Getting married? This is why you need premarital screening

For many ordinary men and women looking to settle down, physical appearance, financial security, character and emotional compatibility are some of the qualities that attract them to a potential mate.

But are these the only factors that matter in a marriage union? Hardly, as obstetrician and gynaecologist John Ongech argues, noting that compatibility on health parameters too is critical. He says this goes a long way in preventing a couple and their children from chronic  diseases.

For a start, Dr Ongech advises couples to test for sexually transmitted diseases (STDs) such as HIV/AIDS, gonorrhoea, herpes, syphilis and hepatitis C to avoid passing it to each other.

“In Kenya and indeed most African societies, the majority of couples meet, court and soon sire a child usually without undergoing premarital screening for STDs and other genetic diseases,” says Dr Ongech, adding that this puts them and their children at risk.

But what is premarital screening? Why is it important?

Premarital screening is testing couples who are planning to get married soon for common genetic blood disorders (such as sickle cell anaemia and thalassemia ) and infectious diseases (hepatitis B, hepatitis C and HIV/AIDS).

Dr Walter Otieno, a paediatrician at the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) notes that this is especially important for people from families with a history of inherited (genetic) diseases.

The medic explains that many people are carriers of genetically inherited traits or underlying medical conditions, which may be passed on to their offspring.

“Take time to know about your family history in regards to various medical/genetic conditions. This will allow you to prepare better as you expect your baby,’’ says Dr Otieno, a lecturer at Maseno University’s School of Medicine.

Revealing one’s medical condition, however, is frowned upon by many dating couples, often out of the fear of broken relationships.

Rehema Akoth, who suffers from sickle-cell anaemia, though, made the tough decision to inform her partner as soon as he made his intentions clear about settling down with her.

Rehema,38, says revealing her medical condition was a monumental step towards their thriving relationship.

“I have had a series of sickle-cell attacks for 37 years. I did not want my child to go through this experience,’’ says the mother of one.

When they settled in marriage, Rehema and her partner decided not to conceive. She says her husband was supportive of her.

“Luckily, my husband had children from his first marriage. This eased the pressure. I was also welcoming to his children. We were a complete family,’’ she adds.

Two years later, Rehema conceived. The couple was thrown into panic.

 “We were worried I could not make it due to my medical condition. At one point we thought of terminating the pregnancy,” she narrates.

The couple would go for a test, where, fortunately, her husband tested negative for the condition. “The doctors advised that my baby would likely be a carrier of the sickle-cell trait. Somehow, we were relieved, assured that our baby would live a normal, painless life,” she recounts.

Ten years later, the couple’s daughter is healthy and without any complications. Rehema says she hopes to reveal her daughter’s condition to her as soon as she reaches puberty.

“I have undergone numerous counselling sessions on sickle cell anaemia. I am determined to ensure that my daughter and her future partner raise a healthy family,’’ Rehema adds.

According to Dr Otieno, sickle cell is the commonest inherited disease in Kenya. Others are red cell membrane abnormalities such as thalassemia.

“Screening helps to detect diseases or body dysfunctions even without current symptoms in individuals but who may be at risk of certain adverse conditions,” says the doctor.

He says most hospitals in the country lack the requisite equipment to screen for these conditions despite the high number of individuals suffering from or acting as carriers. “There is therefore very little awareness on genetic conditions within the population,’’ he observes.

Dr Simon Onsongo, the head of pathology at Aga Khan Hospital, Kisumu, concurs, emphasising the need to educate the public about understanding their genetic conditions and status before conception. Dr Onsongo, however, acknowledges the high cost involved, noting that this locks out many individuals and couples, such as Amos Otieno, from the procedure.

A father of two, Otieno has never been screened medically. He does not intend to undergo one, arguing that he and his wife are healthy. “None of us has shown any signs of a genetic disorder. I do not really see why we should be tested,’’ he says.

Otieno belongs to a segment of the population that erroneously believes that for as long as they do have signs of a genetic disorder, they are healthy.

“A newborn is likely to become a sickler if both parents are carriers or one parent is a sickler and the other a carrier,” explains Dr Onsongo, underscoring the importance of premarital screening.

In developed countries, a blood sample is drawn from the infant after birth and taken through a series of screening before hospital discharge. This allows the child to grow up knowing about any underlying medical disorders they may exhibit.

“We need to carry out screening and awareness campaigns among Kenyans. Where tests are impractical, it is advisable to be aware of the history of inherited diseases in your partner’s family,’’ the chairman of Kenyatta National Hospital says, noting that counselling before and after screening should be done to manage conditions appropriately.

In October last year, Kisumu became the first county in Kenya to launch free newborn sickle cell screening. The region has one of the highest prevalence of the disease in the country.

Dr Otieno, though, says more remains to be done for other genetic disorders across the country.

According to the Center for Disease Control and Prevention, newborn screening identifies conditions that can affect a child’s long-term health or survival.

“Early detection and diagnosis can help prevent death or disability and enable the children to live their full life," he says.

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