Effect of parental knowledge on their thalassemia status and the time of diagnosis of their offspring in Kurunegala, Kandy, and Gampaha Districts.

Effect of parental knowledge on their thalassemia status and the time of diagnosis of their offspring in Kurunegala, Kandy, and Gampaha Districts. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of parental knowledge on their thalassemia status and the time of diagnosis of their offspring in Kurunegala, Kandy, and Gampaha Districts. Jayasooriya HK, Banu SR, Liyanage IKSH, Herath HMDM This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7626213/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Beta-thalassemia represents the most prevalent monogenic disorder in Sri Lanka, with approximately 2,000 active cases requiring lifelong transfusion therapy and 80 new cases born annually. Despite the availability of voluntary carrier screening since 2007, the impact of preconceptional parental awareness on screening and clinical outcomes remains poorly characterized. Objective: To evaluate the association between preconceptional parental thalassemia carrier status awareness and the timing of diagnosis, hemoglobin levels at diagnosis, and long-term complications in children with beta-thalassemia major. Methods: We conducted a multicenter cross-sectional study across three major thalassemia centers in Kurunegala, Kandy, and Gampaha districts. Laboratory-confirmed beta-thalassemia major patients under 18 years were recruited. Primary outcomes included mean age at diagnosis and hemoglobin levels at the time of diagnosis, stratified by parental preconceptional carrier awareness status. Secondary outcomes included complications such as encompassed growth parameters, organ complications, and therapeutic interventions. Results: Among 279 beta-thalassemia major patients, only 42 (15.1%) had at least one parent with preconceptional carrier status awareness. Children of thalassemia status aware parents were diagnosed significantly earlier (5.39 ± 4.2 months vs. 8.32 ± 7.8 months, p < 0.001) and had higher hemoglobin levels at diagnosis (6.23 ± 1.5 g/dL vs. 5.47 ± 1.2 g/dL, p < 0.0001). Notably, children of preconceptionally unaware parents about thalassemia status demonstrated higher rates of complications such as splenomegaly (15.2% vs. 7.1%, p = 0.043), endocrine complications including hypothyroidism (9.3% vs. 14.3%, p = 0.028), and required more palliative interventions including splenectomy (2.1% vs. 0%, p = 0.001). Conclusions: Preconceptional parental carrier awareness is associated with earlier diagnosis, higher hemoglobin levels at presentation, and reduced long-term complications in beta-thalassemia major. These findings support the implementation of mandatory preconceptional screening programs and enhanced public health education initiatives to reduce disease burden and improve patient outcomes. This study provides the first comprehensive evidence from Sri Lanka demonstrating that parental awareness leads to measurable improvements in clinical outcomes, supporting policy recommendations for universal preconceptional screening. Hematology Internal Medicine Preventive Medicine Beta-thalassemia major carrier screening early diagnosis prevention Sri Lanka public health Figures Figure 1 Introduction Beta-thalassemia represents a critical public health challenge in Sri Lanka, constituting the most common monogenic disorder with an estimated carrier frequency of 2.2% in the general population¹. The disease imposes a substantial economic burden, with current estimates indicating approximately 2,000 active cases receiving regular transfusion therapy and 80 new cases born annually, predominantly concentrated in the Wayamba, Uva, and North Central provinces²,³. The pathophysiology of beta-thalassemia results from mutations in the beta-globin gene cluster, leading to reduced or absent beta-globin chain synthesis. When inherited in an autosomal recessive pattern, homozygous or compound heterozygous states result in beta-thalassemia major, characterized by severe anemia with compensatory extramedullary hematopoiesis leading to complications such as hepatosplenomegaly, and multi-organ complications due to chronic hypoxia and iron overload⁴. Current management strategies in Sri Lanka encompass both palliative approaches including lifelong blood transfusions and iron chelation therapy, and curative interventions such as hematopoietic stem cell transplantation. However, the annual cost of palliative care exceeds LKR 400,000 per patient, consuming approximately 27 units of blood annually and placing tremendous strain on healthcare resources⁵. The Sri Lankan National Thalassemia Prevention Program, initiated in 2007, provides voluntary and free carrier screening for individuals aged 16 years and above⁶. Despite this initiative, the screening remains suboptimal, with limited data available on the clinical impact of preconceptional parental awareness on offspring outcomes. Early diagnosis of beta-thalassemia major is crucial for optimal management, as delayed recognition can result in severe anemia, growth retardation, skeletal abnormalities, and irreversible organ damage⁷,⁸. Furthermore, early initiation of appropriate therapy has been demonstrated to improve quality of life, reduce complications, and enhance overall survival⁹,¹⁰. The present study addresses a critical knowledge gap by examining the relationship between preconceptional parental thalassemia carrier status awareness and clinical outcomes in their offspring diagnosed with beta-thalassemia major. Our findings have important implications for public health policy and prevention strategies in high-prevalence regions. Methods 2.1 Study Design and Setting This multicenter cross-sectional study was conducted following approval from the Ethics Review Committee of the Faculty of Medicine, Wayamba University of Sri Lanka (Approval No. PW2021/09/03). The study was performed in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. 