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I am blood group O+…will you marry me?

Reproductive Health

Before marrying, Kenyans check out all manner of qualities. Some men consider looks, smile, fidelity, sexual compatibility, compassion, respect, size of butt as well as boobs. Women size up intelligence, kindness, generosity, virility, sense of humour and whether the wallet can be mistaken for a bible - but not necessarily in that order.

Other attributes which can melt mountains include religion, ethnic extraction, attitude towards money, occupation, in-laws and family history. But rarely do couples consider each other’s medical history beyond HIV status, sometimes with sickly consequences, mostly from hereditary diseases, cases of mental illness, incompatible blood disorders, cyst fibrosis and genetic nerve disorders.

 Graphics: The Standard.

Take Kevine Odunga. She married George Odunga in 1997 and the couple was shortly thereafter blessed with a baby girl who six months later began suffering from persistent malaria and severe pain. Her body would turn pale. The baby was diagnosed with sickle cell anemia, but was electrocuted and died in 2006.

But her second baby also had sickle cell. “My heart was heavy and I would spend sleepless nights crying, as I was in denial.” 

Before their marriage, the Odungas did not know they were sickle cell carriers and “if only I knew my husband was a sickle cell carrier, I would never have  married him,” says Kevine. “This disease is painful. I grew up seeing children struggle and would not want to have such an encounter.”

Bad omen

Though the Odungas are healthy carriers and do not suffer from the disease, managing sickle cell is financially draining. “My daughter must use drugs, if not the pain is unbearable.”

About Sh15,000 goes to treatment besides proper diet supplemented with folic acid, hydroxyurea and paludrine. The daughter also has monthly blood transfusions.

Dr Jemimah Kamano, an endocrinologist (hormone specialist) and chronic disease researcher says couples with hereditary diseases should undergo counselling besides genetic assessment for possibility of transmission to their children.

“It is a nightmare to raise a child with sickle cell disease with the only hope of cure being bone marrow transplant,” says the lecturer at Moi University’s School of Medicine. “It is important to create public awareness of hereditary and lifestyle diseases.”

Seline Museka and her husband from Naivasha town are also carriers and of their four children,  three have been deformed by sickle cell. The eldest has undergone hip replacement, the second born is scheduled for the same while the third born has a ‘silent’ hip.

“At times I am viewed as a bad omen who brought a curse to the family,” offers Museka whose first born died at Matayos hospital after developing fever. “My husband is our pillar, but he’s at times in denial and he, too, accuses me of having the disease.”

Their second and third borns were later diagnosed with sickle cell. They experience low oxygen and low blood levels and dehydration when in deep pain.

“Blood transfusion is a must whenever blood level drops below five pints,” says Museka, and each of her children require Sh4,000 to manage the condition.

 Couples rarely consider each other’s blood groups which are inherited. They can either be A, B, AB or O positive or negative. [Courtesy]

Besides sickle cell, Dr Kamano singles out cystic fibrosis, hemophilia, and muscular dystrophy as the other hereditary diseases carried by parents through genes although others like cancer, diabetes, hypertension, heart diseases and obesity are triggered by lifestyle choices.

“Purely hereditary diseases,” she says, “are almost 100 per cent transmissible once the genes are passed on unlike lifestyle ones like diabetes, where even if a parent is diabetic, it is not necessarily that the child will get the disease if they make better lifestyle choices.”

In choosing future spouses, a partner’s community comes into play considering that hereditary diseases like sickle cell are prevalent in Western, Nyanza and the Rift Valley and thus likely to be found among the Luo, Luhya and Nandi communities. Thus gene screening and testing before getting into a serious relationship leading to marriage is vital besides picking spouses from other ethnic groups to dilute the ‘gene pool.’

Kamano reckons that “parties with sickle cell should make tough decisions if they need babies, or can use IVF, or adopt children to avoid passing the genes to their children because it is painful and expensive to raise children with full blown sickle cell and have reduced life span.”

Kamano noted that genetic screening is difficult for diseases with both hereditary and lifestyle causes as multiple changes predispose people to them and that “for diseases like heart, diabetes and hypertension, partners can adapt to a healthy lifestyle rather than checking for gene”.

Though Museka has accepted her condition, she advocates for counselling to avoid blame games. In retrospect, she says  “I would have handled my condition better if I knew about sickle cell and how it affects children”.

For the Odungas, “we vowed to undertake family planning,” says Kevine after a doctor advised how expensive it would have been raising more children with the condition. She now gives talks in churches, villages and market places to create awareness about sickle cell, which alongside cystic fibrosis, Tay-Sachs disease (TSD), hemophilia, Huntington’s Disease and Muscular Dystrophy are the six commonest hereditary diseases.

Blood group

Something else: Couples rarely consider each other’s blood groups which are inherited. They can either be A, B, AB or O positive or negative.

Blood groups are not a big issue for couples not intent on raising children, but quite vital for those intending to have them, according to Geoffrey Kakai, a medical immunologist and lecturer at Egerton University.

Dr Kakai explains that Rhesus factor is related to protein on red blood cells. If there are proteins one is Rhesus positive and vice versa.

When couples get married without checking their Rhesus factors, it can lead to ‘rhesus incompatibility.’ A woman with a Rhesus factor negative blood group marrying a man a with a Rhesus positive blood group results in the birth of a ‘rhesus incompatible child.’

Unchecked, these incompatible blood groups can lead to miscarriages and neonatal deaths from Hemolytic disease.

Kakai elaborates that “antibodies of a woman with rhesus pass through the placenta to the baby, and from a process of reaction, the baby may die during pregnancy. If they survive, they will have a lot of damage on the liver and eventually they can die.”

In subsequent pregnancies, the mother can also die, with some developing ectopic pregnancy. To avoid fatalities and health complications, pregnant women are screened during antenatal clinics. But Kakai say the number of women with negative rhesus is not a major issue as out of 100, only 15 per cent will be rhesus negative, of which only one per cent will have rhesus complications.

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