1
|
Panwar A. Thalassemia, biobanking infrastructures, and personalized stem cell therapies in Chennai. FRONTIERS IN SOCIOLOGY 2023; 8:1057220. [PMID: 37577128 PMCID: PMC10415100 DOI: 10.3389/fsoc.2023.1057220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 06/30/2023] [Indexed: 08/15/2023]
Abstract
Thalassemia and leukemia and related blood disorders are approved for blood stem cell transplants in India, for a stem cell transplant to be successful, the human leukocyte antigen (HLA) complex located on the arm of chromosome six must be a match between the cord blood donor and the recipient. In the quest to find an exact blood stem cell match for an individual, the HLA becomes the node at the center of community genetics where the HLA match is sought (not necessarily successful) in the extended family, the same caste, language, and ethnic (both national and the diaspora) groups. By considering thalassemia as a case study, how do we understand personalized stem cell therapies within biobanking infrastructures in Chennai? How do social categories get entwined with biological materials like cord blood?
Collapse
Affiliation(s)
- Amishi Panwar
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
2
|
Ahmed S, Jafri H, Faran M, Ahmed WN, Rashid Y, Ehsan Y, Ahmed M. Cascade screening for beta-thalassaemia in Pakistan: relatives' experiences of a decision support intervention in routine practice. Eur J Hum Genet 2022; 30:406-412. [PMID: 34608271 PMCID: PMC8991204 DOI: 10.1038/s41431-021-00974-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022] Open
Abstract
Low uptake of cascade screening for βeta-thalassaemia major (β-TM) in the 'Punjab Thalassaemia Prevention Project' (PTPP) in Pakistan led to the development of a 'decision support intervention for relatives' (DeSIRe). This paper presents the experiences of relatives of children with β-TM of the DeSIRe following its use by PTPP field officers (FOs) in routine clinical practice. Fifty-four semi-structured qualitative interviews were conducted (April to June 2021) with relatives in seven cities in the Punjab province (Lahore, Sheikhupura, Nankana Sahab, Kasur, Gujranwala, Multan and Faisalabad). Thematic analysis shows that participants were satisfied with the content of the DeSIRe and its delivery by the FOs in a family meeting. They understood that the main purpose of the DeSIRe was to improve their knowledge of β-TM and its inheritance, and to enable them to make decisions about thalassaemia carrier testing, particularly before marriage. Participants also raised concerns about the stigma of testing positive; however, they believed the DeSIRe was an appropriate intervention, which supported relatives to make informed decisions. Our findings show that the DeSIRe is appropriate for use by healthcare professionals in routine practice in a low-middle income country, and has the potential to facilitate shared decision making about cascade screening for thalassaemia. Further research is needed to prove the efficacy of the DeSIRe.
Collapse
Affiliation(s)
- Shenaz Ahmed
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Hussain Jafri
- Thalassaemia Society Pakistan, Lahore, Pakistan
- Fatima Jinnah Medical University, Lahore, Pakistan
| | | | | | | | | | | |
Collapse
|
3
|
Alam NE, Islam MS, Khabir MIU, Suriea U, Islam MM, Mohiuddin RB, Akter S, Mahamud N, Bappy MNI, Sardar D, Mahmud S, Chowdhury K, Mohiuddin AKM. The scenario of knowledge, attitude and practice of the Bangladeshi population towards thalassemia prevention: A nationwide study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001177. [PMID: 36962681 PMCID: PMC10022238 DOI: 10.1371/journal.pgph.0001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/21/2022] [Indexed: 03/26/2023]
Abstract
Thalassemia is one of the most common life-threatening yet preventable congenital hemoglobin disorders especially in South Asian regions like Bangladesh. It has become a rising public health concern for Bangladesh as 6-12% of the population are carriers and many of them are unaware of it. The purpose of the study is to inspect the knowledge and attitude towards thalassemia among the general people of Bangladesh. A cross-sectional survey was conducted in eight administrative regions of Bangladesh between January and October of 2020. A structured questionnaire was designed to collect information about thalassemia and socio-demographic characteristics. Multivariate logistic regression models were used to identify factors associated with knowledge of thalassemia. A p-value <0.05 was considered significant. Of the 1,248 participants, only 47.4% had heard of thalassemia. Half of the participants who heard about the disease had no idea that thalassemia was not a transfusion transmitted disease. Only 49.8% of participant correctly identified consanguineous marriages as an important risk factor. Majority of them knew that marriage between two carriers can lead to a child with thalassemia major. About 72.5% knew that blood tests are a diagnosis method to determine thalassemia. Among the socio-demographic variables, the level of education of the respondents was identified as an independent predictor for knowledge (p<0.05) on thalassemia. For example, graduate (aOR: 24.88; 95% CI: 6.238-99.232) or post-graduate (aOR: 33.18; 95% CI: 7.864-140.001) participants were more aware of thalassemia than non-graduates. However, about 68.2% of the participants showed a positive attitude towards premarital screening of themselves or their family members and 85.3% were willing to donate blood to thalassemia patients. The study shows that there is a need to disseminate the information on thalassemia since the knowledge gap is huge among people. These findings will strengthen the implementation of thalassemia major awareness through educational programs, health counseling, premarital screening and campaigning.
Collapse
Affiliation(s)
- Nur E Alam
- Department of Biotechnology and Genetic Engineering, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Md Shariful Islam
- University of Wisconsin- Madison, Madison, Wisconsin, United States of America
| | - Md Imam Ul Khabir
- Department of Biological Science, Alabama State University, Montgomery, Alabama, United States of America
| | - Umme Suriea
- Department of Biotechnology and Genetic Engineering, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Md Muzahidul Islam
- Department of Biotechnology and Genetic Engineering, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Ramisa Binti Mohiuddin
- Department of Pharmacy, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Sumaiya Akter
- Department of Biotechnology and Genetic Engineering, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Nahid Mahamud
- Department of Biotechnology and Genetic Engineering, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Md Nazmul Islam Bappy
- Department of Biotechnology and Genetic Engineering, Sylhet Agricultural University, Sylhet, Bangladesh
| | - Dipankar Sardar
- Department of Biotechnology and Genetic Engineering, Khulna University, Khulna, Bangladesh
| | - Shahin Mahmud
- Department of Biotechnology and Genetic Engineering, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Kamal Chowdhury
- Department of Biology, Claflin University, Orangeburg, South Carolina, United States of America
| | - A K M Mohiuddin
- Department of Biotechnology and Genetic Engineering, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| |
Collapse
|
4
|
Hossain MS, Mosabbir AA. Haemophilia in South Asia: A perspective from Bangladesh. Haemophilia 2021; 28:e18-e19. [PMID: 34676626 DOI: 10.1111/hae.14445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Mohammad Sorowar Hossain
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh
| | - Abdullah Al Mosabbir
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh.,Department of Haematology, Dhaka Medical College Hospital, Dhaka, Bangladesh
| |
Collapse
|
5
|
Xu JZ, Foe M, Tanongsaksakul W, Suksangpleng T, Ekwattanakit S, Riolueang S, Telen MJ, Kaiser BN, Viprakasit V. Identification of optimal thalassemia screening strategies for migrant populations in Thailand using a qualitative approach. BMC Public Health 2021; 21:1796. [PMID: 34615515 PMCID: PMC8495975 DOI: 10.1186/s12889-021-11831-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/17/2021] [Indexed: 11/12/2022] Open
Abstract
Background Thalassemia is a common inherited hemoglobin disorder in Southeast Asia. Severe thalassemia can lead to significant morbidity for patients and economic strain for under-resourced health systems. Thailand’s thalassemia prevention and control program has successfully utilized prenatal screening and diagnosis to reduce the incidence of severe thalassemia in Thai populations, but migrant populations are excluded despite having high thalassemia prevalence. We sought to identify key barriers to and facilitators of thalassemia screening and to develop tailored recommendations for providing migrants with access to thalassemia prevention and control. Methods We conducted 28 in-depth interviews and 4 focus group discussions (FGDs) in Chonburi, Thailand with Myanmar and Cambodian migrants, Thai healthcare providers, Thai parents of children affected by thalassemia, and migrant agents. Results Participant narratives revealed that migrants’ lack of knowledge about the prevalence, manifestations, severity, and inherited nature of thalassemia led to misconceptions, fear, or indifference toward thalassemia and screening. Negative perceptions of pregnancy termination were based in religious beliefs but compounded by other sociocultural factors, presenting a key obstacle to migrant uptake of prenatal screening. Additionally, structural barriers included legal status, competing work demands, lack of health insurance, and language barriers. Participants recommended delivering public thalassemia education in migrants’ native languages, implementing carrier screening, and offering thalassemia screening in convenient settings. Conclusions An effective thalassemia prevention and control program should offer migrants targeted thalassemia education and outreach, universal coverage for thalassemia screening and prenatal care, and options for carrier screening, providing a comprehensive strategy for reducing the incidence of severe thalassemia in Thailand and establishing an inclusive model for regional thalassemia prevention and control.