2.2 Study Population and Sampling Participants were recruited from three major thalassemia treatment centers: the National Thalassemia Center at Teaching Hospital Kurunegala, Colombo North Teaching Hospital, and the Pediatric Unit at National Hospital Kandy. These centers collectively manage approximately 60% of beta-thalassemia major patients in the study regions. Inclusion Criteria: Laboratory-confirmed beta-thalassemia major diagnosis based on hemoglobin electrophoresis and/or high-performance liquid chromatography (HPLC) Age less than 18 years at the time of enrollment Regular attendance at one of the participating centers Parental consent for participation Exclusion Criteria: Hemoglobin E-beta thalassemia major Other hemoglobinopathies requiring regular transfusion Parents declining consent Incomplete medical records 2.3 Data Collection Structured interviews were conducted with parents using a standardized pretested questionnaire developed and validated for this study. Medical records were reviewed to extract clinical data including: Primary Variables: Age at initial beta-thalassemia major diagnosis (months) Hemoglobin level at diagnosis (g/dL) Parental preconceptional thalassemia carrier status awareness Secondary Variables: Growth parameters (height and weight percentiles for age) Presence of hepatosplenomegaly Endocrine complications (hypothyroidism, diabetes mellitus, delayed puberty) Cardiac complications (cardiomyopathy) History of splenectomy Transfusion frequency and iron chelation therapy 2.4 Definitions Preconceptional Awareness Parents were classified as "aware" if at least one parent knew their thalassemia carrier status before conception of the affected child through formal screening or previous experience with affected offspring. Growth Assessment Classified as adequate (≥ 10th percentile for age) or inadequate (< 10th percentile for age) using WHO growth charts. 2.5 Statistical Analysis Statistical analysis was performed using SPSS version 28.0. Descriptive statistics were calculated for all variables. Continuous variables were expressed as means ± standard deviation and compared using independent t-tests or Mann-Whitney U tests as appropriate. Categorical variables were compared using chi-square tests or Fisher's exact tests. A p-value < 0.05 was considered statistically significant. Multivariate logistic regression analysis was performed to identify independent predictors of early diagnosis, adjusting for potential confounders including geographic location, parental education, and socioeconomic status. Results 3.1 Study Population Characteristics A total of 279 children with laboratory-confirmed beta-thalassemia major were enrolled in the study. The demographic and clinical characteristics are summarized in Table 1 . Table 1 Baseline Characteristics of Study Population Characteristic Total (n = 279) Parents Aware (n = 42) Parents Unaware (n = 237) p-value Demographics Male gender, n (%) 147 (52.7) 22 (52.4) 125 (52.7) 0.968 Mean current age, years ± SD 8.4 ± 4.2 7.9 ± 3.8 8.5 ± 4.3 0.412 3.2 Parental Thalassemia Carrier Awareness Among the 279 families studied, only 42 (15.1%) had at least one parent with preconceptional thalassemia carrier status awareness. Maternal awareness was documented in 40 cases (14.3%), while paternal awareness was present in 36 cases (12.9%). Both parents were aware in 25 families (9.0%). Sources of Parental Awareness: Previous affected child: 44 parents (55.0%) Formal screening programs: 32 parents (40.0%) Family history screening: 4 parents (5.0%) Table 2: Reason to aware the thalassemia status preconceptionally 3.3 Primary Outcomes Age at Diagnosis : Children of parents with preconceptional carrier awareness were diagnosed significantly earlier than those of unaware parents (5.39 ± 4.2 months vs. 8.32 ± 7.8 months; mean difference: 2.93 months, 95% CI: 1.2–4.7, p < 0.001). The proportion of children diagnosed before 6 months of age was significantly higher in the aware group (71.4% vs. 52.3%, OR: 2.26, 95% CI: 1.1–4.8, p = 0.029). Hemoglobin Level at Diagnosis : Mean hemoglobin levels at diagnosis were significantly higher in children of aware parents (6.23 ± 1.5 g/dL vs. 5.47 ± 1.2 g/dL; mean difference: 0.76 g/dL, 95% CI: 0.3–1.2, p < 0.0001). 3.4 Secondary Outcomes Growth and Development Adequate growth was more frequently observed in children of aware parents (83.3% vs. 70.9%, p = 0.096), though this difference did not reach statistical significance. Complications Several complications showed significant differences between groups Splenomegaly : Less frequent in aware group (7.1% vs. 15.2%, p = 0.043) Hypothyroidism : Lower prevalence in aware group (14.3% vs. 9.3%, p = 0.028) Delayed puberty : Reduced in aware group (11.9% vs. 12.7%, p = 0.089) Diabetes mellitus : No cases in aware group vs. 8 cases (3.4%) in unaware group (p = 0.001) Cardiomyopathy : No cases in aware group vs. 8 cases (3.4%) in unaware group (p = 0.001) Therapeutic Interventions All 5 patients who underwent splenectomy belonged to the unaware parent group (0% vs. 2.1%, p = 0.001). 3.5 Multivariate Analysis After adjusting for potential confounders including parental education, geographic location, and socioeconomic status, parental preconceptional awareness remained an independent predictor of early diagnosis (adjusted OR: 2.84, 95% CI: 1.3–6.2, p = 0.009). Discussion This study provides the first comprehensive evidence from Sri Lanka demonstrating that preconceptional parental thalassemia carrier awareness is associated with significantly improved clinical outcomes in children with beta-thalassemia major. Our findings have important implications for public health policy and prevention strategies in regions with high thalassemia prevalence. 4.1 Clinical Significance of Early Diagnosis The nearly 3-month difference in mean age at diagnosis between children of aware versus unaware parents represents a clinically meaningful improvement. Early diagnosis before 6 months of age is associated with reduced risk of growth failure, skeletal abnormalities, and organ complications¹¹. Our data support this paradigm, demonstrating that children of aware parents had higher hemoglobin levels at diagnosis, suggesting less severe anemia and potentially reduced tissue hypoxia. The higher hemoglobin levels at diagnosis in the aware group (6.23 vs. 5.47 g/dL) may reflect earlier medical attention and reduced delay in diagnostic workup. This finding is particularly relevant as severe anemia at diagnosis has been associated with increased risk of cardiac complications and growth retardation¹². 