The Sickle Cell Trait and Reproductive Decisions Among Youths in the Fako Division of Cameroon

The Sickle Cell Trait and Reproductive Decisions Among Youths in the Fako Division of Cameroon | 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 The Sickle Cell Trait and Reproductive Decisions Among Youths in the Fako Division of Cameroon Njweng Nde Fon, Samuel Nkengfua, Peter Nde Fon, Anna Njunda, Dora Mbanya This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8864587/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background: Sickle cell disease is a major inherited condition in sub-Saharan Africa, and the sickle cell trait continues to shape reproductive choices among young adults. This study assessed the prevalence of the sickle cell trait among youths in the Fako Division and identified factors influencing knowledge and reproductive decisions. Methods: A hospital cross-sectional study was carried out from January to April 2020 among 300 youths aged 18–40 years in Buea, Limbe, and Tiko. Data were collected using a structured questionnaire that captured sociodemographic characteristics, knowledge of sickle cell disease and trait, behaviour, attitude and reproductive intentions. Haemoglobin electrophoresis was performed to determine genotype status. Descriptive statistics were computed, and logistic regression analyses were used to identify factors independently associated with good knowledge and marriage decisions based on genotype with statistical significance at p<0.05. Results: Among 640 participants who were screened for sickle cell trait, 300 consented to respond to the structured questionnaire. The prevalence of sickle cell trait (AS) was 12.3% (79/640). From the 300 participants who responded, 83.0% (249/300) demonstrated good knowledge of sickle cell disease, only 42.7% (128/300) were aware of their genotype, and 18.7% (56/300) knew their partner's. A significant 76.3% (229/300) indicated that a partner's genotype would affect their marriage decision, while 68.3% (205/300) reported it would influence childbearing choices. Predictors of good knowledge were female sex (aOR: 2.39; 95% CI: 1.17–4.86), residence in Buea (aOR: 7.24; 95% CI: 2.27–23.16), Christian faith (aOR: 10.57; 95% CI: 1.22–91.83), and not having children (aOR: 2.44; 95% CI: 1.09–5.47). Decisions to marry based on genotype were significantly more likely among Christians (aOR: 11.44; 95% CI: 1.01–19.95) and among individuals reporting more than one sexual partner (aOR: 2.04; 95% CI: 1.09–3.81). Conclusion: One in ten youths in Fako carries the sickle cell trait. Despite high awareness, many lacked personal or partner genotype knowledge. Partner genotype influenced reproductive decisions, highlighting the need for improved screening initiatives, premarital counselling, and timely education for sickle cell disease prevention. Prevalence Sickle Cell Trait Haemoglobin genotype Knowledge Reproductive decision Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Highlights One in ten youths in Fako division carries the sickle cell trait. Despite high general knowledge, fewer than half knew their own genotype status. Partner genotype strongly influenced marriage and childbearing decisions among youths. Expanded genotype screening and premarital counselling are critical for informed reproductive choices. 1. Introduction Sickle cell disease (SCD) is a major global public health problem and the most common inherited genetic disorder worldwide [ 1 ]. It comprises a group of haematological conditions characterized by the presence of sickle haemoglobin [ 2 ]. Sickle cell anaemia (SCA), the most severe and prevalent form of SCD, occurs when haemoglobin S genes are inherited from both parents [ 3 ]. Although the disease can be prevented when at least one parent carries a normal haemoglobin AA genotype, SCD remains a leading genetic cause of morbidity and mortality globally [ 4 ]. In recognition of its growing burden, the World Health Organization (WHO) declared SCD a public health problem in 2006, with an estimated 330,000 affected births occurring annually worldwide. Globally, an estimated 7.74 million people were living with SCD in 2021, with approximately 515,000 new births recorded, the majority occurring in sub-Saharan Africa (SSA), which accounts for nearly 80% of global cases [ 5 ]. Alarmingly, 50–90% of affected children in this region are expected to die before their fifth birthday. Projections suggest that, without effective interventions, the global burden of SCD could increase by 30% by 2050, reaching approximately 25 million cases [ 6 ]. In low- and middle-income countries, SCD contributes substantially to the loss of millions of disability-adjusted life years (DALYs) annually [ 7 ]. The burden in SSA continues to rise due to limited health system capacity, low household incomes, and inadequate public health funding, alongside restricted access to disease-modifying therapies such as hydroxyurea, blood transfusions, vaccination programmes, and penicillin prophylaxis [ 8 , 9 ]. Within this regional context, Cameroon ranks among the countries with the highest SCD burden in SSA, occupying the sixth position overall [ 6 ]. Approximately 30% of the country’s estimated 30 million inhabitants carry the sickle cell trait (HbAS), and about 7,000 children are born with SCD each year [ 10 ]. The prevalence of SCD, particularly HbSS, the most severe genotype, is estimated to range between 0.6% and 2% in the general population [ 6 ]. Despite this high burden, many children in Cameroon are diagnosed only after the age of four, contrary to WHO recommendations for newborn screening [ 6 ]. This delay in diagnosis contributes to high under-five mortality, much of which remains undocumented, and exposes affected children to prolonged unmanaged pain, recurrent illness, growth impairment, and frequent school absenteeism [ 11 ]. Access to disease-modifying treatment in Cameroon remains limited, with hydroxyurea used by only about 5% of eligible patients due to cost, perceived side effects such as infertility, and patient reluctance [ 12 ]. Moreover, inadequate awareness of SCD and its prevention, poor uptake of premarital counselling and genotype testing, and uninformed reproductive decision-making continue to fuel the persistence of the disease [ 12 ]. Cultural beliefs, traditional practices, and superstition also contribute to delayed diagnosis and misinterpretation of symptoms; for instance, a study reported that 70 out of 100 children believed to be affected by witchcraft were actually living with SCD [ 13 ]. In contrast, high-income countries such as the United States and other parts of Europe benefit from comprehensive health insurance coverage, early screening, effective disease-modifying therapies, and curative options, resulting in childhood survival rates exceeding 94% [ 14 ]. Given that SCD is inherited, it is largely preventable. Knowledge of haemoglobin genotype is central to reducing disease prevalence by preventing affected births [ 15 ]. In a study carried out by Nini et al in 2020, in Buea, South West region of Cameroon, less than one quarter (20.5%) had good knowledge of SCD [ 16 ]. Also, in the same study, only 13.2% knew their genotype and 59.3% were willing to avoid carrier marriages [ 16 ]. Evidence from certain hospitals in Bahrain demonstrated that compulsory premarital screening and counselling significantly reduced the decision to marry by 37% to 48.9% in couples at risk of giving birth to sickle cell children [ 17 , 18 ]. The success of such programmes depends on adequate knowledge of SCD, understanding of genetic inheritance, acceptance of screening and counselling, and informed reproductive decision-making. As advanced therapeutic options remain largely inaccessible in low-resource settings, prevention through carrier identification and genetic counselling remains the most viable strategy [ 15 ]. In line with WHO recommendations, this study aimed to determine the prevalence of sickle cell trait among youths in multiple cities in the Fako Division of Cameroon and to examine sociodemographic, behavioral, and partner-related factors influencing knowledge of the trait and genotype-based marriage decisions. 1.1 Objective of the Study The goal of this study was to determine the prevalence of sickle cell trait (SCT) among youths aged 18–40 years in the Fako Division and to assess their knowledge of sickle cell disease/trait (SCD/SCT) and reproductive decision-making in relation to partner genotype. The specific objectives were to determine the prevalence of sickle cell trait among youths in the Fako Division; identify sociodemographic factors associated with good knowledge of sickle cell trait among youths; assess factors associated with good attitudes towards sickle cell disease; and examine factors associated with decision to marry based on a partner’s genotype among youths in the Fako Division. 2. Method and material 2.1 Study design, setting and population This hospital- and community-based cross-sectional study assessed sickle cell trait prevalence, knowledge, attitudes, behaviours, and reproductive decisions among youths in the Fako Division, Southwest Cameroon. Conducted from January to April 2020 in Buea, Limbe, and Tiko, the study involved youths aged 18–40 years recruited from selected health facilities. Participants who had received blood transfusions within the previous four months were excluded. Figure 1 . Map of Fako Division, Southwest Region, Cameroon 2.2 Sample size determination The sample size was calculated using the Cochrane’s formula was used to obtain a minimum sample size of 288 participants. The proportion (0.25) of people with SCT was estimated from a similar study by Immaculata and colleagues in Nigeria, which found out that 25% of youths had the sickle cell trait [ 22 ]. Where n = estimated sample size z = 1.96 p = 0.25 q = 1-p = 1-0.25 = 0.75 e = 0.05 n = (1.96) ^ 2 (0.25) (0.75)/0.05*0.05 = 288 participants 2.3 Sampling technique A multistage sampling approach was employed in this study. First, the Fako Division was purposively selected because it had one of the highest burdens of sickle cell disease in the South West Region and hosted the two largest referral hospitals in the region, namely the Buea Regional Hospital and Limbe Regional Hospital. Second, three of the five health districts in the division, Buea, Limbe, and Tiko, were selected. Buea and Limbe were chosen because of their predominantly urban characteristics, while Tiko was selected to represent a semi urban setting. Data were collected at the Buea Regional Hospital and Solidarity Clinic in Buea, Limbe Regional Hospital in Limbe, and Tiko District Hospital in Tiko. Community sensitization was conducted through radio announcements, after which interested youths presented to the outpatient departments of the selected health facilities for screening and participation in the study. After calculating the estimated sample size, we used health area population estimates obtained from the Cameroon’s South West Regional Delegation of Public Health to determine the commensurate percentage of the desired total sample using simple proportions per subdivision. This was to ensure that the subdivisions were represented based on their true relative size. In Buea, with a population of 47,300 we targeted 78 participants. In Limbe, a population of 72,106 we targeted 119 participants and in Tiko with a population of 55,224 we targeted 91 participants. Table 1 Study population proportionate to the health area population. Health area Total population Study population Buea 47,300 78 Limbe 72,106 119 Tiko 55,224 91 2.4 Data collection method Data were collected using a structured and validated questionnaire covering sociodemographic characteristics; knowledge of sickle cell disease and trait (SCD/SCT); attitudes and behaviours; concerns about partner genotype prior to relationships; premarital counselling; and reproductive decisions, intentions, and parenting plans related to SCD/SCT. The questionnaire was pretested among 20 randomly selected youths at Bonamousadi District Hospital in Douala, Cameroon, and revised accordingly. Following radio announcements, interested youths presented to the outpatient departments of the selected health facilities. Upon arrival, participants received detailed information about the study, and written informed consent was obtained. A total of 640 participants consented to screening for sickle cell status. Venous blood samples were then collected from consenting participants for haemoglobin genotype determination using haemoglobin electrophoresis. Two millilitres of venous blood were drawn into labelled K3EDTA tubes, gently mixed, and transported daily under cold chain conditions to the Solidarity Hospital Buea laboratory. Samples were stored at 4°C and analysed within seven days. Standard electrophoresis procedures were followed, and results were interpreted using a known sickle cell trait (AS) sample as control. Participants received their results, accompanied by counselling and education on SCD/SCT, premarital genotype screening, and informed reproductive decision-making Prior to receiving their results, participants were invited to take part in the questionnaire survey. Of the 640 individuals screened, 300 provided additional consent to complete the structured questionnaire, which was administered by trained study personnel. Assistance was provided to participants who were unable to read to ensure accurate and complete responses. Inclusion Criteria Participants were eligible for inclusion if they were aged 18–40 years, resided in Buea, Limbe, or Tiko subdivisions, presented voluntarily for screening during the study period, and provided written informed consent. Study Variables Variables assessed included age, sex, marital status, education level, occupation, health insurance status, parenthood, awareness and knowledge of SCD/SCT, sexual behaviours, partner genotype awareness, premarital counselling practices, influence of partner genotype on marriage and reproductive decisions, contraception use, alternative reproductive options, adoption intentions, and attitudes toward marriage restrictions involving SCT or SCD. 2.5 Data analysis Data was keyed in and analyzed using SPSS version 26.0 (Statistical Package for the Social Sciences). Continuous variables were summarized using means and standard deviation. Categorical variables were summarized using frequencies, proportions, charts and tables. Knowledge on SCD/SCT was assessed based on 9 questions related to SCD/SCT. The knowledge of respondents was classified as good or poor, using a cutoff of less than or equal to 60% for poor and greater than 60% for good. Logistic regression analyses were used to identify factors independently associated with good knowledge and marriage decisions influenced by partner genotype. Adjusted odds ratios and 95 percent confidence intervals were reported with significance set a p < 0.05. 