Thalassemia, a severe inherited blood disorder, remains a significant public health concern in Bangladesh. Recent studies reveal that between 6-12% of the population may carry the genetic trait for thalassemia, putting future generations at risk. Despite this alarming prevalence, there is an urgent lack of awareness among the public and insufficient national data on the disease’s true scope and consequences. To address this growing health crisis, health experts and researchers are advocating for the immediate implementation of compulsory premarital screening for thalassemia in Bangladesh.

Thalassemia is a hereditary disorder that affects the production of hemoglobin, the protein in red blood cells responsible for carrying oxygen throughout the body. In its severe form, thalassemia major, individuals require lifelong blood transfusions, medications, and other treatments to survive. While carriers (those with a single defective gene) may remain symptom-free, two carriers who marry have a 25% chance of giving birth to a child with thalassemia major. This highlights the importance of identifying carrier couples before marriage. 

 Countries such as Saudi Arabia, Iran, Turkey, and Cyprus have successfully reduced the incidence of thalassemia by making premarital screening mandatory. In Iran, for example, the number of children born with thalassemia major has dropped by 65% following the introduction of compulsory screening, while Cyprus has seen a 90% reduction in new cases. By adopting similar policies, Bangladesh can significantly lower the prevalence of this debilitating disease. 

 The Case for Premarital Screening in Bangladesh

Bangladesh is geographically situated in a "thalassemia belt," with regions such as Sylhet reporting an 11% carrier rate among women. Despite this, awareness remains low. Many people, including educated populations such as university students, have little knowledge of the disease and its transmission. This lack of understanding prevents individuals from taking proactive steps to avoid having children with thalassemia major. A national premarital screening program, coupled with genetic counseling, could provide vital education and help at-risk couples make informed decisions.

Premarital screening for thalassemia involves a simple blood test to determine whether individuals are carriers. If both partners are carriers, genetic counseling provides them with options, including prenatal diagnosis and family planning strategies to reduce the risk of having a child with thalassemia major. Importantly, these programs have been shown to improve public health awareness and reduce the social and economic burden of thalassemia.

Saudi Arabia introduced its compulsory premarital screening program in 2004, leading to a 60% reduction in high-risk marriages in some regions. While cultural and religious factors initially posed challenges, over time, public education campaigns have increased community acceptance of the program. Similarly, Turkey’s screening initiative, launched in the Denizli province, identified 15 high-risk couples out of 9,902 screened individuals, with two couples deciding to cancel their marriages after genetic counseling.

In Iran, premarital screening has been mandatory since 1997, and the country now offers free testing for prospective couples. As a result, the incidence of thalassemia major has significantly declined. The program has also expanded to offer prenatal diagnosis and family planning options for couples already at risk. This comprehensive approach has been instrumental in reducing the number of thalassemia major births.

Despite the potential benefits of premarital screening, there are significant barriers to its implementation in Bangladesh. Financial constraints, sociocultural beliefs, and the stigma surrounding genetic disorders can deter people from participating in such programs. In addition, prenatal diagnosis, which can identify thalassemia in early pregnancies, may lead to difficult decisions, including the possibility of abortion, which is culturally sensitive in Bangladesh.

Moreover, the healthcare infrastructure in Bangladesh may struggle to accommodate a large-scale screening program. Establishing the necessary genetic testing facilities, training healthcare personnel, and ensuring follow-up genetic counseling are all essential components of a successful program, but they require substantial investment.

Despite these challenges, the potential for success is significant. Surveys in Bangladesh have shown that a majority of the population holds positive attitudes towards premarital screening. With proper public education campaigns, community engagement, and support from religious leaders, compulsory premarital screening can be effectively introduced. Genetic counseling must be an integral part of the program to guide high-risk couples in making informed decisions that align with their values and circumstances.

Furthermore, voluntary screening programs, as implemented in countries like Italy and Greece, provide an alternative approach that could complement compulsory measures. These programs allow individuals to proactively assess their genetic risks before marriage, giving them time to make informed choices. In Sardinia, Italy, a voluntary screening program has reduced the birth rate of thalassemia major from 1:250 to 1:4000 live births. A similar approach in Bangladesh, adapted to the country’s cultural and social context, could help raise awareness and prevent new cases.

Thalassemia is a preventable genetic disorder, and Bangladesh must act now to curb its growing impact. Implementing compulsory premarital screening, in conjunction with genetic counseling, is a proven strategy to reduce the prevalence of thalassemia. By learning from the successes and challenges of other countries, Bangladesh can develop an effective and culturally sensitive screening program that addresses the unique needs of its population. This will not only reduce the burden on the healthcare system but also improve the quality of life for future generations. The time to act is now, before thalassemia becomes an even greater public health crisis.

For more in-depth information and scientific insights on thalassemia prevention strategies, you can access further reading here.