Collapse
Affiliation(s)
- Julia Z Xu
- Department of Medicine, Duke University, Durham, USA. .,National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive Room 6N240C, Bethesda, MD, 20892, USA.
| | - Meghan Foe
- Department of Hematology/Oncology, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, USA
| | | | | | | | | | | | - Bonnie N Kaiser
- Duke Global Health Institute, Duke University, Durham, USA.,Department of Anthropology and Global Health Program, University of California San Diego, La Jolla, USA
| | - Vip Viprakasit
- Siriraj-Thalassemia Center, Mahidol University, Bangkok, Thailand. .,Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
| |
Collapse
|
6
|
Hossain MS, Mahbub Hasan M, Petrou M, Telfer P, Mosabbir AA. The parental perspective of thalassaemia in Bangladesh: lack of knowledge, regret, and barriers. Orphanet J Rare Dis 2021; 16:315. [PMID: 34271949 PMCID: PMC8283743 DOI: 10.1186/s13023-021-01947-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/11/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Thalassaemia, a hereditary haemoglobin disorder, is a major public health concern in some parts of the world. Although Bangladesh is in the world's thalassaemia belt, the information on this disease is scarce. Additionally, the awareness of this life threatening, but potentially preventable disease is surprisingly poor. However, mass awareness is pivotal for the development of an effective preventive strategy. In this context, the understanding of parental perspectives is essential to grasp the magnitude of the problem. Therefore, this study aimed to investigate the parental knowledge gaps and perceptions regarding thalassemia, the barriers confronted by the parents for caring for their thalassaemic children and their attitude to prenatal screening and prenatal diagnosis. METHODS This cross-sectional study was conducted between January 2018 and December 2018 at a dedicated thalassemia hospital located in Dhaka. A structured questionnaire was used for face-to-face interviews with parents of thalassaemic children. Descriptive statistics were used to analyse data. RESULTS Of 365 respondents, nearly all respondents (97%) had not heard about the term, 'thalassemia' before the disease was diagnosed in their children; all (100%) were unscreened for carrier status prior to marriage. Mean knowledge scores were significantly higher in respondents with higher income and education. Most respondents (~ 91%) had a guilty feeling for not undergoing premarital screening. Only around 36% of them had heard about prenatal diagnosis. Approximately 25% participants would consider prenatal diagnosis in a future pregnancy, while 70% of them were unsure and only ~ 5% would decline prenatal diagnosis. Only 9.3% mothers had prenatal diagnosis in a previous pregnancy. Nearly 80% of the parents faced difficulty for obtaining blood donors regularly and a similar proportion (~ 81%) of them did not receive support from any organized blood clubs. More than 40% of the parents reported they felt socially stigmatized. CONCLUSION This study suggests poor parental knowledge regarding thalassaemia including prenatal diagnosis and the challenges faced while caring for their children. These findings would be of paramount importance in planning and devising effective prevention and intervention strategies in Bangladesh as well as other countries with similar sociocultural setting.
Collapse
Affiliation(s)
- Mohammad Sorowar Hossain
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh.
- School of Environment and Life Sciences, Independent University, Bangladesh, Dhaka, Bangladesh.
| | - Md Mahbub Hasan
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh
- Department of Genetic Engineering and Biotechnology, University of Chittagong, Chattogram, 4331, Bangladesh
| | - Mary Petrou
- Institute of Women's Health , University College London, London, UK
| | - Paul Telfer
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UK
| | - Abdullah Al Mosabbir
- Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh
| |
Collapse
|
7
|
Xu JZ, Tanongsaksakul W, Suksangpleng T, Ekwattanakit S, Riolueang S, Telen MJ, Viprakasit V. Feasibility of and barriers to thalassemia screening in migrant populations: a cross-sectional study of Myanmar and Cambodian migrants in Thailand. BMC Public Health 2021; 21:1177. [PMID: 34154562 PMCID: PMC8215823 DOI: 10.1186/s12889-021-11059-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/10/2021] [Indexed: 11/28/2022] Open
Abstract
Background Thalassemia, an inherited hemoglobin disorder, has become a global public health problem due to population migration. Evidence-based strategies for thalassemia prevention in migrants are lacking. We characterized barriers to thalassemia screening and the burden of thalassemia in migrant workers in Thailand. Methods Multilingual demographic and KAP surveys were completed by 197 Thai, 119 Myanmar, and 176 Cambodian adults residing in Thailand. Thalassemia awareness, socio-demographic predictors, and knowledge and attitude scores were compared between migrant and Thai subjects. Comprehensive thalassemia testing was performed for migrants. Results Migrants had extremely poor thalassemia awareness (4.1%) compared to Thai subjects (79.6%) and had lower thalassemia knowledge scores but similar attitude scores. Surveys identified differing sociodemographic factors predicting awareness in Thai and migrant subjects, as well as key misconceptions likely to hinder thalassemia screening uptake. Nearly all migrants consented to thalassemia testing. We identified abnormal hemoglobin profiles in 52.7% of migrants and a higher projected rate of severe thalassemia births in migrants. Conclusions The high burden of thalassemia and tremendous knowledge gap in migrants needs urgent attention. Thalassemia screening was feasible and acceptable in our migrant population. Sociocultural and structural barriers merit further attention when designing thalassemia screening and prevention policies for migrants in Thailand and globally. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11059-2.