2.6 Ethical Considerations Ethical approval was obtained from the Institutional Review Board of the Faculty of Health Sciences, University of Buea (ID 2020–1095 – 01 / UB / SG / IRB / FHS) and administrative authorization was gotten from the Regional Delegation of Public Health for the Southwest Region (344/MPH/SWR/RHL /DO). Informed consent was obtained from the participants. 3. Results 3.1 Sociodemographic characteristics of study participants Among 640 participants who were screened for sickle cell trait, 300 consented to respond to the structured questionnaire. The sociodemographic characteristics of the 300 study participants are presented on Table 1 . The mean age of the participants was 30.8 ± 4.7 with most 158 (52.7%) participants aged between 30–37 years. The majority of respondents were female 175 (58.3%) and single 260 (86.7%). Most participants attained tertiary education 251 (83.7%). The leading occupation among respondents was student 164 (54.7%). A large number of participants resided in Buea 187 (62.3%). Most respondents identified as Christians 284 (94.7%). The majority did not have health insurance 265 (88.3%), and most participants reported not having children 248 (82.7%). Table 1 Sociodemographic characteristics of study participants (n = 300) Variable Category Frequency Percentage (%) Age group (years) 22 to 29 119 39.7 30 to 37 158 52.7 38+ 23 7.7 Total 300 100 Natal Sex Female 175 58.3 Male 125 41.7 Total 300 100 Marital status Single 260 86.7 Married 37 12.3 Divorced 2 0.7 Widowed 1 0.3 Total 300 100 Level of education No formal education 3 1 Primary 7 2.3 Secondary 39 13 Tertiary 251 83.7 Total 300 100 Occupation Employed 88 29.3 Self-employed 27 9 Student 164 54.7 Unemployed 21 7 Total 300 100 Address Buea 187 62.3 Limbe 92 30.7 Tiko 21 7 Total 300 100 Religion Christian 284 94.7 Muslim 12 4 Atheist 4 1.3 Total 300 100 Health insurance Yes 35 11.7 No 265 88.3 Total 300 100 Have children Yes 52 17.3 No 248 82.7 Total 300 100 3.2 Prevalence of sickle cell traits The prevalence of sickle cell traits among the study participants is presented on Fig. 2 . The prevalence of sickle cell trait (AS) was 12.3% (79/640), while 87.7% (561/640) of participants had a normal haemoglobin genotype (AA). 3.3 Knowledge of sickle cell disease and trait among study participants The level of knowledge of participants on sickle cell disease and trait is presented on Table 2 . Most participants had heard about sickle cell disease 289 (96.3%) and the sickle cell trait 260 (86.7%). The majority knew that sickle cell disease is due to an abnormality in the red blood cells 259 (86.3%) and correctly identified that it is inherited from both parents 279 (93.0%). A large number of respondents reported knowing someone with sickle cell disease 217 (72.3%). Most participants knew that the disease is associated with frequent episodes of pain 241 (80.3%) and frequent shortage of blood 248 (82.7%), while fewer participants were aware that it is associated with stroke 120 (40.0%). The majority of respondents believed that sickle cell disease has no cure 208 (69.3%) and that there is no cure in Cameroon 218 (72.7%). Almost half of the participants knew that carriers of the sickle cell trait do not show symptoms of the disease 149 (49.7%), and most knew that carriers can pass on the disease to their children 272 (90.7%). Most participants, 226 (75.3%), strongly agreed that sickle cell disease can be prevented if carriers do not reproduce with one another or with individuals living with sickle cell disease. The majority of respondents reported receiving information through formal learning in school 212 (70.7%). Other common sources included the media such as television, radio, and social media 151 (50.3%) (Fig. 3 ). Table 2 Knowledge of sickle cell disease and trait among study participants Variable Category Frequency Percentage (%) Heard about sickle cell disease Yes 289 96.3 No 11 3.7 Total 300 100 Heard about sickle cell trait Yes 260 86.7 No 40 13.3 Total 300 100 Sickle cell disease is due to an abnormality in Red blood cells 259 86.3 Kidney cells 5 1.7 Bone cells 13 4.3 I don’t know 33 11 How can one get sickle cell disease Inherited from both parents 279 93 Blood transfusions 20 6.7 Sexual intercourse 12 4 Close person-to-person contact 10 3.3 Insect bite 6 2 Witchcraft 8 2.7 Knows someone with sickle cell disease Yes 217 72.3 No 83 27.7 Total 300 100 Knows that sickle cell disease is associated with frequent pain episodes Yes 241 80.3 No 12 4 I don’t know 47 15.7 Total 300 100 Knows that sickle cell disease is associated with frequent shortage of blood Yes 248 82.7 No 12 4 I don’t know 40 13.3 Total 300 100 Knows that sickle cell disease is associated with stroke Yes 120 40 No 76 25.3 I don’t know 104 34.7 Total 300 100 Believes that sickle cell disease has a cure in the world Yes 48 16 No 208 69.3 I don’t know 44 14.7 Total 300 100 Believes that sickle cell disease has a cure in Cameroon Yes 23 7.7 No 218 72.7 I don’t know 59 19.7 Total 300 100 Knows that carriers of the sickle cell trait do not show symptoms of the disease Yes 149 49.7 No 97 32.3 I don’t know 54 18 Total 300 100 Knows that carriers of the sickle cell trait can pass the disease to their children Yes 272 90.7 No 18 6 I don’t know 10 3.3 Total 300 100 Agrees that sickle cell disease can be avoided if carriers do not marry each other or sticklers Strongly agree 226 75.3 Agree 49 16.3 Disagree 9 3 Strongly disagree 2 0.7 I don’t know 14 4.7 Total 300 100 Regarding overall knowledge of sickle cell, a total of 12 questions were used to assess knowledge and a cut off of greater or equal to 6 on 12 was used to classify participants as having good or poor knowledge. Following this classification, 249 (83.0%) of the participants had good knowledge on sickle disease (Fig. 4 ). 3.4 Behavioral characteristics of study participants The behavioral characteristics of the 300 study participants are presented on Table 3 . Slightly more than half of the respondents reported not having unprotected sexual intercourse 155 (51.7%). The majority had one sexual partner 191 (63.7%). More than half of the participants indicated that they would ask for a potential partner’s sickle cell status before starting a relationship 163 (54.3%). Less than half stated that they would ask for a partner’s sickle cell status before marriage 128 (42.7%). Most respondents reported that they would go in for premarital counselling before marriage 228 (86.7%). Table 3 Behavioral characteristics of youths in the Fako Division Variable Category Frequency Percentage (%) Usually has unprotected sexual intercourse No 155 51.7 Yes 145 48.3 Total 300 100 Number of sexual partners One 191 63.7 More than one 109 36.3 Total 300 100 Would ask for a potential partner’s sickle cell status before relationship Yes 163 54.3 No 85 28.3 Undecided 52 17.3 Total 300 100 Would ask for a partner’s sickle cell status before marriage Yes 128 42.7 No 117 39 Undecided 55 18.3 Total 300 100 Would go in for premarital counselling before marriage Yes 228 86.7 No 27 10.3 Cannot recall 8 3.0 Total 263 100.0 3.5 Attitudes and perceptions toward Sickle cell disease and carrier screening The attitudes and perceptions of the study participants toward sickle cell disease and carrier screening are presented on Table 4 . Most participants believed that everyone should know their sickle cell status 285 (95.0%), although the majority 172 (57.3%) had no knowledge of theirs. The main reason for checking one’s status was concern for the safety of future children 123 (41.0%). Most participants had the genotype AA 171 (57.0%) and did not have a family member with sickle cell disease 202 (67.3%). Nearly half did not know their partner’s genotype 142 (47.3%), and most reported their partner’s genotype as AA 64 (21.3%). Almost all supported making sickle cell screening compulsory 275 (91.7%). The majority stated that a partner’s genotype would influence their decision to marry 229 (76.3%) and to have children 205 (68.3%). Most indicated they would not have another child if they already had one with sickle cell disease 131 (43.7%) and were unsure about what they would do if an unborn baby were diagnosed with the disease 120 (40.0%). A large proportion would not undergo permanent contraception 118 (39.3%) and intended to avoid having a child with sickle cell disease or trait 198 (66.0%). More than half considered having a child to be extremely important 154 (51.3%), while a third said they would not use artificial reproductive techniques 104 (34.7%) and another third would not seek non-childbearing options like adoption 109 (36.3%). Just over half believed that marriage between two sickle cell carriers should be allowed 153 (51.0%). Table 4 Attitudes and perceptions towards Sickle cell disease and carrier screening among youths in the Fako division Variable Category Frequency Percentage (%) Everyone should know their sickle cell status Yes 285 95 No 13 4.3 Undecided 2 0.7 Total 300 100 Knows their own sickle cell status Yes 128 42.7 No 172 57.3 Total 300 100 Reason for checking sickle cell status Because of subsidized price 81 27 Curiosity 47 15.7 Doctor’s request 20 6.7 Important for future children’s safety 123 41 Premarital testing 29 9.7 Total 300 100 Participant’s genotype AA 171 57 AS 102 34 SS 21 7 Others 6 2 Total 300 100 Has a family member with sickle cell disease Yes 53 17.7 No 202 67.3 Undecided 44 14.7 Total 300 100 Knows partner’s sickle cell genotype Yes 56 18.7 No 142 47.3 Undecided 100 33.3 Total 300 100 Partner’s reported genotype AA 64 21.3 AS 7 2.3 SS 1 0.3 Not specified 228 76 Total 300 100 Supports making sickle cell screening compulsory Yes 275 91.7 No 8 2.7 Undecided 16 5.3 Total 300 100 Partner’s genotype would influence decision to marry Yes 229 76.3 No 28 9.3 Undecided 43 14.3 Total 300 100 Partner’s genotype would influence decision to have children Yes 205 68.3 No 38 12.7 Undecided 57 19 Total 300 100 If already has a child with sickle cell disease Would not have another child 131 43.7 Would have another child with different partner 66 22 Undecided 55 18.3 Would take the risk again 48 16 Total 300 100 Decision about an unborn baby diagnosed with sickle cell disease Allow pregnancy to continue 103 34.3 Terminate pregnancy 77 25.7 Not sure 120 40 Total 300 100 Would undergo permanent contraception to prevent having a child with sickle cell disease Yes 102 34 No 118 39.3 Undecided 80 26.7 Total 300 100 Description of future parenting Avoid having a child with SCD or SCT 198 66 Avoid having a child with SCD only 76 25.3 No avoidance 25 8.3 Others 1 0.3 Total 300 100 Importance of having a child Extremely important 154 51.3 Very important 103 34.3 Somewhat important 22 7.3 Not very important 6 2 Not at all important 15 5 Total 300 100 Would use artificial reproductive techniques Yes 101 33.7 No 104 34.7 Undecided 95 31.7 Total 300 100 Would seek non-childbearing options like adoption Yes 93 31 No 109 36.3 Undecided 98 32.7 Total 300 100 Marriage between two sickle cell carriers should be allowed Yes 153 51 No 84 28 Undecided 63 21 Total 300 100 Regarding attitudes of participants on sickle cell, a total of 10 questions were used to assess attitude and a cut off of greater or equal to 5 on 10 was used to classify participants as having positive or negative attitude. Following this classification, 166 (55.3%) of the participants had positive attitude towards sickle disease (Fig. 5 ). 3.6 Sociodemographic factors independently associated with good knowledge on sickle cell disease. In the multivariate analysis, after adjusting for potential confounders, sex, address, religion, and having children were found to be independently associated with good knowledge on sickle cell disease among youths in the Fako Division (Table 5 ). Female participants were 2 times more likely to have good knowledge compared to males (aOR = 2.39; 95% CI: 1.17–4.86; p = 0.016). Participants residing in Buea were over seven times more likely to have good knowledge compared to those living in Tiko (aOR = 7.24; 95% CI: 2.27–23.16; p = 0.001). Similarly, Christians were about ten times more likely to have good knowledge than atheists (aOR = 10.57; 95%CI: 1.22–91.83; p = 0.033). Furthermore, participants without children were two times more likely to have good knowledge compared to those with children (aOR = 2.44; 95% CI: 1.09–5.47; p = 0.031). Table 5 Sociodemographic factors independently associated with knowledge on sickle cell disease among youths in Fako Division Variable Category Poor knowledge n (%) Good knowledge n (%) cOR (95% CI) p-value aOR (95% CI) p-value Sex Male (ref) 26 (8.7) 99 (33.0) 1.00 — 1.00 — Female 25 (8.3) 150 (50.0) 1.58 (0.86–2.89) 0.141 2.39 (1.17–4.86) 0.016 Level of education Tertiary (ref) 31 (10.3) 220 (73.3) 1.00 — 1.00 — Secondary 15 (5.0) 24 (8.0) 0.23 (0.11–0.48) < 0.001 0.30 (0.13–0.68) 0.004 Primary 3 (1.0) 4 (1.3) 0.19 (0.04–0.88) 0.034 0.26 (0.05–1.39) 0.116 No formal education 2 (0.7) 1 (0.3) 0.07 (0.01–0.80) 0.032 0.12 (0.01–1.51) 0.101 Address Tiko (ref) 6 (2.0) 15 (5.0) 1.00 — 1.00 — Limbe 29 (9.7) 63 (21.0) 0.87 (0.31–2.47) 0.792 1.94 (0.61–6.16) 0.261 Buea 16 (5.3) 171 (57.0) 4.28 (1.46–12.55) 0.008 7.24 (2.27–23.16) 0.001 Religion Atheist (ref) 2 (0.7) 2 (0.7) 1.00 — 1.00 — Muslim 4 (1.3) 8 (2.7) 2.00 (0.20–19.91) 0.554 5.57 (0.46–67.94) 0.178 Christian 45 (15.0) 239 (79.7) 5.31 (0.73–38.69) 0.099 10.57 (1.22–91.83) 0.033 Children Yes (ref) 17 (5.7) 35 (11.7) 1.00 — 1.00 — No 34 (11.3) 214 (71.3) 3.06 (1.54–6.05) 0.001 2.44 (1.09–5.47) 0.031 cOR = crude odds ratio; aOR = adjusted odds ratio; CI = confidence interval; ref = reference