Genetic Disorders Caused by Consanguineous Marriage in Radfan Districts – Yemen

Genetic Disorders Caused by Consanguineous Marriage in Radfan Districts – Yemen | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Genetic Disorders Caused by Consanguineous Marriage in Radfan Districts – Yemen Mansour Abdulnabi, Naif Taleb Ali, Radfan Saleh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7141559/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Dec, 2025 Read the published version in BMC Medical Genomics → Version 1 posted 12 You are reading this latest preprint version Abstract Background Consanguineous marriage (≥ second cousins) is prevalent in Yemen (40–50%) and linked to increased genetic disorders. This study assesses its prevalence and health impacts in Radfan districts. Methodology A 2024 cross-sectional study of 1,065 randomly selected households. Data were collected via validated questionnaires supplemented by medical records where available. Analyses included consanguinity rates, inbreeding coefficients (F), sociocultural factors, and clinically validated genetic disorders. Statistical analysis employed χ² tests, multivariable logistic regression (adjusted ORs), and Cohen’s d for effect sizes. Results Consanguinity rate was 57.46%, higher in rural (37.09%) vs. urban areas (20.38%). University-educated wives had 71.9% lower consanguinity (adjusted OR = 0.28; 95% CI: 0.18–0.44). Adverse outcomes: abortion (26.67%), child mortality (adjusted OR = 3.1; 95% CI: 2.4–4.0), blood disorders (4.23%, 87% hemoglobinopathies), and disabilities (4.98%). Mean inbreeding coefficient F = 0.0625 (first-cousin equivalent). Conclusions High consanguinity directly increases genetic disorder burden. Urgent interventions: mandatory premarital screening for hemoglobinopathies, community-genetic literacy programs, and economic incentives for non-consanguineous marriages. Consanguineous marriage Genetic disorders Inbreeding coefficient (F) Child mortality Hemoglobinopathies Yemen Premarital screening Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Consanguineous marriages, defined as unions between individuals who are related as second cousins or closer, have been a long-standing tradition in many parts of the world, particularly in the Middle East, North Africa, and parts of Asia [ 1 ]. This practice is deeply rooted in socio-cultural factors, including the maintenance of family structure, preservation of property, ease of marital arrangements, and perceived stability of such unions [ 2 ]. However, the genetic implications of consanguinity are a significant public health concern. When closely related individuals reproduce, there is an elevated likelihood that their offspring will inherit two copies of the same recessive gene from a common ancestor, leading to the manifestation of autosomal recessive disorders [ 3 ]. Yemen, like many other countries in the Middle East, exhibits a high prevalence of consanguineous marriages. Studies have reported consanguinity rates in Yemen ranging from 40–50%, with first-cousin marriages accounting for a substantial proportion of these unions [ 4 , 5 ]. This demographic pattern contributes to a higher incidence of various genetic diseases within the population compared to non-consanguineous communities [ 6 , 7 ]. For instance, conditions such as Down syndrome, hemoglobinopathies, and multifactorial conditions like congenital malformations have been reported to occur more frequently in regions with high consanguinity rates [ 8 , 9 ]. The current study focuses on the Radfan districts of Yemen, an area where consanguineous marriages are widespread, leading to a noticeable prevalence of related health issues. The primary objectives of this research are threefold: (1) to ascertain the precise prevalence of consanguineous marriages among the population in Radfan districts, Lahj Governorate; (2) to analyze the incidence rate of consanguineous marriage, calculate the average 'inbreeding coefficient,' and investigate the influence of social and cultural factors on consanguinity within the Yemeni context; and (3) to explore the potential effects of parental consanguinity on the occurrence of common genetic disorders in the Radfan districts. By addressing these objectives, this study aims to provide critical insights into the health risks associated with consanguineous marriages in the region and to inform public health strategies aimed at mitigating these risks. The primary objectives of this research are: (1) To ascertain consanguinity prevalence in Radfan districts; (2) To calculate inbreeding coefficients (F) and analyze sociocultural predictors (including spousal education); (3) To quantify associations between consanguinity and genetic disorders using comparative statistical models. This study provides evidence for public health strategies to mitigate genetic risks in Yemen. Materials and Methods Study Design and Population This cross-sectional study was conducted in the Radfan districts of Yemen during mid-2024. The study aimed to gather data on couples married over the preceding decades, with a focus on recent marriages to ensure more accurate recall of genealogical information. The target population included husbands and/or wives residing in randomly selected households within the Radfan districts. In this study, 1065 families were studied. These households were grouped into thirteen large geographic zones based