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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 34  |  Issue : 4  |  Page : 1284-1291

Awareness, attitude, and satisfaction of Egyptian adults by premarital care services


1 Department of Family Medicine, Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Community Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Family Medicine, Quweina Family Health Center Ministry of Health, Menoufia Health Administration, Menoufia, Egypt

Date of Submission18-Dec-2020
Date of Decision08-Mar-2021
Date of Acceptance21-Mar-2021
Date of Web Publication24-Dec-2021

Correspondence Address:
Safa H Alkalash
MD, Department of Community medicine and Health Care, Al Qunfudhah College of Medicine, Umm Al Qura University
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_458_20

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  Abstract 


Objectives
To assess knowledge, attitude, and satisfaction by premarital care (PMC) and its associated factors among attendants of Qweisna Family Health Center.
Background
PMC is a primary preventive approach for couples before marriage to optimize women's wellness and subsequent pregnancy outcomes. It is one of the most important strategies for prevention of genetic disorders and congenital anomalies. Hence, it will save the society and allow people to enjoy their life.
Participants and methods
A descriptive cross-sectional study was conducted on 202 participants who attended Qweisna Family Health Center. A predesigned questionnaire was used to assess participants' knowledge, attitude, and satisfaction by premarital healthcare services.
Results
More than two-third of the participants had good knowledge about PMC (73.8%). The main source of knowledge was healthcare provider (44.0%). Good knowledge was significantly higher among younger spouse (20–30 years) (72.9%), females (65.8%), and who were from urban areas (57.0%). Premarital screening explored that nearly half of the participants (49.0%) had microcytic hypochromic anemia, while 15.8% had urine abnormalities. Participants' attitude was positive by 82.7%, which was significantly higher among females) 63.5%) and who were from urban areas (60.0%). Finally, about 69% were satisfied by PMC and it was significantly higher among younger spouse (20–30, years) (75.9%), and females (57.7%).
Conclusion
Generally; majority of the participants had good knowledge regarding PMC. The beneficiaries showed a positive attitude toward importance of the PMC program, who were very satisfied with the conducted service. Females showed good knowledge and positive attitude toward PM services. Also, participants from urban areas had good knowledge and positive attitude than rural. The level of satisfaction was higher in females and those from urban areas.

Keywords: attitude, genetic disorders, knowledge, premarital care service, satisfaction


How to cite this article:
Alkalash SH, Badr SA, Nasr Eldeen AG. Awareness, attitude, and satisfaction of Egyptian adults by premarital care services. Menoufia Med J 2021;34:1284-91

How to cite this URL:
Alkalash SH, Badr SA, Nasr Eldeen AG. Awareness, attitude, and satisfaction of Egyptian adults by premarital care services. Menoufia Med J [serial online] 2021 [cited 2024 Mar 29];34:1284-91. Available from: http://www.mmj.eg.net/text.asp?2021/34/4/1284/333259




  Introduction Top


Premarital care (PMC) is a global activity aiming to diagnose, treat unrecognized disorders, and reduce transmission of diseases to couples, which may affect the quality of marriage and the health of their offspring. Promotion of the health and well-being of a woman and her partner before pregnancy can promote the health of future generation [1]. PMC is known to be the major defensive and preventive approach for the couples who are planning for marriage [2]. It is considered one component of preconception care, which is a preventive primary approach applied to address different health issues [3]. In Egypt, the first checkup center has been operating since mid-2001 [4]. Egyptian Ministry of Health introduces premarital screening for genetic carrier services as a main component of marital and child health services since 1946, and started to provide such services free of charge for prospective spouses in either maternal and child health centers or specialized health centers [5]. The target population for PMC are youth who are in the way for marriage as they will benefit from early appropriate interventions to manage and prevent suspected diseases [6]. Many of them get married with inadequate information on reproduction, sexuality, and family planning. Also, there is a big deficiency of knowledge related to reproductive health even between educated individuals [7]. So they are in need for more information about reproductive health and family planning before they have their first child [8]. So, this study was conducted to assess knowledge, attitude, and satisfaction by PMC and its associated factors among attendants of Qweisna Family Health Center.


  Participants and methods Top


This was a cross-sectional study that was approved by the Ethical Committee of Faculty of Medicine, Menoufia University. Qweisna district was selected through multi-stage-stratified sampling technique to be the study setting and then Qweisna Family Health Center was selected for data collection as it is the only family health facility that provides PMC services in Qweisna district. An official permission letter was obtained from the authorities and directed to health administration in Qweisna Family Health Center. All participants of the study were adult males and female attendants in reproductive age who were seeking for PMC in Qwiesna Family Health Center during the period of the study.