category. Adjusted odds ratios were derived from multivariable logistic regression analysis. Statistical significance was defined as p < 0.05 3.7 Sociodemographic factors independently associated with attitudes towards sickle cell disease In the multivariate analysis, after adjusting for potential confounders, only level of education was found to be associated with attitude toward sickle cell disease among youths (Table 7 ). Participants with secondary education had lower odds of having a positive attitude toward sickle cell disease compared to those with tertiary education (aOR = 0.47; 95% CI: 0.23–0.94; p = 0.033). Table 6: Sociodemographic factors independently associated with attitudes towards sickle cell disease Variable Category No n (%) Yes n (%) cOR (95% CI) p-value aOR (95% CI) p-value Religion Atheist (ref) 3 (1.0) 1 (0.3) 1.00 — 1.00 — Christian 64 (21.3) 220 (73.3) 10.31 (1.1–12.9) 0.045 11.44 (1.0–19.9) 0.039 Muslim 3 (1.0) 9 (3.0) 9.00 (0.7–11.8) 0.099 11.63 (0.7–17.3) 0.083 Number of sexual partners One (ref) 50 (16.7) 141 (47.0) 1.00 — 1.00 — >1 20 (6.7) 89 (29.7) 0.63 (0.4–1.1) 0.125 2.04 (1.1–3.8) 0.026 Ask potential partner’s SCD status Yes (ref) 27 (9.0) 136 (45.3) 1.00 — 1.00 — No 23 (7.7) 62 (20.7) 1.87 (0.9–3.5) 0.053 0.44 (0.2–0.9) 0.028 Undecided 20 (6.7) 32 (10.7) 3.15 (1.6–6.3) 0.001 0.43 (0.2–1.0) 0.049 Ask partner’s SCD status Yes (ref) 23 (7.7) 105 (35.0) 1.00 — 1.00 — No 26 (8.7) 91 (30.3) 1.30 (0.7–2.4) 0.406 0.91 (0.4–1.9) 0.795 Undecided 21 (7.0) 34 (11.3) 2.82 (1.4–5.7) 0.004 0.44 (0.1–1.0) 0.056 cOR = crude odds ratio; aOR = adjusted odds ratio; CI = confidence interval; ref = reference category. Adjusted odds ratios were derived from multivariable logistic regression analysis. Statistical significance was defined as p < 0.05 3.8 Factors independently associated with decision to marry based on a partner’s genotype In the multivariate analysis, after adjusting for potential confounders, religion, number of sexual partners, and willingness to ask a potential partner’s sickle cell status were found to be independently associated with using genotype status to make marriage decisions (Table 6 ). Christian participants were over eleven times more likely to base their marriage decision on a partner’s genotype compared to atheists (aOR = 11.44; 95% CI: 1.01–19.95; p = 0.039). Participants with more than one sexual partner were two times more likely to consider genotype in marriage decisions compared to those with only one partner (aOR = 2.04; 95% CI: 1.09–3.81; p = 0.026). Additionally, youths who reported they would not ask a potential partner’s sickle cell status had lower odds of basing their marriage decision on genotype (aOR = 0.44; 95% CI: 0.21–0.92; p = 0.028), and those who were undecided also showed reduced odds (aOR = 0.43; 95% CI: 0.19–1.00; p = 0.049) compared to those who would ask. Table 7 Factors independently associated with decision to marry based on a partner’s genotype among youths in the Fako Division. Variable Category No n (%) Yes n (%) cOR (95% CI) p-value aOR (95% CI) p-value Religion Atheist (ref) 3 (1.0) 1 (0.3) 1.00 — 1.00 — Christian 64 (21.3) 220 (73.3) 10.31 (1.1–12.9) 0.045 11.44 (1.0–19.9) 0.039 Muslim 3 (1.0) 9 (3.0) 9.00 (0.7–11.8) 0.099 11.63 (0.7–17.3) 0.083 Number of sexual partners One (ref) 50 (16.7) 141 (47.0) 1.00 — 1.00 — > 1 20 (6.7) 89 (29.7) 0.63 (0.4–1.1) 0.125 2.04 (1.1–3.8) 0.026 Ask potential partner’s SCD status Yes (ref) 27 (9.0) 136 (45.3) 1.00 — 1.00 — No 23 (7.7) 62 (20.7) 1.87 (0.9–3.5) 0.053 0.44 (0.2–0.9) 0.028 Undecided 20 (6.7) 32 (10.7) 3.15 (1.6–6.3) 0.001 0.43 (0.2–1.0) 0.049 Ask partner’s SCD status Yes (ref) 23 (7.7) 105 (35.0) 1.00 — 1.00 — No 26 (8.7) 91 (30.3) 1.30 (0.7–2.4) 0.406 0.91 (0.4–1.9) 0.795 Undecided 21 (7.0) 34 (11.3) 2.82 (1.4–5.7) 0.004 0.44 (0.2–1.0) 0.056 4. Discussion This study assessed the prevalence of sickle cell trait (SCT), knowledge levels, behavioral practices, and attitudes regarding sickle cell disease (SCD) and reproductive decision-making among youths in the Fako Division of Cameroon. These findings provide critical insights into the awareness and perceptions of young people in a region where SCD remains a major public health priority. The prevalence of sickle cell traits (AS) was found to be 12.3%. A similar result was reported in a study conducted by Ngwengi et al. (2020) in Buea, which revealed that 16.0% of the youth had the sickle cell trait (HbAS) [ 15 ]. Comparable prevalence rates, ranging from 8.89% to 16.0%, have also been documented among other young adults in Cameroon and neighboring countries, highlighting the persistent genetic burden of sickle cell disease in the region [ 15 , 22 – 24 ] Our study found that 96.3% of participants had heard about sickle cell disease (SCD). This finding is consistent with other studies conducted in Cameroon, Ghana, and Nigeria, which reported knowledge and awareness of sickle cell disease ranging between 46.3% and 96.75% [ 25 – 27 ]. This high level of awareness reflects increasing exposure to genetic health education, particularly among youths in urban and academic environments, as demonstrated in similar African studies by Adegoke et al. [ 28 ]. We identified the level of education as a factor associated with good knowledge. Similarly, Brown et al. (2025) reported in a study carried out in Ghana that medical students at the tertiary education level had significantly higher knowledge of SCD [ 27 ]. Despite this overall awareness, important knowledge gaps persist. Less than half of our study participants recognized that carriers of the sickle cell trait are typically asymptomatic—an important misconception that contributes to stigma and misunderstandings about genetic risk [ 32 ]. Furthermore, our study revealed a low knowledge level on the identification of serious complications associated with the disease, a pattern also observed among youths in Ghana and Tanzania [ 33 ]. This gap is echoed in a study by Brown et al. (2022), which found that among university students in Ghana, 62%, 35.8%, and 2.3% had inadequate, moderate, and adequate knowledge of SCD, respectively [ 27 ]. Such disparities suggest that educational initiatives may currently focus more on basic disease awareness than on the comprehensive clinical and genetic implications of sickle cell disease. Additionally, our study indicated that female participants were significantly more likely to possess good knowledge of sickle cell disease than their male counterparts. This finding aligns with a study by Okolue et al. (2019) in Nigeria, which also found that females demonstrated better knowledge of SCD and that married individuals had more awareness than unmarried ones [ 29 ]. This trend may be attributed to the fact that women tend to engage more with reproductive and preventive health information due to their perceived caregiving and childbearing roles. Moreover, residence in Buea was strongly associated with higher levels of knowledge, likely reflecting better access to universities, health facilities, and health promotion activities in this urban setting, as reported in a study conducted by Momore et al. (2025) in Ghana [ 30 ]. Furthermore, although overall knowledge levels were high, only slightly more than half of the participants demonstrated a positive attitude toward sickle cell disease (SCD). This finding is consistent with a study conducted by Oluwadamilola et al. (2021) in Nigeria, in which 65% of respondents reported positive attitudes toward SCD [ 26 ]. This may be explained by the fact that attitudes toward genetic conditions are shaped not only by knowledge, but also by deeply rooted cultural beliefs, social norms, and stigma, which continue to play a significant role in influencing perceptions and attitudes in many African societies [ 31 ]. However, attitudes toward reproductive options revealed contrasting patterns. While many participants reported actively avoiding having children with SCD or sickle cell trait, there was a notable reluctance to consider assisted reproductive technologies or adoption. Similar findings have been reported in studies conducted in Nigeria and Cameroon, where strong cultural expectations surrounding biological parenthood, lineage, and inheritance continue to influence reproductive decision [ 32 – 34 ]. Partner genotype also emerged as a key determinant of reproductive decisions. A high proportion of participants (76.3%) indicated that a partner’s genotype would influence their decision to marry, and more than two-thirds reported that it would affect their decision to have children. These findings align with those of Schultz et al. (2020), who reported that genotype compatibility is increasingly considered during partner selection, particularly among educated youth populations [ 34 ]. Additionally, religion was independently associated with genotype-based marriage decisions, likely reflecting the influence of church-mandated premarital counselling practices. Participants reporting multiple sexual partners were more likely to consider genotype compatibility in marriage decisions, possibly due to increased risk perception and greater exposure to sexual and reproductive health information [ 35 ]. The study further revealed that educational level was the only sociodemographic factor independently associated with attitudes toward sickle cell disease. Participants with tertiary education demonstrated significantly more positive attitudes compared to those with secondary education. Interestingly, although the majority of participants expressed a willingness to undergo premarital counselling, findings from Sarpong et al. (2025) highlight a critical gap between intention and practice. In their study, only 15.4% of respondents demonstrated good knowledge of premarital carrier screening (PMCS), while just 14.1% reported positive PMCS practices [ 36 ]. Notably, tertiary education and marital status were significant predictors of both adequate knowledge and positive practices. This discrepancy mirrors findings from multiple studies across Africa, suggesting that barriers such as fear of stigma, potential relationship conflicts, and concerns about social rejection may hinder the uptake of premarital carrier screening, despite expressed willingness to seek counselling. Addressing these barriers is essential to improving knowledge, attitudes, and practices related to sickle cell disease prevention and management. CONCLUSION The prevalence of the sickle cell trait among youths in the Fako Division was 12.3%, with most participants having the AA genotype. Overall knowledge of sickle cell disease was high (83.0%) and was significantly associated with female sex, residence in Buea, Christian affiliation, and not having children. A partner’s genotype influenced marriage decisions for 76.3% of respondents, while religion, having multiple sexual partners, and willingness to request a partner’s genotype were independent predictors of using genotype information when deciding to marry; similarly, 68.3% reported that a partner’s genotype influenced decisions about having children. Despite this relatively high level of awareness, important gaps persist, as 57.3% of participants did not know their own genotype, 47.3% were unaware of their partner’s genotype, and 40.0% were uncertain about decisions concerning an unborn child with sickle cell disease. These findings highlight the need to improve access to and uptake of genotype testing among young people, potentially through routine screening at secondary and tertiary institutions, alongside targeted educational interventions for groups with lower knowledge, such as males, youths living outside Buea, and those who already have children. Strengthening premarital counselling and promoting open partner discussions around genotype status may further support informed marital and reproductive decision-making and contribute to reducing the risk of having children affected by sickle cell disease. Abbreviations Adjusted Odds Ratio (aOR), Confidence Interval (CI), Odds Ratio (OR), Sickle Cell Anaemia (SCA), Sickle cell disease (SCD), Sickle Cell Trait (SCT), World Health Organization (WHO). Declarations Ethical approval was obtained from the Institutional Review Board of the Faculty of Health Sciences, University of Buea (ID 2020 – 1095 – 01 / UB / SG / IRB / FHS) and administrative authorization was gotten from the Regional Delegation of Public Health for the Southwest Region (344/MPH/SWR/RHL /DO). All participants whose responses are included in the dataset had given their Informed Consent to Participate at the start of the questionnaire. Acknowledgments Beatrice, Junior, Achu, Mbabit and Tsi Nde Fon, Paul Enongene Ngang, Mbolle Sylvia, Hilda Enongene, Stephane Mabouna, Collins Fonsho, Ayisha Rilindis, Njang Emmanuel, Nkengeh Dave. Data management Survey data were not accessible to participants at participating Health Centres. Responses were transmitted electronically to Google Sheets linked to the project lead’s account and subsequently exported to GitHub for secure storage. Access to the dataset was restricted to the study statistician for analysis. Collaborative group HERO Cameroon, Publish & Thrive Network. Authors’ contributions N.N.F, P.N.F, A.N and D.M participated in the study design. N.N.F oversaw pilot testing and data collection. N.N.F, P.N.F, S.N, A.N and D.M contributed to the writing and review of the manuscript and approved the final version. N.N.F and S.N assisted in statistical analysis and interpretation of results. N.N.F had overall responsibility for the study design, overseeing survey distribution and interpretation of results. Funding This research received no funding. Data availability The datasets generated and analyzed in this study are not publicly available due to institutional regulations but can be obtained from the corresponding author upon reasonable request. All data access requests will be subject to review by the Ethics Committee of the Cameroonian Ministry of and the Regional Ethics Committee for Human Health Research for the South west Region, Institutional Review Board of the Department of Medicine, Faculty of Health Science, University of Buea, to ensure adherence to ethical and legal requirements. Competing interests The authors declare no competing interests. Author details 1 Department of Medicine, Faculty of Health Sciences, University of Buea, South West Region, Cameroon. 