Collapse
Affiliation(s)
- Julia Z Xu
- Department of Medicine, Duke University, Durham, USA. .,National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, MD, 20892, Bethesda, USA.
| | | | - Thidarat Suksangpleng
- Thalassemia Center, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Supachai Ekwattanakit
- Thalassemia Center, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Suchada Riolueang
- Thalassemia Center, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | | | - Vip Viprakasit
- Thalassemia Center, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand. .,Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand. .,Thalassemia Center and Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
| |
Collapse
|
8
|
Boardman FK, Clark C, Jungkurth E, Young PJ. Social and cultural influences on genetic screening programme acceptability: A mixed-methods study of the views of adults, carriers, and family members living with thalassemia in the UK. J Genet Couns 2020; 29:1026-1040. [PMID: 32114710 PMCID: PMC7754126 DOI: 10.1002/jgc4.1231] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 02/01/2020] [Accepted: 02/01/2020] [Indexed: 12/15/2022]
Abstract
As population‐level carrier screening panels for reprogenetic information emerge globally, conditions to be included, and the timing of implementation is widely debated. Thalassemia is the only condition for which population‐based prenatal carrier screening is offered in the UK. However, little is known about the views and experiences of the UK thalassemia‐affected community toward this screening or other forms of genetic screening for thalassemia (newborn, preconception), despite the range of direct consequences of screening programmes for this group. Using a mixed‐methods integrative analysis (qualitative interviews n = 20 and quantitative survey n = 80), this study outlines the experiences and attitudes of adults with thalassemia, their family members, and screen‐identified thalassemia carriers toward preconception, prenatal, and newborn screening for thalassemia. The majority of participants described thalassemia as a burdensome condition with a range of negative impacts, which contributed to their strong support for screening in all its potential formats. However, the data also highlight the challenges of each screening mode for this group, reflected in the high level of value conflict in participants' accounts and decisions. Cultural, social, and (to a lesser extent) religious factors were found to mitigate against the advantages of early screens, particularly within faith communities. Social stigma emerged as key to this process, informing the way that thalassemia severity was not only perceived, but also experienced by affected adults, which ultimately influenced screening uptake and outcomes. These findings suggest that cultural and social sensitivity is as important as the mode of screening delivery itself, if the iatrogenic and unintended harms of screening—particularly the social/psychological burden of value conflict—are to be adequately addressed and minimized.
Collapse
Affiliation(s)
- Felicity K Boardman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Corinna Clark
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Philip J Young
- School of Life Sciences, University of Warwick, Coventry, UK
| |
Collapse
|
9
|
Hossain MS, Hasan MM, Raheem E, Islam MS, Al Mosabbir A, Petrou M, Telfer P, Siddiqee MH. Lack of knowledge and misperceptions about thalassaemia among college students in Bangladesh: a cross-sectional baseline study. Orphanet J Rare Dis 2020; 15:54. [PMID: 32085790 PMCID: PMC7035777 DOI: 10.1186/s13023-020-1323-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thalassaemia is a potentially life-threatening yet preventable inherited hemoglobin disorder. Understanding local socio-cultural context and level of public awareness about thalassaemia is pivotal for selecting effective prevention strategies. This study attempted to assess knowledge and perceptions about thalassaemia among college students in Bangladesh. METHODS A supervised cross-sectional survey was conducted on 1578 college students using a self-administered structured questionnaire. The survey took place from 15 February 2018 to 17 March 2018 in the Jamalpur district in Bangladesh. Besides the attitude-related questions, the study asked a total of 12 knowledge-related questions, which were scored on a scale of 0-12 points. RESULTS Over two-thirds (67%) of the college students had never heard of thalassaemia. The urban-rural dichotomy was observed among those familiar with the term; (46.4% from urban vs. 25.8% from rural colleges). A similar pattern was observed for knowledge score; 5.07 ± 1.87 for students from the urban colleges compared to 3.69 ± 2.23 for rural colleges. Students from the science background had the highest knowledge score (5.03 ± 1.85), while those from arts and humanities background scored lowest (3.66 ± 2.3). Nearly 40% of the students were not sure or did not want to be a friend of a thalassaemia patient. Whereas 39% either declined or remained hesitant about helping thalassaemia patients by donating blood. However, most of the respondents (88%) showed a positive attitude towards 'premarital' screening to prevent thalassaemia. CONCLUSIONS This study has identified critical knowledge gaps and societal misperceptions about thalassaemia. A better understanding of these aspects will be pivotal for disseminating thalassaemia related information. As the first study of this kind in Bangladesh, findings from this study has generated baseline data that would contribute to developing effective intervention strategies in Bangladesh and other countries with a comparable socio-cultural setting.
Collapse
Affiliation(s)
- Mohammad Sorowar Hossain
- Biomedical Research Foundation, Dhaka, Bangladesh. .,Independent University, Bangladesh (IUB), Dhaka, Bangladesh. .,Bangladesh University of Health Sciences, Dhaka, Bangladesh.
| | - Md Mahbub Hasan
- Biomedical Research Foundation, Dhaka, Bangladesh.,Department of Genetic Engineering and Biotechnology, University of Chittagong, Chattogram 4331, Bangladesh
| | | | | | | | - Mary Petrou
- Institute of Womens Health, Fetal and Maternal Medicine, University College London, University of London, London, UK
| | - Paul Telfer
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UK
| | - Mahbubul H Siddiqee
- Biomedical Research Foundation, Dhaka, Bangladesh.,Department of Mathematics and Natural Sciences (MNS), BRAC University, Dhaka 1212, Bangladesh
| |
Collapse
|
10
|
Ebrahim S, Raza AZ, Hussain M, Khan A, Kumari L, Rasheed R, Mahmood S, Khatri MA, Bijoora M, Zaheer R, Sattar N, Sohail W, Zakir H, Jafry FH, Memon A, Anwer S, Fatima K. Knowledge and Beliefs Regarding Thalassemia in an Urban Population. Cureus 2019; 11:e5268. [PMID: 31576261 PMCID: PMC6764615 DOI: 10.7759/cureus.5268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Thalassemia is one of the most common genetic blood disorders in Asia. Consanguineous marriages and avoiding pre-marital and antenatal screening are common in Pakistan due to psychosocial, cultural, and religious factors. Few studies have investigated the beliefs regarding thalassemia, especially in a developing country. The aim of this study was to assess the knowledge, beliefs, and practices regarding thalassemia in an urban population. Method: A cross-sectional descriptive study was conducted in the urban areas of Karachi, Pakistan over a period of six months during March 2016 through August 2016. Participants selected by representative sampling were interviewed face-to-face using a pre-designed, pre-tested questionnaire. The questionnaire was divided into four parts. The first part inquired about general demographic variables, while the second part assessed knowledge of the participant regarding thalassemia. The third and fourth parts were concerning the beliefs and practices regarding thalassemia. Data were entered and analyzed using the Statistical Package for Social Sciences (SPSS) Statistics, v. 24.0 (IBM SPSS Statistics, Armonk, NY). Results: Only 53% (n = 720) of the respondents had heard about thalassemia. The mean knowledge score was 5.8. The total possible score ranged between 0 - 12 with the higher scores indicating better knowledge. About three-quarters (70%) of the sample did not know that an individual can be a carrier of thalassemia. Less than half (38%) of the participants viewed premarital screening for thalassemia as necessary, with only 10% agreeing that thalassemia carriers should not marry. There was no pre-marriage counseling done in 98% of the families. Conclusion: Our study highlights the prevalence of numerous myths and a low level of knowledge regarding thalassemia in an urban population of Pakistan.