A written consent was taken from each participant after explanation of the purpose of this study and confidentiality was assured. The data were collected in the context of time frame 23 months (starting on the end of November 2018, till the end of October 2020) through a structured questionnaire that was designed in Arabic language. It consisted of multiple-choice questions to find out the knowledge, attitude, and satisfaction about PMC among the participants. The researcher attended the PMC clinic within Qwiesna Family Health Center twice weekly and conducted face-to-face interview with the participants to collect the study data. Each interview lasted for about 10 min and was done for each participant individually.

Sample size was calculated by using EPI Info. program,version 7 (CDC, Atlanta, Georgia, USA) [9]. Based on prevalence, there was 50% of proper adult knowledge regarding PMC in accordance with Khamis et al. [10], and the total number of adults in Qwiesna district was 9062, so the study had been conducted on 202 patients.

A predesigned questionnaire was used to assess participants' knowledge, attitude, and satisfaction by the PMC services through direct interview. This questionnaire included four parts, the first part was 18 questions about sociodemographic data, including age, sex, family size, participants' work, and participants' education. Socioeconomic status (SES) was assessed according to El-Gilany et al. [11], which included seven domains, with a total score of 84 of these domains, considering low SES when (score <38), middle (score 38–57), and high (score ≥57).

The second part included 21 questions evaluating participants' knowledge as regards PMC services as their source of knowledge, components of PMC services as examinations, investigations, recommended vaccinations, and counseling also assessing their knowledge about infectious, genetic, and sexual transmitted diseases. The total score for knowledge was graded as 70–100% for good knowledge, 50–70% for fair knowledge, andless than 50% for bad knowledge according to Babu et al. [12].

The third part included 12 questions for evaluation of participants' attitude toward PMC services by asking about the benefits of these services and importance of counseling and whether the Premarital Screening Genetic Counseling (PMSGC) is expected to decrease the prevalence of some genetic and sexually transmitted diseases. The total score level of attitude was classified into positive attitude (>50%), and negative attitude (<50%), according to Babu et al. [12]. The fourth part included 11 questions to assess the satisfaction level of the participants by the PMSGC with respect to the individuals who conducted the service, for example, place of providing the service inside the family health center, place of taking the sample, waiting place, and confidentiality. The total score level of satisfaction was classified into very satisfied (>75%), satisfied (50–75%), neutral (25–50%), and unsatisfied (<25%).

A pilot study was conducted on 22 participants where the predesigned questionnaire was pretested through its application to ensure questionnaire validity and program feasibility. Data that were collected by such pilot study could not be included in the study results.

Statistical analysis

Data were fed to the computer and analyzed using IBM SPSS software package, version 20.0 (IBM, Armonk, New York, USA). Qualitative data were described using number and percent. Quantitative data were described using range (minimum and maximum), mean, and SD. Frequency and percentage were used for qualitative data, which were analyzed using χ2 test for comparison between two independent qualitative variables. Monte Carlo correction for χ2 when more than 20% of the cells have expected count less than 5. Student t test was used for normally distributed quantitative variables to compare between two studied groups. F test (analysis of variance) was used for normally distributed quantitative variables to compare between more than two groups. Significance of the finally obtained results was judged at the 5% level.


  Results Top


The study reported that 74% of the participants had age 20–30 years, with female sex predominance that represented 53.5% of the sample; 64.4% of the participants were secondary educated and about two-third of them were from urban areas. The majority of the participants (83.2%) had moderate SES.

Participants' knowledge about premarital services

The results showed that 63.4% had known about premarital services, 47% knew that it should be provided by family physicians. The majority (69.8%) informed that premarital counseling is a part of premarriage services; 41.6% were aware by topics of premarital counseling, while 60.4% did not know about the presence of referral system if needed; more than half of the participants reported that general examination is a part of Premarital Screening (PMS), also, nearly half of them (51.5%) reported that German measles vaccination is the vaccination that is provided during PMS, the majority (75.2%) knew about basic tests that are required in the services before marriage. There were statistically significant differences between participants' knowledge and their age, sex, and residency as about 72.5% of those who had good knowledge had aged group 20–30 years, 65.8% of them were female, and 57.0% were from urban areas [Table 1].
Table 1: Factors affecting knowledge about premarital services among the participants

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Source of information about premarital care among the participants

The main source of information about PMC was from the healthcare providers (44%), while a low percent (9.4%) received their information from more than one source [Figure 1].
Figure 1: Source of information about premarital care among the participants.

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Diseases were detected during premarital screening

Nearly all the participants (99%) did not have any infectious diseases. The vast majority (93.6%) did not have hereditary disease within their families, while a little percent (2.0%) had deafness in their families. Nearly all (99.5%) and 95.0% did not have genetic abnormalities nor any chronic diseases, respectively; about half of them (49.0%) had nutritional problems such as anemia and finally 15.8% had urine abnormalities [Figure 2].
Figure 2: Diseases detected among the participants during premarital screening.