4.2 Long-term Complications and Quality of Life Our study demonstrates significant differences in long-term complications between groups. The absence of diabetes mellitus and cardiomyopathy in children of aware parents, compared to 3.4% prevalence in each condition among children of unaware parents, suggests that early diagnosis and treatment initiation may prevent or delay these serious complications. The reduced prevalence of splenomegaly in the aware group (7.1% vs. 15.2%) is consistent with earlier treatment initiation and better disease management. Splenomegaly in thalassemia major is associated with increased transfusion requirements, hypersplenism, and eventual need for splenectomy¹³. The fact that all 5 patients requiring splenectomy belonged to the unaware parent group underscores the importance of early diagnosis and optimal management. 4.3 Public Health Implications The low rate of preconceptional parental awareness (15.1%) highlights a critical gap in the current voluntary screening program. Despite the availability of free screening since 2007, uptake remains inadequate. This finding supports recommendations for transitioning from voluntary to mandatory preconceptional screening, as implemented successfully in other Mediterranean countries¹⁴. The economic implications are substantial. With an annual treatment cost of LKR 400,000 per patient and improved outcomes associated with parental awareness, investment in enhanced screening programs could yield significant cost savings while improving patient outcomes. A comprehensive cost-effectiveness analysis would be valuable to inform policy decisions. 4.4 International Context Our findings align with studies from other high-prevalence regions. Research from Cyprus and Sardinia has demonstrated that comprehensive screening programs can reduce the incidence of new cases by over 90%¹⁵,¹⁶. Similar programs in Iran and Thailand have shown comparable improvements in early diagnosis rates when parental awareness is high¹⁷,¹⁸. 4.5 Recommendations for Program Enhancement Based on our findings, we propose several strategies to enhance the current prevention program: Universal Preconceptional Screening : Implementation of mandatory screening for all couples planning marriage or pregnancy Integration with Routine Healthcare : Incorporation of thalassemia screening into routine antenatal care at first visit Enhanced Public Education : Community-based awareness programs targeting high-prevalence regions School-Based Screening : Implementation of screening programs in secondary schools before students reach reproductive age Genetic Counseling Services : Expansion of counseling services for identified carrier couples Assisted Reproductive Technologies : Improved access to preimplantation genetic diagnosis for at-risk couples 4.6 Study Limitations Several limitations should be acknowledged. The cross-sectional design precludes causal inference, and recall bias may affect parental reporting of awareness status. The study was conducted in major treatment centers, potentially missing patients managed in peripheral facilities. Additionally, socioeconomic factors and parental education levels, which may influence both screening behavior and healthcare-seeking patterns, require further investigation. Future prospective cohort studies with longer follow-up periods would provide stronger evidence for the relationship between parental awareness and long-term outcomes. Cost-effectiveness analyses would also be valuable for policy development. 4.7 Global Health Perspective Thalassemia represents a major global health challenge, with an estimated 240 million carriers worldwide¹⁹. Our findings from Sri Lanka may be applicable to other high-prevalence regions in South Asia, Southeast Asia, and the Mediterranean. The success of prevention programs in reducing new cases while improving outcomes for affected individuals demonstrates the importance of comprehensive public health approaches to genetic disorders. Conclusions The thalassemia diagnosis was early when parenteral thalassemia status was known preconceptionally with a higher haemoglobin level at the time of diagnosis. Early treatment initiation has improved the QoL with fewer complications and more definitive treatment strategies. The H512 pregnancy record will include parenteral thalassemia status, enabling early diagnosis and treatment initiation, and enhancing community health education and screening programs. The low rate of preconceptional awareness (15.1%) in our study population highlights the urgent need for improved screening uptake and public education. Given the substantial economic burden of thalassemia management and the demonstrated benefits of early diagnosis, investment in comprehensive prevention programs represents both a clinical and economic imperative. Policy recommendations emerging from this research include the consideration of mandatory preconceptional screening, integration of thalassemia testing into routine healthcare services, and enhanced community education programs. Implementation of these strategies could significantly reduce the burden of thalassemia in Sri Lanka while improving outcomes for affected patients. The global burden of thalassemia requires sustained commitment to prevention and management strategies. Our findings contribute to the evidence base supporting comprehensive public health approaches to genetic disorders and may inform similar programs in other high-prevalence regions. Declarations Acknowledgments We thank the patients and families who participated in this study, and the healthcare teams at the participating centers for their support. Conflicts of Interest The authors declare no conflicts of interest. References de Silva S, Fisher CA, Premawardhena A et al (2000) Thalassaemia in Sri Lanka: implications for the future health burden of Asian populations. Lancet 355(9206):786–791 Premawardhana AP, Mudiyanse R, De Silva ST et al (2019) A nationwide survey of hospital-based thalassemia