Collapse
Affiliation(s)
- Sidra Ebrahim
- Internal Medicine, Dow Medical College and Civil Hospital, Karachi, PAK
| | - Anum Z Raza
- Internal Medicine, Dow Medical College and Civil Hospital, Karachi, PAK
| | - Mahnoor Hussain
- Internal Medicine, Dow Medical College and Civil Hospital, Karachi, PAK
| | - Arsalan Khan
- Internal Medicine, Dow Medical College and Civil Hospital, Karachi, PAK
| | - Lavita Kumari
- Internal Medicine, Dow Medical College and Civil Hospital, Karachi, PAK
| | - Ramsha Rasheed
- Internal Medicine, Dow Medical College and Civil Hospital, Karachi, PAK
| | - Saad Mahmood
- Internal Medicine, Dow Medical College and Civil Hospital, Karachi, PAK
| | - Muneeza A Khatri
- Internal Medicine, Dow Medical College and Civil Hospital, Karachi, PAK
| | - Manaal Bijoora
- Surgery, Jinnah Medical and Dental College, Karachi, PAK
| | - Ramsha Zaheer
- Internal Medicine, Dow Medical College and Civil Hospital, Karachi, PAK
| | - Naveed Sattar
- Internal Medicine, Dow Medical College and Civil Hospital, Karachi, PAK
| | - Wafa Sohail
- Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, PAK
| | - Hareem Zakir
- Internal Medicine, Dow Medical College and Civil Hospital, Karachi, PAK
| | - Fatima H Jafry
- Internal Medicine, Dow Medical College and Civil Hospital, Karachi, PAK
| | - Areeba Memon
- Internal Medicine, Dow Medical College and Civil Hospital, Karachi, PAK
| | - Shayan Anwer
- Internal Medicine, Dow Medical College and Civil Hospital, Karachi, PAK
| | - Kaneez Fatima
- Internal Medicine, Dow Medical College and Civil Hospital, Karachi, PAK
| |
Collapse
|
11
|
Hatherall B, Newell JN, Emmel N, Baral SC, Khan MA. "Who Will Marry a Diseased Girl?" Marriage, Gender, and Tuberculosis Stigma in Asia. QUALITATIVE HEALTH RESEARCH 2019; 29:1109-1119. [PMID: 30499375 PMCID: PMC7322934 DOI: 10.1177/1049732318812427] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
In a qualitative study on the stigma associated with tuberculosis (TB), involving 73 interviews and eight focus groups conducted in five sites across three countries (Bangladesh, Nepal, and Pakistan), participants spoke of TB's negative impact on the marriage prospects of women in particular. Combining the approach to discovering grounded theory with a conceptualization of causality based on a realist ontology, we developed a theory to explain the relationships between TB, gender, and marriage. The mechanism at the heart of the theory is TB's disruptiveness to the gendered roles of wife (or daughter-in-law) and mother. It is this disruptiveness that gives legitimacy to the rejection of marriage to a woman with TB. Whether or not this mechanism results in a negative impact of TB on marriage prospects depends on a range of contextual factors, providing opportunities for interventions and policies.
Collapse
Affiliation(s)
- Bethan Hatherall
- University of East London, London, United Kingdom
- Bethan Hatherall, Institute for Health and Human Development, University of East London, Water Lane, London E15 4LZ, UK.
| | | | - Nick Emmel
- University of Leeds, Leeds, United Kingdom
| | | | | |
Collapse
|
12
|
Kumar N, Turbitt E, Biesecker BB, Miller IM, Cham B, Smith KC, Rimal RN. Managing the need to tell: Triggers and strategic disclosure of thalassemia major in Singapore. Am J Med Genet A 2019; 179:762-769. [PMID: 30821068 DOI: 10.1002/ajmg.a.61107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/10/2019] [Accepted: 02/09/2019] [Indexed: 11/08/2022]
Abstract
This study explored patients' experiences and perceptions of living with thalassemia (an inherited hematologic disorder), perceptions of social stigma, and impact on disclosure decision-making. Semistructured, in-person interviews were conducted in Singapore with 30 individuals: 16 thalassemia major patients and 14 parents of children with thalassemia. Findings were indicative of felt or enacted stigma that may have influenced disclosure decisions. Although affected individuals commonly disclosed their thalassemia diagnosis to family members, they either downplayed the condition with or avoided disclosure to unrelated individuals. Disclosure outside the family occurred only in response to triggers, such as questions about absences due to medical care. Health professionals should provide anticipatory guidance about disclosure strategies when managing individuals with thalassemia.
Collapse
Affiliation(s)
- Neha Kumar
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Maryland
| | - Erin Turbitt
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Maryland.,University of Technology Sydney, Graduate School of Health, Australia
| | - Barbara B Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Maryland
| | - Ilana M Miller
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Maryland
| | - Breana Cham
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Katherine C Smith
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rajiv N Rimal
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
13
|
Kent J, Fannin M, Dowling S. Gender dynamics in the donation field: human tissue donation for research, therapy and feeding. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:567-584. [PMID: 30105865 PMCID: PMC6446825 DOI: 10.1111/1467-9566.12803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This paper examines how gender dynamics shape human tissue donation for research and for human health. Drawing on research investigating the donation of different types of bodily tissues including blood, plasma, breastmilk, cord blood, foetal tissue and placentae we consider how and why women and men are viewed as different kinds of donors. We situate these donation practices within a broader understanding of gender difference to explain why any sociology of donation needs to take account of gender. In so doing we explore how tissue derived from the bodies of women acquires value in distinctive ways and for distinctive purposes and reasons. Within these gendered bioeconomies of donation, the supply and demand for tissue is structured by social understandings of maternity, parental responsibility, and risk, which in turn affect the experiences of donors.
Collapse
Affiliation(s)
- Julie Kent
- Department of Health and Social SciencesUniversity of the West of EnglandBristolUK
| | - Maria Fannin
- School of Geographical SciencesUniversity of BristolBristolUK
| | - Sally Dowling
- Department of Nursing and MidwiferyUniversity of the West of EnglandBristolUK
| |
Collapse
|
14
|
Zhong A, Darren B, Loiseau B, He LQB, Chang T, Hill J, Dimaras H. Ethical, social, and cultural issues related to clinical genetic testing and counseling in low- and middle-income countries: a systematic review. Genet Med 2018; 23:2270-2280. [PMID: 30072741 DOI: 10.1038/s41436-018-0090-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 06/04/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE We performed a systematic review of the ethical, social, and cultural issues associated with delivery of genetic services in low- and middle-income countries (LMICs). METHODS We searched 11 databases for studies addressing ethical, social, and/or cultural issues associated with clinical genetic testing and/or counselling performed in LMICs. Narrative synthesis was employed to analyze findings, and resultant themes were mapped onto the social ecological model (PROSPERO #CRD42016042894). RESULTS After reviewing 13,308 articles, 192 met inclusion criteria. Nine themes emerged: (1) genetic counseling has a tendency of being directive, (2) genetic services have psychosocial consequences that require improved support, (3) medical genetics training is inadequate, (4) genetic services are difficult to access, (5) social determinants affect uptake and understanding of genetic services, (6) social stigma is often associated with genetic disease, (7) family values are at risk of disruption by genetic services, (8) religious principles pose barriers to acceptability and utilization of genetic services, and (9) cultural beliefs and practices influence uptake of information and understanding of genetic disease. CONCLUSION We identified a number of complex and interrelated ethical, cultural, and social issues with implications implications for further development of genetic services in LMICs.
