Premarriage Checkup In Egypt:

We have the 1st Premarriage Checkup Center in Egypt and the Middle East, established in mid-2001. We do a general, andrological and gynaecological examination and genetic counseling. We aim to decrease the rate of divorce and handicapped children in new families in Egypt. We have a very good response in the community, media and youth. We hope to make the idea popular between youth. We have a website to ask and sex education of youth.

http://www.premarriage.1hh.com

This is an article in Al-Ahram weekly newspaper in Egypt-29 August - 4 Sept. 2002 Issue No. 601:

To marry or not to marry?

Is pre-marital health care vital to a happy marriage? Reham El-Adawi investigates

The issue of pre-marital health care has become a hot topic among young couples in Cairo. Many young women have been convinced of the utility of such examinations, while their suitors remain skeptical about the usefulness of seeing a doctor before marriage. One young man, convinced of his virility and sound health, proclaimed the health of his brothers and sisters as a guarantee for his worthiness as a companion. Yet, perhaps even more important to him was the potential embarrassment of being seen at a pre-marital health clinic. He was unable to convince the object of his affections so easily, and ended by saying Khaliha ala Allah (leave the whole matter for God).

The issue of pre-marital check-ups was addressed in an article appearing in the British Medical Journal of 26 May 2001. According to the article, the US state of "Indiana has now joined in the endeavour to make marriages healthy... On 4 March, the Senate of that state passed a bill intended to limit divorces in the state by preventing ill-chosen marriages. The idea of the bill is to require physical examinations and an inquiry into the parentage of applicants (for a marriage license)". Pre- marital check-ups are not legally mandated in this part of the world but they are becoming more prevalent.

The first pre-marital check-up centre in the Middle East opened its doors in Egypt in July 2001. The centre, located at Nasser Institute Hospital, has welcomed over 2,000 cases in its first year. Director of the centre, internal medicine specialist Tarek Rashed, stated that since the centre's purpose is to educate couples before marriage it has organised several seminars to raise awareness of prevention. Last month, a seminar was held to tackle several health related issues.

Dr Salah El-Ghazali Harb, supervisor of the project, pointed out that the pre-marital check up centre helps couples to avoid health problems during marriage. Rashed focused on its importance in limiting disabilities in children and reducing cases of divorce. Mohamed El-Sawi, a geneticist, highlighted the importance of performing an examination of the family tree to accurately suggest the possibility of having children with hereditary diseases.

Rashed again stated that the centre does not have only a preventive goal but also an instructive one. The centre instructs new couples on the proper use of birth control methods and issues regarding sexually transmitted diseases. Moreover, the centre helps couples understand the significant changes that come along with such an important step in life. Education at the centre focuses on preparing young couples for the increase in responsibility and the ways to deal with the challenges ahead.

In an attempt to soothe couples who fear coming to the centre, Rashed explained that medical examinations simply include a comprehensive abdominal check-up and examining the family history for any chronic illnesses that may be passed on to future generations. A clinical examination is performed on both sexes. Males have a semen analysis while females undergo an ultrasound scan on their pelvis. He pointed out that in cases involving marriages within the same family a hereditary consultation is a must.

Concerning the difference between what happens in the pre-marriage check-up centre and other reproductive health centres scattered across Egypt, Rashed explained "other reproductive health centres are only concerned with making a blood test for the female." While the centre at the Nasser Institute Hospital provides pre-natal check-ups, pregnancy analysis, and post-natal care.

Remarkably, the majority of women seen by the centre do not suffer from any problems that affect their pregnancy or reproductive health. However, there are many cases of varicocele (swelling of veins in the male reproductive tract) among young men which cause fertility problems. It is important to note that smoking plays a large role in the spread of this ailment among young men. Moreover, "50 per cent of couples who visit the centre are relatives, of these couples I have advised only two couples not to get married," he stated. One couple are cousins and have a family history of congenital disturbance which appears at the age of 10. So, their offspring have 25 per cent chance to inherit the disease. However, they insisted on continuing their marriage. In the other case, the couple are also relatives and both suffer from retinitis pigmentosa which leads to complete blindness. Their children would definitely lose their sight so they decided not to marry.

Rashed continued that among the most prevalent diseases afflicting men is impotency, while the decrease of libido or virility is leading among women. For both sexes there are common diseases which can disturb their marital life such as diabetes, high-blood pressure and high cholesterol.

Rashed explained that in intra-familial marriages, heredity plays a crucial role in the appearance of disease. This is because offspring from these unions are 25 per cent more likely to suffer from hereditary disease and mental disorder.

It seems that girls are more enthusiastic than boys to have the pre- marriage check-up. In most of the cases, the girl's father convinces her fiancé to make the check-up in order to soothe his own fears about his daughter's future.

On my way out of Rashed's office, I met an enthusiastic couple who welcomed me with a big smile. A smile that gave me the courage to ask about their feelings after finishing the medical examinations.

Ahmed and Omayma are cousins and they heard about the centre from a relative who works there. "We are very keen as relatives to make sure that our children will not suffer from hereditary diseases," Omayma told Al- Ahram Weekly. "We were impressed by the five-star check up rooms and the sophisticated equipment used in the centre, we were asked to fast before our appointment. And all of the tests were completed by 2pm," she added.

However, in all situations there is good and bad. For another couple going to the centre was more urgent. This second couple are also relatives but have had a bad experience with the intra- familial marriage. Ihab Gharib and Abeer Abdel-Hafiz were just married few weeks ago. Ihab's elder brother is married to his cousin and they lost their first child to an orthopedic disease (a disease of the bones).

