title: Effectiveness of antenatal screening for sickle cell trait: the impact on women's self-report of sickle cell trait status.
abstract: OBJECTIVE
  The sickle gene frequency in the Jamaican population has not changed over a generation. It is unknown whether routine antenatal screening for sickle cell trait (SCT) has affected women's knowledge of their SCT status. The aim of this study  was to compare the prevalence of self-reported SCT in parous women to the prevalence in nulliparous women, men and to the observed prevalence of SCT measured in an antenatal clinic.
  
  
  METHODS
  All participants in the nationally representative Jamaica Health and Lifestyle Survey 2008  were asked whether they had the SCT. The impact of gender, age, educational attainment, geographical location, and pregnancy on self-reported SCT were assessed. The prevalence of SCT in women attending a large antenatal clinic concurrently was compared to that reported by women of child-bearing  age in the lifestyle survey.
  
  
  RESULTS
  Self-report significantly underestimated the prevalence of SCT (2·9% versus 10·1%, P<0·001). Those with secondary education were more likely than those with presecondary education (P = 0·01)  and women more likely than men (3·2% versus 1·1%, P = 0·001) to report having SCT. Women who had been pregnant were no more likely than other women to report having SCT (3·1% versus 4·1%, P = 0·4).
  
  
  CONCLUSIONS
  Attendance at antenatal clinic where SCT screening is routine, is not associated with increased self-report of SCT. Screening programs must ensure that, as well as technically accurate screening, there is effective communication of the results of screening for SCT to those tested to help reduce  the public health burden of sickle cell disease in tropical countries.
authors.affiliation: Sickle Cell Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Jamaica. jennifer.knightmadden@uwimona.edu.jm
authors.forename: J M
authors.initials: JM
authors.lastname: Knight-Madden
authors.forename: M
authors.initials: M
authors.lastname: Reid
authors.forename: N
authors.initials: N
authors.lastname: Younger
authors.forename: D
authors.initials: D
authors.lastname: Francis
authors.forename: S
authors.initials: S
authors.lastname: McFarlane
authors.forename: R
authors.initials: R
authors.lastname: Wilks
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D007563:Jamaica / Q000453:epidemiology; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010298:Parity; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis / Q000453:epidemiology; D011296:Prenatal Diagnosis / Q000379:methods*; D015995:Prevalence; D057566:Self Report; D012805:Sickle Cell Trait / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult