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Obligatory premarital tests for beta-thalassaemia in the Gaza Strip: evaluation and recommendations
I Tarazi1, E Al Najjar, N Lulu
1Thalassaemia and Haemophilia Centre, Palestine Avenir Foundation, PO Box 5160, Gaza, Palestine.
Insights
Palestine
Area of Science:
- Medical Genetics
- Public Health
- Hematology
Background:
- Beta-thalassaemia poses a significant health challenge in the Gaza Strip.
- A substantial patient population requires ongoing blood transfusions and chelation therapy.
- Preventive measures are crucial to reduce the incidence of this genetic disorder.
Purpose of the Study:
- To evaluate the 5-year experience of Gaza's obligatory premarital screening program for beta-thalassaemia.
- To assess the program's impact on reducing beta-thalassaemia major births.
- To identify recommendations for program improvement.
Main Methods:
- Analysis of 21,825 blood samples from 19,712 couples undergoing premarital testing (April 2003 - May 2005).
- Screening for microcytosis and hypochromasia, followed by serum ferritin and HbA(2) quantification for suspicious cases.
- Monitoring marriage decisions of carrier couples.
Main Results:
- 10.3% of samples were suspicious for beta-thalassaemia; 25% of these were carriers, and 32.4% had iron deficiency.
- An increasing percentage of carrier couples (up to 73.7% in 2005) opted not to marry.
- A notable reduction in the birth of children with beta-thalassaemia major was observed post-implementation.
Conclusions:
- The obligatory premarital testing program in Gaza has demonstrated success in reducing beta-thalassaemia major births.
- The program effectively influences marriage decisions among carrier couples.
- Further measures are recommended to enhance the program's effectiveness and reach.
Abstract:
Beta-thalassaemia is a major health problem in the Gaza Strip, Palestine, where 293 patients are currently treated with transfusions and chelation. In September 2000, Palestine adopted a prevention programme of obligatory premarital testing for beta-thalassaemia before the issue of a marriage certificate. From April 2003 to May 2005, 21,825 blood samples from 19,712 couples were collected and analysed. Samples (n = 2251, 10.3%) with microcytosis (mean cell volume <80 fl) and/or hypochromasia (mean cell haemoglobin <26 pg) were considered as suspicious for beta-thalassaemia and subjected to serum ferritin and HbA(2) quantification. Of these samples, 25% were carriers for beta-thalassaemia while 32.4% were iron deficient. A diagnosis could not be established in 15.3% of the suspect samples. An increasing percentages of carrier couples did not go ahead with their marriage in the successive years of the programme, which was fitted to zero in the first year and reached 73.7% in the year 2005 (both partners were carriers in 19 couples, 14 decided to separate while five continued). Since implementation, there has been a reduction in the birth of children with beta-thalassaemia major. This study evaluated the 5-year experience of the Gaza Strip in implementing the obligatory premarital testing programme for beta-thalassaemia and recommends measures that could improve it.
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