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ORIGINAL ARTICLE
Year : 2019  |  Volume : 8  |  Issue : 8  |  Page : 2607-2611  

Perception of premarital counseling among King Khalid University students


1 Department of Family and Community Medicine; Department of College of Medicine, King Khalid University, Abha, Saudi Arabia
2 Department of College of Medicine, King Khalid University, Abha, Saudi Arabia
3 Department of Family Medicine, College of Medicine, University of Bisha, Saudi Arabia
4 Department of Family Medicine, Najran University, Najran, Saudi Arabia
5 Department of Anatomy, King Khalid University, Abha, Saudi Arabia

Date of Submission04-May-2019
Date of Decision20-May-2019
Date of Acceptance29-May-2019
Date of Web Publication28-Aug-2019

Correspondence Address:
Dr. Faisal Saeed Al-Qahtani
Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_364_19

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  Abstract 


Background: Genetic blood disorders are common in Arab countries which are related to many physical and mental disorders. Premarital counseling has been one of the strongest ways to prevent hereditary diseases. It can provide a capability to intervene according to identified risks, vaccinations, genetic consulting, nutrition, consulting regarding behavior and advice regarding contraception. This study aimed to assess university students' knowledge, attitude and practice of pre-marital counseling (PMC) in king Khalid University. Methodology: A cross-sectional study was conducted at King Khalid University in Abha city from May to August 2018. The students were selected using two stage stratified cluster sampling technique (medical and non-medical). A total sample of 541 students were included. A structured questionnaire with close-ended questions was designed by the authors following an extensive review of the literature on knowledge, practice, and attitude of premarital screening program. The questionnaire was developed in English and then translated to Arabic by experts at the College of Medicine. Results: A total sample of 541students were involved with ages ranged from 18 years to 27 years old and 56.6% at medical colleges. Exact 73.4% of the students were aware of PMC and 95.2% reported its importance. 96.5% of the students reported their welling to do PMC on marriage and 72.1% see that it should be mandatory. Conclusions: Nearly three out of each four students had good awareness level regarding PMC. Most of the students have a positive attitude towards PMS and their readiness to adopt the counseling before marriage.

Keywords: Attitude, awareness, genetic blood disorders, practices, pre-marital counseling


How to cite this article:
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. Perception of premarital counseling among King Khalid University students. J Family Med Prim Care 2019;8:2607-11

How to cite this URL:
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. Perception of premarital counseling among King Khalid University students. J Family Med Prim Care [serial online] 2019 [cited 2019 Sep 15];8:2607-11. Available from: http://www.jfmpc.com/text.asp?2019/8/8/2607/265576




  Background Top


Genetic blood disorders are common in Arab countries which are related to many physical and mental disorders.[1] Sickle cell anemia and thalassemia major are the most frequent inherited haemoglobinopathies and are a more common all over the world countries.[2] According to the World Health Organization (WHO), approximately 240 million people are carriers for these disorders and at least 200,000 affected individuals are born annually; approximately equally divided between sickle cell anemia and thalassemia.[3]

Premarital counseling has been one of the strongest ways to prevent hereditary diseases, congenital abnormalities and genetic disorders. It can provide a capability to intervene according to identified risks, vaccinations, genetic consulting, nutrition, consulting regarding behavior and advice regarding contraception.[4]

In Saudi Arabia, genetic blood disorders (e.g., sickle cell anemia and thalassemia), constitute a common health problem.[1] Moreover, consanguineous marriages are encouraged, which increases the risk of children with genetic disorders.[5],[6] A study in KSA to estimate the rate of at-risk marriages and reveled that about 90% of couples in Saudi Arabia at risk of having affected by sickle cell disease and β- thalassemia children still decide to marry.[7] in addition, some other diseases, e.g., hearing impairment, mental disorders, may result from premarital infections by certain microorganisms like hepatitis B virus or rubella during pregnancy.[8],[9]

Another study in Jeddah City reported low knowledge about the premarital counseling among attendees of governmental outpatient clinics, and most participants (96.0%) agreed on its importance.[10]

In Oman, Al-Farsi et al. showed that 1/3rd of adults attending primary healthcare centers were unwilling to do the premarital counseling even though they had high levels of knowledge.[11] Moreover, the majority of Omani university students thought that it is important to do premarital counseling.[12]

Almost 2 decades ago, a study in Abha City reported that 70% of King Khalid university students showed acceptance of premarital counseling while 13% rejected it. The same study revealed Legalization of premarital counseling was agreed on by 19% compared to 41% who refused it.[12] Therefore, it is important to explore university students' knowledge, attitude, and practice regarding premarital counseling which is the objective of the current study.


