Knowledge, attitudes and utilization of premarital sickle cell disease screening among primigravida mothers at Mulago Hospital

Abstract

Background: Sickle cell anemia remains the most frequent and traumatizing genetic disease which continues to devastate the families of sickle cell patients both mentally and economically in Uganda with an average of 33,000 babies born annually of whom 80% die before celebrating their fifth birthday. Objectives: To determine knowledge, attitudes and utilization of premarital sickle cell disease screening and factors associated with screening among primigravida mothers at Mulago hospital. Methods: A descriptive and analytical cross-sectional study was conducted among 500 primigravida mothers who were enrolled systematically. Knowledge, attitude and utilization of premarital sickle cell disease screening among pregnant mothers at Mulago Hospital were assessed using interview guided semi-structured questionnaires. Binary logistic analysis was done to determine factors associated with premarital SCD screening. Results: Majority of participants (65.4%) had adequate knowledge about PMSC. About half of them (49%) knew that sickle cell can be screened by testing of blood and only 31.2% knew that sickle cell screening involves both blood testing and physical examination. Overall, the participants had positive attitude to PMSC (72.2%) and 66% of the participants supported the view of making PMS compulsory. However, only 55(11%) had screened for sickle cell. At adjusted analysis: partner SCD status (OR=3.52, 95% CI 1.12 - 10.31), positive attitude (OR=4.88, 95% CI 2.35 - 10.13) and positive family history (OR=6.04, 95% CI 2.54- 14.35) were associated with premarital SCD screening. Based largely on their personal experiences, participants possessed an understanding of the natural progression of SCD but had a limited understanding of the inheritance and probable xiv

risk of giving birth to a child with the disease. Barriers to successful implementation of screening for sickle cell disease before marriage were classified as personal, minimal media attention, cost and availability of screening services. Conclusion: Despite the high level of knowledge and positive attitude, a small proportion had screened for sickle cell. Knowledge and attitude alone are not sufficient to promote premarital screening for SCD, so there is need to provide a comprehensive behavioral package to promote premarital screening for SCD.