1. Prof. Laila kamel

2. Premarital Care & Counseling (PMCC)
Prof. Laila Kamel
Professor of Public Health & Community Medicine
Cairo University
Prof. Laila kamel

3. Some references
MOHP (2007); “Practice Guidelines for Family Physicians; Vol. 3
Premarital screening & Counseling
Prof. Laila kamel

4. Overview
Premarital care and counseling (PMCC) is a health promotion activity directed to each of the future couples to establish a healthy family raising a healthy future generation (Healthy marriage). This is also an opportunity to meet with a physician who can address any other health concerns before marriage.
Prof. Laila kamel

5. Health is a state of complete physical, mental, social and spiritual wellbeing not just the absence of disease or infirmity
Prof. Laila kamel

6. Healthy Marriage
Healthy marriage is defined as state of agreement and harmony between the marriage partners with regard to the healthy, psychological, sexual, social, and legislative aspects, aiming at making a sound family and begetting healthy, happy children.
Prof. Laila kamel

7. Overview (Cont.)
PMCC would prevent reproductive health hazards, sexual dysfunction, marital distress, divorce & family breakdown and it will allow people to enjoy life.
PMCC can help ensure that future couples have a strong, healthy relationship and a better chance for a stable and satisfying marriage.
Premarital counseling can help identifying weaknesses that could become bigger problems during marriage.
Prof. Laila kamel

8. Overview (Cont.)
In some countries premarital counseling is provided by licensed therapists known as marriage and family therapists. In Egypt Family Physicians is the key provider
Religious leaders can play an important role
Prof. Laila kamel

9. Background information
On 12 June 2008, a presidential decree regarding the Child Law was issued. The decree included two main articles, increasing the minimum age of marriage for males and females to 18 years, and the establishment of premarital testing and counseling as a precondition to issue a marriage certificate
Prof. Laila kamel

10. Background information (Cont.)
UNFPA was involved through supporting a steering committee on premarital examination.
The role of the committee was to come up with a draft of the components to be included in the premarital testing and counseling. 
Prof. Laila kamel

11. Background information (Cont.)
the committee recommended the following: 
Obligatory tests should include a complete blood picture, RH factor in the blood and urine analysis, whereas additional tests could be requested based on history taking, counseling and consent of the couple.
Prof. Laila kamel

12. Background information (Cont.)
Necessary vaccinations and supplementation should be taken by the couple, including Hepatitis B vaccine, Rubella vaccine and folic acid pills for the female.
Premarital counseling, to include counseling on such topics as nutrition, harmful behavior and misconceptions regarding sexual and reproductive health, married life and responsibilities of the married couple, intimate relations and budgeting for the family.
Prof. Laila kamel

13. By the end of this session we should have covered the following:
Value of premarital care
Premarital care package
Premarital counseling
Timing of PMCC
Components of premarital counseling
At-risk approach in PMCC
Genetic counseling
Prof. Laila kamel

14. Value of premarital care
Establish a healthy family
Prevent several medical and psychological problems
Prevention of genetic disorders and congenital anomalies
Promotion of a healthy life style for each of the couples, early detection and management of any health problems.
Prof. Laila kamel

15. Timing of PMCC
Conceptually premarital care extends from birth, throughout the premarital period. It is also affected by the health of the grandparents in a spiral life cycle continuum. By caring for the health of the present children and adolescents we are actually starting to provide care for the future generation.
In practice the specific service provided is the premarital examination which is now required by law.
Prof. Laila kamel

16. Timing (cont.)
School years: Mainly secondary school (May be late preparatory)
Just before marriage
Premarital care should be an essential part of primary and preventive care rather than an isolated visit.
Prof. Laila kamel

17. Who provides PMCC
As premarital care extends from birth, throughout the premarital period, the Primary Health Care / family physician is the main provider
Immediate pre-marriage mandatory examination to obtain the certificate required to register marriage is done in specified hospitals
Prof. Laila kamel

18. Premarital care package
Examination: clinical and basic investigations, referral as needed.
Vaccination and supplementation
Health education and counseling
Genetic counseling
The at-risk approach
Prof. Laila kamel

19. Premarital examination
Although the main concern in premarital examination is to diagnose and manage health problems related to marriage and reproduction, yet, it is a chance to provide full clinical assessment and to care for the individual in a total person approach.
Prof. Laila kamel

20. Premarital examination (Cont.)
Medical examination includes
Personal medical history / any specific concerns
Family history / consanguinity
Family pedigree
General and systematic examination
Laboratory investigations
Prof. Laila kamel

21. Laboratory investigations
Routine investigations
complete blood picture,
Rh factor in the blood
urine analysis
Additional tests could be requested based on history taking, counseling and consent of the couple. These may include VDRL, HIV, etc. Examination for thalassemia is now under consideration.
Prof. Laila kamel

22. Vaccination and supplementation
Rubella
HBV
Folic acid for females (to prevent neural tubal defect)
Prof. Laila kamel

23. Premarital counseling
Health education and counseling are key components of PMCC
What is the difference between HE and counseling?
Prof. Laila kamel

24. Health Education HE messages include Healthy life style
family life and reproductive health in general
Appropriate time for the first pregnancy and contraception
Importance of antenatal care visit early in pregnancy
Precautions to be taken in pregnancy e.g., to avoid taking any drugs or be exposed to other teratogens
Prof. Laila kamel

25. Healthy life style
Lifestyle is a way of living based on identifiable patterns of behaviour which are determined by the interplay between an individual's personal characteristics, social interactions, and socioeconomic and environmental living conditions

26. Healthy life style Healthy surroundings and housing Personal hygiene
Adequate diet and good nutrition
Physical exercise
Coping with stress
Avoid harmful practices as smoking, alcohol, violence, etc.
Accident and injury prevention
Preventive practices: immunization, early detection of disease, etc.

27. Adequate diet and good nutrition
Premarital education is a good chance to improve the feeding habits for the future family
Good nutrition education takes into consideration the socioeconomic level of the future couple
Food exchange lists should be discussed
Prof. Laila kamel

29. Premarital counseling
Counseling is geared to specific needs of individuals
It is directed to specific health problems, either related to the health of the individual him/herself, or to the expected offspring.
 Genetic counseling is an important form of premarital counseling
Counseling should end with an informed decision
Prof. Laila kamel

30. Genetic counseling
A specific form of counseling to advise the parents about the probabilities of having a congenital or hereditary disease. It is done either in the premarital period, or during inter-conceptual care, usually after having such a problem with the previous child. Genetic counseling include study of the pedigree (through family history for both partners), and chromosomal studies for cases that could be discovered through this technique.
Prof. Laila kamel

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Prof. Laila kamel
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