2 Solidarity Hospital, Buea, South West Region, Cameroon. 3 Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, South West Region, Cameroon, 4 Haematology and Blood Transfusion Service, Yaounde University Teaching Hospital, Yaounde, Cameroon. 5 Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon. References Modell B, Darlison M. 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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-8864587","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":590555641,"identity":"a188ce93-6ce4-4857-b82e-f8e9478eb44b","order_by":0,"name":"Njweng Nde 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17:23:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8864587/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8864587/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102738707,"identity":"50d2b55d-3a36-49fd-a220-e002409ea8ec","added_by":"auto","created_at":"2026-02-16 07:00:31","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":366782,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMap of Fako Division, Southwest Region, Cameroon\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSource: District Health Service Buea.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8864587/v1/3dfc11c511ed4a33cc7cd2e3.png"},{"id":102738706,"identity":"fddba4bf-93d1-4180-a0d1-770cfa8365bf","added_by":"auto","created_at":"2026-02-16 07:00:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30359,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrevalence of the sickle cell trait among youths in the Fako Division\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8864587/v1/6bf81de42f117ca87c2051d0.png"},{"id":102738704,"identity":"390ad2ba-af83-4289-a158-612d861fcb2b","added_by":"auto","created_at":"2026-02-16 07:00:31","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":45675,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of participants according to source of information on sickle cell disease\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8864587/v1/a9e1b791ab5adeff0984df20.png"},{"id":102738703,"identity":"cf1b263e-9c26-424f-85df-bc1a7363f93a","added_by":"auto","created_at":"2026-02-16 07:00:31","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":33213,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOverall knowledge youths in Fako Division on sickle cell disease and sickle cell traits\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8864587/v1/56ebca67472ce75f40910946.png"},{"id":102749163,"identity":"727100e7-455c-48bc-ab80-da801271a412","added_by":"auto","created_at":"2026-02-16 09:12:09","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":22012,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAttitudes of youths in Fako Division regarding sickle cell disease\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-8864587/v1/c81a6d6828c30d932ea49f7b.png"},{"id":102751281,"identity":"2376086f-6dc8-4e75-8836-2685d59447e3","added_by":"auto","created_at":"2026-02-16 09:24:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2708163,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8864587/v1/073c892f-a615-40d7-a4f0-f552316b729c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Sickle Cell Trait and Reproductive Decisions Among Youths in the Fako Division of Cameroon","fulltext":[{"header":"Highlights","content":"\u003cul\u003e\n \u003cli\u003eOne in ten youths in Fako division carries the sickle cell trait.\u003c/li\u003e\n \u003cli\u003eDespite high general knowledge, fewer than half knew their own genotype status.\u003c/li\u003e\n \u003cli\u003ePartner genotype strongly influenced marriage and childbearing decisions among youths.\u003c/li\u003e\n \u003cli\u003eExpanded genotype screening and premarital counselling are critical for informed reproductive choices.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"1. Introduction","content":"\u003cp\u003eSickle cell disease (SCD) is a major global public health problem and the most common inherited genetic disorder worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It comprises a group of haematological conditions characterized by the presence of sickle haemoglobin [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Sickle cell anaemia (SCA), the most severe and prevalent form of SCD, occurs when haemoglobin S genes are inherited from both parents [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Although the disease can be prevented when at least one parent carries a normal haemoglobin AA genotype, SCD remains a leading genetic cause of morbidity and mortality globally [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In recognition of its growing burden, the World Health Organization (WHO) declared SCD a public health problem in 2006, with an estimated 330,000 affected births occurring annually worldwide.\u003c/p\u003e \u003cp\u003eGlobally, an estimated 7.74\u0026nbsp;million people were living with SCD in 2021, with approximately 515,000 new births recorded, the majority occurring in sub-Saharan Africa (SSA), which accounts for nearly 80% of global cases [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Alarmingly, 50\u0026ndash;90% of affected children in this region are expected to die before their fifth birthday. Projections suggest that, without effective interventions, the global burden of SCD could increase by 30% by 2050, reaching approximately 25\u0026nbsp;million cases [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In low- and middle-income countries, SCD contributes substantially to the loss of millions of disability-adjusted life years (DALYs) annually [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The burden in SSA continues to rise due to limited health system capacity, low household incomes, and inadequate public health funding, alongside restricted access to disease-modifying therapies such as hydroxyurea, blood transfusions, vaccination programmes, and penicillin prophylaxis [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWithin this regional context, Cameroon ranks among the countries with the highest SCD burden in SSA, occupying the sixth position overall [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Approximately 30% of the country\u0026rsquo;s estimated 30\u0026nbsp;million inhabitants carry the sickle cell trait (HbAS), and about 7,000 children are born with SCD each year [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The prevalence of SCD, particularly HbSS, the most severe genotype, is estimated to range between 0.6% and 2% in the general population [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Despite this high burden, many children in Cameroon are diagnosed only after the age of four, contrary to WHO recommendations for newborn screening [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This delay in diagnosis contributes to high under-five mortality, much of which remains undocumented, and exposes affected children to prolonged unmanaged pain, recurrent illness, growth impairment, and frequent school absenteeism [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccess to disease-modifying treatment in Cameroon remains limited, with hydroxyurea used by only about 5% of eligible patients due to cost, perceived side effects such as infertility, and patient reluctance [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Moreover, inadequate awareness of SCD and its prevention, poor uptake of premarital counselling and genotype testing, and uninformed reproductive decision-making continue to fuel the persistence of the disease [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Cultural beliefs, traditional practices, and superstition also contribute to delayed diagnosis and misinterpretation of symptoms; for instance, a study reported that 70 out of 100 children believed to be affected by witchcraft were actually living with SCD [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In contrast, high-income countries such as the United States and other parts of Europe benefit from comprehensive health insurance coverage, early screening, effective disease-modifying therapies, and curative options, resulting in childhood survival rates exceeding 94% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven that SCD is inherited, it is largely preventable. Knowledge of haemoglobin genotype is central to reducing disease prevalence by preventing affected births [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In a study carried out by Nini et al in 2020, in Buea, South West region of Cameroon, less than one quarter (20.5%) had good knowledge of SCD [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Also, in the same study, only 13.2% knew their genotype and 59.3% were willing to avoid carrier marriages [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Evidence from certain hospitals in Bahrain demonstrated that compulsory premarital screening and counselling significantly reduced the decision to marry by 37% to 48.9% in couples at risk of giving birth to sickle cell children [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe success of such programmes depends on adequate knowledge of SCD, understanding of genetic inheritance, acceptance of screening and counselling, and informed reproductive decision-making. As advanced therapeutic options remain largely inaccessible in low-resource settings, prevention through carrier identification and genetic counselling remains the most viable strategy [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In line with WHO recommendations, this study aimed to determine the prevalence of sickle cell trait among youths in multiple cities in the Fako Division of Cameroon and to examine sociodemographic, behavioral, and partner-related factors influencing knowledge of the trait and genotype-based marriage decisions.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Objective of the Study\u003c/h2\u003e \u003cp\u003eThe goal of this study was to determine the prevalence of sickle cell trait (SCT) among youths aged 18\u0026ndash;40 years in the Fako Division and to assess their knowledge of sickle cell disease/trait (SCD/SCT) and reproductive decision-making in relation to partner genotype. The specific objectives were to determine the prevalence of sickle cell trait among youths in the Fako Division; identify sociodemographic factors associated with good knowledge of sickle cell trait among youths; assess factors associated with good attitudes towards sickle cell disease; and examine factors associated with decision to marry based on a partner\u0026rsquo;s genotype among youths in the Fako Division.\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Method and material","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1 Study design, setting and population\u003c/h2\u003e\n \u003cp\u003eThis hospital- and community-based cross-sectional study assessed sickle cell trait prevalence, knowledge, attitudes, behaviours, and reproductive decisions among youths in the Fako Division, Southwest Cameroon. Conducted from January to April 2020 in Buea, Limbe, and Tiko, the study involved youths aged 18\u0026ndash;40 years recruited from selected health facilities. Participants who had received blood transfusions within the previous four months were excluded.\u003c/p\u003e\n \u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. \u003cstrong\u003eMap of Fako Division, Southwest Region, Cameroon\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2 Sample size determination\u003c/h2\u003e\n \u003cp\u003eThe sample size was calculated using the Cochrane\u0026rsquo;s formula was used to obtain a minimum sample size of 288 participants.\u003c/p\u003e\n \u003cp\u003eThe proportion (0.25) of people with SCT was estimated from a similar study by Immaculata and colleagues in Nigeria, which found out that 25% of youths had the sickle cell trait [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003e\u003cimg 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K9V2PTUNNqsdVLugdhV/nDzxG+wyBTx9feHj6emoS7p0EZs3bYZNpkKDyEhUq1qp1DjOzmI14/VXJuKV12YhomU7LJj7Nvy8Sy6i2LF1AxrVDceoia/Aeg/bMtpsNiRfuw67XAajhzu0jjAhvlv0GdJyCyFXu6BfbG8AgFavR3BIJchhx/Vr15GRk/3H4f513l5eCA0NRUhIyF09QkNDUaGCH2Tyv44BEji8dx/ybVbo3bzQplmUo23vjvX47UwibHY5WjzRFg1rVC3VFwBy83JhI6FQqCBX3P9vCeXRX38Cwr8mJycLE58dhi+WbsTEadMx/aUJ0GpKFvnPfe8NjHh6Ai5dL7nk9W5du3YNxWYz1C5GeOhuBnvimV9x6PAxFFmIp7p3R+UAf2RlZqLYakfDBtGoXaumozYvLxdXribBLpOhTp068HF3d7Q5O4vVgvdmTMX7788GtUbkpF7Hm2/MwhtvvIEpL07ExDHP4lqhHGHVK0P5N6FzOwf2bUNWdhFkchkUipuXl1+9eA7Llq5AVoEVvfoPRWzX9gAAhVyNqtWqQ6EgLiVexKWkpD+MdjuEzWaDDDcSXiYDefd/MO6XvPxMpKZlQAYZqFDAainZhtViKcLyb7/Fhasp8K1YHS9NHCvtimJzEY4fPwa5TAW9wQC9ViUtESAu6PhPJCddYZ+uT9BocGWN+o25bsNP/PXYMR47dpQfv/cGfQxaVglvwuOnT0u7/q3kpAvs0DyKOrWa/lXr8+KV6462ObNepV4JegZU4dY9B0mSE0f1JwAOGv3CH0YhP357Kl21Wrq4+vC9T78q1ebMbHY735/1GgPdDXT3DWJIpUB6urpQo9XRaDJRr9NQpTGyadunmHj57nets9vtfPGZAXTRaWgwuLBCxZr84NNF3Ll9C7u1f4wqhZJP9R7KS0mlL5z54ctP6KZT0uhdiRt+vv0JqtSU61z54wq+Nn06m0TUoJe7iUajG0PCGnDY8BGcPXs2jxy7uZyurKxd/hWDvFxpNBqoc3Fnz8GjeeDAfr76whi66zX09A/lkpXrpd1IkteuXWGj8BDqNXq2iRnA9Ix0aYkgVk3cf4WFhRzapzPddBqa3D3p7eVFL28/hlauwpBKQfRyNVDt4sXJ02dKu96R3VvXM8jTQIPBQKN3CHceKFkxsWHVEgZ7magzevPrH9Y56j+f8w4VAKuGP8JfT58nSa5d/g0Dfdyo0+sZGhbNi3dwNZ6zSL5yiWHBXvQJqsa3P5zDPXt28ZlhsfT3cqVOp6dHhUC279KLJ06dkna9I2ZrMQf1aEedRk1P/xDWqFyR7h7e9PR0p5dPAF978x2mpGdKu3Hdqu8Z7GWgxuTDr5euljaTJDesXEqjRkad3oVuriaaTCaaTEYajSWhB7mCfYaOlXb7z31+Yx2w0dOP1atVYQVvH3p4etLd3YNPdO7OTdtK1r/fTtLlCwwL8qBKY+KYl2ZIm4UbxD3r7rPJE0Zi3tyFqBjeFG1aNETyuZPYtHUH8osJyOVQ6d3RoXNHLPz4Xej1emn3v7Xsm08xcsRo2LSukJHQmTwQ7OeGhNNnofXww+sz30G/bk866mktxMQxo/DevK8RXLUmvA1yXE2+hqLCYhRbraharwWO7lpX6jWcWXFREX74YRlMbp54sv0TkMnlsFjMWL92Hbbv3IXHWrZE61atoNNppV3vyO6dP2FE7ABcTM1HUO1IbPjhC6QkJyEzKweRUdEwGV1ue+fnzKwMDO/VEau3n0DTtu2wbumX0GpK/xtyc7LxxRdfIv7cOeh0OqhUKthsNpjNZscthnr17oPoqMhS/f5LWdkZeGZgL6zZuBM0+WHB/NloXD8M+w4eRlhYbVSpUhka9Z9PN8yf/Q5mTJ2CAn0lfPjh64jtFiMtESCmJu67eR/MYueuPbl52w6SZEpKCud99A4jGzRg2/YduXjJcmZm3npEdSeKigrYtV0Tuur0NHlX5PgXJvP9WW9xxIiRfPf92Txw5Ji0C0mysKCAXy38hNNefYUz3pjJ2H49GOhhok5n4lOxI6TlD7V1P3xNb6OaKq0rx09945Y9Qf6M3W7n1ElP00Orpm+Vejx+8t6OyMtawtlTrB7gTr3WwLCGzXnqXOk9Uv6K3W5n707NqVfrGN60DQuLbl4EI5Qmgvg+KzZbmJ+fV2pbH6vVytTUFGZl3VsA/y43O5P1q/lRo9Gx0WOdmXJj057f7zxxpz6Y8SKNWiW1pgr8dtXt5/oeRqmpKRwzrDc9XDTUuvlyzqLvpCV/6eqVREbVDKJW78ERz78kbXZ6VpuNa1Z8z4qeOqq0BvYYPIaFhSWXNd+JZUu+ZBVfV6rd/Dl3Ufk571AW7v4UsnBX1Col9HqXG5dplFAoFPDy8oar6z+7ZfuuXVuQlZUPAvALCoS3qytwY2P5O2WzW3Dx4kXY7IRab0Cd6tWlJQ+lywlnMHRgLFas2gAzFVDLiVmvT8fiJXe+p65/QDD6Dh0GkzwXG9dtxu79B6UlTstckIs3pk3BuAkTkFskg1qlwPZNa/HCC9NQZP/72cy0tFSs/PZrXMm0oFXrNujR5eb0mHCrO/+NFZzKpk0/4aN3ZiK70AaVSotLieexffsOadlfIBISEvDcmNHYuHkbZAoddFo1vvrqcxQVm6XFD50L5+KRlHwNBk9/hFapgpDACtCrgV2/HJCW/qXBI8ajb9+eSE04icmvvonrKeXjxq/Z2Zk4/dsJyFUGBIRWQZXQSvB112HvgUMo/ps7bVhtVrw1/SX8tGUnQsIjMWPq8/B0Kz/LIcuE9BBZcH7pKcmMqlPZsUTLaDRRo1GzcauOTM++uWfFX8lJucxWTaMpk8tLVlwYjTQajNS6mDhn0RJp+UMpOzubCQkJTE5OZkpKCnNzb24/ejeSk5M4pO9T1GgN/N87H0ubnZbFYuGFCxd4+fJlpqSkMD09nRbLrdupSu3dvpGBXq6sFvEIf9pS+oapwu055aoJi8WMDevXIyMzG926d4fBpWQ1waWLiVizdi3y8gvQunVr1K1bF4q7+Br+oLCYzdi/bw+uJqdCpVJCpVJBLpPB1z8QdcPrQKX8+z0iLMVFOHbsGK6lpDrO+hcWFsJgNCGsVm0E/mEPCuGfS09Pw8+bNqJitTqIalBX2vxAyUhJxtqNW1G3fj2E16oJmezh+x29W04XxBkZaZg8dhTW/fQzCq1ElToNMWXiszh5cDc+++IbZOTkQ0E7VAZPPNm5C96bNR2mP2yYIwiCUN44XRAvmP0OXn5pOryq14Qi4zIuXM+HVqeBzQb07Ncfndq3wcpvP8OKlauRL3fHZ4s+Q9+uHaTD3OLo0aP4+eef7+pE1u9IQqFQoEOHDqhcubK0WQBgtVqxfv16xMfHQ6H4+yNyKbvdDi8vL3Tu3BmuN046CsLDwqmCOD09FV3aNMHZVCW6dm2BvWtWIjElF0UyPd5+7208PbgfFHI5ft64Cr179UBqsRavzXgLU54bJR3qFtMmjsbMjz6D8sZWkr//2H/248tubBMlk8lKauRavDdnLobH3mZ3KQG52Zno160TNu86CIVK9bfvLyTvsc1mg6tPEFb9uBxR9WpLSwXhgeZUQZyRkowW0fURFN0Rw7o2x7hnRiEpF4jpOwiL5syC7sYmOVvXr0CP7j2QAyNmvfchxo/oLx3qFvv37cEvvxxAUXExNBoNNBoNlMob86uSo2S73Q6LxQKz2Yzi4mKYzWaYXN3R8vGWqFm9Wqna28nKysKmTZtQWFjoCJv7QS6Xl7qqy263Ox7/FEnI5XJERUWh+h0saTObi7H5p404FXcGdtLxHqtUKqhUt155ZbVaYbFYYLFYUFxcDKvVBp8KfniyQ3v4eHtJy28RFxeHffv23dPRt1D27HY7jEYj2rRpA6Px3raBfZA4VRDbbFZcvnQJrp4+WLvsCzw3bgKyYcKHc+ZjZP+S7R1JG14ePxxz5i+GTe+FeZ/OQ2y3jtKhytRXX32FMWPGlOyodR+DWCaTlRr/xgU6IPmvvK7NZkOzZs2wfPlyuDjRPDxJ9OjRA2vXrr1tyAvOz263Q6PRYM6cOejVq5e0+aHjVEH8O6vVjMG9O2Ll6h3wDKmFb7//Eo9ElHxdzc/JQrMGNXDqSg7qRLXEymULEeDjKx2iTG3cuBHjxo1DUVHRLUfb/zaFQgG5XH5LINvtdthstlK1d8tms+Hxxx/H3LlzodXe214N9wNJPP/881i6dKkI4nLKbrfDxcUFH330ER5//OZG+w8rpwziooI8tIyqjcPx19CkTVdsW/Oto+3nzT9iQK8BuF5AxAwYgW/nv4O0tDS4urn/5bKtPbt3YemyH+4pGElCqVRh8NAhCKtRQ9p8C6vVisTERFgsln/lyPSv/H5ULA3i3x//BEn4+vrCw+PmrXH+jNVqxeJvvsahw0duuwnO37HZbPDzD8CwoUPh5XVzw/o/k52djaSkpPv+/gr3B0mo1WpUqlRJTC85axDv3rUVQ3t3x4W0YjwRE4tVi+c72p4ZGINF362B1iMYP676Hmf3bsSrMz/BzNnzERtTsjH37UybNBrvzvkcSrWmVED92Y8v/QWnTIuZH3yAkQPE16jbycnOxIAenbF1zxHIVSr8fr+2P3t/UepkHWC32aH38MfKFUsRXT9cWioIDzSnDOLXXh6DOR8uQB5MGD9lMl6fPB4AkJGZhNinOmPbvpMIrBWFJQvfxZiBvXE6XYmvv5yNdn/xFef06VM4dPAw8gsKSp1EUqlUUCgUjr/KVqsVdrsdZrPZcTKpqLAQ7p5eaNq0CQIDAqRDCzfetwP79+G3U3Gw2wmdTut4f5VKpWMKhSy5G8UfT9aZzWZYrVYEVQxGkyaN4WoSN6AUHi5OGcTjB/fAp9+thNItGDu2rkFEWMl0QGrqZfTt/CR2Hk5ASHgEAvRFOHI0HjGDRmHBh29Kh3moWCwWJCYmQi6XIzg4+J6mBwTn9fvnq1KpEBwcfMs3NqF8u/sJ0/vMZrMjr6gQZrMdIZVDEVIxyNHm7R2ELj16wE0PXEuIw9HfLqFFxxj87+WSI+aHVdxvv2LKpPHo3KkTunSJwTPjX8DREyelZUI5dfTQPkx4ZiQ6PvkkYmK6Y+zzL+HU2XhpmVCOOeUR8aGD+7Fu3UbE9OiB2mE3b3AJAHabDVs2b8KPq1ajSdPm6BbTBVptyfrih1HcyaMYMWgQLmaY0TiqLi6dPYHDJ+MRWD0Ciz6djUcbld3dHYR/7sAv2zFs4BDkyQxoGh2OY/t34XRCEirXicb3X3+G8LC/X+MtlAM3Nv8RyiGbzcoJT8fSRaVnx16DWGSxcN/eHQwL9qRKqWXbmAHMzC7ZLF4of6xWC2O7taFOa2S3AcNJkhvX/cgage6UK7XsOmA07TartJtQDjnd1IRw5ywWM87GxaHQUoDjR4/j/OVrCI+oj/CIutCrZNi3ZzcOHT8l7SaUE3abFUkXL6GwKBenTp5FlrkYUY2awM3DHQalAgf37cPeo0el3YRySARxOabR6DB91gfo16cXxo19GmEhgSgqLkJhYSEAQC4vWakglE8qtRZT3ngHsb17YdiQWLipNbDTDpkMIAD5H1b7COWbU84RC3enuLgYarUaMpkMFy+cRbsWjyD+WhGe6jMIX857G3qtTtpFKEcsFguUSiVkMhkSz59BuxaP4FyKGX2HjcYXs2dKy4VySBwuPQA0Go1jOdPc99/C1ZR8BFSujfGjB4kQfgCoVCrIZDJYbVa89tI4XL6ejxoNGmHyuOHSUqGcEkfE5YDVasW+fb/g0MFDCKoYjHbt2kGvvzVgf1qzDEMGD4fCqzJmfzATHdv++QUugvOw2Ww4fOgQfvnlF/j5B6Bd+/YwGm7dZGn1si8xbPgz8KsZjY/ffxPNosWKmAeG9Oyd4DyyMjP41aIFfKxpFIMC/Wkymejp6cHoR1vz2G+nS9Vu3bCSIX5efKRlRx458RuL8nN49uw5Fpv//h5jQtnIyc7it199zlbNH2FwUEDJ5+vhwQaNW/DgrydL1W5et5zBft5s26UvL165yrysdJ49l0Cr3V6qTiifRBA7qaLCAo4a2IseLhpqDF4c8vQ4rlm7nhNGD6JBqeAT3QYyKy+fJHnkwC42DKtK/yrh3HvgEC0WC6c/N5I16zbmgeMnpEMLTsBcXMyxw/vT06ChWu/B/sNHc/WadXxh3HCaVEo+3qkPM2/crHTHlnWsVtGPFWs04LkLiczKzuL4ob0Z2bw94xLOS4cWyiERxE7IbDHz2SG9aNAo6eJagVNmvEubreTIZ+PGFazh78mgavV56nwik68mskOLKLp5+LF23Qi2bt2KrVq1YpVAX/pXieDeAwekwwtlzGKxcOLogTRqlNSbfPj81DdosZasB962bR3rVPRhYOW6PHY6nmdOHWNUWCV6+ASxTkQ9tmndmo891pyBvh5s0Lw9z58XQfwgEEHshFYs+ZKBHi7U6wysGdXSMb1QUFDAyeOH0kWpZPdBz5IkV337KZUAdTo99Tot1WoVVSoVZQo123UbyOysTMnoQllbt3IJK3obqdcZWDmiKfMKCkmSxUVFnPrCaBrVCnbuO4IWu5Xz33615PPV66nT6ahSqahWqQiFij0GjyPtNunwQjkkTtY5mazsDDw7qBdWb9wJu8YNlWtUR+smDZGXm42E+LPYt/8gKtaKxMLP5iEqvBauXkrE+x/ORuKlxJLFpTe2ntRotBg7fgKiIxtIX0IoQ3l5ORgzpA9WrN0Cm9oVwVWroW2zSBTl5yLh/Dn88st++FeNwIKF89Ckfl2cPxOHD+fOR3JSkmNLUdIONzd3jBo9Bg3r15W+hFAOiSB2MufPnESHlo8iKccKlc4ArUYJWq1wc3dHSGhl1I5oiOFDB6JypYrSrkI5cCXxHNo+2giXM81Q6Vyg1ahht5rh5uaOkNBQhNePwuBBsagWGiLtKjzARBA7mXNxx9G6RROk5Mth8qmIt2e+ioiaNaDR6uDj7SVuNV/OXU44i8eaROJaLuHiFYQ335iC6PA6UGu18Pbygpubm7SL8BAQF3Q4IZkMsNqIqtVroOWjTVG7dm1UrVLZEcJ5eblITU2TdhPKA5nM8fmGVqmKx5s/ilq1a6NqlSqOEM4vyEdKSqq0p/AAE0HsZOQqFfQ6HZQgUlJTkZWTW6r9yKH9GD24D0aPn4zrGdml2gTnJ1MqodfroACQlpaGzOysUu2/HjuMscP6YdSY53E1Jb1Um/DgEkHsZCpVroEBg4dApyjGlQvn8MOP63D6dByOHTmM58aNRv/ePfDDhj0ICAqEQSPuwlHeBAaFYMjwUXBRmZF0MQHLVqxDXFwcjh87iheeH4vYnt3w7cqfUSEgEAatWtpdeECJOWInlHI9GW+/MQ3ff78CuRZAc+OEHRRK+AWGYNz4sejdtRO0ulsvcxacX1rqdbw/cwa+WbwE2cWERqMErFZQoYCvXyU8O+YZ9OvZFXq9XtpVeECJIHZSZosFxw4fxNffLEZmZhZc3dzRuUsXNKxfD25ubmJ7y3LOYrXgxLGj+Orrb5CWlg6jyRUdO3VGdFQk3NxcxfaWDxkRxIIgCGVMHFYJgiCUMRHEgiAIZUwEsSAIQhkTQSwIglDGRBALgiCUMRHEgiAIZUwEsSAIQhkTQSwIglDGRBALgiCUMRHEgiAIZUwEsSAIQhn7P4/jKXuHxDJSAAAAAElFTkSuQmCC\"\u003e\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003eWhere\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;estimated sample size\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ez\u0026thinsp;=\u0026thinsp;1.96\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.25\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eq\u0026thinsp;=\u0026thinsp;1-p\u0026thinsp;=\u0026thinsp;1-0.25\u0026thinsp;=\u0026thinsp;0.75\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ee\u0026thinsp;=\u0026thinsp;0.05\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003en = (1.96) ^ 2 (0.25) (0.75)/0.05*0.05\u003c/p\u003e\n \u003cp\u003e=\u0026thinsp;288 participants\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3 Sampling technique\u003c/h2\u003e\n \u003cp\u003eA multistage sampling approach was employed in this study. First, the Fako Division was purposively selected because it had one of the highest burdens of sickle cell disease in the South West Region and hosted the two largest referral hospitals in the region, namely the Buea Regional Hospital and Limbe Regional Hospital. Second, three of the five health districts in the division, Buea, Limbe, and Tiko, were selected. Buea and Limbe were chosen because of their predominantly urban characteristics, while Tiko was selected to represent a semi urban setting. Data were collected at the Buea Regional Hospital and Solidarity Clinic in Buea, Limbe Regional Hospital in Limbe, and Tiko District Hospital in Tiko. Community sensitization was conducted through radio announcements, after which interested youths presented to the outpatient departments of the selected health facilities for screening and participation in the study.\u003c/p\u003e\n \u003cp\u003eAfter calculating the estimated sample size, we used health area population estimates obtained from the Cameroon\u0026rsquo;s South West Regional Delegation of Public Health to determine the commensurate percentage of the desired total sample using simple proportions per subdivision. This was to ensure that the subdivisions were represented based on their true relative size.\u003c/p\u003e\n \u003cp\u003eIn Buea, with a population of 47,300 we targeted 78 participants. In Limbe, a population of 72,106 we targeted 119 participants and in Tiko with a population of 55,224 we targeted 91 participants.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\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\u003eStudy population proportionate to the health area population.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHealth area\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal population\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStudy population\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBuea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47,300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLimbe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72,106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTiko\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55,224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e2.4 Data collection method\u003c/h2\u003e\n \u003cp\u003eData were collected using a structured and validated questionnaire covering sociodemographic characteristics; knowledge of sickle cell disease and trait (SCD/SCT); attitudes and behaviours; concerns about partner genotype prior to relationships; premarital counselling; and reproductive decisions, intentions, and parenting plans related to SCD/SCT. The questionnaire was pretested among 20 randomly selected youths at Bonamousadi District Hospital in Douala, Cameroon, and revised accordingly.\u003c/p\u003e\n \u003cp\u003eFollowing radio announcements, interested youths presented to the outpatient departments of the selected health facilities. Upon arrival, participants received detailed information about the study, and written informed consent was obtained. A total of 640 participants consented to screening for sickle cell status.\u003c/p\u003e\n \u003cp\u003eVenous blood samples were then collected from consenting participants for haemoglobin genotype determination using haemoglobin electrophoresis. Two millilitres of venous blood were drawn into labelled K3EDTA tubes, gently mixed, and transported daily under cold chain conditions to the Solidarity Hospital Buea laboratory. Samples were stored at 4\u0026deg;C and analysed within seven days. Standard electrophoresis procedures were followed, and results were interpreted using a known sickle cell trait (AS) sample as control. Participants received their results, accompanied by counselling and education on SCD/SCT, premarital genotype screening, and informed reproductive decision-making\u003c/p\u003e\n \u003cp\u003ePrior to receiving their results, participants were invited to take part in the questionnaire survey. Of the 640 individuals screened, 300 provided additional consent to complete the structured questionnaire, which was administered by trained study personnel. Assistance was provided to participants who were unable to read to ensure accurate and complete responses.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eInclusion Criteria\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eParticipants were eligible for inclusion if they were aged 18\u0026ndash;40 years, resided in Buea, Limbe, or Tiko subdivisions, presented voluntarily for screening during the study period, and provided written informed consent.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eStudy Variables\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eVariables assessed included age, sex, marital status, education level, occupation, health insurance status, parenthood, awareness and knowledge of SCD/SCT, sexual behaviours, partner genotype awareness, premarital counselling practices, influence of partner genotype on marriage and reproductive decisions, contraception use, alternative reproductive options, adoption intentions, and attitudes toward marriage restrictions involving SCT or SCD.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003e2.5 Data analysis\u003c/h2\u003e\n \u003cp\u003eData was keyed in and analyzed using SPSS version 26.0 (Statistical Package for the Social Sciences). Continuous variables were summarized using means and standard deviation. Categorical variables were summarized using frequencies, proportions, charts and tables. Knowledge on SCD/SCT was assessed based on 9 questions related to SCD/SCT. The knowledge of respondents was classified as good or poor, using a cutoff of less than or equal to 60% for poor and greater than 60% for good. Logistic regression analyses were used to identify factors independently associated with good knowledge and marriage decisions influenced by partner genotype. Adjusted odds ratios and 95 percent confidence intervals were reported with significance set a p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003e2.6 Ethical Considerations\u003c/h2\u003e\n \u003cp\u003eEthical approval was obtained from the Institutional Review Board of the Faculty of Health Sciences, University of Buea (ID 2020\u0026ndash;1095 \u0026ndash; 01 / UB / SG / IRB / FHS) and administrative authorization was gotten from the Regional Delegation of Public Health for the Southwest Region (344/MPH/SWR/RHL /DO). Informed consent was obtained from the participants.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e\u003cem\u003e3.1 Sociodemographic characteristics of study participants\u003c/em\u003e\u003c/h2\u003e\n \u003cp\u003eAmong 640 participants who were screened for sickle cell trait, 300 consented to respond to the structured questionnaire. The sociodemographic characteristics of the 300 study participants are presented on Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean age of the participants was 30.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7 with most 158 (52.7%) participants aged between 30\u0026ndash;37 years. The majority of respondents were female 175 (58.3%) and single 260 (86.7%). Most participants attained tertiary education 251 (83.7%). The leading occupation among respondents was student 164 (54.7%). A large number of participants resided in Buea 187 (62.3%). Most respondents identified as Christians 284 (94.7%). The majority did not have health insurance 265 (88.3%), and most participants reported not having children 248 (82.7%).