Adesola Adeniyi Abraham, Lawal Joshua Simpa, Akoki David Mobolaji, Oyedokun Abigail Olawumi, Agboola Oluwatomisin Esther, Babawale Anuoluwapo Agnes, Brown Biobele Jotham
Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Department of Paediatrics, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria.
BMC Public Health. 2025 May 17;25(1):1824. doi: 10.1186/s12889-025-23066-8.
Sickle cell disease (SCD) is a significant public health concern in Nigeria. Despite widespread awareness campaigns advocating for premarital phenotype testing, many couples still make marital decisions that increase the risk of having children with SCD. This study aims to explore the factors influencing marital decisions among parents of children with SCD, focusing on the relationship between phenotype awareness and marital choices.
This mixed-method study was conducted among 209 parents of children with SCD receiving care at the paediatric haematology clinics of University College Hospital (UCH) and Oni Memorial Children Hospital (OMCH) in Ibadan, Nigeria. Quantitative data were collected through interviewer-administered structured questionnaires. Qualitative data were obtained through key informant interviews with stakeholders, including parents, healthcare providers, and SCD advocates. Qualitative data were thematically analysed and integrated with the quantitative findings.
Findings revealed low premarital awareness of sickle cell phenotypes as only 14.5% of couples had mutual knowledge, while 36.7% were completely unaware. Key factors influencing phenotype combinations that carry risk of SCD birth included a willingness to "take the risk and hope for the best" (46.7%), limited understanding of the implications of SCD (33.3%), willingness to bear consequences (26.7%) and reliance on faith (20%). Higher educational levels correlated with improved awareness.
This study identifies significant gaps in premarital genetic awareness. Key gaps include a lack of knowledge about the implications of phenotype combinations and the tendency to prioritise cultural, emotional and religious factors over genetic risk considerations when making marital decisions. To bridge these gaps, improved public health education, accessible pre-marital genetic counselling and strategic engagement with religious and community leaders are essential to translating awareness into informed action.
镰状细胞病（SCD）是尼日利亚一个重大的公共卫生问题。尽管开展了广泛的倡导婚前表型检测的宣传活动，但许多夫妇在做出婚姻决定时，仍会增加生育患镰状细胞病子女的风险。本研究旨在探讨影响镰状细胞病患儿父母婚姻决定的因素，重点关注表型认知与婚姻选择之间的关系。
这项混合方法研究是在尼日利亚伊巴丹大学学院医院（UCH）和奥尼纪念儿童医院（OMCH）的儿科血液科诊所接受治疗的209名镰状细胞病患儿的父母中进行的。定量数据通过访员管理的结构化问卷收集。定性数据通过与包括父母、医疗服务提供者和镰状细胞病倡导者在内的利益相关者进行关键信息访谈获得。对定性数据进行了主题分析，并与定量研究结果相结合。
研究结果显示，婚前对镰状细胞表型的认知较低，只有14.5%的夫妇有共同认知，而36.7%的夫妇完全不了解。影响携带镰状细胞病出生风险的表型组合的关键因素包括“冒险并抱最好的希望”的意愿（46.7%）、对镰状细胞病影响的了解有限（33.3%）、愿意承担后果（26.7%）和依赖信仰（20%）。较高的教育水平与更高的认知度相关。
本研究发现婚前基因认知存在重大差距。关键差距包括对表型组合影响的知识缺乏，以及在做出婚姻决定时倾向于将文化、情感和宗教因素置于基因风险考虑之上。为了弥合这些差距，改善公共卫生教育、提供可及的婚前基因咨询以及与宗教和社区领袖进行战略互动对于将认知转化为明智行动至关重要。