patients and standards of care and a preliminary assessment of the national prevention program in Sri Lanka. PLoS ONE 14(8):e0220852 Samarakoon P, Wijesuriya A (2011) A clinical audit of thalassaemia management at the Lady Ridgeway Hospital for Children, Colombo. Sri Lanka J Child Health 40(2):51–56 Weatherall DJ, Clegg JB (2001) Inherited haemoglobin disorders: an increasing global health problem. Bull World Health Organ 79(8):704–712 Samarakoon P, Wijesuriya A (2011) A clinical audit of thalassaemia management at the Lady Ridgeway Hospital for Children, Colombo. Sri Lanka J Child Health 40:51–56 Mudiyanse RM, Senanayake MP, Rathnayake RMS (2015) Safe Marriages for Thalassaemia Prevention: A KAP Survey in Sri Lanka. Transl Biomed 6(3):26 Olivieri NF, Muraca GM, O'Donnell A et al (2008) Studies in haemoglobin E beta-thalassaemia. Br J Haematol 141(3):388–397 Dhirar N, Khandekar J, Bachani D, Mahto D (2016) Thalassemia Major: How do we improve quality of life? SpringerPlus. ;5(1):1895 Premawardhena A, Silver SD, Arambepola M et al (2005) Hemoglobin E-β-Thalassemia: Progress Report from the International Study Group. Ann NY Acad Sci 1054(1):33–39 Mettananda S (2018) Management of Thalassaemia. Sri Lanka J Child Health 47(2):159–165 Cappellini MD, Cohen A, Porter J, Taher A, Viprakasit V (2014) Guidelines for the Management of Transfusion Dependent Thalassaemia (TDT), 3rd edn. Thalassaemia International Federation Borgna-Pignatti C, Rugolotto S, De Stefano P et al (2004) Survival and complications in patients with thalassemia major treated with transfusion and deferoxamine. Haematologica 89(10):1187–1193 Caocci G, Efficace F, Ciotti F et al (2012) Health related quality of life in Middle Eastern children with beta-thalassemia. BMC Blood Disord 12:6 Angastiniotis M, Modell B (1998) Global epidemiology of hemoglobin disorders. Ann NY Acad Sci 850:251–269 Cao A, Rosatelli MC, Monni G, Galanello R (2002) Screening for thalassemia: a model of success. Obstet Gynecol Clin North Am 29(2):305–328 Loukopoulos D (2011) Haemoglobinopathies in Greece: prevention programme over the past 35 years. Indian J Med Res 134:572–576 Samavat A, Modell B (2004) Iranian national thalassaemia screening programme. BMJ 329(7475):1134–1137 Fucharoen S, Winichagoon P (2011) Haemoglobinopathies in southeast Asia. Indian J Med Res 134:498–506 Weatherall DJ (2010) The inherited diseases of hemoglobin are an emerging global health burden. Blood 115(22):4331–4336 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7626213","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":515695077,"identity":"9755ebcc-57f7-47cc-9795-95ae3a4f21c4","order_by":0,"name":"Jayasooriya 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The disease imposes a substantial economic burden, with current estimates indicating approximately 2,000 active cases receiving regular transfusion therapy and 80 new cases born annually, predominantly concentrated in the Wayamba, Uva, and North Central provinces\u0026sup2;,\u0026sup3;.\u003c/p\u003e\u003cp\u003eThe pathophysiology of beta-thalassemia results from mutations in the beta-globin gene cluster, leading to reduced or absent beta-globin chain synthesis. When inherited in an autosomal recessive pattern, homozygous or compound heterozygous states result in beta-thalassemia major, characterized by severe anemia with compensatory extramedullary hematopoiesis leading to complications such as hepatosplenomegaly, and multi-organ complications due to chronic hypoxia and iron overload⁴.\u003c/p\u003e\u003cp\u003eCurrent management strategies in Sri Lanka encompass both palliative approaches including lifelong blood transfusions and iron chelation therapy, and curative interventions such as hematopoietic stem cell transplantation. However, the annual cost of palliative care exceeds LKR 400,000 per patient, consuming approximately 27 units of blood annually and placing tremendous strain on healthcare resources⁵.\u003c/p\u003e\u003cp\u003eThe Sri Lankan National Thalassemia Prevention Program, initiated in 2007, provides voluntary and free carrier screening for individuals aged 16 years and above⁶. Despite this initiative, the screening remains suboptimal, with limited data available on the clinical impact of preconceptional parental awareness on offspring outcomes.\u003c/p\u003e\u003cp\u003eEarly diagnosis of beta-thalassemia major is crucial for optimal management, as delayed recognition can result in severe anemia, growth retardation, skeletal abnormalities, and irreversible organ damage⁷,⁸. Furthermore, early initiation of appropriate therapy has been demonstrated to improve quality of life, reduce complications, and enhance overall survival⁹,\u0026sup1;⁰.\u003c/p\u003e\u003cp\u003eThe present study addresses a critical knowledge gap by examining the relationship between preconceptional parental thalassemia carrier status awareness and clinical outcomes in their offspring diagnosed with beta-thalassemia major. Our findings have important implications for public health policy and prevention strategies in high-prevalence regions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study Design and Setting\u003c/h2\u003e\u003cp\u003e This multicenter cross-sectional study was conducted following approval from the Ethics Review Committee of the Faculty of Medicine, Wayamba University of Sri Lanka (Approval No. PW2021/09/03). The study was performed in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Study Population and Sampling\u003c/h2\u003e\u003cp\u003e Participants were recruited from three major thalassemia treatment centers: the National Thalassemia Center at Teaching Hospital Kurunegala, Colombo North Teaching Hospital, and the Pediatric Unit at National Hospital Kandy. These centers collectively manage approximately 60% of beta-thalassemia major patients in the study regions.