  Methodology Top


A cross-sectional study was conducted at King Khalid University in Abha city, which is the capital of Aseer provenance at southern region of Saudi Arabia, from May to August 2018. The students were selected using two stage stratified cluster sampling technique. Stratification factor was the nature of the college (medical and non-medical). Within each strata, 3 colleges were included randomly. Students were then selected by simple random sampling and those willing to participate were enrolled in the study. A total sample of 541 students were included from 600 distributed questionnaires with a response rate of 90.1%. A structured questionnaire with close-ended questions was designed by the authors following an extensive review of the literature on knowledge, practice, and attitude of premarital screening program. The questionnaire was developed in English and then translated to Arabic by experts at the College of Medicine. A pilot study was conducted on a sample of 60 students to assess the reliability of the questionnaire and to check for ease and clarity of items. Questions that were unclear or distracting were then modified. The students involved in the pilot study were excluded from the final study. A self-reporting questionnaire was distributed to the sampled students after giving brief explanation about the main aims of the study before distributing the questionnaires. The questionnaire consisted of 3 main parts. The first part was on the socio-demographic traits including gender, age, college, academic year, parents' consanguinity and personal and family history of hereditary diseases. The second part tested the students' knowledge regarding premarital screening program. The third part consisted of items that explored the students' attitudes and practice towards premarital screening program. The students were informed that their participation was voluntary and all the information would be confidential. Anonymity and confidentiality was assured and emphasized. Oral consent was obtained from all participants before completing the questionnaires.

Data analysis

After data was collected, it was revised, coded and fed to statistical software IBM SPSS version 20. The given graphs were constructed using Microsoft excel software. All statistical analysis was done using two tailed tests and alpha error of 0.05. P value less than or equal to 0.05 was considered to be statistically significant. Frequency and percent were used to describe the frequency distribution of each category for different variables. Chi square/Mont Carlo exact test and Fishers exact test were used to test for the association between students' characteristics and their awareness level. Exact testes were used if there are small frequencies where chi square is invalid.


  Results Top


A total sample of 541 students were involved with ages ranged from 18 to 27 years old, and 73.8% of the sampled students were males. Exactly 56.6% were in medical colleges. About 81% of the students were of families with average income, whereas 7.4% were married. Genetic diseases in the students' families were recorded among 10.7% while 28.8% of the students' parents were with consanguinity of which 72.4% from father side [Table 1].
Table 1: Bio-demographic data of sampled King Khalid University Students

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[Table 2] shows the students awareness details regarding PMC. Exact of 76% of the students know about premarital screening and 72.1% know it should be mandatory. About 69% of the students know the role of PMC in preventing genetic disorders. About 70% of the sampled students recorded no reasons to avoid PMC and 85.2% agreed on the importance of medical care with PMC. Exact 92.2% of the students know the method of transmission of HIV and 73.6% know about sickle cell anemia. Generally, 73.4% of the students were aware of pre-marital counseling [Figure 1].
Table 2: Awareness regarding pre-marital counselling among sampled King Khalid University Students

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Figure 1: Overall awareness regarding pre-marital counselling among sampled King Khalid University Students

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A for attitude of students towards PMC [Table 3], 95.2% of the students think pre-marital screening is important and 94.1% of the students agreed on their acceptance of PMC. Exact 93% of the students think pre-marital screening goes beyond personal freedom while 88.7% of the students think that premarital screening may be contrary to some of the teachings of Islam, while 91.1% of them think that premarital screening contravenes customs. About 85% of the students will not consider marriage if asked to do a premarital screening, and 40% considered premarital screening to be an insult.
Table 3: Attitude regarding pre-marital counselling among sampled King Khalid University Students

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With regard to practice [Table 4], 96.5% of the students wanted to do PM screening when they get married and 87.5% of married students did PMC before marriage.
Table 4: Practice regarding pre-marital counselling among sampled King Khalid University Students, Abha, 2018

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Finally on relating PMC awareness with students characteristics [Table 5], 80.5% of students aged 25 years or more recorded good awareness compared to 56.9% of students below the age of 21 years with recorded statistical significance (P = 0.001). As for gender, 86.6% of female students had good awareness level compared to 68.7% of males (P = 0.001). Considering college nature, 90.5% of medical students' had good awareness level compared to 51.1% of non-medical students with significant difference. Married students recorded significantly higher awareness level than non-married (90% vs. 72.1%, respectively). Exact 76.7% of students who think in importance of PMC recorded good awareness compared to 7.7% of who did not (P = 0.001). Also 75.3% of students who willing to do PMC had good awareness level compared to 21.1% of others who did not (P =.001). Exact of 86% of students who performed PMC before marriage had good awareness compared to 54.2% of those who were single (P =.013).
Table 5: Relation between students‘ characteristics and their awareness regarding pre-marital counseling among sampled King Khalid University Students

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  Discussion Top


Across the world, genetic screening programs are conducted either before or after birth or in adults before conception but while they are married and able to reproduce.[13] Premarital screening can potentially reduce the burden of inherited hemoglobin diseases b reducing the number of high-risk marriages.[14]

The Saudi community is basically a tribal society with a high proportion of consanguineous marriages, which means that the recessive genes have been able to survive, concentrate, and exhibit disease in these populations over the centuries.[15]

