Inherited disorders represent a major health problem in the Arab World including Saudi Arabia. Consanguineous marriages are considered a main cause of concentration of genetic diseases in those countries. Premarital screening is one of the important measures to prevent such diseases. The Saudi Premarital Screening Program (SPSP) for sickle cell disease and thalassemia was implemented as a mandatory procedure since 1425 H. Our study aims to assess the public attitudes towards consanguinity, to explore the feedback of public regarding legislation of the program, and to investigate the public attitudes toward a possible increase in the number of screened diseases and the different reproductive alternatives for the incompatible couples.
Methodology
A cross-sectional study was conducted in a sample of primary health care (PHC) centers of the Ministry of Health in Al-Ahssa region, Eastern Province in Saudi Arabia. Stratified single-stage cluster sampling with probability proportionate to size (PPS) was used as a sampling method of the centers in the 3 health sectors of the region. The total sample size was 356 Saudi visitors to the sampled centers randomly selected with equal gender distribution and they were above the age of 18 years. A pre-designed interview-based questionnaire was used as an instrument for data collection. The collected information was tabulated and statistically analyzed.
Results
The study showed that 160 participants (44.9%) agreed that consanguineous marriage is a good practice, compared to 137 (38.5%) who disagreed. 218 of the subjects (61.2%) do believe that consanguineous marriages can lead to a diseased offspring, while 93 (26.1%) do not believe so. The vast majority (325) of participants (91.3%) agreed on the compulsory application of the SPSP. Only 21 (5.9%) of participants knew that sickle cell disease and thalassemia are the only 2 diseases currently screened. However, 244 (68.5%) of them supported an increase in the number of screened diseases. 189 (53.1%) agreed on providing the incompatible couples with reproductive alternatives. Among those who agreed, pre-implantation diagnosis was the most preferred alternative, where it was preferred by 54 (28.6%) of them. The majority (287) of participants (80.6%) agreed on the early screening of high school and university students. 142 subjects (39.9%) evaluated the effects of the SPSP as excellent, compared to only 13 (3.7%) as poor. Illiteracy was found to negatively affect the public attitudes toward the previous issues. Attitudes of those participants who don't have genetic blood diseases or affected children were better than those of affected participants and those who have affected children.
Conclusion
Consanguineous marriages were still preferred by a large percentage of the study population despite their awareness of its possible harms. Social values and traditions were the major causes of popularity of this habit. However, the majority of the study population accepted the Saudi Premarital Screening Program and its mandatory application. They showed a very poor knowledge of the currently screened diseases, but they accepted an increase in the number of them. Reproductive alternatives for incompatible couples were welcomed by a considerable proportion. Illiteracy and misunderstanding of Islamic rules were found to negatively affect the attitudes of population. Intensification of health and religious education is needed through all the possible channels (e.g. schools, media, mosques, primary care centers).