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eInclusion Criteria:\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eLaboratory-confirmed beta-thalassemia major diagnosis based on hemoglobin electrophoresis and/or high-performance liquid chromatography (HPLC)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAge less than 18 years at the time of enrollment\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eRegular attendance at one of the participating centers\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eParental consent for participation\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eExclusion Criteria:\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eHemoglobin E-beta thalassemia major\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eOther hemoglobinopathies requiring regular transfusion\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eParents declining consent\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIncomplete medical records\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Data Collection\u003c/h2\u003e\u003cp\u003eStructured interviews were conducted with parents using a standardized pretested questionnaire developed and validated for this study. Medical records were reviewed to extract clinical data including:\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePrimary Variables:\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eAge at initial beta-thalassemia major diagnosis (months)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHemoglobin level at diagnosis (g/dL)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eParental preconceptional thalassemia carrier status awareness\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eSecondary Variables:\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eGrowth parameters (height and weight percentiles for age)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePresence of hepatosplenomegaly\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEndocrine complications (hypothyroidism, diabetes mellitus, delayed puberty)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eCardiac complications (cardiomyopathy)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHistory of splenectomy\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTransfusion frequency and iron chelation therapy\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Definitions\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003ePreconceptional Awareness\u003c/strong\u003e\u003cp\u003e Parents were classified as \"aware\" if at least one parent knew their thalassemia carrier status before conception of the affected child through formal screening or previous experience with affected offspring.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eGrowth Assessment\u003c/strong\u003e\u003cp\u003eClassified as adequate (\u0026ge;\u0026thinsp;10th percentile for age) or inadequate (\u0026lt;\u0026thinsp;10th percentile for age) using WHO growth charts.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Statistical Analysis\u003c/h2\u003e\u003cp\u003eStatistical analysis was performed using SPSS version 28.0. Descriptive statistics were calculated for all variables. Continuous variables were expressed as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and compared using independent t-tests or Mann-Whitney U tests as appropriate. Categorical variables were compared using chi-square tests or Fisher's exact tests. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003cp\u003eMultivariate logistic regression analysis was performed to identify independent predictors of early diagnosis, adjusting for potential confounders including geographic location, parental education, and socioeconomic status.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 Study Population Characteristics\u003c/h2\u003e\n \u003cp\u003eA total of 279 children with laboratory-confirmed beta-thalassemia major were enrolled in the study. The demographic and clinical characteristics are summarized in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBaseline Characteristics of Study Population\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;279)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParents Aware (n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParents Unaware (n\u0026thinsp;=\u0026thinsp;237)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDemographics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale gender, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e147 (52.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22 (52.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e125 (52.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.968\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean current age, years\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.412\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Parental Thalassemia Carrier Awareness\u003c/h2\u003e\n \u003cp\u003eAmong the 279 families studied, only 42 (15.1%) had at least one parent with preconceptional thalassemia carrier status awareness. Maternal awareness was documented in 40 cases (14.3%), while paternal awareness was present in 36 cases (12.9%). Both parents were aware in 25 families (9.0%).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eSources of Parental Awareness:\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003ePrevious affected child: 44 parents (55.0%)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eFormal screening programs: 32 parents (40.0%)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eFamily history screening: 4 parents (5.0%)\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2: Reason to aware the thalassemia status preconceptionally\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cimg 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\"\u003e\u003c/strong\u003e\u003cbr\u003e\u003c/p\u003e\n \u003ch2\u003e3.3 Primary Outcomes\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eAge at Diagnosis\u003c/strong\u003e: Children of parents with preconceptional carrier awareness were diagnosed significantly earlier than those of unaware parents (5.39\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 months vs. 8.32\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8 months; mean difference: 2.93 months, 95% CI: 1.2\u0026ndash;4.7, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n \u003cp\u003eThe proportion of children diagnosed before 6 months of age was significantly higher in the aware group (71.4% vs. 52.3%, OR: 2.26, 95% CI: 1.1\u0026ndash;4.8, p\u0026thinsp;=\u0026thinsp;0.029).