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSociodemographic characteristics of study participants (n\u0026thinsp;=\u0026thinsp;300)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge group (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 to 29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 to 37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNatal Sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLevel of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAddress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBuea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLimbe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTiko\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReligion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAtheist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHealth insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHave children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Prevalence of sickle cell traits\u003c/h2\u003e\n \u003cp\u003eThe prevalence of sickle cell traits among the study participants is presented on Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eThe prevalence of sickle cell trait (AS) was 12.3% (79/640), while 87.7% (561/640) of participants had a normal haemoglobin genotype (AA).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3 Knowledge of sickle cell disease and trait among study participants\u003c/h2\u003e\n \u003cp\u003eThe level of knowledge of participants on sickle cell disease and trait is presented on Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. Most participants had heard about sickle cell disease 289 (96.3%) and the sickle cell trait 260 (86.7%). The majority knew that sickle cell disease is due to an abnormality in the red blood cells 259 (86.3%) and correctly identified that it is inherited from both parents 279 (93.0%). A large number of respondents reported knowing someone with sickle cell disease 217 (72.3%). Most participants knew that the disease is associated with frequent episodes of pain 241 (80.3%) and frequent shortage of blood 248 (82.7%), while fewer participants were aware that it is associated with stroke 120 (40.0%). The majority of respondents believed that sickle cell disease has no cure 208 (69.3%) and that there is no cure in Cameroon 218 (72.7%). Almost half of the participants knew that carriers of the sickle cell trait do not show symptoms of the disease 149 (49.7%), and most knew that carriers can pass on the disease to their children 272 (90.7%). Most participants, 226 (75.3%), strongly agreed that sickle cell disease can be prevented if carriers do not reproduce with one another or with individuals living with sickle cell disease. The majority of respondents reported receiving information through formal learning in school 212 (70.7%). Other common sources included the media such as television, radio, and social media 151 (50.3%) (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eKnowledge of sickle cell disease and trait among study participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeard about sickle cell disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeard about sickle cell trait\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSickle cell disease is due to an abnormality in\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRed blood cells\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKidney cells\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBone cells\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHow can one get sickle cell disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInherited from both parents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlood transfusions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSexual intercourse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClose person-to-person contact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsect bite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWitchcraft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnows someone with sickle cell disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnows that sickle cell disease is associated with frequent pain episodes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnows that sickle cell disease is associated with frequent shortage of blood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnows that sickle cell disease is associated with stroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBelieves that sickle cell disease has a cure in the world\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBelieves that sickle cell disease has a cure in Cameroon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnows that carriers of the sickle cell trait do not show symptoms of the disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnows that carriers of the sickle cell trait can pass the disease to their children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAgrees that sickle cell disease can be avoided if carriers do not marry each other or sticklers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStrongly disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\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\u003eRegarding overall knowledge of sickle cell, a total of 12 questions were used to assess knowledge and a cut off of greater or equal to 6 on 12 was used to classify participants as having good or poor knowledge. Following this classification, 249 (83.0%) of the participants had good knowledge on sickle disease (Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4 Behavioral characteristics of study participants\u003c/h2\u003e\n \u003cp\u003eThe behavioral characteristics of the 300 study participants are presented on Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. Slightly more than half of the respondents reported not having unprotected sexual intercourse 155 (51.7%). The majority had one sexual partner 191 (63.7%). More than half of the participants indicated that they would ask for a potential partner\u0026rsquo;s sickle cell status before starting a relationship 163 (54.3%). Less than half stated that they would ask for a partner\u0026rsquo;s sickle cell status before marriage 128 (42.7%). Most respondents reported that they would go in for premarital counselling before marriage 228 (86.7%).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBehavioral characteristics of youths in the Fako Division\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUsually has unprotected sexual intercourse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of sexual partners\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOne\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMore than one\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWould ask for a potential partner\u0026rsquo;s sickle cell status before relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWould ask for a partner\u0026rsquo;s sickle cell status before marriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWould go in for premarital counselling before marriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCannot recall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e263\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003e3.5 Attitudes and perceptions toward Sickle cell disease and carrier screening\u003c/h2\u003e\n \u003cp\u003eThe attitudes and perceptions of the study participants toward sickle cell disease and carrier screening are presented on Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e. Most participants believed that everyone should know their sickle cell status 285 (95.0%), although the majority 172 (57.3%) had no knowledge of theirs. The main reason for checking one\u0026rsquo;s status was concern for the safety of future children 123 (41.0%). Most participants had the genotype AA 171 (57.0%) and did not have a family member with sickle cell disease 202 (67.3%). Nearly half did not know their partner\u0026rsquo;s genotype 142 (47.3%), and most reported their partner\u0026rsquo;s genotype as AA 64 (21.3%). Almost all supported making sickle cell screening compulsory 275 (91.7%). The majority stated that a partner\u0026rsquo;s genotype would influence their decision to marry 229 (76.3%) and to have children 205 (68.3%). Most indicated they would not have another child if they already had one with sickle cell disease 131 (43.7%) and were unsure about what they would do if an unborn baby were diagnosed with the disease 120 (40.0%). A large proportion would not undergo permanent contraception 118 (39.3%) and intended to avoid having a child with sickle cell disease or trait 198 (66.0%). More than half considered having a child to be extremely important 154 (51.3%), while a third said they would not use artificial reproductive techniques 104 (34.7%) and another third would not seek non-childbearing options like adoption 109 (36.3%). Just over half believed that marriage between two sickle cell carriers should be allowed 153 (51.0%).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAttitudes and perceptions towards Sickle cell disease and carrier screening among youths in the Fako division\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEveryone should know their sickle cell status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnows their own sickle cell status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReason for checking sickle cell status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBecause of subsidized price\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCuriosity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoctor\u0026rsquo;s request\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImportant for future children\u0026rsquo;s safety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePremarital testing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eParticipant\u0026rsquo;s genotype\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHas a family member with sickle cell disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnows partner\u0026rsquo;s sickle cell genotype\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePartner\u0026rsquo;s reported genotype\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot specified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupports making sickle cell screening compulsory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePartner\u0026rsquo;s genotype would influence decision to marry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePartner\u0026rsquo;s genotype would influence decision to have children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIf already has a child with sickle cell disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWould not have another child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWould have another child with different partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWould take the risk again\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDecision about an unborn baby diagnosed with sickle cell disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAllow pregnancy to continue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTerminate pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWould undergo permanent contraception to prevent having a child with sickle cell disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDescription of future parenting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAvoid having a child with SCD or SCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAvoid having a child with SCD only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo avoidance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImportance of having a child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExtremely important\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery important\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSomewhat important\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot very important\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot at all important\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWould use artificial reproductive techniques\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWould seek non-childbearing options like adoption\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarriage between two sickle cell carriers should be allowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\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\u003eRegarding attitudes of participants on sickle cell, a total of 10 questions were used to assess attitude and a cut off of greater or equal to 5 on 10 was used to classify participants as having positive or negative attitude. Following this classification, 166 (55.3%) of the participants had positive attitude towards sickle disease (Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003e3.6 Sociodemographic factors independently associated with good knowledge on sickle cell disease.\u003c/h2\u003e\n \u003cp\u003eIn the multivariate analysis, after adjusting for potential confounders, sex, address, religion, and having children were found to be independently associated with good knowledge on sickle cell disease among youths in the Fako Division (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e). Female participants were 2 times more likely to have good knowledge compared to males (aOR\u0026thinsp;=\u0026thinsp;2.39; 95% CI: 1.17\u0026ndash;4.86; p\u0026thinsp;=\u0026thinsp;0.016). Participants residing in Buea were over seven times more likely to have good knowledge compared to those living in Tiko (aOR\u0026thinsp;=\u0026thinsp;7.24; 95% CI: 2.27\u0026ndash;23.16; p\u0026thinsp;=\u0026thinsp;0.001). Similarly, Christians were about ten times more likely to have good knowledge than atheists (aOR\u0026thinsp;=\u0026thinsp;10.57; 95%CI: 1.22\u0026ndash;91.83; p\u0026thinsp;=\u0026thinsp;0.033). Furthermore, participants without children were two times more likely to have good knowledge compared to those with children (aOR\u0026thinsp;=\u0026thinsp;2.44; 95% CI: 1.09\u0026ndash;5.47; p\u0026thinsp;=\u0026thinsp;0.031).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSociodemographic factors independently associated with knowledge on sickle cell disease among youths in Fako Division\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePoor knowledge n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGood knowledge n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ecOR (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eaOR (95% CI)\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 \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale (ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e99 (33.