Collapse
Affiliation(s)
- Adrina Zhong
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Schulich School of Medicine & Dentistry, Western University, Canada
| | - Benedict Darren
- Human Biology Program, Faculty of Arts & Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bethina Loiseau
- Human Biology Program, Faculty of Arts & Science, University of Toronto, Toronto, ON, Canada
| | - Li Qun Betty He
- Human Biology Program, Faculty of Arts & Science, University of Toronto, Toronto, ON, Canada.,Michael G. DeGroote Medical School, McMaster University, Hamilton, ON, Canada
| | - Trillium Chang
- Human Biology Program, Faculty of Arts & Science, University of Toronto, Toronto, ON, Canada
| | - Jessica Hill
- Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Helen Dimaras
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,Department of Ophthalmology & Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada. .,Child Health Evaluative Sciences Program & The Centre for Global Child Health, SickKids Research Institute, Toronto, ON, Canada. .,Department of Human Pathology, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
| |
Collapse
|
15
|
Chattoo S. Inherited blood disorders, genetic risk and global public health: framing 'birth defects' as preventable in India. Anthropol Med 2018. [PMID: 29533092 DOI: 10.1080/13648470.2017.1381231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This paper engages critically with the global assemblage framing sickle cell and thalassaemia disorders as a 'global health crisis'; and the promise of genomics, largely DNA-based carrier/pre-conceptual screening, prenatal diagnosis with a view to terminations, deployed in framing a solution to these historically racialised spectrum of diseases as essentially preventable. Sickle cell and thalassaemia are recessively inherited, potentially life-threatening haemoglobin disorders with significant variation of severity, often needing life-long treatment. I argue that the re-classification of inherited blood disorders (IBDs) under 'prevention and management of birth defects' by the WHO in 2010 can be read as an ethical moment within the 'globalising turn' of IBDs and the use of genomics in addressing structural inequalities underpinning health in low- and middle-income countries. Using an Indian case study, the paper aims at first examining the language of risk through which genes and IBDs are mapped onto pre-existing populations (e.g. caste and tribe) as discrete, categories. Second, it discusses the likely social and ethical ramifications of classifying these recessive gene disorders as essentially preventable, despite cheaply available diagnostic tests and treatment options available in most countries in the South.
Collapse
Affiliation(s)
- Sangeeta Chattoo
- a Department of Health Sciences , University of York , York , United Kingdom
| |
Collapse
|
16
|
Chawla S, Singh RK, Lakkakula BVKS, Vadlamudi RR. Attitudes and beliefs among high- and low-risk population groups towards β-thalassemia prevention: a cross-sectional descriptive study from India. J Community Genet 2017; 8:159-166. [PMID: 28386676 DOI: 10.1007/s12687-017-0298-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 03/08/2017] [Indexed: 10/19/2022] Open
Abstract
β-thalassemia is an autosomal recessive blood disorder caused by gene mutations that affect all aspects of β-globin production. In majority of Asian countries including India, the frequency of β-thalassemia is closely intertwined with social, cultural, and religious issues of the respective country. Several national level screening programs imparted education regarding β-thalassemia, but follow-up evaluation revealed that education was not effective. It has been hypothesized that the beliefs and attitudes, carrier screening, and education among "high risk communities" will have far-reaching implications towards β-thalassemia prevention in the country. The present study is aimed to investigate attitudes, intention, and behavior of β-thalassemia high- and low-risk ethnic groups towards carrier screening and education. A structured questionnaire on knowledge, attitude, and practice regarding β-thalassemia was administered on 926 individuals belong to Arora, a high-risk ethnic group for β-thalassemia (347 rural (AR) and 202 urban (AU)) and 377 cosmopolitan commoners (CC) aged above 18 years of both sexes. To understand the relationship between various questions, Pearson's correlation test and factor analysis was performed. The responses were further categorized into the theory of planned behavior (TPB) constructs with the measures of the main constructs reported as a mean. Various dimensions of knowledge, attitude, and practice reveal that the urban groups (AU and CC) are better aware of the disease "β-thalassemia" than the rural group (AR) who witness suffering at close quarters. The AR group is more positive for preventive measures than the urban groups. Significant correlations and factor analysis show "intentions" for premarital and prenatal screening highly loaded as outcome behaviors. The Ajzen's "Theory of planned behavior" support that the "intention" and "perceived behavior control" are better predictors of "outcome behavior" compared to "attitude" and "subjective norm." As this study is cross-sectional and descriptive in nature, the constructs of the theory should be considered as perceptions. However, we believe the patterns observed are indicative of "predicting behavior" that has far-reaching implications on health planners and administrators in designing β-thalassemia screening and prevention program.
Collapse
Affiliation(s)
- Swati Chawla
- Department of Anthropology, University of Delhi, North Campus, Delhi, 110 007, India
| | - Rajnish Kumar Singh
- Department of Anthropology, University of Delhi, North Campus, Delhi, 110 007, India
| | | | - Raghavendra Rao Vadlamudi
- Department of Anthropology, University of Delhi, North Campus, Delhi, 110 007, India. .,Department of Genetics, Osmania University, Hyderabad, India. .,Genome Foundation, Hyderabad, India.
| |
Collapse
|
17
|
Ekstrand Ragnar M, Tydén T, Kihlbom U, Larsson M. Swedish parents' interest in preconception genetic carrier screening. Ups J Med Sci 2016; 121:289-294. [PMID: 27647125 PMCID: PMC5098495 DOI: 10.1080/03009734.2016.1218575] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Genetic technologies advance rapidly. It is possible to undergo genetic carrier screening before pregnancy to examine genetic risks to future offspring. We aimed to investigate parents' interest and motives towards preconception genetic carrier screening (PCS) as well as factors associated with interest in PCS. MATERIAL AND METHODS Our study sample consists of 777 parent couples within the longitudinal Swedish Pregnancy Planning study. Women responded to questionnaires at three occasions: in early pregnancy, late pregnancy, and one year after childbirth. Male partners responded to one questionnaire one year after childbirth. RESULTS One-third of the parents were positive (30% versus 34% of women and men, respectively), less than a third were negative (26% versus 28%), and 45% versus 38% were uncertain about whether to consider PCS before a future pregnancy. No differences in PCS interest were found between women and men (P = 0.091), but a higher proportion of women were concerned about negative consequences (53% versus 46%, P < 0.003) and were 'opposed to such a way of child selection' (31.8% versus 25.2%, P = 0.002). Factors associated with PCS interest were experiences of prenatal diagnostics and positive attitudes towards finding out or choosing sex of one's child (women), and prenatal diagnostics, self-rated poor health, and pregnancy planning (men). CONCLUSION Both women and men had relatively high uncertainty towards PCS, but women were more concerned about negative consequences. The future extent of the clinical utility of PCS is currently unknown, but parents' interests and doubts are important aspects to consider.
Collapse
Affiliation(s)
- Maria Ekstrand Ragnar
- Department of Women’s and Children’s Health, Uppsala University, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
- CONTACT Maria Ekstrand Ragnar Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Tanja Tydén
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Ulrik Kihlbom
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Margareta Larsson
- Department of Women’s and Children’s Health, Uppsala University, Sweden
| |
Collapse
|
18
|
Assessing Parental Knowledge About Thalassemia in a Thalassemia Center of Karachi, Pakistan. J Genet Couns 2015; 24:945-51. [DOI: 10.1007/s10897-015-9830-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
|
19
|
Abstract
In 2003 the UK National Blood Service introduced a policy of 'male donor preference' which involved women's plasma being discarded following blood collection. The policy was based on the view that data relating to the incidence of Transfusion-Related Acute Lung Injury (TRALI) was linked to transfusion with women's plasma. While appearing to treat female donors as equal to male donors, exclusion criteria operate after donation at the stage of processing blood, thus perpetuating myths of universality even though only certain 'extractions' from women are retained for use in transfusion. Many women in the UK receive a plasma-derived product called Anti-D immunoglobulin which is manufactured from pooled male plasma. This article examines ways in which gender has significance for understanding blood relations, and how the blood economy is gendered. In our study of relations between blood donors and recipients, we explore how gendered bodies are produced through the discursive and material practices within blood services. We examine both how donation policies and the manufacturing and use of blood products produces gendered blood relations.
