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Impact of Pre-Marital Health Screening on Sickle Cell Trait Detection among Couples in Nigeria

Abstract

Sickle cell disease remains a significant public health concern in Nigeria, where the sickle cell trait is relatively common within the population. Couples who are unaware of their haemoglobin genotype may unknowingly have an increased risk of having children affected by sickle cell disease. Premarital health screening provides an important opportunity for couples to determine their haemoglobin genotype before marriage and receive appropriate health information and counselling. Early detection of sickle cell trait can improve awareness of genotype status and support informed reproductive health decisions among couples. Premarital screening may include haemoglobin genotype testing alongside other health assessments and counselling services designed to identify health conditions that may have implications for marriage and future family planning. However, uptake of premarital health screening may be limited by inadequate awareness, cost of screening, misconceptions, fear of stigma, concerns about confidentiality, cultural and religious beliefs, and limited access to reliable screening facilities. Against this background, this study investigates the impact of pre-marital health screening on sickle cell trait detection among couples in Nigeria. The study will be anchored on the Health Belief Model, Theory of Planned Behavior, and Health Systems Framework. The Health Belief Model explains how couples' perceptions of susceptibility to sickle cell disease, perceived severity, perceived benefits of genotype screening, perceived barriers, and cues to action may influence their participation in premarital health screening. The Theory of Planned Behavior explains how attitudes, subjective norms, perceived behavioural control, and intentions may influence couples' decisions to undergo health screening before marriage. The Health Systems Framework emphasizes service delivery, health workforce, health information, medical products and technologies, financing, and accessibility as essential components of effective screening services. Collectively, these theoretical perspectives provide a suitable framework for explaining how premarital health screening may influence the detection of sickle cell trait among couples in Nigeria. The study will adopt a quantitative cross-sectional analytical or comparative research design. The study population will comprise couples preparing for marriage or recently married couples who have access to selected healthcare facilities, marriage registration centres, religious institutions, or community-based screening programmes across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, screening centres, and eligible couples. Premarital health screening will be measured using indicators such as availability of screening services, participation in genotype testing, accessibility of screening centres, screening frequency, availability of trained healthcare personnel, availability of haemoglobin genotype testing, counselling services, and provision of screening results. Sickle cell trait detection will be assessed using indicators such as number of couples tested, haemoglobin genotype results, number and proportion of individuals identified with sickle cell trait, confirmation of abnormal results, awareness of genotype status, and referral for appropriate genetic counselling. Data will be collected using structured questionnaires, screening registers, laboratory records, genotype testing reports, healthcare facility records, counselling records, and relevant programme documents. Descriptive statistics will be used to summarize participants' characteristics, screening uptake, genotype testing patterns, and sickle cell trait detection. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the impact of premarital health screening on sickle cell trait detection. Where appropriate, detection rates among couples who participate in premarital screening may be compared with those who do not participate in formal screening services. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that premarital health screening has a significant positive impact on sickle cell trait detection among couples in Nigeria. Couples who participate in premarital health screening are expected to have a higher likelihood of knowing their haemoglobin genotype and identifying sickle cell trait than couples who do not undergo screening. Routine genotype testing before marriage may improve early identification of individuals carrying the sickle haemoglobin gene and provide opportunities for appropriate genetic counselling and reproductive health education. Premarital screening may also improve couples' understanding of sickle cell inheritance and encourage informed reproductive decisions. However, inadequate screening coverage, limited availability of reliable genotype testing, high screening costs, low awareness, fear of stigma, concerns about confidentiality, and misconceptions regarding sickle cell trait may reduce participation in screening programmes. The study therefore expects accessible, affordable, confidential, and properly organized premarital health screening to contribute significantly to improved detection of sickle cell trait among couples in Nigeria. The study is expected to contribute to the literature on premarital health screening, sickle cell trait detection, haemoglobin genotype testing, genetic health, reproductive health, preventive healthcare, counselling, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, healthcare providers, genetic counselling centres, sickle cell control programmes, religious organizations, marriage registration institutions, community health organizations, development partners, and policymakers regarding strategies for improving premarital genotype screening. The study will also provide evidence-based recommendations for expanding access to affordable genotype testing, integrating genetic counselling into premarital health screening, improving public awareness of sickle cell inheritance, strengthening confidentiality of screening services, increasing availability of trained healthcare and counselling personnel, improving laboratory testing quality, and incorporating premarital screening into broader reproductive and preventive health programmes across Nigeria.

Keywords: Premarital health screening, sickle cell trait detection, couples, haemoglobin genotype, sickle cell disease, genetic screening, genetic counselling, reproductive health, preventive healthcare, Nigeria, public health.