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e150 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.58 (0.86\u0026ndash;2.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.39 (1.17\u0026ndash;4.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTertiary (ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e220 (73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.23 (0.11\u0026ndash;0.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.30 (0.13\u0026ndash;0.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.19 (0.04\u0026ndash;0.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.26 (0.05\u0026ndash;1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.07 (0.01\u0026ndash;0.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.12 (0.01\u0026ndash;1.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.101\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAddress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTiko (ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLimbe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63 (21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.87 (0.31\u0026ndash;2.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.792\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.94 (0.61\u0026ndash;6.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.261\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBuea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e171 (57.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.28 (1.46\u0026ndash;12.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.24 (2.27\u0026ndash;23.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAtheist (ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.00 (0.20\u0026ndash;19.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.554\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.57 (0.46\u0026ndash;67.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.178\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e239 (79.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.31 (0.73\u0026ndash;38.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.57 (1.22\u0026ndash;91.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eChildren\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes (ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35 (11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e214 (71.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.06 (1.54\u0026ndash;6.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.44 (1.09\u0026ndash;5.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.031\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\u003cem\u003ecOR\u0026thinsp;=\u0026thinsp;crude odds ratio; aOR\u0026thinsp;=\u0026thinsp;adjusted odds ratio; CI\u0026thinsp;=\u0026thinsp;confidence interval; ref\u0026thinsp;=\u0026thinsp;reference category. Adjusted odds ratios were derived from multivariable logistic regression analysis. Statistical significance was defined as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003e3.7 Sociodemographic factors independently associated with attitudes towards sickle cell disease\u003c/h2\u003e\n \u003cp\u003eIn the multivariate analysis, after adjusting for potential confounders, only level of education was found to be associated with attitude toward sickle cell disease among youths (Table \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e). Participants with secondary education had lower odds of having a positive attitude toward sickle cell disease compared to those with tertiary education (aOR = 0.47; 95% CI: 0.23\u0026ndash;0.94; p = 0.033).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable 6: Sociodemographic factors independently associated with attitudes towards sickle cell disease\u003c/strong\u003e\u003c/p\u003e\n \u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eAtheist (ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e3 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 93px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e64 (21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e220 (73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e10.31 (1.1\u0026ndash;12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e11.44 (1.0\u0026ndash;19.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 93px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e3 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e9 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e9.00 (0.7\u0026ndash;11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e11.63 (0.7\u0026ndash;17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of sexual partners\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eOne (ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e50 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e141 (47.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 93px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026gt;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e20 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e89 (29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.63 (0.4\u0026ndash;1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e2.04 (1.1\u0026ndash;3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAsk potential partner\u0026rsquo;s SCD status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eYes (ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e27 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e136 (45.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 93px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e23 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e62 (20.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e1.87 (0.9\u0026ndash;3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e0.44 (0.2\u0026ndash;0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 93px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e20 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e32 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e3.15 (1.6\u0026ndash;6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e0.43 (0.2\u0026ndash;1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAsk partner\u0026rsquo;s SCD status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eYes (ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e23 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e105 (35.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 93px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e26 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e91 (30.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e1.30 (0.7\u0026ndash;2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e0.91 (0.4\u0026ndash;1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 93px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e21 (7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e34 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e2.82 (1.4\u0026ndash;5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e0.44 (0.1\u0026ndash;1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cem\u003ecOR = crude odds ratio; aOR = adjusted odds ratio; CI = confidence interval; ref = reference category. Adjusted odds ratios were derived from multivariable logistic regression analysis. Statistical significance was defined as p \u0026lt; 0.05\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003e3.8 Factors independently associated with decision to marry based on a partner\u0026rsquo;s genotype\u003c/h2\u003e\n \u003cp\u003eIn the multivariate analysis, after adjusting for potential confounders, religion, number of sexual partners, and willingness to ask a potential partner\u0026rsquo;s sickle cell status were found to be independently associated with using genotype status to make marriage decisions (Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e). Christian participants were over eleven times more likely to base their marriage decision on a partner\u0026rsquo;s genotype compared to atheists (aOR\u0026thinsp;=\u0026thinsp;11.44; 95% CI: 1.01\u0026ndash;19.95; p\u0026thinsp;=\u0026thinsp;0.039). Participants with more than one sexual partner were two times more likely to consider genotype in marriage decisions compared to those with only one partner (aOR\u0026thinsp;=\u0026thinsp;2.04; 95% CI: 1.09\u0026ndash;3.81; p\u0026thinsp;=\u0026thinsp;0.026). Additionally, youths who reported they would not ask a potential partner\u0026rsquo;s sickle cell status had lower odds of basing their marriage decision on genotype (aOR\u0026thinsp;=\u0026thinsp;0.44; 95% CI: 0.21\u0026ndash;0.92; p\u0026thinsp;=\u0026thinsp;0.028), and those who were undecided also showed reduced odds (aOR\u0026thinsp;=\u0026thinsp;0.43; 95% CI: 0.19\u0026ndash;1.00; p\u0026thinsp;=\u0026thinsp;0.049) compared to those who would ask.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab10\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eFactors independently associated with decision to marry based on a partner\u0026rsquo;s genotype among youths in the Fako Division.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYes n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ecOR (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eaOR (95% CI)\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 \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAtheist (ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64 (21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e220 (73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.31 (1.1\u0026ndash;12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.44 (1.0\u0026ndash;19.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.00 (0.7\u0026ndash;11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.63 (0.7\u0026ndash;17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of sexual partners\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOne (ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e141 (47.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e89 (29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.63 (0.4\u0026ndash;1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.04 (1.1\u0026ndash;3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAsk potential partner\u0026rsquo;s SCD status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes (ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e136 (45.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62 (20.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.87 (0.9\u0026ndash;3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.44 (0.2\u0026ndash;0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.15 (1.6\u0026ndash;6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.43 (0.2\u0026ndash;1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAsk partner\u0026rsquo;s SCD status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes (ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e105 (35.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e91 (30.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.30 (0.7\u0026ndash;2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.91 (0.4\u0026ndash;1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21 (7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.82 (1.4\u0026ndash;5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.44 (0.2\u0026ndash;1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study assessed the prevalence of sickle cell trait (SCT), knowledge levels, behavioral practices, and attitudes regarding sickle cell disease (SCD) and reproductive decision-making among youths in the Fako Division of Cameroon. These findings provide critical insights into the awareness and perceptions of young people in a region where SCD remains a major public health priority.\u003c/p\u003e \u003cp\u003eThe prevalence of sickle cell traits (AS) was found to be 12.3%. A similar result was reported in a study conducted by Ngwengi et al. (2020) in Buea, which revealed that 16.0% of the youth had the sickle cell trait (HbAS) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Comparable prevalence rates, ranging from 8.89% to 16.0%, have also been documented among other young adults in Cameroon and neighboring countries, highlighting the persistent genetic burden of sickle cell disease in the region [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOur study found that 96.3% of participants had heard about sickle cell disease (SCD). This finding is consistent with other studies conducted in Cameroon, Ghana, and Nigeria, which reported knowledge and awareness of sickle cell disease ranging between 46.3% and 96.75% [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This high level of awareness reflects increasing exposure to genetic health education, particularly among youths in urban and academic environments, as demonstrated in similar African studies by Adegoke et al. [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. We identified the level of education as a factor associated with good knowledge. Similarly, Brown et al. (2025) reported in a study carried out in Ghana that medical students at the tertiary education level had significantly higher knowledge of SCD [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite this overall awareness, important knowledge gaps persist. Less than half of our study participants recognized that carriers of the sickle cell trait are typically asymptomatic\u0026mdash;an important misconception that contributes to stigma and misunderstandings about genetic risk [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Furthermore, our study revealed a low knowledge level on the identification of serious complications associated with the disease, a pattern also observed among youths in Ghana and Tanzania [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. This gap is echoed in a study by Brown et al. (2022), which found that among university students in Ghana, 62%, 35.8%, and 2.3% had inadequate, moderate, and adequate knowledge of SCD, respectively [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Such disparities suggest that educational initiatives may currently focus more on basic disease awareness than on the comprehensive clinical and genetic implications of sickle cell disease.