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eHemoglobin Level at Diagnosis\u003c/strong\u003e: Mean hemoglobin levels at diagnosis were significantly higher in children of aware parents (6.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 g/dL vs. 5.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 g/dL; mean difference: 0.76 g/dL, 95% CI: 0.3\u0026ndash;1.2, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4 Secondary Outcomes\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eGrowth and Development\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAdequate growth was more frequently observed in children of aware parents (83.3% vs. 70.9%, p\u0026thinsp;=\u0026thinsp;0.096), though this difference did not reach statistical significance.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSeveral complications showed significant differences between groups\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eSplenomegaly\u003c/strong\u003e: Less frequent in aware group (7.1% vs. 15.2%, p\u0026thinsp;=\u0026thinsp;0.043)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eHypothyroidism\u003c/strong\u003e: Lower prevalence in aware group (14.3% vs. 9.3%, p\u0026thinsp;=\u0026thinsp;0.028)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eDelayed puberty\u003c/strong\u003e: Reduced in aware group (11.9% vs. 12.7%, p\u0026thinsp;=\u0026thinsp;0.089)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes mellitus\u003c/strong\u003e: No cases in aware group vs. 8 cases (3.4%) in unaware group (p\u0026thinsp;=\u0026thinsp;0.001)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eCardiomyopathy\u003c/strong\u003e: No cases in aware group vs. 8 cases (3.4%) in unaware group (p\u0026thinsp;=\u0026thinsp;0.001)\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cstrong\u003eTherapeutic Interventions\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAll 5 patients who underwent splenectomy belonged to the unaware parent group (0% vs. 2.1%, p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003e3.5 Multivariate Analysis\u003c/h2\u003e\n \u003cp\u003eAfter adjusting for potential confounders including parental education, geographic location, and socioeconomic status, parental preconceptional awareness remained an independent predictor of early diagnosis (adjusted OR: 2.84, 95% CI: 1.3\u0026ndash;6.2, p\u0026thinsp;=\u0026thinsp;0.009).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides the first comprehensive evidence from Sri Lanka demonstrating that preconceptional parental thalassemia carrier awareness is associated with significantly improved clinical outcomes in children with beta-thalassemia major. Our findings have important implications for public health policy and prevention strategies in regions with high thalassemia prevalence.\u003c/p\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Clinical Significance of Early Diagnosis\u003c/h2\u003e\u003cp\u003eThe nearly 3-month difference in mean age at diagnosis between children of aware versus unaware parents represents a clinically meaningful improvement. Early diagnosis before 6 months of age is associated with reduced risk of growth failure, skeletal abnormalities, and organ complications\u0026sup1;\u0026sup1;. Our data support this paradigm, demonstrating that children of aware parents had higher hemoglobin levels at diagnosis, suggesting less severe anemia and potentially reduced tissue hypoxia.\u003c/p\u003e\u003cp\u003eThe higher hemoglobin levels at diagnosis in the aware group (6.23 vs. 5.47 g/dL) may reflect earlier medical attention and reduced delay in diagnostic workup. This finding is particularly relevant as severe anemia at diagnosis has been associated with increased risk of cardiac complications and growth retardation\u0026sup1;\u0026sup2;.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Long-term Complications and Quality of Life\u003c/h2\u003e\u003cp\u003eOur study demonstrates significant differences in long-term complications between groups. The absence of diabetes mellitus and cardiomyopathy in children of aware parents, compared to 3.4% prevalence in each condition among children of unaware parents, suggests that early diagnosis and treatment initiation may prevent or delay these serious complications.\u003c/p\u003e\u003cp\u003eThe reduced prevalence of splenomegaly in the aware group (7.1% vs. 15.2%) is consistent with earlier treatment initiation and better disease management. Splenomegaly in thalassemia major is associated with increased transfusion requirements, hypersplenism, and eventual need for splenectomy\u0026sup1;\u0026sup3;. The fact that all 5 patients requiring splenectomy belonged to the unaware parent group underscores the importance of early diagnosis and optimal management.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Public Health Implications\u003c/h2\u003e\u003cp\u003eThe low rate of preconceptional parental awareness (15.1%) highlights a critical gap in the current voluntary screening program. Despite the availability of free screening since 2007, uptake remains inadequate. This finding supports recommendations for transitioning from voluntary to mandatory preconceptional screening, as implemented successfully in other Mediterranean countries\u0026sup1;⁴.\u003c/p\u003e\u003cp\u003eThe economic implications are substantial. With an annual treatment cost of LKR 400,000 per patient and improved outcomes associated with parental awareness, investment in enhanced screening programs could yield significant cost savings while improving patient outcomes. A comprehensive cost-effectiveness analysis would be valuable to inform policy decisions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\u003ch2\u003e4.4 International Context\u003c/h2\u003e\u003cp\u003eOur findings align with studies from other high-prevalence regions. Research from Cyprus and Sardinia has demonstrated that comprehensive screening programs can reduce the incidence of new cases by over 90%\u0026sup1;⁵,\u0026sup1;⁶. Similar programs in Iran and Thailand have shown comparable improvements in early diagnosis rates when parental awareness is high\u0026sup1;⁷,\u0026sup1;⁸.