Our study reveals large number were aware of premarital counseling and conceptualized that it should be made mandatory for the couples who are planning to get marry to avoid future risk of genetic disease like thalassemia etc. Our finding were in agreement of other study done by Essa et al.[16],[17] who reported that the attitude of the students towards the premarital screening was found significantly higher in relation to its importance and many participants were agreed on this statement that it helps in preventing the marriage of someone with genetic disorders and not interfering with customs and similar understanding was observed by Al- Fassti et al.[11] However, acceptance of premarital counseling was found satisfactory among participants in order to prevent genetic diseases and this study also explored the reason for the acceptance showed that the many individuals wants to marry a healthy person and avoid to transmit of any hereditary diseases to their children was seen in agreement of other study conducted by Al-Kahtani.[9]


  Conclusions Top


In conclusion, nearly three out of each four students had good awareness level regarding PMC. Also, the study showed that most of the students have a positive attitude towards PMS and their readiness to adopt the counseling before marriage. Even though the vast majority of them thought it is important to carry out PMS and agreed to do it, Three quarters of the students agreed that it should be made a mandatory procedure before marriage. Health education programs with medical advice and community attitude are required for improving knowledge and attitude towards PMS.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Teebi AS, Farag TI. Genetic Disorders among Arab Populations. Second ed. Springer; 2010.  Back to cited text no. 1
    
2.
Old JM. Screening and genetic diagnosis of haemoglobinopathies. Scand J Clin Lab Invest 2007;67:71-86.  Back to cited text no. 2
    
3.
Hereditary anaemias: Genetic basis, clinical features, diagnosis, and treatment. WHO working group. Bull World Health Organ 1982;60:643-60.  Back to cited text no. 3
    
4.
Ibrahim NK, Al-Bar H, Al-Fakeeh A, Al Ahmadi J, Qadi M, Al-Bar A, et al. An educational program about premarital screening for unmarried female students in King Abdul-Aziz University, Jeddah. J Infect Public Health 2011;4:30-40.  Back to cited text no. 4
    
5.
Al-Nood HA, Al-Akmar MM, Al-Erynai EF. Knowledge and attitudes of Sana'a University medical students towards premarital screening. Yemeni J Med Sci 2016;27:39-47.  Back to cited text no. 5
    
6.
Oluwole O, Elison A, Olateju O. Awareness of premarital genetic counselling among youth corpers in South-West Nigeria. TAF Prev Med Bull 2010;9:575.  Back to cited text no. 6
    
7.
Mahdi AH. Autosomal recessive osteopetrosis. Ann Saudi Med 1994;14:102-6.  Back to cited text no. 7
    
8.
Alswaidi FM, Memish ZA, O'Brien SJ, Al-Hamdan NA, Al-Enzy FM, Alhayani OA, et al. At-risk marriages after compulsory premarital testing and counseling for β-thalassemia and sickle cell disease in Saudi Arabia, 2005-2006. J Genet Couns 2012;21:243-55.  Back to cited text no. 8
    
9.
Al-Kahtani Acceptance of premarital health counseling in Riyadh city, 1417h. J. Family Community Med 2000;7:27-34.  Back to cited text no. 9
    
10.
Ibrahim NK, Bashawri J, Al Bar H, Al Ahmadi J, Al Bar A, Qadi M, et al. Premarital Screening and Genetic Counseling program: Knowledge, attitude, and satisfaction of attendees of governmental outpatient clinics in Jeddah. J Infect Public Health 2013;6:41-54.  Back to cited text no. 10
    
11.
Al-Farsi OA, Al-Farsi YM, Gupta I, Ouhtit A, Al-Farsi KS, Al-Adawi S. Astudy on knowledge, attitude, and practice towards premarital carrier screening among adults attending primary healthcare centers in a region in Oman. BMC Public Health 2014;14:380-7.  Back to cited text no. 11
    
12.
Al Kindi R, Al Rujaibi S, Al Kendi M. Knowledge and attitude of University students towards premarital screening program. Oman Med J 2012;27:291-6.  Back to cited text no. 12
    
13.
Bener A, Hussain R, Teebi AS. Consanguineous marriages and their effects on common adult diseases: Studies from an endogamous population. Med Princ Pract 2007;16:262-7.  Back to cited text no. 13
    
14.
Memish ZA, Saeedi MY. Six-year outcome of the nationalpremarital screening and genetic counseling program for sickle cell disease and thalassemia in Saudi Arabia. Ann Saudi Med 2011;31:229-35.  Back to cited text no. 14
[PUBMED]  [Full text]  
15.
Memish ZA, Owaidah TM, Saeedi MY. Marked regional variations in the prevalence of sickle cell disease and b-thalassemia in Saudi Arabia: Findings from the premarital screening and genetic counseling program. J Epidemiol Glob Health 2011;1:61-8.  Back to cited text no. 15
    
16.
Eissa M, Patel AA, Farag S, Babiker NH, Al-Shahrani MS, Al-Nahari AM, et al. Awareness and attitude of university students about screening and testing for hemoglobinopathies: Case study of the Aseer Region, Saudi Arabia. Int J Hemoglobin Res 2019;42:264-8.  Back to cited text no. 16
    
17.
El-Hazmi MA. Pre-marital examination as a method of prevention from blood genetic disorders. Community views. Saudi Med J 2006;27:1291-5.  Back to cited text no. 17
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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