In Italy, a statistical investigation, led in 1994 by officials of the Ministry of the Health, has pointed out that in the various thalassaemic sources prevention levels ranging from 48 to 88% have been reached.
Among the data the complete cessation of new patients' births have emerged in the Ferrara province since almost a twenty-year period and since thirteen years in all provinces of Lazio.
In southern Sardinia and in Basilicata, the affected children' births are in progressive and very significant decrease. In Sicily, they are in decrease of 50%. In these thalassaemic areas, the plans of screening have usually had, as central intervention, screening of women in pregnancy or of couples in fertile age.
Prevention Program of the Mediterranean anaemia in action in Latium
In comparison to the interventions that have been set in different Italian regions, Lazio has effected a different and complete strategy of prevention based on a middle - long term plan including the analyses performed in youngers of the 1st level secondary schools and a plan with more immediate evidences including the specific analyses performed in the population in fertile age. Since years all this program has been realizing till now for the financing obtained by the region of Latium to the "Associazione Nazionale per la Lotta contro le Microcitemie in Italia" [http://www.anmi-microcitemie-roma.it/] (A.N.M.I.), working in this region.
Collaboration with schools
In 1975, a profitable collaboration has been started between the A.N.M.I. and the scholastic Institutes of Lazio allowing us to perform a vast screening among the students of the last year of 1st level secondary schools. During the year, the screening is also executed in the families of the thal carrier youngers and is completed by an intense work of information, of assistance and of genetic counselling explained to the youngers and to their families.
It is evident that this strategy essentially aims to allow the thal-carrier youngers, through a precocious identification and information, to freedom of preventive choice not only through prenatal diagnosis and abortion, but also and above all through the choice of a not thalassaemic partner.
Screening of the population in fertile age
A population screening in fertile age that need a differential diagnosis, as the women in pregnancy, is also executed with particular attention. In order to optimize this initiative the A.N.M.I collaborates with some Family Counsellors operating on the territory and with the Marriage Register Offices, suitable to give effective information.
Results of the preventive program in Lazio
During the last thirty years more than 90% of the thal-carrier youngers resident in Lazio have been identified, informed and assisted near the Genetic Counselling Service of the Center, obtaining the optimal result that since the beginning of 1993 there have not been more births of Mediterranean anaemia patients from unaware couples at risk.
Optimal and advantageous results have been reached at moral, social and also economic level. In fact, during the last thirty years, more than 300 of Mediterranean anaemia patients would have been born in Lazio that, today, would have a cost for the sanitary assistance superior than the annual cost of the prevention plan.
The prevention in the near future
The prevention plan that we are programming includes:
- the strategy continuation already effected for bringing up to date the information both at level of the Lazio's population and of the health care professionals;
- a specific plan organization in order to stimulate the sensitization regarding the problem list of the haemoglobinopathies in the extracommon populations having new residence in Lazio. This objective must be absolutely reached both to get a social and sanitary integration and to provide the complete useful news to the immigrants in order to allow them to a total freedom of choice based on their culture and religion.
Actual situation regarding the prevention in the world
Prevention programs of the Mediterranean anaemia have been started by the half of the 1980s in many thalassaemic areas. Preventive projects were born with similar plans to those carried out in Latium, in Greece and in Cyprus, obtaining excellent results with time. In Great Britain, Belgium and Holland similar plans are directed towards the information and the carrier identification in the immigrated populations by countries with high thalassaemic incidence.
Since the beginning of the 1990s the development of organic prevention programs through sanitary education, mass screening, genetic counselling and prenatal diagnosis have been intensified in all the thalassaemic areas. This has occurred in France and in several countries whose population is mainly of Muslim religion, such as Turkey, Egypt, Iran and Pakistan.
Also in Thailand since 1994, there is a preventive program that is essentially based on the identification of at-risk couples. This systematic plan of prevention has allowed a drastic reduction in the birth of affected newborns, although the widespread Buddism religion prohibits any interruption of life.
In India, where each year more than 6.000 newborns are affected with Mediterranean anaemia, since 1988 have been carried out 1500 prenatal diagnosis, mainly in couples with previously affected children. These exams have been performed with non-government funds.
The effectiveness of the prevention programs, that require the availability to the abortion, results scarce in the Afro-Americans. Therefore, a different approach is necessary to allow to the at-risk couples of knowing their condition before procreation. So, it emerges the indication of preceding the programme by a suitable sanitary education intervention and of offering a genetic counselling, according to the more appropriate modalities for each ethnic group.