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003e4.5 Recommendations for Program Enhancement\u003c/h2\u003e\u003cp\u003eBased on our findings, we propose several strategies to enhance the current prevention program:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eUniversal Preconceptional Screening\u003c/b\u003e: Implementation of mandatory screening for all couples planning marriage or pregnancy\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eIntegration with Routine Healthcare\u003c/b\u003e: Incorporation of thalassemia screening into routine antenatal care at first visit\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eEnhanced Public Education\u003c/b\u003e: Community-based awareness programs targeting high-prevalence regions\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eSchool-Based Screening\u003c/b\u003e: Implementation of screening programs in secondary schools before students reach reproductive age\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eGenetic Counseling Services\u003c/b\u003e: Expansion of counseling services for identified carrier couples\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eAssisted Reproductive Technologies\u003c/b\u003e: Improved access to preimplantation genetic diagnosis for at-risk couples\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\u003ch2\u003e4.6 Study Limitations\u003c/h2\u003e\u003cp\u003eSeveral limitations should be acknowledged. The cross-sectional design precludes causal inference, and recall bias may affect parental reporting of awareness status. The study was conducted in major treatment centers, potentially missing patients managed in peripheral facilities. Additionally, socioeconomic factors and parental education levels, which may influence both screening behavior and healthcare-seeking patterns, require further investigation.\u003c/p\u003e\u003cp\u003eFuture prospective cohort studies with longer follow-up periods would provide stronger evidence for the relationship between parental awareness and long-term outcomes. Cost-effectiveness analyses would also be valuable for policy development.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e\u003ch2\u003e4.7 Global Health Perspective\u003c/h2\u003e\u003cp\u003eThalassemia represents a major global health challenge, with an estimated 240\u0026nbsp;million carriers worldwide\u0026sup1;⁹. Our findings from Sri Lanka may be applicable to other high-prevalence regions in South Asia, Southeast Asia, and the Mediterranean. The success of prevention programs in reducing new cases while improving outcomes for affected individuals demonstrates the importance of comprehensive public health approaches to genetic disorders.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe thalassemia diagnosis was early when parenteral thalassemia status was known preconceptionally with a higher haemoglobin level at the time of diagnosis. Early treatment initiation has improved the QoL with fewer complications and more definitive treatment strategies. The H512 pregnancy record will include parenteral thalassemia status, enabling early diagnosis and treatment initiation, and enhancing community health education and screening programs.\u003c/p\u003e\u003cp\u003eThe low rate of preconceptional awareness (15.1%) in our study population highlights the urgent need for improved screening uptake and public education. Given the substantial economic burden of thalassemia management and the demonstrated benefits of early diagnosis, investment in comprehensive prevention programs represents both a clinical and economic imperative.\u003c/p\u003e\u003cp\u003ePolicy recommendations emerging from this research include the consideration of mandatory preconceptional screening, integration of thalassemia testing into routine healthcare services, and enhanced community education programs. Implementation of these strategies could significantly reduce the burden of thalassemia in Sri Lanka while improving outcomes for affected patients.\u003c/p\u003e\u003cp\u003eThe global burden of thalassemia requires sustained commitment to prevention and management strategies. Our findings contribute to the evidence base supporting comprehensive public health approaches to genetic disorders and may inform similar programs in other high-prevalence regions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the patients and families who participated in this study, and the healthcare teams at the participating centers for their support.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ede Silva S, Fisher CA, Premawardhena A et al (2000) Thalassaemia in Sri Lanka: implications for the future health burden of Asian populations. Lancet 355(9206):786\u0026ndash;791\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePremawardhana AP, Mudiyanse R, De Silva ST et al (2019) A nationwide survey of hospital-based thalassemia patients and standards of care and a preliminary assessment of the national prevention program in Sri Lanka. PLoS ONE 14(8):e0220852\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSamarakoon P, Wijesuriya A (2011) A clinical audit of thalassaemia management at the Lady Ridgeway Hospital for Children, Colombo. Sri Lanka J Child Health 40(2):51\u0026ndash;56\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeatherall DJ, Clegg JB (2001) Inherited haemoglobin disorders: an increasing global health problem. Bull World Health Organ 79(8):704\u0026ndash;712\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSamarakoon P, Wijesuriya A (2011) A clinical audit of thalassaemia management at the Lady Ridgeway Hospital for Children, Colombo. Sri Lanka J Child Health 40:51\u0026ndash;56\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMudiyanse RM, Senanayake MP, Rathnayake RMS (2015) Safe Marriages for Thalassaemia Prevention: A KAP Survey in Sri Lanka. Transl Biomed 6(3):26\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOlivieri NF, Muraca GM, O'Donnell A et al (2008) Studies in haemoglobin E beta-thalassaemia. Br J Haematol 141(3):388\u0026ndash;397\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDhirar N, Khandekar J, Bachani