Collapse
Affiliation(s)
- Julie Kent
- University of the West of England, Bristol, UK
| | | |
Collapse
|
20
|
Abstract
Thalassemia, once a rarity in the United States, is increasingly encountered in clinical practice due to shifts in immigration. Early carrier screening in at-risk populations can help clinicians implement genetic counseling and prevent new cases. Chronic transfusions are the mainstay of therapy for patients with severe thalassemia (beta thalassemia major), and are used intermittently in individuals with milder forms of thalassemia (Hb H/H Constant Spring disease and beta thalassemia intermedia). Iron overload is a major source of morbidity and mortality in individuals with transfusion and non-transfusion-dependent thalassemia, necessitating iron chelation therapy. Iron overload contributes to increased risk of cirrhosis, heart failure, and endocrinopathies, while ineffective erythropoiesis and hemolysis contribute to multiple complications, including splenomegaly, extramedullary hematopoiesis, pulmonary hypertension, and thrombosis. An understanding of the importance of carrier screening, complications, monitoring, and management strategies, coupled with collaboration with a hematologist with thalassemia expertise, is essential to reduce the morbidity and mortality in patients with thalassemia.
Collapse
Affiliation(s)
- Farzana A Sayani
- a Perelman School of Medicine, University of Pennsylvania , Division of Hematology-Oncology, Department of Medicine , Philadelphia , USA
| | - Janet L Kwiatkowski
- b Perelman School of Medicine, University of Pennsylvania , Children's Hospital of Philadelphia, Division of Hematology, Department of Pediatrics , Philadelphia , USA
| |
Collapse
|
21
|
Verma S, Talukdar B, Gupta R. 'Reflex' HPLC testing as a screening modality for variant hemoglobins: a pilot study of 1310 cases at a pediatric referral hospital. Hematology 2013; 19:299-303. [PMID: 24196522 DOI: 10.1179/1607845413y.0000000128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE High-performance liquid chromatography (HPLC) has been evaluated as useful technique for detection of variant hemoglobins in newborn screening, ethnicity-based screening, and patients with abnormal hemoglobin electrophoresis. This study aimed at evaluating this technique as 'reflex' testing in a pediatric referral center. METHODS This study included 1317 children visiting the pediatric hospital, who underwent HPLC analysis on anticoagulated blood samples. These patients were divided into clinician-requisitioned HPLC (group A), 'reflex' testing for anemia (group B), and unrelated etiologies (group C). HPLC graphs were evaluated for various hemoglobins. Statistical analysis was performed for comparison between these groups for frequency of abnormal HPLC assay and various red cell parameters. RESULTS The frequency of abnormal HPLC assay was 22.89% in group A (125 of 546 cases), 26.89% in group B (78 of 290 cases), and 31.8% in group C (153 of 781 cases) with statistically significant difference. The most frequent variant in all three groups was thalassemia trait. Thalassemia intermedia and major, both were detected in few patients in groups B and C. CONCLUSION 'Reflex' testing for hemoglobin variants can be undertaken for pediatric samples to enhance detection of these variants and avoid an additional venepuncture.
Collapse
|
22
|
Dadheech S, Rao AV, Shaheen U, Hussien MD, Jain S, Jyothy A, Munshi A. Three most common nonsynonymous UGT1A6*2 polymorphisms (Thr181Ala, Arg184Ser and Ser7Ala) and therapeutic response to deferiprone in β-thalassemia major patients. Gene 2013; 531:301-5. [PMID: 24036429 DOI: 10.1016/j.gene.2013.08.078] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 08/05/2013] [Accepted: 08/26/2013] [Indexed: 11/16/2022]
Abstract
Deferiprone is used as a chelation agent in chronic iron overload in β-thalassemia patients. Patients on deferiprone therapy show variable response to this drug in terms of reduction in iron overload as well as adverse drug reactions (ADRs). The pharmacogenetic studies on deferiprone have not carried out in patients with blood disorders in India. Therefore, the present study was carried out to evaluate the three most common nonsynonymous UGT1A6 polymorphisms Thr181Ala (541 A/G), Arg184Ser (552 A/C) and Ser7Ala (19 T/G) and therapeutic response to deferiprone in β-thalassemia major patients. Two hundred and eighty six (286) β-thalassemia major patients were involved in the study. Serum ferritin levels were estimated periodically to assess the status of the iron overload and the patients were grouped into responders and non-responders depending on the ferritin levels. The UGT1A6 2 polymorphisms were detected by PCR-RFLP methods. The association between the genotypes and outcome as well as ADRs was evaluated by Open EPI software. A significant difference was observed in the genotypic distribution of UGT1A6 2 Thr181Ala polymorphism in responders and non-responders. However, there was no difference in the genotypic distribution between patients with and without ADRs. As far as the UGT1A6 2 Arg184Ser polymorphism is concerned, no significant difference was observed between responders and non-responders. Further, evaluating the association of UGT1A6 2 Ser7Ala polymorphism with drug response, there was no significant difference in the genotypic distribution between responders and non-responders. However, there was a significant difference between responders with and without ADRs and non-responders with and without ADRs. In addition to this haplotype analysis was also carried out. However, we did not find any specific haplotype to be significantly associated with the deferiprone response in β-thalassemia major patients.
Collapse
Affiliation(s)
- Sneha Dadheech
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad-500016, India; Dr. NTR University of Health Sciences, Vijayawada, A.P., India
| | | | | | | | | | | | | |
Collapse
|
23
|
Datta J, Wellings K, Kessel A. 'Once the stuff's left my body, it's not me': service users' views on unlinked anonymous testing of blood for HIV. CULTURE, HEALTH & SEXUALITY 2013; 15:896-909. [PMID: 23659556 DOI: 10.1080/13691058.2013.790075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This paper reports on the qualitative component of a mixed-methods study on unlinked anonymous testing for HIV in genitourinary medicine (GUM) clinics in two English cities. Unlinked anonymous testing is a system of monitoring population prevalence by testing residual blood samples taken for diagnostic purposes after they have been unlinked and anonymised from their source. Little is known about how individuals feel about their blood being tested in this way without their explicit consent, nor is it clear whether the process of unlinking blood affects how people feel about the use of their bodily material for public health surveillance purposes. We report participants' views on these issues, drawing on in-depth interviews with 20 GUM clinic users. The majority thought it preferable for blood samples to be used for population surveillance rather than being discarded. For most, blood and bodily tissue were not seen to represent personal identity even though participants understood that information about them could be gleaned from their analysis. The provision of information, rather than a strict consent process, was advocated as many felt that transactions between health professionals and patients should be as transparent as possible.
Collapse
Affiliation(s)
- Jessica Datta
- a Department of Social and Environmental Health Research, Faculty of Public Health and Policy , London School of Hygiene and Tropical Medicine , London , UK
| | | | | |
Collapse
|
24
|
Alkuraya FS. Impact of new genomic tools on the practice of clinical genetics in consanguineous populations: the Saudi experience. Clin Genet 2013; 84:203-8. [DOI: 10.1111/cge.12131] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 02/19/2013] [Accepted: 02/19/2013] [Indexed: 12/29/2022]
|
25
|
Kingsmore SF, Lantos JD, Dinwiddie DL, Miller NA, Soden SE, Farrow EG, Saunders CJ. Next-generation community genetics for low- and middle-income countries. Genome Med 2012; 4:25. [PMID: 22458566 PMCID: PMC3446275 DOI: 10.1186/gm324] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
A recent report by the World Health Organization calls for implementation of community genetics programs in low- and middle-income countries (LMICs). Their focus is prevention of congenital disorders and genetic diseases at the population level, in addition to providing genetics services, including diagnosis and counseling. The proposed strategies include both newborn screening and population screening for carrier detection, in addition to lowering the incidence of congenital disorders and genetic diseases through the removal of environmental factors. In this article, we consider the potential impact of such testing on global health and highlight the near-term relevance of next-generation sequencing (NGS) and bioinformatic approaches to their implementation. Key attributes of NGS for community genetics programs are homogeneous approach, high multiplexing of diseases and samples, as well as rapidly falling costs of new technologies. In the near future, we estimate that appropriate use of population-specific test panels could cost as little as $10 for 10 Mendelian disorders and could have a major impact on diseases that currently affect 2% of children worldwide. However, the successful deployment of this technological innovation in LMICs will require high value for human life, thoughtful implementation, and autonomy of individual decisions, supported by appropriate genetic counseling and community education.
