure Ondo State Nigeria. International Journal of Caring Sciences -11 (3) 1671
• Mudathir A. Adam , Nassreldeen K. Adam,Babiker A.Mohamed.(2019). Prevalence of sickle cell disease and sickle cell trait among children admitted to Al Fashir Teaching Hospital North Darfur State, Sudan. BMC Res Notes 12:659
• E. Houwing, P.J. de Pagter, E.J. van Beers, B.J. iemond, E. Rettenbacher,A.W. Rijneveld, E.M. Schols, J.N.J. Philipsen, R.Y.J. Tamminga, K. Fijn van Draat,j, E. Nurc, M.H. Cnossena,, on behalf of the SCORE Consortium (2019). Sickle cell disease: Clinical presentation and management of a global health challenge. Blood Reviews. doi:10.1016/j.blre.2019.05.004
• Nahla Khamis Ragab Ibrahim, Hussein Al-Bara, Ali Al-Fakeeha, Jawaher Al Ahmadi, Mahdi Qadi, Adnan Al-Bara, Waleed Milaat.(2010). An educational program about premarital screening for unmarried female students in King Abdul-Aziz University, Jeddah. Journal of Infection and Public Health.;4(1):30–40 Available from.https://pubmed.ncbi.nlm.nih.gov/21338957/
• Prithu Sundd,Mark T. Gladwin,Enrico M. Novelli.(2019). Pathophysiology of Sickle Cell Disease . Annu Rev Pathol 24; 14: 263–292