Knowledge regarding consanguineous marriage and it effects on pregnancy outcome among the adolescents of village in Bagalakote district

Introduction

In India, marriages are considered as the most important ritual and social institution, which establish a strong relationship between two families. Most of the marriages in India are arranged by the parents because it is considered as the success rates of these marriages are high. Especially in rural areas of south India consanguineous marriage are widely in practice and it is still a huge challenge¹. Parents only consider the benefits of consanguineous marriage but they neglect the consequences.

According to Bittel (2005) “a consanguineous marriage is defined as a union between two individuals who are related as second cousins or closer, with the inbreeding coefficient (F) equal or higher than 0.0156, where (F) represents a measure of the proportion of loci at which the offspring of a consanguineous union is expected to inherit identical gene copies from both parents".1, 2, 3, 4

Globally, in some countries like Western Europe, North America, Australia, and Russian societies consanguineous marriage is lesser than 1%. In societies of the Iberian Peninsula, Japan, South American countries the consanguineous marriages are about 1 to 10% of all marriages and comparatively consanguineous marriages are more in countries like Iran, India, Sub Saharan Africa, Central and South Asia i.e. about 20%-50% of all marriages.3, 5, 4

Consanguinity is seen widely practised in South India than in Northern India.1, 2, 3, 5, 4 It is practised in Muslims, Hindus, Buddhism and Parsi religions, however in Christianity it is considered as taboo. Again, different religions follow the different types of consanguinity or degree of consanguinity according to their tradition.4 In Islam religion marriages between a man and his father's brother’s daughter which is first cousin marriage are accepted, however they oppose the marriage between man and mother’s brother’s daughter. Where as in Hindu’s it is vice versa, they prefer marriages between a man and a mother's brother daughter pattern of first-cousinmarriage.1, 2, 3, 5, 4

Genuine reason for consanguineous marriage in the community is primarily social and cultural.2, 3, 6 Several social studies indicated that reasons for consanguinity are: Stability in marriage due to high Compatibility between husband, wife, and between couples and Family. Who shares the same social relationship before the marriage and after the marriage, it is considered favorable for Status of women who will have a better relationship with her in-laws, reduces the possibility of a hidden uncertainty in health and financial issues, strengthens the financial ties and provides solidarity. It helps in transmission of cultural values and cultural continuity. It reduces the burden of a dowry or less costly marriages and also to avoid the “Dowry Death”.5 Girl's parents prefer to have their daughter living near them and to enjoy the presence of their grandchildren, and lastly the family wants to keep their wealth or property within the family.1, 2, 3, 6

Socially, consanguineous marriages may provide strength to relationships, the economic condition in families.3, 5 But many health-care providers and genetic scientists consider consanguineous marriage as the risk to health.2, 4 The major risk of consanguineous marriage is increasing genetic disorder of the offspring.3, 5, 4, 6, 7 Due to the expression of Autosomal recessive genetic mutation inherited from common ancestors, the children born by the consanguineous union are at increased risk for the recessive disorder and other congenital disorders like Neural tube defect, congenital heart disease, recessive hearing loss disorder, retrieval dystrophies.2, 3, 6, 7, 8 However, because of less or no national or state-level data for all genetic disorders makes the derivation of credible prevalence rates virtually impossible.3 Studies state there is a significant association between consanguineous marriage and cystic fibrosis, Alzheimer’s disease1. Previous studies show that in consanguineous marriage, fertility rates are high.1, 2, 4

As populations progress in economic terms, there is a significant increase in the total burden of disease increase with the upgraded treatment of formerly lethal genetic disorders placing an ever-increasing demand on family resources.1, 3 In the current situation, probably because of urbanization and trending nuclear family patterns, consanguineous marriage in urban areas may be less in numbers.2, 6 However, it remains culturally a major shift in the balance between social and economic benefits associated with the consanguineous marriage and health consequences which can be attributed to the effectiveness of a community education program and increased level of education and awareness among urban population regarding the consequences of consanguinity.1, 3, 9 Previous studies conducted to assess the knowledge regarding consanguineous and its effects among youth of Iran10 and Turkey indicated that youth had very poor knowledge and negative attitude toward consanguineous marriage.11

Many studies reports that consanguine­ous marriage do take place in younger ages, in comparison with non-consanguineous marriage.7, 9 It has been demonstrated that this can result in lower maternal age at first child-birth, higher pregnancy-related risk, and higher number of children.1, 2, 3, 5, 4, 6

Hence, the aim of present study was to assess the knowledge about consanguineous marriage and its effect on pregnancy outcome and to investigate the effect of structured teaching program on high school students' knowledge.