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Participants' attitude toward premarital services

Approximately 74.8% agreed to have a premarital examination as well as counseling without objection, the majority (76.7%) thought that the service is useful, 78.2% thought that the best time to get this service is just before marriage, and 77.7% believed that religious leaders should involve PMC as an essential topic in their discussion. More than half agreed that the result of the tests might affect continuation of marriage, 48.5% were not with that Ma'zon should proceed marriage contract only for couples who have a certificate for PMC, 78.2% agreed that PM services contribute to reduction of genetic diseases among offspring, more than half disagreed continuation of marriage in case of one of the spouses suffering from a genetic disease, 65.3% agreed that the spouse should do PMS even if it is not compulsory, and finally 63.4% agreed that the benefits obtained by this service are much more compared with the time consumed by it [Table 2]. There were statistically significant differences between the level of participants' attitude regarding their sex and residency as about 63.5% of the participants who had positive attitude were females and about 60% were from urban areas [Table 3].
Table 2: Attitude of the participants toward importance of premarital services

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Table 3: Factors affecting participants' attitude toward premarital care

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Satisfaction of participants regarding premarital care services

Approximately 77.2% of the participants agreed that the PMC services' provider was careful by spouse interest, 62.9% get advice and treatment in a proper way, while 69.3% had got full privacy during the examination or counseling, and about 80% reported that the place was safe and clean. More than half of the participants (53%) agreed that the information received from the healthcare provider was beneficial, the majority (82%) trust the service provider, 92.1% said that there was no difficulty until getting the final examination report, and finally 84.7% agreed that PM services were provided in a good quality from their point of view. The satisfaction by the provided PMC services was significantly higher among the age group 20–30 years and females (57.7%) [Table 4].
Table 4: Factors affecting participants' satisfaction by premarital care

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  Discussion Top


PMC is the promotion of the health and well-being of a woman and her partner before pregnancy. It is a worldwide activity aiming to diagnose, treat unrecognized disorders, and reduce transmission of diseases to couples [13]. It is directed mainly at unmarried young adults as their beliefs and attitudes will affect their choices in life, including their choice of a partner [14]. PMC can identify and modify behavioral, medical, and other health risk factors known to impact pregnancy outcomes through prevention and management. In addition, it plays a very important role in minimizing marital difficulties caused by hereditary diseases that are responsible for a significant proportion of prenatal morbidity, mortality, infant deaths, and handicapping [15].

It was evident from the results of the present study that about 63% had knowledge about premarital services and more than half of them knew about topics of premarital counseling, general examination, and German measles vaccination, and about three-quarters knew about basic tests that were required in the services before marriage. These results are similar to the results of a study conducted by Abou Elyazid et al. [16], in Cairo, which reported that medical students knew that PMC includes investigations, examination, immunization, and counseling in higher percentages than nonmedical. In comparison, a previous study carried out by Al Ali et al. [17] reported that the participants were conscious about the availability of PMSGC in Egypt, but their knowledge was insufficient about its various aspects such as what it includes and what diseases it focuses and targets.

The results of the current study are in concordance with a study in Nigeria done by Adeyemo et al. [18], who found that high percentages of their respondents showed lack of knowledge about PMC counseling. It was observed from the present study that while 69.8% knew that premarital counseling is a part of premarriage services, few participants were aware of premarital counseling topics and conceptualized that it should be made mandatory for the couples who are planning to get married to avoid future risk of genetic disease, prevention of infectious diseases, and hoping for healthy upcoming family. This is in line with Ibrahim et al. [19] study, which revealed that the majority of students were willing to use free premarital counseling and agreed that premarital counseling and testing can detect hereditary diseases and sexually transmitted infections.

It is important to educate the population about the potential benefits of counseling, so that members of the general population make the right decisions for themselves and their families. Many young women and men enter into marriage with insufficient information about sexuality reproduction and family planning. According to Al ghamdi et al. [2], a school-based sexual health education is one of the most important ways to help young people improve their knowledge about current and future sexual and reproductive health as per Coppola et al. [20].

The present study showed that majority of the participants (73.8%) had good overall knowledge about the PMC services. This result is in line with a study in Oman by Bener et al. [21], which showed that participants were aware about the availability of PMC in higher frequency, this study is supported by Abou Elyazid et al. [16], in another study, who found that about two-thirds of the participants of Al Azhar University students in Cairo heard before about PMC. On the other hand, the present finding is not in line with a study in Qatar conducted by Al Kindi et al. [22], who revealed that knowledge about PMSGC program was low in population. Another study in Jeddah conducted by Ibrahim et al. [19], reported low participants' knowledge about the PMSGC program. It was observed from our study that female participants were more knowledgeable than males about PMC services. This result is in agreement with the result of Alkhaldi et al. [23] study in Sudan, which revealed a significantly higher level of knowledge about the premarital testing among females compared with males.