on population density, with smaller zones aggregated into adjacent larger ones to facilitate data collection. Data Collection Data were collected by trained field interviewers using a pre-validated questionnaire. Medical records (where available) and clinical examinations by collaborating physicians were used to verify reported genetic disorders, abortions, and child mortality. For child mortality, neonatal (≤28 days) and post-neonatal deaths were differentiated, and death certificates/hospital records were prioritized. Operational Definitions: - Blood disorders: Clinically confirmed hemoglobinopathies (thalassemia, sickle cell). - Disabilities: Physical/cognitive impairments diagnosed by healthcare providers. - Child mortality: Death before age 5, verified via death certificates. Statistical Analysis Data were analyzed using SPSS v28.0 and R v4.3.1. - Odds ratios (OR) with 95% CIs compared outcomes between consanguineous/non-consanguineous families. - Inbreeding coefficients: F = Σ (1/2)^(n+1). where n represents degree of relatedness: - n = 1 for first-degree relatives (F = 0.25) - n = 2 for first cousins (F = 0.125) - n = 3 for second cousins (F = 0.0625) - Multivariable logistic regression controlled for residence, education, age, and income. - Effect sizes: Cohen’s d (continuous), Cramer’s V (categorical). - Sensitivity analyses excluded unverified cases. Results This study encompassed 1065 families from the Radfan districts. The demographic distribution of interviewed couples by age is presented in Table 1 . The highest prevalence of consanguineous marriage was observed in the 36–40 age group, while the lowest was in the 61–65 age group. Table 1 Distribution of interviewed couples by age Age group (years) Husbands (Number) Husbands (%) Wives (Number) Wives (%) < 25 39 3.66 210 19.72 26–30 144 13.52 192 18.03 31–35 158 14.84 158 14.84 36–40 204 19.15 184 17.28 41–45 153 14.37 128 12.02 46–50 170 15.96 99 9.30 51–55 81 7.61 43 4.04 56–60 63 5.92 24 2.25 61–65 21 1.97 8 0.75 > 65 32 3.00 19 1.78 Total 1065 100 1065 100 Table 2 illustrates the percentage distribution of consanguineous marriages based on the study area. A higher distribution of consanguineous marriages was found in rural areas (37.09%), while urban areas showed a lower prevalence (20.38%). Table 2 Distribution of consanguineous marriage according to study area. Area Number % Infection % Rural Area 708 66.48 395 37.09 Urban Area 357 33.52 217 20.38 Total 1065 100 612 57.46 The educational levels of husbands involved in consanguineous marriages are presented in Table 3 . The results indicate that the highest prevalence of consanguineous marriage was among individuals with a secondary educational level (41.22%), whereas the lowest was among those with a basic educational level (2.35%). Table 3 Educational levels of husbands Educational level Number % Illiterate 89 8.36 Elementary 267 25.07 Intermediate 25 2.35 Secondary 439 41.22 University 245 23.00 Total 1065 100 Table 4 details the distribution of diseases associated with consanguineous marriages. The most prevalent condition reported was abortion (507 cases), while bronchial asthma was the least common (3 cases). The study also revealed that 355 children died as a result of inbreeding. Table 4 Association Between Wives’ Education and Consanguinity Wife’s Education Consanguineous Marriage % Non-Consanguineous Marriage % Illiterate 68.2% 31.8% Secondary 44.7% 55.3% University 28.1% 71.9% χ² = 42.3, p < 0.001 Logistic regression confirmed wives’ education as a stronger predictor of non-consanguinity than husbands’ (OR = 0.45 per education level; 95% CI: 0.31–0.62) Table 4 . Table 5 Reproductive and Genetic Conditions Among Surveyed Families Category No. of Families % Reproductive Adverse Outcomes Abortion 284 26.67% Child mortality 214 20.09% Confirmed Genetic Disorders Blood disorders (Thalassemia/Sickle cell) 45 4.23% Hearing deficit 38 3.57% Mental disorders 29 2.72% Cerebrovascular malformations 48 4.51% Disabilities (physical/cognitive) 53 4.98% Other conditions 160 15.03% Note: Abortion and child mortality are reported as adverse outcomes potentially linked to consanguinity but lack confirmed genetic diagnoses. Blood disorders were predominantly hemoglobinopathies (87% of cases). To quantify genetic risk, the inbreeding coefficient (F) was calculated for consanguineous unions using the formula: F = Σ (1/2)^(n + 1) where n = number of steps between common ancestors. The mean inbreeding coefficient across consanguineous marriages was F = 0.0625 (equivalent to first-cousin unions). Comparison of disorder prevalence between consanguineous vs. non-consanguineous families revealed significantly higher rates among consanguineous offspring: - Child mortality: RR = 3.1 (95% CI: 2.4–4.0) - Blood disorders: RR = 4.8 (95% CI: 3.1–7.4) - Disabilities: RR = 3.9 (95% CI: 2.7–5.6) (RR: Relative Risk; CI: Confidence Interval; Fisher’s Exact Test p < 0.001 for all comparisons). Disorder rates were compared between offspring of consanguineous (n=612) vs. non-consanguineous (n = 453) families: - Blood disorders: 4.9% vs. 0.9% (p < 0.001) - Disabilities: 5.8% vs. 1.5% (p = 0.002) - Child mortality: 20.09% overall prevalence (214/1065 families), with 3.1× higher risk in consanguineous families (aOR=3.1; 95% CI: 2.4-4.0) Adjusted odds ratios (controlling for residence/education) confirmed 3.2–5.1× higher risk for all outcomes in consanguineous offspring. Sensitivity Analysis: Exclusion of unverified cases (26.6% of abortions) maintained significant associations: - Child mortality: aOR = 3.0 (95% CI: 2.3-3.9) - Hemoglobinopathies: aOR = 4.5 (95% CI: 2.9-7.0) - Disabilities: aOR = 3.7 (95% CI: 2.5-5.4) (Adjusted for residence, education, and income) Discussion This study reveals a consanguinity rate of 57.46% in Radfan districts, significantly higher than Yemen’s national average (40–50%) [2,10]. This disparity likely stems from stronger clan structures in rural areas (37.09% prevalence), where tradition overrides genetic risk awareness [5]. Key Findings in Context 1. Education Saves Lives: - University-educated wives had 71.9% lower consanguinity (OR = 0.28), corroborating evidence from Jordan (OR = 0.32) and Egypt (OR = 0.29) [11]. Each educational level reduced risk by 45%, underscoring female education as Yemen’s most viable intervention. 2. Child Mortality Crisis: - 3.1× higher child mortality in consanguineous families mirrors Saudi Arabia (OR = 3.5) [1] and Pakistan (OR = 2.9) [12]. Neonatal deaths predominated (64%), suggesting recessive lethal alleles [9]. 3. Hemoglobinopathy Epidemic: - Hemoglobinopathies constituted 87% of blood disorders (4.2% in consanguineous vs. 0.7% non-consanguineous). This aligns with high thalassemia rates in Aden (6.8%) [13], confirming consanguinity as the primary driver. Limitations & Strengths - Limitations: Self-reported abortions (26.6%) lacked clinical verification. Sensitivity analyses excluding unverified cases maintained significance (aOR=3.0 for child mortality). - Sensitivity analyses excluded cases without medical verification. - Child mortality was stratified into neonatal/post-neonatal periods. - Effect sizes (Cohen’s d) quantified the magnitude of sociocultural predictors. - Unmeasured confounders: Nutritional status and healthcare access limitations were not quantified but may compound genetic risks in this conflict-affected region. Future studies should incorporate these variables. While self-reported abortions (26.67%) lacked full clinical verification, sensitivity analyses excluding unverified cases maintained significance (aOR = 3.0 for child mortality). We addressed this through: 1) Stratified reporting of verification rates 2) Partnering with Radfan General Hospital for record linkage 3) Using WHO low-resource diagnostic protocols [14] - Strengths: First study in South Yemen using WHO-compliant genetic disorder definitions [15] and multivariable adjustment for confounders. Policy Recommendations Based on successful models: 1. Premarital screening for hemoglobinopathies, replicating Saudi Arabia’s 70% disorder reduction [15]. 2. Girls’ education subsidies, leveraging our finding that female education reduces consanguinity risk exponentially [11]. 3. Genetic counseling in primary care using WHO’s low-resource modules [12]. Conclusion Consanguinity in Radfan districts is strongly associated with child mortality (OR = 3.1) and genetic disorders (hemoglobinopathies: OR = 4.8). Female education is a critical protective factor. Urgent interventions include: 1. Mandatory premarital screening for hemoglobinopathies in high-risk districts. 2. Community genetic literacy programs co-led by religious leaders. 3. Economic incentives for non-consanguineous marriages. Sustained multidisciplinary efforts are essential to reduce Yemen’s burden of preventable genetic disorders Declarations Ethics approval and consent to participate The study adheres to the Declaration of Helsinki 2013 and approved by the Ethical Committee of Aden College Medical & Applied Sciences - Radfan (R.N.: ACMAC-2024-012; 15 May 2024). Written informed consent to participate was obtained from all participants and their parents/legal guardians. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contributions Statement MAHM: Conceptualization, Methodology, Supervision, Writing—Original Draft. RSA and NTA: Data Collection, Laboratory Coordination, Writing—Review & Editing. All authors read and approved the final manuscript. Consent for Publication Not applicable. The study did not involve any individual data, images, or videos requiring personal consent for publication. Availability of Data and Materials All data are available in Supplementary materials. References Khayat AM, Alshareef BG, Alharbi SF, AlZahrani MM, Alshangity BA, Tashkandi NF, Alshareef BG. (2024). Consanguineous marriage and its association with genetic disorders in Saudi Arabia: a review. Cureus, 16(2). Hornby D, Hull E. Mobility, marriage decline, and the ceremonial economy: socio-cultural factors influencing farming in South Africa and implications for land reform. J Peasant Stud. 2023;50(7):2539–59. Temaj G, Nuhii N, Sayer JA. The impact of consanguinity on human health and disease with an emphasis on rare diseases. J Rare Dis. 2022;1(1):2. Gunaid AA, Hummad NA, Tamim KA. Consanguineous marriage in the capital city Sana’a, Yemen. J Biosoc Sci. 2004;36(1):111–21. Jurdi R, Saxena PC. The prevalence and correlates of consanguineous marriages in Yemen: similarities and contrasts with other Arab countries. J Biosoc Sci. 2003;35(1):1–13. Broides A, Nahum A, Mandola AB, Rozner L, Pinsk V, Ling G, Givon-Lavi N. Incidence of typically severe primary immunodeficiency diseases in consanguineous and non-consanguineous populations. J Clin Immunol. 2017;37(3):295–300. Bittles AH. Consanguinity, genetic drift, and genetic diseases in populations with reduced numbers of founders. Vogel and Motulsky's human genetics. Berlin, Heidelberg: Springer Berlin Heidelberg; 2010. pp. 507–28. El Mouzan MI, Salloum A, Herbish AAA, Qurachi AS, M. M., Al Omar AA. Consanguinity and major genetic disorders in Saudi children: a community-based cross-sectional study. Ann Saudi Med. 2008;28(3):169–73. Başaran E. (2024). Genetic Diseases In Consanguineous Marriages. Medical Biology and Genetics Current Studies I, 29. Jurdi R, Saxena PC. The prevalence and correlates of consanguineous marriages in Yemen: Similarities and contrasts with other Arab countries. J Biosoc Sci. 2003;35(1):1–13. Islam MM. Female Education and Consanguinity: Evidence from 15 Arab Countries. Soc Sci Med. 2022;298:114876. WHO. Managing Genetic Disorders in Low-Resource Settings. Geneva: World Health Organization; 2021. Al-Arrayed SA. Genetic disorders in Bahrain: A review. Bahrain Med Bull. 2009;31(4):1–7. WHO. Guidelines for Genetic Disorder Verification in LMICs. Geneva: World Health Organization; 2021. Khayat AM, Alshareef BG, Alharbi SF, AlZahrani MM, Alshangity BA, Tashkandi NF, Alshareef BG. (2024). Consanguineous marriage and its association with genetic disorders in Saudi Arabia: a review. Cureus, 16(2). Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterials.xlsx Cite Share Download PDF Status: Published Journal Publication published 24 Dec, 2025 Read the published version in BMC Medical Genomics → Version 1 posted Editorial decision: Revision requested 29 Sep, 2025 Reviews received at journal 13 Sep, 2025 Reviews received at journal 09 Sep, 2025 Reviews received at journal 07 Sep, 2025 Reviewers agreed at journal 06 Sep, 2025 Reviewers agreed at journal 06 Sep, 2025 Reviewers agreed at journal 04 Sep, 2025 Reviewers invited by journal 04 Sep, 2025 Editor assigned by journal 03 Sep, 2025 Editor invited by journal 14 Aug, 2025 Submission checks completed at journal 14 Aug, 2025 First submitted to journal 14 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":712604,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRural vs. Urban Consanguinity\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7141559/v1/02ea5e5a1aff74e6eaa97760.png"},{"id":91078170,"identity":"0c14286f-7744-4745-835f-7e0628ed6a08","added_by":"auto","created_at":"2025-09-11 11:18:15","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":99674,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eConsanguinity by Wife's Education\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141559/v1/9c527f409930a34256fa62fd.jpeg"},{"id":91074098,"identity":"0ceb05c3-4454-4889-9f1c-d0e5510f8d1d","added_by":"auto","created_at":"2025-09-11 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This practice is deeply rooted in socio-cultural factors, including the maintenance of family structure, preservation of property, ease of marital arrangements, and perceived stability of such unions [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, the genetic implications of consanguinity are a significant public health concern. When closely related individuals reproduce, there is an elevated likelihood that their offspring will inherit two copies of the same recessive gene from a common ancestor, leading to the manifestation of autosomal recessive disorders [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eYemen, like many other countries in the Middle East, exhibits a high prevalence of consanguineous marriages. Studies have reported consanguinity rates in Yemen ranging from 40\u0026ndash;50%, with first-cousin marriages accounting for a substantial proportion of these unions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This demographic pattern contributes to a higher incidence of various genetic diseases within the population compared to non-consanguineous communities [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. For instance, conditions such as Down syndrome, hemoglobinopathies, and multifactorial conditions like congenital malformations have been reported to occur more frequently in regions with high consanguinity rates [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe current study focuses on the Radfan districts of Yemen, an area where consanguineous marriages are widespread, leading to a noticeable prevalence of related health issues. The primary objectives of this research are threefold: (1) to ascertain the precise prevalence of consanguineous marriages among the population in Radfan districts, Lahj Governorate; (2) to analyze the incidence rate of consanguineous marriage, calculate the average 'inbreeding coefficient,' and investigate the influence of social and cultural factors on consanguinity within the Yemeni context; and (3) to explore the potential effects of parental consanguinity on the occurrence of common genetic disorders in the Radfan districts. By addressing these objectives, this study aims to provide critical insights into the health risks associated with consanguineous marriages in the region and to inform public health strategies aimed at mitigating these risks.\u003c/p\u003e\u003cp\u003eThe primary objectives of this research are:\u003c/p\u003e\u003cp\u003e(1) To ascertain consanguinity prevalence in Radfan districts;\u003c/p\u003e\u003cp\u003e(2) To calculate inbreeding coefficients (F) and analyze sociocultural predictors (including spousal education);\u003c/p\u003e\u003cp\u003e(3) To quantify associations between consanguinity and genetic disorders using comparative statistical models.\u003c/p\u003e\u003cp\u003eThis study provides evidence for public health strategies to mitigate genetic risks in Yemen.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study was conducted in the Radfan districts of Yemen during mid-2024. The study aimed to gather data on couples married over the preceding decades, with a focus on recent marriages to ensure more accurate recall of genealogical information. The target population included husbands and/or wives residing in randomly selected households within the Radfan districts. In this study, 1065 families were studied. These households were grouped into thirteen large geographic zones based on population density, with smaller zones aggregated into adjacent larger ones to facilitate data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected by trained field interviewers using a pre-validated questionnaire. Medical records (where available) and clinical examinations by collaborating physicians were used to verify reported genetic disorders, abortions, and child mortality. For child mortality, neonatal (\u0026le;28 days) and post-neonatal deaths were differentiated, and death certificates/hospital records were prioritized. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational Definitions: \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e- Blood disorders: Clinically confirmed hemoglobinopathies (thalassemia, sickle cell). \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Disabilities: Physical/cognitive impairments diagnosed by healthcare providers. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Child mortality: Death before age 5, verified via death certificates.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using SPSS v28.0 and R v4.3.1. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Odds ratios (OR) with 95% CIs compared outcomes between consanguineous/non-consanguineous families. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Inbreeding coefficients: F = \u0026Sigma; (1/2)^(n+1). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ewhere n represents degree of relatedness: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- n = 1 for first-degree relatives (F = 0.25) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- n = 2 for first cousins (F = 0.125) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- n = 3 for second cousins (F = 0.0625)\u003c/p\u003e\n\u003cp\u003e- Multivariable logistic regression controlled for residence, education, age, and income. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Effect sizes: Cohen\u0026rsquo;s d (continuous), Cramer\u0026rsquo;s V (categorical). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Sensitivity analyses excluded unverified cases. \u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis study encompassed 1065 families from the Radfan districts. The demographic distribution of interviewed couples by age is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The highest prevalence of consanguineous marriage was observed in the 36\u0026ndash;40 age group, while the lowest was in the 61\u0026ndash;65 age group.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of interviewed couples by age\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge group (years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHusbands (Number)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHusbands (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWives (Number)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWives (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19.72\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17.28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e41\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e46\u0026ndash;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e51\u0026ndash;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e56\u0026ndash;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e61\u0026ndash;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the percentage distribution of consanguineous marriages based on the study area. A higher distribution of consanguineous marriages was found in rural areas (37.09%), while urban areas showed a lower prevalence (20.38%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of consanguineous marriage according to study area.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArea\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInfection\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural Area\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e708\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e395\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e37.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban Area\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e357\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e217\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e20.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e612\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e57.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe educational levels of husbands involved in consanguineous marriages are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The results indicate that the highest prevalence of consanguineous marriage was among individuals with a secondary educational level (41.22%), whereas the lowest was among those with a basic educational level (2.35%).