PESHAWAR: Experts have proposed the government to simplify the pre-marriage screening model for would-be couples and free availability of chorionic villus sampling (CVS) test to contain the spread of thalassaemia in the province.

Officials said the Khyber Pakhtunkhwa Health Preventive Act was enforced in 2009 to control thalassaemia and hepatitis but it remained far from being implemented, mainly because the High-Performance Liquid Chromatography (HPLC) test costs Rs2,500 and has just six machines in the province, including Peshawar, Swat and Abbottabad.

They said about 200,000 marriages took place every year in Khyber Pakhtunkhwa, suggesting 400,000 HPLC tests annually, costing about Rs1 billion.

Haematologist Prof Yasar Mehmood Yousafzai, of the Institute of Pathology and Diagnostic Medicine of the Khyber Medical University, has requested the health department to adopt a practical model to achieve the important public health goal and safeguard people against avoidable suffering, repeated transfusions and lifelong treatment.

In a letter, he said success of the screening programme depended on scientific design, affordability and feasibility but making HPLC, an advanced haemoglobin analysis test, compulsory for every hopeful couple would be an expensive and restrictive business.

“In public health practice, the first step should be a simple and accessible screening test, while more expensive confirmatory testing should be reserved for those who actually need it,” he noted.

The expert said complete blood count (CBC) should be adopted as the first-line screening test for all prospective couples, with HPLC reserved for those whose CBC shows microcytosis, low mean corpuscular haemoglobin (MCH), anaemia or other suspicious red-cell indices.

He added that CBC-based first-line premarital screening was expected to identify the overwhelming majority of clinically relevant beta-thalassaemia carriers.

“A small minority of silent carriers may have near-normal or normal red-cell indices and therefore escape first-line detection, but such cases are uncommon.”

Dr Yasar, who is also director of the Public Health Reference Laboratory, said that the likelihood of both partners being undetected silent carriers was exceptionally low in the general population, though this risk might be relatively higher in communities with consanguineous marriage patterns.

He said CBC was far cheaper than HPLC and was available at many peripheral facilities whereas making the latter compulsory for the entire province would require substantial investment not only in equipment, but also in recurring costs, like reagents, calibrators, maintenance contracts, technical human resource, validation, external quality assurance and uninterrupted supply chains.

“It would take considerable time to establish a reliable province-wide HPLC network and if implementation is rushed without adequate public-sector readiness, the burden will shift to the private sector, with predictable risks of high cost, variable quality and chorionic villus superficial compliance,” he insisted.

The expert said a screening programme must also be acceptable to the public brcause if couples were forced to travel long distances, pay high charges and wait for reports from a few urban centres, compliance would suffer.

He said an accessible CBC-first model would likely achieve better uptake, trust and public cooperation than an HPLC-only approach.

Prof Yasar called for the adoption of a simple model under which CBC is meant for all, HPLC for “abnormal or equivocal cases”, and partner testing for one individual who is a confirmed carrier.

He said the government should act before an important preventive measure becomes an administrative and financial burden.

Chairman of the Hamza Foundation Ijaz Ali said the province had around 50,000 thalassaemia patients.

“We are still registering two or three new patients every month which is proof that the law isn’t implemented,” he said.

According to Ali, there is no diagnostic facility to detect thalassaemia major in foetus through sampling (CVS) test, so thalassaemia-hit mothers are sent to Rawalpindi for the testing, which costs around Rs20,000.

He said Punjab had already implemented the law about eradication of thalassaemia and providing all services free of charge.

“We have facilitated abortion of 129 babies with thalassaemia major diagnosed during CVS test in the last one year and if this test is made free, we will be able to prevent birth of thalassaemia children,” he said.

Published in Dawn, April 21st, 2026