Enhancing public health through the Kano pre-marital health screening bill: analysis of implications, challenges, and opportunities

¹Department of Immunology, School of Medical Laboratory Science, Usmanu Danfodiyo University, Sokoto, Nigeria, ²Department of Public Health and Maritime Transport, University of Thessaly, Volos, Greece, ³Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia, ⁴Department of Internal Medicine, Asokoro District Hospital, Abuja, Nigeria, ⁵Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom, ⁶Research and Development Office, Biliran Province State University, Naval, Leyte, Philippines, ⁷Research and Innovation Office, Southern Leyte State University, Sogod, Southern Leyte, Philippines

^&Corresponding author
Mohamed Mustaf Ahmed, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia

To the editors of the Pan African Medical Journal    

The Kano State House of Assembly recently passed a bill to mandate couples undergo medical screenings for HIV, hepatitis, and sickle cell anemia before marriage. The pre-marital health screening bill represents a significant step towards enhancing healthcare practices and upholding marital rights in Kano State, Nigeria. The Assembly stated that the decision marks a significant step towards protecting public health and preventing the spread of life-threatening diseases [1]. The bill was introduced because of the prevalence of health issues such as HIV and hepatitis, which are spread through uninformed marriages where individuals are unaware of the necessity for health screening before marriage in the state [1]. The bill emphasizes that couples intending to marry undergo essential medical screening and other relevant health examinations. By requiring premarital health screenings, the bill aims to promote public health, prevent the spread of diseases, and ensure that couples are aware of their health status before entering marriage. This proactive approach not only emphasizes the importance of health in relationships but also underscores the government's commitment to safeguarding the well-being of its citizens through preventive healthcare measures. This paper critically analyzes the Kano pre-marital health screening bill, focusing on its ethical, cultural, and practical implications. It highlights the bill's potential benefits and challenges and its impact on public health, individual rights, and societal acceptance. The aim is to stimulate discussion and provide recommendations for Kano's future policy development and implementation strategies.

Implications to public health: pre-marital screening signifies a shift in Kano toward organized healthcare practices, improved access to care, and advanced reproductive health. This screening is performed to detect the status of the intended couples and, subsequently, to prevent transmission to their respective partners through health counseling, education, and further treatment [2]. Ethical considerations of the Kano Pre-Marital Health Screening Bill include ensuring informed consent, respecting personal autonomy, protecting privacy and confidentiality, and avoiding discrimination. The program is accessible to all and aims to improve public health while minimizing harm and ensuring equitable implementation. Cultural sensitivity is crucial, as it respects local values and involves community leaders. These factors ensure the screening is fair, respectful, and beneficial to the community. Pre-marital screening programs have significant cultural and societal impacts. In cultures where arranged or consanguineous marriages are common, pre-marital screening can influence marriage decisions and family dynamics [3]. The acceptance and implementation of these screening programs reflect the cultural value placed on the health and well-being of future generations. Additionally, the emphasis on genetic testing in pre-marital screenings can lead to increased awareness and education about inherited diseases within communities, potentially reducing the prevalence of genetic disorders and birth defects [3,4]. The societal impact also extends to the stigma associated with certain genetic conditions, as screening programs can help de-stigmatize these conditions by promoting understanding and acceptance [4]. The Kano pre-marital health screening bill aims to promote early detection and prevention of diseases such as HIV, hepatitis, and genotype through mandatory pre-marital screenings in the state [5]. The involvement of developmental partners such as the National Center for Disease Control (NCDC), the Reproductive Health and Traditional Medicine Board (RTSL), and the Foreign, Commonwealth & Development Office (FCDO)-Lafiya Programme in the sponsorship of the bill and its implementation highlights the collaborative efforts to address public health concerns through pre-marital screening programs. Partnerships facilitate the provision of resources, expertise, and support necessary for the effective implementation of screening programs. Furthermore, the mandatory nature of screenings ensures that a larger proportion of the population, particularly those planning to marry, will be tested for these conditions. This increased coverage will reduce the burden of these diseases on the healthcare system and society as a whole [6].

Challenges and opportunities: implementing the Kano Pre-Marital Health Screening Bill may face several challenges, including ensuring that pre-marital screenings are accessible and affordable for all prospective couples, particularly those from low-income backgrounds, which is crucial for the program's success. Acceptance of screening may be hampered by cultural resistance, especially in areas where traditional beliefs significantly influence healthcare decisions [7]. Addressing the stigma and discrimination associated with certain health conditions, such as HIV and sickle cell anemia, is necessary to encourage participation and support those affected. Ensuring that healthcare facilities have the necessary infrastructure, equipment, and trained personnel to conduct the screenings and provide appropriate counseling and treatment will be a significant challenge. Enforcing the law and ensuring that all prospective couples comply with mandatory screening requirements may prove difficult without proper monitoring and penalties for non-compliance. Protecting the privacy and confidentiality of individuals' health information is crucial for maintaining trust in the program and encouraging participation. Effective coordination among various stakeholders, including the government, healthcare providers, and civil society organizations, is necessary for the successful implementation of the program [8].

Pre-marital screening programs offer various potential benefits and opportunities for improving public health outcomes. Pre-marital screening allows for the early detection of health conditions such as HIV, hepatitis, and genetic disorders, enabling timely intervention and prevention of disease transmission to minimize the prevalence of certain conditions and associated complications, subsequently reducing the burden on the already strained healthcare system. Implementation can strengthen healthcare systems by enhancing their capacity, training personnel, and improving laboratory services. The bill encourages community engagement and partnership building to address local health needs and promote health equity. Establishing a legal framework for pre-marital screening ensures clarity, accountability, and protection of individuals´ rights, setting standards for informed consent, privacy, and non-discrimination [9]. Genetic screening helps couples assess the risk of hereditary diseases passing on to their offspring, enabling informed decisions about family planning [3]. Pre-marital screenings offer a platform for health education and awareness about their medical status, genetic makeup, and potential risks, promoting better health management and decision-making [3,9]. While further promoting healthy relationships, it fosters open communication and encourages mutual support in managing health conditions. Despite facing challenges in implementation, the Kano pre-marital health screening bill offers significant opportunities to improve public health outcomes and advance health equity. This requires collaboration between government agencies, healthcare providers, civil society organizations, and community stakeholders. By effectively addressing these challenges, Kano can enhance its population's health and well-being, thereby promoting a culture of health awareness and responsibility [10].

Competing interests    

The authors declare no competing interests.

Authors' contributions     

All the authors have read and agreed to the final manuscript.

References