Abstract
To determine whether identifying haemoglobin genotype, and providing education and counselling to senior school students will influence their choice of partner and reduce the frequency of births with sickle cell disease. The Manchester Project provided free voluntary blood tests to determine haemoglobin genotype to the fifth and sixth forms (grades 11–13), median age of 16.7 years, of all 15 secondary schools in the parish of Manchester in south central Jamaica. A total of 16,636 students complied, and counselling was offered to carriers of abnormal genes over 6 years (2008–2013). The genotypes of their offspring were determined by newborn screening of 66,892 deliveries in 12 regional hospitals over 8 years (2008–2015). The study focused on the genotypes of live deliveries to female students with the four most common haemoglobin genotypes: 7905 with an AA genotype, 898 with the sickle cell trait, 326 with the HbC trait and 78 with the beta thalassaemia trait. A total of 2442 live deliveries were identified by the end of 2015 in mothers screened at school. Eleven babies had clinically significant genotypes, and the prevalence of SS and SC disease did not differ from that predicted by random mating. First pregnancy was not delayed in AS or AC mothers. There was no evidence that knowledge of maternal haemoglobin genotype influenced choice of partner. On an interview, mothers of affected babies correctly recalled their genotype, but either did not discuss this with their partners or the latter refused to be tested. Subjects delaying child bearing for tertiary education would be largely excluded from the present study of first pregnancies and may make greater use of this information. Future options are a greater role for prenatal diagnosis.
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Acknowledgements
This work was supported by grants from the National Health Fund in Jamaica, the Alcoa Foundation and the Chase Fund of Jamaica. These funders played no role in the study other than providing financial support to a grant proposal. The Southern Regional Health Authority of the Ministry of Health, Jamaica provided valuable infrastructural support to the Mandeville laboratory.
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The corresponding author states that he has had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Contributions of Authors
Graham Serjeant, Beryl Serjeant and Karlene Mason conceived and organised the study including presentations to the school staff, Parent-Teacher Associations and illustrated lecture to the students. They were also intimately involved with the school screening component and collation of the newborn screening data.
Graham Serjeant, Beryl Serjeant, Karlene Mason and Felicea Gibson planned and conducted the school screening along with teams of phlebotomists.
Karlene Mason conducted the follow-up, dissemination of results and counselling of carriers.
Felicea Gibson, Beryl Serjeant and Karlene Mason analysed the haematology and electrophoretic results of the school screening.
Ruth-Ann Gardner and Lansford Warren organised the collection of cord blood samples and analysis by HPLC.
Marianne Jonker advised on the data collection and performed the statistical analysis.
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The National Health Fund of Jamaica, the Alcoa Foundation, the Chase Fund of Jamaica and organisations within the private sector of Jamaica supplied funding for the conduct of the study but had no role in the design, conduct or publication of the work.
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Serjeant, G.R., Serjeant, B.E., Mason, K.P. et al. Voluntary premarital screening to prevent sickle cell disease in Jamaica: does it work?. J Community Genet 8, 133–139 (2017). https://doi.org/10.1007/s12687-017-0294-8
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DOI: https://doi.org/10.1007/s12687-017-0294-8