Project – Influence of Pre-Marital Blood Group and Genotype Screening on the Prevention of Genetic Disorders among Couples in Selected Churches in Awka South

CHAPTER ONE

1.0 Introduction

Marriage is a major life transition that normally involves not only social and emotional preparation but also health considerations that affect both partners and their future children. In many societies, especially in Nigeria, genetic and blood‑related diseases—most notably sickle cell disease (SCD)—remain a significant public health challenge. SCD is an inherited haemoglobin disorder caused by genetic mutations that alter red blood cell shape and function, leading to chronic pain, severe anaemia, organ damage, and reduced life expectancy. Nigeria has one of the highest burdens of sickle cell disease globally, with estimates suggesting that approximately 2–3% of newborns are born with SCD and about 22–25% of adults carry the sickle cell trait (AS) — thus, making genotype awareness vital before marriage planning.

Blood group and genotype screening — which typically includes determining ABO/Rh blood type and haemoglobin phenotype — are part of premarital medical evaluations aimed at identifying couples at risk of having offspring with genetic disorders. These screenings help couples make informed decisions, prevent high‑risk unions where both partners carry harmful genes, and potentially reduce the incidence of inherited conditions such as SCD. Premarital genotype screening has been identified internationally as one of the most realistic measures to curb the burden of genetic disorders, especially in regions with high carrier prevalence.

In the context of religious communities, especially in Christian churches in Awka South, Oyo State, premarital screening is sometimes encouraged, though it is not always compulsory. However, the extent to which blood group and genotype screening influences the prevention of genetic disorders and how this affects marital planning remains under‑researched in this region. This study, therefore, explores the influence of pre‑marital blood group and genotype screening on the prevention of genetic disorders among couples in selected churches in Awka South and seeks to provide evidence to inform community and church‑based health interventions.

1.1 Background of the Study

Genetic disorders are diseases caused by abnormalities in an individual’s DNA and often follow inherited patterns. Among these, haemoglobinopathies — such as sickle cell disease and thalassemias — represent some of the most common and severe forms of inherited disorders in sub‑Saharan Africa. In Nigeria, which bears the largest burden of sickle cell disease in the world, the disease imposes substantial physical, economic, and social burdens on families and healthcare systems, given recurrent hospitalizations, complications, and shortened lifespans.

Premarital blood group and genotype screening entails testing prospective couples to determine their blood types (e.g., A, B, AB, O and Rh factor) and genotype phenotypes (e.g., AA, AS, SS). While blood group incompatibilities, such as Rh incompatibility, can present risks during pregnancy (e.g., hemolytic disease of the newborn), genotype incompatibility — where both partners carry recessive genes — can lead to birth of children with serious inherited disorders like sickle cell disease. Screening provides vital knowledge that can influence marriage decisions, reproductive planning, and early health interventions.

Despite efforts from public health sectors and community initiatives to encourage premarital screenings, uptake remains inconsistent. Studies among various Nigerian populations have shown mixed levels of knowledge and attitudes toward genotype and blood group screening: some urban studies report good willingness to screen and positive attitudes, yet actual screening practices lag behind. Evidence also shows that knowledge gaps persist — many individuals may know about sickle cell disease but lack accurate understanding of how screening before marriage can prevent its occurrence in offspring.

In the religious setting of Awka South, where churches are important community institutions, linkage between faith‑based premarital practices and health screenings has the potential to influence couples’ choices and health outcomes. However, the influence of such screenings on actual prevention of genetic disorders, couples’ decisions, and subsequent generations remains inadequately explored. This study aims to fill that gap by assessing how pre‑marital blood group and genotype screening influences the incidence (or potential prevention) of genetic disorders among church couples in Awka South.

1.2 Statement of the Problem

In Nigeria, genetic disorders such as sickle cell disease continue to contribute to morbidity and mortality due to high carrier prevalence and limited preventive measures. Despite the known benefits of premarital genotype screening in reducing the incidence of genetic diseases, many intending couples do not undergo formal testing before marriage due to lack of awareness, cost, cultural beliefs, or inconsistent health promotion initiatives.

Premarital screening, including blood group and genotype evaluation, has been promoted as a strategy for early recognition of genetic risk and prevention of hereditary disorders in offspring. Yet evidence suggests that many young adults have only partial knowledge about these screenings, and actual screening practices remain low even in urban Nigerian settings.

In Awka South, selected churches represent a microcosm of communities where health behaviors intersect with religious guidance. However, there is little empirical data on whether premarital screening influences couples’ decisions about marriage, prenatal planning, or the prevention of genetic disorders. Without such data, community health planners, church leaders, and couples lack evidence‑based direction to improve uptake and integrate genetic screening into premarital counseling and health education effectively. Therefore, understanding the influence of pre‑marital blood group and genotype screening on the prevention of genetic disorders remains crucial for public health and family wellbeing in this context.

1.3 Research Objectives

The main objective of this study is to assess the influence of pre‑marital blood group and genotype screening on the prevention of genetic disorders among couples in selected churches in Awka South, Anambra State.

The specific objectives are:

1. To determine the level of awareness and uptake of pre‑marital blood group and genotype screening among couples in selected churches in Awka South.
2. To evaluate the relationship between pre‑marital screening results and couples’ reproductive decision‑making.
3. To assess the perceived influence of screening on the likelihood of genetic disorder prevention.
4. To examine associations between premarital screening participation and demographic factors (e.g., education level, age, church affiliation).

1.4 Research Questions

1. What is the level of awareness and uptake of pre‑marital blood group and genotype screening among couples in selected churches in Awka South?
2. How do pre‑marital screening results influence couples’ decisions about marriage and childbearing?
3. To what extent do couples believe that premarital screening can help prevent genetic disorders?
4. What demographic factors are associated with uptake of premarital screening?

1.5 Research Hypothesis

H₀: There is no significant influence of pre‑marital blood group and genotype screening on the prevention of genetic disorders among couples in selected churches in Awka South.

1.6 Significance of the Study

This study is significant for several reasons:

• Public Health Policy: Findings can inform public health strategies to improve genotype and blood group screening uptake, potentially reducing the incidence of genetic disorders.
• Church Ministry: Church leaders can use evidence to enhance premarital counseling and embed health promotion activities within their pastoral care.
• Couples and Families: Intending couples will gain insights into how screening affects reproductive planning and child health outcomes.
• Academic Knowledge: The study contributes to literature on genetics, preventive health, and behavioural responses to health screening in Nigerian church communities.

1.7 Scope of the Study

This study focuses on couples who are married or about to marry and attend selected Christian churches in Awka South Local Government Area, Anambra State, Nigeria. It examines their awareness, attitudes, and practices regarding premarital blood group and genotype screening, and explores the influence of such screening on genetic disorder prevention. The study does not cover prenatal genetic diagnostics nor screening practices outside the church or unrelated community settings.

1.8 Definition of Terms

• Premarital Screening: Health tests conducted before marriage, including blood group and genotype analysis, to detect possible genetic or blood disorders.
• Genotype: Genetic constitution of an individual’s blood cells (e.g., AA, AS, SS relevant to sickle cell gene).
• Blood Group: Classification of blood (A, B, AB, O and Rh factor) that has medical implications, particularly for pregnancy.
• Genetic Disorders: Diseases caused by abnormalities in DNA, including inherited conditions like sickle cell disease.
• Uptake: The rate or frequency at which couples choose to undergo premarital screening.

Project – Influence of Pre-Marital Blood Group and Genotype Screening on the Prevention of Genetic Disorders among Couples in Selected Churches in Awka South