Regarding the source of information about PMC, the present study revealed that the healthcare provider was the most common source of knowledge and occupied about 44%, while relatives and friends came in the second rank as a source of knowledge (16.3%) of the sample. This is in line with a study of Oluwole et al. [24], in Nigeria, which showed that the majority of their respondents were informed about PM services by healthcare workers. These results are not in concordance with the results of a study in Egypt done by Kabbash et al. [25], which concluded that the main source of information about PMC cited by the participants was media.

Concerning risky marriage in the current study, 1% had infectious disease, 6.4% had hereditary diseases, 0.5% had genetic diseases, and 5.0% had chronic diseases. In correlation with the study of Ibrahim et al. [19], the prevalence of at-risk marriages where hereditary diseases were identified was 6.7%.

As regards participants' attitude toward PMC, majority of the participants (74.8%) agreed to have a premarital examination as well as counseling without any objection, 77% thought that the service was useful, and the majority (78.2%) believed that if this service was provided better, it will contribute to the reduction of genetic diseases and the offspring will have better health. These results are similar to the results of the study conducted by Al-Farsi et al. [26].

More than half of the participants (53.5%) insisted that if one of the spouses suffered from genetic disease, they would disagree to continue marriage. This may reflect the importance of premarital counseling in spousal education about risky marriage and may limit its drawbacks on the upcoming offspring. A large percent of the participants decided that they would encourage their friends and relatives to benefit from premarital services. These results are comparable to the results of Eissa et al. [27] study, which reported that most of the respondents (92%) agreed that PMS reduces hereditary and sexually transmitted diseases believing that it is important to carry out and agreed to do it. Prevention of marriage in case of positive results was accepted by majority of the respondents.

Concerning the Islamic point of view toward PMC in the current study, few of the participants (7.4%) had religious misunderstandings regarding PMSGC, while the majority agreed that religious leaders should involve PMC program as an essential topic in their discussions. This result is in agreement with a study in Sudan conducted by AlKhaldi et al. [23], who found that few students showed negative attitudes arising from religious misunderstandings. Alam [28], another older study done in Riyadh, had findings similar to these studies as the majority of participants who rejected screening believed that it interfered with God's will.

Majority of the participants (82.7%) in the current study showed positive attitude toward PMC service. This is in line with Al-Farsi et al. [26] study in Oman, which reported that the participants had a good score of attitude regarding PMC. It was observed from our study that females exhibited a better attitude toward PMC services than males. This result is in line with Abd Al-Azeem et al. [1] study among medical students in Fayoum University, which reported that females showed a better attitude toward PMC services than males.

Regarding the satisfaction by the conducted PM services, about two-third of the participants documented that the service provider listened to them with interest, gave them advices in a way that they can understand; about 70% had given adequate privacy during examination and counseling. The majority (80.2%) agreed that the place of premarital service was safe and clean, trusted the service providers, and did not find difficulty in any of the procedures. These results are in line with Ibrahim et al. [19] study, which documented that the satisfaction level regarding the program for the participants who took part in the screening is presented in the majority as 80.0% gave an excellent or very good score for program confidentiality. More than 60% said that the place of implementation of the program inside the hospital and the place of sample taking were either excellent or very good. One-half of the beneficiaries gave excellent or very good scores regarding the waiting area in the hospital. The areas of least satisfaction were related to counseling, approximately 40% of the participants gave excellent and very good scores for the questions related to counseling.

Generally in the present study, the majority of the participants gave a very good satisfaction score regarding PMC as about 69% were very satisfied by the PMC conducted for them. This is in agreement with Doaee et al. [29] study, which revealed that overall the patients were so satisfied that 99% planned to return to the same center for future visits.

The present study showed that females were very satisfied by PMC services in higher rate than males. Approximately 84% of the very satisfied participants were in the middle socioeconomic level. This result is not in agreement with Nnebue et al. [30] study, which documented that the level of satisfaction was not different among women of different socioeconomic groups.


  Conclusion Top


This study highlights that although the majority of upcoming spouses were aware of PMC services, they were not aware of some aspects of the service. However, there was generally a positive attitude toward the importance of the program. Approximately half of the couples contemplating at-risk marriages canceled their marriage plans. The beneficiaries were generally satisfied with the conducted PMC service while they need more attention to some parts of the program, some areas need further improvement.

Recommendations

Based on the results of this study, it is recommended that awareness of the importance of PMC is very important. Involvement of government, community, religious leaders, universities, and healthcare providers in providing more health education regarding different aspects of PMSGC. More attention needs to be paid to physical examination and laboratory investigations according to guidelines. Counseling requires marked improvement, including the addition of some important topics to prevent at-risk marriage.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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