Dear Editor,
Africa is the hub of sickle cell disease, an inherited blood disorder that shortens red blood cell survival, causing anemia. According to the WHO, 1000 sickle cell births occur daily on the continent, and without intervention, 50–90% of affected children in many sub-Saharan African countries die before their fifth birthday.[1] In 2019 alone, more than 38000 sickle cell deaths were registered, which was said to represent a 26% increase compared to the preceding years.[2]
According to Dr. Matshidiso Moeti, WHO Regional Director for Africa, “Most African countries do not have the necessary resources to provide comprehensive care for people with sickle cell disease despite the availability of proven cost-effective interventions for prevention, early diagnosis and management of this condition,” He said “we need to shine the spotlight on this disease and help improve the quality of life of those living with it.”[2]
Regrettably, sickle cell disease prevention has largely been neglected in Africa. One renowned and cost-effective preventive measure is premarital genotype screening.[3,4] Premarital genotype screening is a medical test for couples wanting to marry to determine their hemoglobin phenotype and compatibility; this allows them to make informed decisions to prevent sickle cell diseases in the offspring.
However, the promotion of this method may have been misguided. An erroneous assumption prevails, suggesting that only married couples produce offspring at risk of inheriting sickle cell disease, thus promoting premarital genotype screening. This narrow perspective overlooks that individuals intending to conceive children, regardless of their marital status, also face this risk. According to Clark et al.,[5] premarital fertility has increased by 13% in recent years in some African countries. For example, in Uganda, a country with the fifth highest global burden of SCD (20000 annual births),[6] 20–30% of childbirths are premarital, same with Kenya.[5] In the same Uganda, more than 25% of women aged 15–19 years have given birth before the age of 18,[7] meaning that they have not met the minimum legal age of marriage for both women and men. In Botswana and Namibia, 60% of births are premarital, and the trend is not different in South Africa, where almost 50% of children birthed by women aged 12–26 is also premarital. In Nigeria, premarital births are less than 10%.[5]
To address this health communication gap and promote inclusivity, we propose redefining “premarital genotype screening” to “preconception genotype screening.” This revised terminology reflects the broader range of individuals and couples planning to conceive and acknowledges the importance of early genetic screening and counseling before conception. By making this linguistic shift, healthcare providers can effectively reach and serve all individuals who are embarking on parenthood regardless of their marital status.
It is crucial to raise awareness about the importance of preconception genotype screening and its potential to prevent sickle cell disease. It empowers individuals to understand their genetic risks and make informed choices regarding family planning, breaking the cycle of inherited blood disorders. By implementing widespread preconception genotype screening programs and ensuring accessible genetic counseling services, we can significantly contribute to reducing the incidence of sickle cell disease and improving the overall well-being of future generations.
In conclusion, it is imperative to prioritize sickle cell disease prevention in Africa by emphasizing the significance of preconception genotype screening. Redefining the terminology is crucial to promoting awareness, inclusivity, and equitable access to these vital healthcare services. Through collaborative efforts among healthcare professionals, policymakers, and communities, we can make significant strides in winning the fight against sickle cell disease in Africa and improving the lives of those affected.
Financial support and sponsorship
There was no financial aid for this study
Conflicts of interest
There are no conflicts of interest.
References
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