D, Mahto D (2016) Thalassemia Major: How do we improve quality of life? SpringerPlus. ;5(1):1895\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePremawardhena A, Silver SD, Arambepola M et al (2005) Hemoglobin E-β-Thalassemia: Progress Report from the International Study Group. Ann NY Acad Sci 1054(1):33\u0026ndash;39\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMettananda S (2018) Management of Thalassaemia. Sri Lanka J Child Health 47(2):159\u0026ndash;165\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCappellini MD, Cohen A, Porter J, Taher A, Viprakasit V (2014) Guidelines for the Management of Transfusion Dependent Thalassaemia (TDT), 3rd edn. Thalassaemia International Federation\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBorgna-Pignatti C, Rugolotto S, De Stefano P et al (2004) Survival and complications in patients with thalassemia major treated with transfusion and deferoxamine. Haematologica 89(10):1187\u0026ndash;1193\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCaocci G, Efficace F, Ciotti F et al (2012) Health related quality of life in Middle Eastern children with beta-thalassemia. BMC Blood Disord 12:6\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAngastiniotis M, Modell B (1998) Global epidemiology of hemoglobin disorders. Ann NY Acad Sci 850:251\u0026ndash;269\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCao A, Rosatelli MC, Monni G, Galanello R (2002) Screening for thalassemia: a model of success. Obstet Gynecol Clin North Am 29(2):305\u0026ndash;328\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLoukopoulos D (2011) Haemoglobinopathies in Greece: prevention programme over the past 35 years. Indian J Med Res 134:572\u0026ndash;576\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSamavat A, Modell B (2004) Iranian national thalassaemia screening programme. BMJ 329(7475):1134\u0026ndash;1137\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFucharoen S, Winichagoon P (2011) Haemoglobinopathies in southeast Asia. Indian J Med Res 134:498\u0026ndash;506\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeatherall DJ (2010) The inherited diseases of hemoglobin are an emerging global health burden. Blood 115(22):4331\u0026ndash;4336\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Faculty of Medicine, Wayamba University of Sri Lanka","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Beta-thalassemia major, carrier screening, early diagnosis, prevention, Sri Lanka, public health","lastPublishedDoi":"10.21203/rs.3.rs-7626213/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7626213/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eBeta-thalassemia represents the most prevalent monogenic disorder in Sri Lanka, with approximately 2,000 active cases requiring lifelong transfusion therapy and 80 new cases born annually. Despite the availability of voluntary carrier screening since 2007, the impact of preconceptional parental awareness on screening and clinical outcomes remains poorly characterized.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo evaluate the association between preconceptional parental thalassemia carrier status awareness and the timing of diagnosis, hemoglobin levels at diagnosis, and long-term complications in children with beta-thalassemia major.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe conducted a multicenter cross-sectional study across three major thalassemia centers in Kurunegala, Kandy, and Gampaha districts. Laboratory-confirmed beta-thalassemia major patients under 18 years were recruited. Primary outcomes included mean age at diagnosis and hemoglobin levels at the time of diagnosis, stratified by parental preconceptional carrier awareness status. Secondary outcomes included complications such as encompassed growth parameters, organ complications, and therapeutic interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAmong 279 beta-thalassemia major patients, only 42 (15.1%) had at least one parent with preconceptional carrier status awareness. Children of thalassemia status aware parents were diagnosed significantly earlier (5.39 ± 4.2 months vs. 8.32 ± 7.8 months, p \u0026lt; 0.001) and had higher hemoglobin levels at diagnosis (6.23 ± 1.5 g/dL vs. 5.47 ± 1.2 g/dL, p \u0026lt; 0.0001). Notably, children of preconceptionally unaware parents about thalassemia status demonstrated higher rates of complications such as splenomegaly (15.2% vs. 7.1%, p = 0.043), endocrine complications including hypothyroidism (9.3% vs. 14.3%, p = 0.028), and required more palliative interventions including splenectomy (2.1% vs. 0%, p = 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003ePreconceptional parental carrier awareness is associated with earlier diagnosis, higher hemoglobin levels at presentation, and reduced long-term complications in beta-thalassemia major. These findings support the implementation of mandatory preconceptional screening programs and enhanced public health education initiatives to reduce disease burden and improve patient outcomes.\u003c/p\u003e\n\u003cp\u003eThis study provides the first comprehensive evidence from Sri Lanka demonstrating that parental awareness leads to measurable improvements in clinical outcomes, supporting policy recommendations for universal preconceptional screening.\u003c/p\u003e","manuscriptTitle":"Effect of parental knowledge on their thalassemia status and the time of diagnosis of their offspring in Kurunegala, Kandy, and Gampaha Districts.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-23 07:49:00","doi":"10.21203/rs.3.rs-7626213/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"338b8aeb-5689-4619-bebc-87c21a704621","owner":[],"postedDate":"September 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":55022018,"name":"Hematology"},{"id":55022019,"name":"Internal Medicine"},{"id":55022020,"name":"Preventive Medicine"}],"tags":[],"updatedAt":"2025-09-23T07:49:00+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-23 07:49:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7626213","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7626213","identity":"rs-7626213","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}