Materials and Methods

The present interventional cross-sectional study was conducted in government high school in rural village of Nagur, Bagalkot District, Karnataka. Complete enumeration of the students in the village studying in the high school was done. Total 121 students participated in survey. Pre-tested structured questionnaire was used to collect data from the students and questionnaire was translated in to Kannada language for their easy understanding. For intervention, lecture method with PowerPoint presentation was adopted. To assess the knowledge after intervention immediate post-test results were collected and to assess the retained knowledge follow up test was conducted after 2 months of intervention with the same questionnaire. Before collecting data, informed consent was taken from their parents, school authorities and from respondents. The questionnaire included three parts first socio-demographic information, second knowledge regarding consanguineous marriage and consisted questions like meaning of consanguineous marriage and types of consanguineous marriage, third part consisted of effects of consanguineous marriage on women’s health, children’s health, association with certain disorder like deafness etc. Statistical analysis was done using IBM SPSS 26^th version. Simple frequency distribution was used for socio-demographic data. Inferential statistics were performed by marginal homogeneity test to assess the knowledge after intervention. P value less than 0.05 was considered significant.

Results

Socio-demographic findings- Among 121 respondents 56.20% students were in the age of 15 years, 40.50% and 3.31% were in the age group of 14 and 13 years respectively. 59.5% were female and 40.5% were male. Most of them 62.8% were studying in 9^th standard 36.6% were in 10^th standard. Majority 97.5% students belonged to Hindu religion. 48.8% and 52.9% of respondent’s father’s and mother’s education was till primary school respectively. 69.2% and 43.8% of respondents reported that their fathers’ occupation was daily wager and mother’s occupation was farmer respectively. 52.1% of respondents were living in joint family.

Knowledge of respondents regarding consanguineous marriage before intervention, immediately after intervention and after two months of intervention.

Before intervention only 42% of respondents knew the true meaning of Consanguineous marriage i.e marriage between two family member who are second cousin or closer than them. Significant association was found in knowledge about true meaning and types of consanguineous marriage (P=0), immediately after intervention and after 2 months of intervention.

Discussion

In rural areas of India, consanguineous marriages are culturally accepted, socially benefited and these marriage alliances are fixed by the elders of the family, before the children attain the legal age to get married. Lack of knowledge and awareness regarding the consequences of consanguineous marriage on health is a major predictor for the increasing number of consanguineous marriages in the rural area of South India.12 Because of consanguineous marriage the load of genetic disorder in community becomes relatively high.

Hence, the present school-based study to assess the knowledge regarding consanguineous marriage and its effect on pregnancy outcomes was done for the first time among young adolescents aged 13-15 in the rural areas of South India. The present study highlighted the effectiveness of structured teaching program to improve the knowledge among adolescents. There are no previous studies done among young adolescents of aged 13-15 years.

The overall results of the present study show that the initial knowledge of students on consanguineous marriage and its effect was low. Taking consideration of age and other social aspect very superficial knowledge was given through the PPT presentation. A significant level of knowledge increased among the students after the education program. This result was expected because immediately after intervention students recalling capacity likely to be high. Hence, to assess the retention knowledge among students follow up test was conducted after 2 months. At follow up, results showed that in few categories significant level was observed. It could be because educational program was conducted only once. Hence this result can be attributed to that.

This study demonstrated initially, students had poor knowledge regarding consanguineous marriage (42%) and its types (14%), even though majority (72.7%) of students heard the word consanguinity. Pre-test results also showed that school students had a low level of knowledge about the effects of consanguineous marriage on pregnancy outcomes. 28.9% and 39.7% of students thought that there is no effect on women’s and children’s health because of consanguineous marriage.

Conclusion

The present study showed that school students had low level of knowledge regarding consanguineous marriage and its effects on pregnancy outcome before the educational program. And results also showed that, structured teaching education program about consanguineous marriage increased the students’ knowledge about the topic. Hence, more such educational program should be planned in the schools to educate adolescents about consequences of consanguineous marriage and these educational programs should be performed community level more focusing on problems associated with consanguineous marriage and genetic disorders. However, while performing these educational programs among young adults, should consider all the limits to transfer the knowledge regarding consanguineous marriage and also social aspects.

Financial support & Sponsorship

Self-sponsored

Conflict of Interest

The authors declare that they have no conflict of interests

Acknowledgement

Authors are grateful to all participants who participated in this study.