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SOURCE : Journal of Health, Social and Environmental Issues (2005) Vol 6, No 2
Abstract
Genetic diseases, especially hereditary blood disorders
such as sickle-cell disease and thalassaemia syndromes
impose a significant burden on many countries. Their
chronic nature with little or no prospect of cure makes
them one of the leading causes of morbidity and
mortality.
In Bahrain 1-2% of newborns have sickle-cell disease
while 11% are carriers, and 2% are carriers of betathalassaemia.
In an attempt to reduce the incidence of
genetic diseases in the Kingdom of Bahrain a premarital
screening programme was introduced in 1985, which
included a national campaign to increase the awareness
of genetic blood diseases among the population. In 1992
the premarital counselling service was expanded to
include all health centres and more recently a law has
been issued mandating premarital screening and
counselling for all individuals wishing to get married.
The development of this law included wide consultation
with all stakeholders to ensure that socio-cultural mores,
theological issues and aspects of human rights had been
exhaustively considered.
The benefits and effects of this premarital counselling
programme will be seen in the improved genetic health of
present and future generations.
Keywords
Genetic counselling, premarital counselling, genetic
diseases
Introduction
Premarital counselling is a vitally important public
health measure for many nations around the world. Its
operational concepts were developed under the auspices
of the World Health Organization (WHO). Data available
from the WHO indicates that 240 million people world
wide are heterozygous for genetic disorders and at least
200,000 lethally affected homozygotes are born
annually, with a major proportion of these accounting for
sickle-cell anaemia and thalassaemia syndromes (WHO
1982).
In an attempt to reduce the incidence of genetic diseases
in Bahrain a premarital screening service was introduced
at the Ministry of Health in 1985. This was expanded in
1992 and premarital counselling was subsequently
included as a part of the primary health care services in
all health centres throughout the Kingdom of Bahrain.
More recently a law (Government Gazette: Issue 2640,
23rd June 2004) has been passed by the Bahrain
Government which requires that all Bahraini couples,
who are planning to marry, undergo mandatory
premarital counselling.
Consanguineous marriage and
genetic diseases
The word consanguineous is derived from the Latin con sanguinis, "of common blood" and consanguineous
"of common blood" and consanguineous
"of common blood" and consanguineous
"of common blood" and consanguineous kinship is characterized by the sharing of common
ancestors. Two or more individuals are said to be
consanguineous if they have a common recent ancestor
(Bodmer and Cavalli-Sforza, 1976) and a consanguineous
marriage is typically defined as occurring between a
couple related as second cousins or even closer.
Worldwide figures have illustrated that there is a 4-5%
increase in the risk of premature mortality among
offspring of the union of first cousins (Modell and Darr,
2002). Consanguineous marriages are a significant
factor in the propagation of genetic diseases, in Bahrain
the rate of consanguineous marriage has decreased quite
markedly from 39.4% (Al-Arrayed, 1999) to 20% (Al-
Arrayed in press) but this is still substantially lower than
in some neighbouring Arab countries. In Saudi Arabia
where cultural reasons support a strong preference for
consanguineous marriage the average rate is 58% with a
range of 34-80% (El-Hazmi et al. 2005), and similarly in
Jordan where the frequency of consanguineous marriage
ranges from 50-66 % (El-Shanti, 2001).
Consanguineous marriage poses a significantly greater
risk in that both parents will carry the same recessive
allele for an inherited trait with the likelihood their
offspring will be homozygous for that trait which will
Premarital genetic counselling: A new law in the
Kingdom of Bahrain
Shaikha Salim Al-Arrayed,
Amani Ali Al-Hajeri,
M.B.ch.B, DHCG-PhD, Head of Genetic Department, Salmaniya Medical
Complex, Kingdom of Bahrain
MD, RCSI in Family Medicine, Chief Resident, Assistant Editor-Bahrain
Medical Bulletin, Genetic Department, Salmaniya Medical Complex,
Kingdom of Bahrain
M.B.ch.B, DHCG-PhD, Head of Genetic Department, Salmaniya Medical
Complex, Kingdom of Bahrain
MD, RCSI in Family Medicine, Chief Resident, Assistant Editor-Bahrain
Medical Bulletin, Genetic Department, Salmaniya Medical Complex,
Kingdom of Bahrain