\u003c/p\u003e \u003cp\u003eAdditionally, our study indicated that female participants were significantly more likely to possess good knowledge of sickle cell disease than their male counterparts. This finding aligns with a study by Okolue et al. (2019) in Nigeria, which also found that females demonstrated better knowledge of SCD and that married individuals had more awareness than unmarried ones [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This trend may be attributed to the fact that women tend to engage more with reproductive and preventive health information due to their perceived caregiving and childbearing roles. Moreover, residence in Buea was strongly associated with higher levels of knowledge, likely reflecting better access to universities, health facilities, and health promotion activities in this urban setting, as reported in a study conducted by Momore et al. (2025) in Ghana [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Furthermore, although overall knowledge levels were high, only slightly more than half of the participants demonstrated a positive attitude toward sickle cell disease (SCD). This finding is consistent with a study conducted by Oluwadamilola et al. (2021) in Nigeria, in which 65% of respondents reported positive attitudes toward SCD [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This may be explained by the fact that attitudes toward genetic conditions are shaped not only by knowledge, but also by deeply rooted cultural beliefs, social norms, and stigma, which continue to play a significant role in influencing perceptions and attitudes in many African societies [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, attitudes toward reproductive options revealed contrasting patterns. While many participants reported actively avoiding having children with SCD or sickle cell trait, there was a notable reluctance to consider assisted reproductive technologies or adoption. Similar findings have been reported in studies conducted in Nigeria and Cameroon, where strong cultural expectations surrounding biological parenthood, lineage, and inheritance continue to influence reproductive decision [\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePartner genotype also emerged as a key determinant of reproductive decisions. A high proportion of participants (76.3%) indicated that a partner\u0026rsquo;s genotype would influence their decision to marry, and more than two-thirds reported that it would affect their decision to have children. These findings align with those of Schultz et al. (2020), who reported that genotype compatibility is increasingly considered during partner selection, particularly among educated youth populations [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Additionally, religion was independently associated with genotype-based marriage decisions, likely reflecting the influence of church-mandated premarital counselling practices. Participants reporting multiple sexual partners were more likely to consider genotype compatibility in marriage decisions, possibly due to increased risk perception and greater exposure to sexual and reproductive health information [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study further revealed that educational level was the only sociodemographic factor independently associated with attitudes toward sickle cell disease. Participants with tertiary education demonstrated significantly more positive attitudes compared to those with secondary education. Interestingly, although the majority of participants expressed a willingness to undergo premarital counselling, findings from Sarpong et al. (2025) highlight a critical gap between intention and practice. In their study, only 15.4% of respondents demonstrated good knowledge of premarital carrier screening (PMCS), while just 14.1% reported positive PMCS practices [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Notably, tertiary education and marital status were significant predictors of both adequate knowledge and positive practices.\u003c/p\u003e \u003cp\u003eThis discrepancy mirrors findings from multiple studies across Africa, suggesting that barriers such as fear of stigma, potential relationship conflicts, and concerns about social rejection may hinder the uptake of premarital carrier screening, despite expressed willingness to seek counselling. Addressing these barriers is essential to improving knowledge, attitudes, and practices related to sickle cell disease prevention and management.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe prevalence of the sickle cell trait among youths in the Fako Division was 12.3%, with most participants having the AA genotype. Overall knowledge of sickle cell disease was high (83.0%) and was significantly associated with female sex, residence in Buea, Christian affiliation, and not having children. A partner\u0026rsquo;s genotype influenced marriage decisions for 76.3% of respondents, while religion, having multiple sexual partners, and willingness to request a partner\u0026rsquo;s genotype were independent predictors of using genotype information when deciding to marry; similarly, 68.3% reported that a partner\u0026rsquo;s genotype influenced decisions about having children. Despite this relatively high level of awareness, important gaps persist, as 57.3% of participants did not know their own genotype, 47.3% were unaware of their partner\u0026rsquo;s genotype, and 40.0% were uncertain about decisions concerning an unborn child with sickle cell disease. These findings highlight the need to improve access to and uptake of genotype testing among young people, potentially through routine screening at secondary and tertiary institutions, alongside targeted educational interventions for groups with lower knowledge, such as males, youths living outside Buea, and those who already have children. Strengthening premarital counselling and promoting open partner discussions around genotype status may further support informed marital and reproductive decision-making and contribute to reducing the risk of having children affected by sickle cell disease.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAdjusted Odds Ratio (aOR), Confidence Interval (CI), Odds Ratio (OR), Sickle Cell Anaemia (SCA), Sickle cell disease (SCD), Sickle Cell Trait (SCT), World Health Organization (WHO).\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthical approval was obtained from the Institutional Review Board of the Faculty of Health Sciences, University of Buea (ID 2020 \u0026ndash; 1095 \u0026ndash; 01 / UB / SG / IRB / FHS) and administrative authorization was gotten from the Regional Delegation of Public Health for the Southwest Region (344/MPH/SWR/RHL /DO). All participants whose responses are included in the dataset had given their Informed Consent to Participate at the start of the questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBeatrice, Junior, Achu, Mbabit and Tsi Nde Fon, Paul Enongene Ngang, Mbolle Sylvia, Hilda Enongene, Stephane Mabouna, Collins Fonsho, Ayisha Rilindis, Njang Emmanuel, Nkengeh Dave.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSurvey data were not accessible to participants at participating Health Centres. Responses were transmitted electronically to Google Sheets linked to the project lead\u0026rsquo;s account and subsequently exported to GitHub for secure storage. Access to the dataset was restricted to the study statistician for analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCollaborative group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHERO Cameroon, Publish \u0026amp; Thrive Network.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN.N.F, P.N.F, A.N and D.M participated in the study design. \u0026nbsp;N.N.F oversaw pilot testing and data collection. N.N.F, P.N.F, S.N, A.N and D.M contributed to the writing and review of the manuscript and approved the final version. N.N.F and S.N assisted in statistical analysis and interpretation of results. N.N.F had overall responsibility for the study design, overseeing survey distribution and interpretation of results.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed in this study are not publicly available due to institutional regulations but can be obtained from the corresponding author upon reasonable request. All data access requests will be subject to review by the Ethics Committee of the Cameroonian Ministry of \u0026nbsp;and the Regional Ethics Committee for Human Health Research for the South west Region, Institutional Review Board of the Department of Medicine, Faculty of Health Science, University of Buea, to ensure adherence to ethical and legal requirements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eDepartment of Medicine, Faculty of Health Sciences, University of Buea, South West Region, Cameroon.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eSolidarity Hospital, Buea, South West Region, Cameroon.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003eDepartment of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, South West Region, Cameroon,\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e4\u003c/sup\u003eHaematology and Blood Transfusion Service, Yaounde University Teaching Hospital, Yaounde, Cameroon.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e5\u003c/sup\u003eFaculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eModell B, Darlison M. 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Open Journal of Obstetrics and Gynecology, 4, 1065-1071. doi: 10.4236/ojog.2014.416146. \u003c/li\u003e\n\u003cli\u003eSchultz CL, Tchume-Johnson T, Jackson T, Enninful-Eghan H, Schapira MM, Smith-Whitley K. Reproductive intentions in mothers of young children with sickle cell disease. Pediatr Blood Cancer. 2020 May;67(5):e28227. doi: 10.1002/pbc.28227. Epub 2020 Feb 17. PMID: 32065500.\u003c/li\u003e\n\u003cli\u003eBadedi M, Muidh A, Alsayed M, Darraj H, Shubaili A, Darraj A, Hobani Y, Ahmadini M, Hakami I, Gharawi N, Hakami M, Shrwani K, Malhan N, Mokali A, Abdaly A. Factors affecting marriage decisions among couples with sickle cell or beta-thalassemia traits. J Taibah Univ Med Sci. 2025 Sep 8;20(5):622-628. doi: 10.1016/j.jtumed.2025.08.003. PMID: 40989578; PMCID: PMC12452585.\u003c/li\u003e\n\u003cli\u003eSarpong ML, Tetteh RJ, Amponsah FA, Amo-Kodieh P, Owusu EA, Ntiamoah P, Pillay JD, Kuupiel D. 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PMID: 40346681; PMCID: PMC12063372\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Prevalence, Sickle Cell Trait, Haemoglobin genotype, Knowledge, Reproductive decision","lastPublishedDoi":"10.21203/rs.3.rs-8864587/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8864587/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eSickle cell disease is a major inherited condition in sub-Saharan Africa, and the sickle cell trait continues to shape reproductive choices among young adults. This study assessed the prevalence of the sickle cell trait among youths in the Fako Division and identified factors influencing knowledge and reproductive decisions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A hospital cross-sectional study was carried out from January to April 2020 among 300 youths aged 18–40 years in Buea, Limbe, and Tiko. Data were collected using a structured questionnaire that captured sociodemographic characteristics, knowledge of sickle cell disease and trait, behaviour, attitude and reproductive intentions. Haemoglobin electrophoresis was performed to determine genotype status. Descriptive statistics were computed, and logistic regression analyses were used to identify factors independently associated with good knowledge and marriage decisions based on genotype with statistical significance at p\u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Among 640 participants who were screened for sickle cell trait, 300 consented to respond to the structured questionnaire. The prevalence of sickle cell trait (AS) was 12.3% (79/640). From the 300 participants who responded, 83.0% (249/300) demonstrated good knowledge of sickle cell disease, only 42.7% (128/300) were aware of their genotype, and 18.7% (56/300) knew their partner's. A significant 76.3% (229/300) indicated that a partner's genotype would affect their marriage decision, while 68.3% (205/300) reported it would influence childbearing choices. Predictors of good knowledge were female sex (aOR: 2.39; 95% CI: 1.17–4.86), residence in Buea (aOR: 7.24; 95% CI: 2.27–23.16), Christian faith (aOR: 10.57; 95% CI: 1.22–91.83), and not having children (aOR: 2.44; 95% CI: 1.09–5.47). Decisions to marry based on genotype were significantly more likely among Christians (aOR: 11.44; 95% CI: 1.01–19.95) and among individuals reporting more than one sexual partner (aOR: 2.04; 95% CI: 1.09–3.81).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e One in ten youths in Fako carries the sickle cell trait. Despite high awareness, many lacked personal or partner genotype knowledge. Partner genotype influenced reproductive decisions, highlighting the need for improved screening initiatives, premarital counselling, and timely education for sickle cell disease prevention.\u003c/p\u003e","manuscriptTitle":"The Sickle Cell Trait and Reproductive Decisions Among Youths in the Fako Division of Cameroon","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-16 07:00:22","doi":"10.21203/rs.3.rs-8864587/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-17T05:43:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-17T04:35:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-17T04:33:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-02-12T17:16:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a677c03e-f0ad-4523-892c-c6de313a93e5","owner":[],"postedDate":"February 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-17T08:30:24+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-16 07:00:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8864587","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8864587","identity":"rs-8864587","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}