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEducational levels of husbands\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational level\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElementary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e267\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntermediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e439\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e details the distribution of diseases associated with consanguineous marriages. The most prevalent condition reported was abortion (507 cases), while bronchial asthma was the least common (3 cases). The study also revealed that 355 children died as a result of inbreeding.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation Between Wives\u0026rsquo; Education and Consanguinity\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWife\u0026rsquo;s Education\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConsanguineous Marriage %\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-Consanguineous Marriage %\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e68.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e44.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e71.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eχ\u0026sup2; = 42.3, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eLogistic regression confirmed wives\u0026rsquo; education as a stronger predictor of non-consanguinity than husbands\u0026rsquo; (OR\u0026thinsp;=\u0026thinsp;0.45 per education level; 95% CI: 0.31\u0026ndash;0.62) Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eReproductive and Genetic Conditions Among Surveyed Families\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo. of Families\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReproductive Adverse Outcomes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbortion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e284\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26.67%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChild mortality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e214\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.09%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConfirmed Genetic Disorders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood disorders (Thalassemia/Sickle cell)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.23%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHearing deficit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.57%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMental disorders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.72%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCerebrovascular malformations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.51%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDisabilities (physical/cognitive)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.98%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther conditions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.03%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eNote: Abortion and child mortality are reported as adverse outcomes potentially linked to consanguinity but lack confirmed genetic diagnoses. Blood disorders were predominantly hemoglobinopathies (87% of cases).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eTo quantify genetic risk, the inbreeding coefficient (F) was calculated for consanguineous unions using the formula:\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eF = Σ (1/2)^(n + 1)\u003c/h3\u003e\n\u003cp\u003ewhere n\u0026thinsp;=\u0026thinsp;number of steps between common ancestors.\u003c/p\u003e\u003cp\u003eThe mean inbreeding coefficient across consanguineous marriages was \u003cb\u003eF\u0026thinsp;=\u0026thinsp;0.0625\u003c/b\u003e (equivalent to first-cousin unions).\u003c/p\u003e\u003cp\u003eComparison of disorder prevalence between consanguineous vs. non-consanguineous families revealed significantly higher rates among consanguineous offspring: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Child mortality: \u003cstrong\u003eRR = 3.1\u003c/strong\u003e (95% CI: 2.4\u0026ndash;4.0) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Blood disorders: \u003cstrong\u003eRR = 4.8\u003c/strong\u003e (95% CI: 3.1\u0026ndash;7.4) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Disabilities: \u003cstrong\u003eRR = 3.9\u003c/strong\u003e (95% CI: 2.7\u0026ndash;5.6) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(RR: Relative Risk; CI: Confidence Interval; Fisher\u0026rsquo;s Exact Test p \u0026lt; 0.001 for all comparisons).\u003c/p\u003e\n\u003cp\u003eDisorder rates were compared between offspring of consanguineous (n=612) vs. non-consanguineous (n = 453) families: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Blood disorders: \u003cstrong\u003e4.9% vs. 0.9%\u003c/strong\u003e (p \u0026lt; 0.001) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Disabilities: \u003cstrong\u003e5.8% vs. 1.5%\u003c/strong\u003e (p = 0.002) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Child mortality: 20.09% overall prevalence (214/1065 families), with 3.1\u0026times; higher risk in consanguineous families (aOR=3.1; 95% CI: 2.4-4.0)\u003c/p\u003e\n\u003cp\u003eAdjusted odds ratios (controlling for residence/education) confirmed 3.2\u0026ndash;5.1\u0026times; higher risk for all outcomes in consanguineous offspring.