Collapse
Affiliation(s)
- Stephen F Kingsmore
- Center for Pediatric Genomic Medicine, Children's Mercy Hospitals and Clinics, 2401 Gilham Road, Kansas City, MO 64108, USA
| | - John D Lantos
- Center for Pediatric Genomic Medicine, Children's Mercy Hospitals and Clinics, 2401 Gilham Road, Kansas City, MO 64108, USA
| | - Darrell L Dinwiddie
- Center for Pediatric Genomic Medicine, Children's Mercy Hospitals and Clinics, 2401 Gilham Road, Kansas City, MO 64108, USA
| | - Neil A Miller
- Center for Pediatric Genomic Medicine, Children's Mercy Hospitals and Clinics, 2401 Gilham Road, Kansas City, MO 64108, USA
| | - Sarah E Soden
- Center for Pediatric Genomic Medicine, Children's Mercy Hospitals and Clinics, 2401 Gilham Road, Kansas City, MO 64108, USA
| | - Emily G Farrow
- Center for Pediatric Genomic Medicine, Children's Mercy Hospitals and Clinics, 2401 Gilham Road, Kansas City, MO 64108, USA
| | - Carol J Saunders
- Center for Pediatric Genomic Medicine, Children's Mercy Hospitals and Clinics, 2401 Gilham Road, Kansas City, MO 64108, USA
| |
Collapse
|
26
|
Munshi A, Dadheech S, Jain S, Joseph J, Al-Hazzani A, Alshatwi AA, Sai Babu M, Rajeshwar K, Jyothy A. Lack of association of G779A ZHX-2 gene variant with HbF levels in β-thalassemia major. Eur J Haematol 2011; 86:502-6. [PMID: 21443521 DOI: 10.1111/j.1600-0609.2011.01614.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The inherited disorders of hemoglobin synthesis are the most common monogenic disorders worldwide. They include thalassemias, hemoglobin variants, and hereditary persistence of fetal hemoglobin. β-thalassemia is the most common monogenic disorder in India. Clinical manifestations of β-thalassemia are extremely variable in severity. The reasons for this heterogeneity are not very well understood. Previous studies have shown that the genetic variants that modulate HbF levels have a very strong impact on ameliorating the clinical phenotype. In the present study, 5570 blood samples from suspected cases were analyzed using HPLC, amplification refractory mutation system-PCR and reverse dot blot techniques. Of 5570 individuals, we found 676 cases of β-thalassemia disease. Molecular analysis revealed the presence of different β-thalassemia mutations in the population under study. Patients with β-thalassemia were classified into mild, moderate, and severe according to severity score based on Hb level, age of onset, age at which patients received their first blood transfusion, degree of growth retardation and splenectomy. Patients with β-thalassemia were analyzed for zinc finger and homeoboxes 2 (ZHX2) G779A polymorphism, and the association between ZHX2 gene polymorphism and severity of β-thalassemia was evaluated. We did not find a significant difference in genotypic and allelic frequency of ZHX2 gene between mild and moderate, mild and severe, and moderate and severe cases. There was no significant difference in high and low percentage of HbF in GG, GA, and AA bearing individuals showing that ZHX2 gene variant has no role in ameliorating the severity of β-thalassemia major in the South Indian population from Andhra Pradesh.
Collapse
Affiliation(s)
- Anjana Munshi
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad, India.
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Reed K. 'He's the dad isn't he?' Gender, race and the politics of prenatal screening. ETHNICITY & HEALTH 2011; 16:327-341. [PMID: 21797721 DOI: 10.1080/13557858.2010.531196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Men's involvement in prenatal screening is becoming increasingly important. However, despite the potentially significant role of fathers in haemoglobinopathy screening, their participation is under researched. Furthermore, the portrayal of Black and minority ethnic (BME) fathers tends to be based on persisting stereotypes of men as either absentee parents with limited roles in screening or as controlling decision-makers. OBJECTIVE To describe the influence of ethnicity and gender on the process of participation of men in antenatal screening for sickle cell and thalassaemia. DESIGN A qualitative study, using in-depth interviews and focus groups with 22 pregnant women from a range of socio-economic and ethnic backgrounds, 16 male partners and 15 midwives in a northern city in the UK. RESULTS Men from BME groups take a pragmatic and equitable role in screening with their partners. White British men on the other hand, while willing to participate in screening, take a more casual view of their own direct participation. Accounts from hospital midwives supported these findings. CONCLUSIONS While acknowledging the importance of material connections between certain BME groups and blood disorders, two key issues are raised. First, BME men's involvement contribute a challenge towards existing assumptions often made about BME fathers. Second, White British men's participation can be useful in determining the genetic status of the foetus and therefore their role should not be neglected. Screening research and practice need to broaden out their focus on issues of gender, ethnicity and screening.
Collapse
Affiliation(s)
- Kate Reed
- Department of Sociological Studies, University of Sheffield, Elmfield, Northumberland Road, Sheffield, S10 2TU, UK.
| |
Collapse
|
28
|
Affiliation(s)
- Mary Petrou
- Haemoglobinopathy Genetics Centre, University College London, Institute of Women's Health, University College London Hospitals NHS Foundation Trust, Pathology Division 86-96 Chenies Mews London WC1E 6HX
| |
Collapse
|
29
|
Moffett A, Ross LF. A pilot study to determine whether health care professionals perceive stigma in heterozygote carrier identification and disclosure decisions. Am J Med Genet A 2011; 155A:1897-905. [DOI: 10.1002/ajmg.a.34091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 04/12/2011] [Indexed: 11/07/2022]
|
30
|
Chatterjee N, Mishra A, Soni R, Kulkarni H, Mamtani M, Shrivasatava M. Bayesian estimates of the prevalence of β-thalassemia trait in voluntary blood donors of central India: a survey. Hemoglobin 2011; 34:548-60. [PMID: 21077762 DOI: 10.3109/03630269.2010.526488] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Early detection of β-thalassemia (β-thal) trait is important. Voluntary blood donors represent an important group who are accessible and cooperative for this purpose. However, the usefulness of this population in β-thal trait detection programs has not been studied in India. We conducted a hematological survey of 5,045 blood donors who visited the Bhopal Memorial Hospital & Research Centre, Bhopal in central India. Using robust Bayesian methods, we estimated the prevalence of β-thal trait. The overall prevalence of β-thal trait in the study population was 9.59% [95% confidence interval (95% CI) 8.78-10.4%]. The prevalence of β-thal trait varied across the states of origin and within the state of Madhya Pradesh. We observed a cline effect for β-thal trait prevalence in relation to the latitude (p = 0.024). We conclude that blood donors offer an attractive adjunct to β-thal trait detection in national programs. Our study also offers insights into the β-thal trait gene flow and migration in India.