Ihab was a little bit worried before the check-up, but after going to the centre he said, "All thanks go to Dr Rashed who soothed me and said that all health problems can be treated, especially in the early stages and thank God all results were positive." However, Abeer sees the costs of the check- up: LE430 (LE230 for female and LE200 for male) in addition to LE50 for having a hereditary consultation. The cost is quite considerable. At the end of the talk, she wonders why I didn't ask her if negative results from the pre- marriage check-up would have prevented their union. "Nothing was going to stop our marriage," she confirmed.

Mohamed Salah, a civil servant, complained that he can't afford the costs of the check-up. He wished that this check-up, which he thinks should be part of the marriage contract procedures, was covered by health insurance.

Sixty per cent of the couples who frequent the centre are from rural governorates. As a result, Rashed expects great success for a similar project in remote areas. He explained that promoting the idea across Egypt's rural areas will reduce the current centre's expenses.

The doctor detailed his vision for improving health services in rural areas. Firstly, the coordination between the National Council for Childhood and Motherhood (NCCM), the Ministry of Health represented by the Pre- Marriage Check-up Centre at Nasser Institute Hospital, the Institute of Childhood and Motherhood Studies at the Faculty of Medicine and the Heredity Department at the National Centre for Research. Secondly, this coordination should include the five governorates that have medical facilities capable of performing relevant research -- specifically Assiut and Qena Universities in Upper Egypt and Alexandria and Sinai Universities in Lower Egypt. Thirdly, training doctors in rural areas to survey young couples and counsel them before marriage, and how to perform hereditary consultation and analysis. "All this can be achieved by allocating one room in each hospital for the pre-marital check-up, all you need is an internal medicine specialist," ended Rashed.

Despite the success of the centre. The number of couples who frequent the centre are very few for a country with the population of Egypt. It seems that the approach of khaliha ala Allah is still predominant.

Practical Information

For couples on the verge of marriage and newly weds who seek more information go to http://naser.home.icq.com

or call 203 8874.

Dr. Tarek Rashed, Manager of the Center, Who introduced the idea and fight to make it true in Egypt and Arab World.

NCHPEG’s 8^th Annual Meeting

Erin K. Herrick, Sc.M.

 “Every child deserves a complete family medical history in their chart. It should be completed before they are born,” according to Dr. Richard H. Carmona, the US Surgeon General and keynote speaker at NCHPEG’s 8^th annual meeting.  More than 200 attendees, including representatives from many of NCHPEG’s 150 member organizations, and Dr/ Tarek Rashed Khater on behalf of Naser Institute Hospital Premarriage Checkup Center - Egypt, gathered for the meeting in Bethesda, Maryland, on January 27^th and 28^th.  Family history was the topic on everyone’s mind, as was the take home message: A three-generation pedigree is the starting point for personalized, preventive medicine in the genomic era.

“As a surgeon, you can change one life a day, but in public health, you can change populations. We have to figure out how to move this country from a treatment oriented society to a prevention oriented society,” said Dr. Carmona, a former surgeon who believes the key to success is health literacy. He challenged the audience to teach others about the importance of the family history in a culturally competent way, “so that you don’t alienate the people you’re trying to embrace.”

The surgeon general launched his family history initiative and “My Family Health Portrait,” a web-based family history tool, on Thanksgiving day, 2004 – a time during the year when American families come together. The tool is available in English and Spanish at www.hhs.gov/familyhistory. Everyone is encouraged to use it to collect his or her family health history, and to share that information with health care provider(s).

Dr. Elizabeth Duke, senior administrator for the Health Resources and Services Administration, highlighted the “Healthy Choices Through Family History Awareness Project.” This collaborative project brings together anthropologists, folklorists, genetic health specialists, and consumers to reach diverse African-American and Latino communities in Pennsylvania. The project relies on the oral tradition in those communities and focuses on storytelling, anecdotes, and other narratives used to transmit information and attitudes about health and disease. Ultimately, the project hopes to increase the community’s genetics literacy, and physicians’ cultural literacy.

Meanwhile, the Centers for Disease Control and Prevention (CDC) is using the family history to target heart disease, stroke, diabetes, and breast, ovarian, and colorectal cancer – diseases that cause high rates of illness and death in the population at large. With the tacit admission that, “one size does not fit all,” speakers Maren Scheuner, MD, MPH, and Paula Yoon, ScD, MPH, explained how the CDC proposes to use a family history tool to stratify risk and to tailor individual screening and preventive health messages.

Following a series of presentations on genetics-education programs for health professionals, Dr. Alan Guttmacher, deputy director of the National Human Genome Research Institute, provided some final thoughts on the subject of family history and its unique ability to capture not only individual genetic variation, but also shared elements that influence health status: the physical environment (e.g., sunlight and pollutants); the built environment (e.g., sidewalks, which promote walking and therefore better health); the dietary environment (e.g., meat, fat, junk food); the social environment (e.g., socioeconomic status and marital status); and the cultural environment (e.g. spirituality). As a tool for documenting the social, health, and environmental history of generations past, the future of the family history is assured.

Look to the winter and spring issues of NCHPEG’s Genetic Family History in Practice newsletter for more information and updates about these and other family history initiatives. In addition, speakers’ PowerPoint presentations are available for free viewing and downloading at www.nchpeg.org. Visit the website, or call NCHPEG at 410-583-0600 to learn more about the coalition’s membership, its mission, and ongoing genetics education projects for health care professionals.