UPTAKE, PERCEPTIONS AND ASSOCIATED FACTORS ON PREMARITAL SICKLE CELL TRAIT (SCT) TESTING SERVICES AMONG MARRIED INDIVIDUALS IN MITYANA MUNICIPALITY, MITYANA DISTRICT

Abstract

Introduction: Sickle Cell Disease (SCD) is one of the biggest health challenges worldwide. The greatest burden exists in Sub-Saharan Africa, where 75% of the world's SCD occurs. Preventive approaches include screening couples intending to have children by inexpensive and reliable blood tests in addition to genetic counselling. However, there is a lack of information about the adoption of these approaches to aid in creating meaningful, tailored interventions. Objective: To determine the uptake of premarital sickle cell trait testing, explore the perceptions and associated factors among married individuals in Mityana Municipality, Mityana District. Methods: A convergent parallel mixed-methods design was employed. The quantitative component employed a cross-sectional design, involving 272 consecutively sampled married individuals who had married between January 2023 and December 2024. Uptake was summarised as a proportion, along with its associated 95% confidence interval (95% CI). Mixed effects modified Poisson regression (with robust standard errors) was used to determine the factors associated with the uptake of SCTT. The qualitative component employed an exploratory descriptive design using in-depth interviews with 17 purposively selected married individuals. The data was analysed using deductive thematic analysis. Results: The uptake of SCTT identified among the married individuals was 14.71% (95% CI: 9.03-23.04). Multivariable analysis results revealed that, age of 18-30 years (adjusted prevalence ratio (aPR): 1.23, 95%CI: 1.08-1.40, P=0.004), being Muslim (aPR: 1.10, 95% CI: 1.07-1.14, P<0.001), a family history of SCD (aPR: 1.17, 95% CI: 1.07-1.27, P=0.001) and not attending antenatal (ANC) visits (aPR: 0.92, 95% CI: 0.86-0.98, P=0.009). Qualitative findings revealed perceptions around SCTT, i.e. perceived barriers highlighting health care and socio-cultural issues hindering testing, perceived benefits highlighting socio-cultural issues favouring testing, perceived severity highlighting especially around the presentation of SCD, perceived susceptibility highlighting the possible causes/transmission of SCD, perceived threats highlighting family issues around testing or SCD, and cues for action highlighting the concerns for improvement of SCT testing. Conclusion: The study revealed a low uptake of SCTT among married individuals living in Mityana Municipality, Mityana District. Younger age groups, being Muslim, a family history of SCD and attending antenatal care visits were associated with better uptake rates. The perceptions are multifaceted, highlighting that complex patterns influence the uptake of the test. These findings highlight the need for community sensitisation of SCT testing, improve awareness among religious leaders, improve access to sickle cell testing facilities, and emphasise the need for premarital SCTT during hospital and church marriage counselling.