Collapse
Affiliation(s)
- Nirupama Chatterjee
- Thalassaemia Unit, Department of Transfusion Medicine, Bhopal Memorial Hospital & Research Centre, Karond, Raisen Bypass, Bhopal, India
| | | | | | | | | | | |
Collapse
|
31
|
Wong LP, George E, Tan JAMA. Public perceptions and attitudes toward thalassaemia: Influencing factors in a multi-racial population. BMC Public Health 2011; 11:193. [PMID: 21447191 PMCID: PMC3076274 DOI: 10.1186/1471-2458-11-193] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 03/30/2011] [Indexed: 12/02/2022] Open
Abstract
Background Thalassaemia is a common public health problem in Malaysia and about 4.5 to 6% of the Malays and Chinese are carriers of this genetic disorder. The major forms of thalassaemia result in death in utero of affected foetuses (α-thalassaemia) or life-long blood transfusions for survival in β-thalassaemia. This study, the first nationwide population based survey of thalassaemia in Malaysia, aimed to determine differences in public awareness, perceptions and attitudes toward thalassaemia in the multi-racial population in Malaysia. Methods A cross-sectional computer-assisted telephone interview survey of a representative sample of multi-racial Malaysians aged 18 years and above was conducted between July and December 2009. Results Of a total of 3723 responding households, 2846 (76.4%) have heard of thalassaemia. Mean knowledge score was 11.85 (SD ± 4.03), out of a maximum of 21, with higher scores indicating better knowledge. Statistically significant differences (P < 0.05) in total knowledge score by age groups, education attainment, employment status, and average household income were observed. Although the majority expressed very positive attitudes toward screening for thalassaemia, only 13.6% of married participants interviewed have been screened for thalassaemia. The majority (63.4%) were unsupportive of selective termination of foetuses diagnosed with thalassaemia major. Conclusion Study shows that carrier and premarital screening programs for thalassaemia may be more effective and culturally acceptable in the reduction of pregnancies with thalassaemia major. The findings provide insights into culturally congruent educational interventions to reach out diverse socio-demographic and ethnic communities to increase knowledge and cultivate positive attitudes toward prevention of thalassaemia.
Collapse
Affiliation(s)
- Li Ping Wong
- Department of Social and Preventive Medicine Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | | | | |
Collapse
|
32
|
Wong LP, George E, Tan JAMA. A holistic approach to education programs in thalassemia for a multi-ethnic population: consideration of perspectives, attitudes, and perceived needs. J Community Genet 2011; 2:71-9. [PMID: 22109791 DOI: 10.1007/s12687-011-0039-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 02/03/2011] [Indexed: 11/27/2022] Open
Abstract
Hemoglobin disorders which include thalassemias are the most common heritable disorders. Effective treatment is available, and these disorders can be avoided as identification of carriers is achievable using simple hematological tests. An in-depth understanding of the awareness, attitudes, perceptions, and screening reservations towards thalassemia is necessary, as Malaysia has a multi-ethnic population with different religious beliefs. A total of 13 focus group discussions (70 participants) with members of the general lay public were conducted between November 2008 and January 2009. Lack of knowledge and understanding about thalassemia leads to general confusions over differences between thalassemia carriers and thalassemia major, inheritance patterns, and the physical and psychologically impact of the disorder in affected individuals and their families. Although most of the participants have not been tested for thalassemia, a large majority expressed willingness to be screened. Views on prenatal diagnosis and termination of fetuses with thalassemia major received mixed opinions from participants with different religions and practices. Perceived stigma and discrimination attached to being a carrier emerged as a vital topic in some group discussions where disparity in the answers exhibited differences in levels of participants' literacy and ethnic origins. The two most common needs identified from the discussion were information and screening facilities. Participants' interest in knowing the severity of the disease and assessing their risk of getting the disorder may imply the health belief model as a possible means of predicting thalassemia public screening services. Findings provide valuable insights for the development of more effective educational, screening, and prenatal diagnostic services in the multi-ethnic Asian society.
Collapse
Affiliation(s)
- Li Ping Wong
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia,
| | | | | |
Collapse
|
33
|
Reed K. 'It's them faulty genes again': women, men and the gendered nature of genetic responsibility in prenatal blood screening. SOCIOLOGY OF HEALTH & ILLNESS 2009; 31:343-359. [PMID: 19055590 DOI: 10.1111/j.1467-9566.2008.01134.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Prenatal blood tests are routinely offered to pregnant women in the UK. Male partners are tested only where a combined positive male and female test could detect fetal abnormality such as sickle cell anaemia. Little is known about the gendered nature of screening and the impact it has on lay feelings of genetic responsibility. For example, do women take exclusive 'maternal responsibility' for the fetus? How is this responsibility challenged when men are also screened? Drawing on empirical research with pregnant women and their male partners in a northern city in the UK, this paper aims to explore the gendered nature of genetic responsibility in prenatal blood screening. The paper will argue that women and men feel a sense of genetic responsibility for the fetus throughout screening. However, while women's sense of responsibility is directly 'embodied' and is heightened by the detection of 'faulty genes', men's manifests itself indirectly through shared responsibility with their pregnant partners and directly through their own genetic connections to the fetus. The paper concludes that the gendered nature of genetic responsibility is complex and contradictory, producing a set of gender roles that both challenges and reinforces a traditional gender division of labour.
Collapse
Affiliation(s)
- Kate Reed
- Department of Sociological Studies, University of Sheffield, Elmfield, Northumberland Road, Sheffield.
| |
Collapse
|
34
|
Munshi A, Anandraj M, Joseph J, Shafi G, Anila A, Jyothy A. Inherited hemoglobin disorders in Andhra Pradesh, India: A population study. Clin Chim Acta 2009; 400:117-9. [DOI: 10.1016/j.cca.2008.10.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 10/22/2008] [Accepted: 10/22/2008] [Indexed: 10/21/2022]
|
35
|
Tamhankar PM, Agarwal S, Arya V, Kumar R, Gupta UR, Agarwal SS. Prevention of homozygous beta thalassemia by premarital screening and prenatal diagnosis in India. Prenat Diagn 2008; 29:83-8. [PMID: 19090545 DOI: 10.1002/pd.2176] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Parag M Tamhankar
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | | | | | | | | | | |
Collapse
|
36
|
Parents' experiences of universal screening for haemoglobin disorders: implications for practice in a new genetics era. Br J Gen Pract 2008; 58:161-8. [PMID: 18318970 DOI: 10.3399/bjgp08x277276] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND England is the only country in the world that currently has universal population screening for haemoglobin disorders through linked antenatal and newborn screening. Little is known about the acceptability of such screening. AIM To explore parents' experiences of, and attitudes towards, new universal genetic screening for haemoglobin disorders. DESIGN OF STUDY Narrative interview study. SETTING Primary and community care settings across England. METHOD Narrative interviews were undertaken with a maximum variation sample of 39 people who had experienced gene-carrier identification through antenatal and newborn screening for sickle cell, thalassaemia, and other haemoglobin variants within the previous 2 years. RESULTS Most parents were unaware screening had occurred or had given it little consideration and so were surprised or shocked by results. However, they were glad to learn of their carrier status, reproductive genetic risk, or their newborn's carrier status. Participants emphasised that antenatal screening should happen as early as possible. Many would rather have known their carrier status before pregnancy or before entering a relationship. Although most were satisfied with the information they received, significant misunderstandings remained. There were culturally diverse attitudes towards prenatal diagnosis and termination. These procedures were acceptable to some parents with strong religious beliefs, including Christians and Muslims. CONCLUSION Parents support screening for haemoglobin disorders but need to be better informed and better prepared for results and what they mean. Sensitivity to patient diversity in attitudes and choices is also required. Universal screening for genetic reproductive risk will increasingly involve generalists, particularly in primary care, presenting opportunities for screening before or earlier in pregnancy, which is likely to be welcomed by patients.
Collapse
|