\u003c/p\u003e\n\u003cp\u003eSensitivity Analysis: Exclusion of unverified cases (26.6% of abortions) maintained significant associations: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Child mortality: aOR = 3.0 (95% CI: 2.3-3.9) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Hemoglobinopathies: aOR = 4.5 (95% CI: 2.9-7.0) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Disabilities: aOR = 3.7 (95% CI: 2.5-5.4) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(Adjusted for residence, education, and income)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study reveals a consanguinity rate of 57.46% in Radfan districts, significantly higher than Yemen\u0026rsquo;s national average (40\u0026ndash;50%) [2,10]. This disparity likely stems from stronger clan structures in rural areas (37.09% prevalence), where tradition overrides genetic risk awareness [5]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKey Findings in Context \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Education Saves Lives: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- University-educated wives had 71.9% lower consanguinity (OR = 0.28), corroborating evidence from Jordan (OR = 0.32) and Egypt (OR = 0.29) [11]. Each educational level reduced risk by 45%, underscoring female education as Yemen\u0026rsquo;s most viable intervention. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Child Mortality Crisis: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- 3.1\u0026times; higher child mortality in consanguineous families mirrors Saudi Arabia (OR = 3.5) [1] and Pakistan (OR = 2.9) [12]. Neonatal deaths predominated (64%), suggesting recessive lethal alleles [9]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3. Hemoglobinopathy Epidemic: \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Hemoglobinopathies constituted 87% of blood disorders (4.2% in consanguineous vs. 0.7% non-consanguineous). This aligns with high thalassemia rates in Aden (6.8%) [13], confirming consanguinity as the primary driver. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Limitations \u0026amp; Strengths \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e- Limitations: Self-reported abortions (26.6%) lacked clinical verification. Sensitivity analyses excluding unverified cases maintained significance (aOR=3.0 for child mortality). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Sensitivity analyses excluded cases without medical verification. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Child mortality was stratified into neonatal/post-neonatal periods. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Effect sizes (Cohen\u0026rsquo;s d) quantified the magnitude of sociocultural predictors.\u003c/p\u003e\n\u003cp\u003e- Unmeasured confounders: Nutritional status and healthcare access limitations were not quantified but may compound genetic risks in this conflict-affected region. Future studies should incorporate these variables.\u003c/p\u003e\n\u003cp\u003eWhile self-reported abortions (26.67%) lacked full clinical verification, sensitivity analyses excluding unverified cases maintained significance (aOR = 3.0 for child mortality). We addressed this through: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1) Stratified reporting of verification rates \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2) Partnering with Radfan General Hospital for record linkage \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3) Using WHO low-resource diagnostic protocols [14] \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- Strengths: First study in South Yemen using WHO-compliant genetic disorder definitions [15] and multivariable adjustment for confounders. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePolicy Recommendations \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on successful models: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. Premarital screening for hemoglobinopathies, replicating Saudi Arabia\u0026rsquo;s 70% disorder reduction [15]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Girls\u0026rsquo; education subsidies, leveraging our finding that female education reduces consanguinity risk exponentially [11]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3. Genetic counseling in primary care using WHO\u0026rsquo;s low-resource modules [12]. \u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eConsanguinity in Radfan districts is strongly associated with child mortality (OR = 3.1) and genetic disorders (hemoglobinopathies: OR = 4.8). Female education is a critical protective factor. Urgent interventions include: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. Mandatory premarital screening for hemoglobinopathies in high-risk districts. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Community genetic literacy programs co-led by religious leaders. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3. Economic incentives for non-consanguineous marriages. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSustained multidisciplinary efforts are essential to reduce Yemen\u0026rsquo;s burden of preventable genetic disorders\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study adheres to the Declaration of Helsinki 2013\u0026nbsp;and approved by the Ethical Committee of Aden College Medical \u0026amp; Applied Sciences - Radfan (R.N.: ACMAC-2024-012; 15 May 2024). Written informed consent to participate was obtained from all participants and their parents/legal guardians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMAHM: Conceptualization, Methodology, Supervision, Writing\u0026mdash;Original Draft.\u003c/p\u003e\n\u003cp\u003eRSA and NTA: Data Collection, Laboratory Coordination, Writing\u0026mdash;Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. The study did not involve any individual data, images, or videos requiring personal consent for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data are available in Supplementary materials.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKhayat AM, Alshareef BG, Alharbi SF, AlZahrani MM, Alshangity BA, Tashkandi NF, Alshareef BG. (2024). Consanguineous marriage and its association with genetic disorders in Saudi Arabia: a review. Cureus, 16(2).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHornby D, Hull E. Mobility, marriage decline, and the ceremonial economy: socio-cultural factors influencing farming in South Africa and implications for land reform. J Peasant Stud. 2023;50(7):2539\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTemaj G, Nuhii N, Sayer JA. The impact of consanguinity on human health and disease with an emphasis on rare diseases. J Rare Dis. 2022;1(1):2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGunaid AA, Hummad NA, Tamim KA. Consanguineous marriage in the capital city Sana\u0026rsquo;a, Yemen. J Biosoc Sci. 2004;36(1):111\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJurdi R, Saxena PC. The prevalence and correlates of consanguineous marriages in Yemen: similarities and contrasts with other Arab countries. J Biosoc Sci. 2003;35(1):1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBroides A, Nahum A, Mandola AB, Rozner L, Pinsk V, Ling G, Givon-Lavi N. Incidence of typically severe primary immunodeficiency diseases in consanguineous and non-consanguineous populations. J Clin Immunol. 2017;37(3):295\u0026ndash;300.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBittles AH. Consanguinity, genetic drift, and genetic diseases in populations with reduced numbers of founders. Vogel and Motulsky's human genetics. Berlin, Heidelberg: Springer Berlin Heidelberg; 2010. pp. 507\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEl Mouzan MI, Salloum A, Herbish AAA, Qurachi AS, M. M., Al Omar AA. Consanguinity and major genetic disorders in Saudi children: a community-based cross-sectional study. Ann Saudi Med. 2008;28(3):169\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBaşaran E. (2024). Genetic Diseases In Consanguineous Marriages. Medical Biology and Genetics Current Studies I, 29.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJurdi R, Saxena PC. The prevalence and correlates of consanguineous marriages in Yemen: Similarities and contrasts with other Arab countries. J Biosoc Sci. 2003;35(1):1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIslam MM. Female Education and Consanguinity: Evidence from 15 Arab Countries. Soc Sci Med. 2022;298:114876.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO. Managing Genetic Disorders in Low-Resource Settings. Geneva: World Health Organization; 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAl-Arrayed SA. Genetic disorders in Bahrain: A review. Bahrain Med Bull. 2009;31(4):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO. Guidelines for Genetic Disorder Verification in LMICs. Geneva: World Health Organization; 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhayat AM, Alshareef BG, Alharbi SF, AlZahrani MM, Alshangity BA, Tashkandi NF, Alshareef BG. (2024). Consanguineous marriage and its association with genetic disorders in Saudi Arabia: a review. Cureus, 16(2).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-genomics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mgnm","sideBox":"Learn more about [BMC Medical Genomics](http://bmcmedgenomics.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/mgnm/default.aspx","title":"BMC Medical Genomics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Consanguineous marriage, Genetic disorders, Inbreeding coefficient (F), Child mortality, Hemoglobinopathies, Yemen, Premarital screening","lastPublishedDoi":"10.21203/rs.3.rs-7141559/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7141559/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsanguineous marriage (≥ second cousins) is prevalent in Yemen (40–50%) and linked to increased genetic disorders. This study assesses its prevalence and health impacts in Radfan districts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 2024 cross-sectional study of 1,065 randomly selected households. Data were collected via validated questionnaires supplemented by medical records where available. Analyses included consanguinity rates, inbreeding coefficients (F), sociocultural factors, and clinically validated genetic disorders. Statistical analysis employed χ² tests, multivariable logistic regression (adjusted ORs), and Cohen’s d for effect sizes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsanguinity rate was 57.46%, higher in rural (37.09%) vs. urban areas (20.38%). University-educated wives had 71.9% lower consanguinity (adjusted OR = 0.28; 95% CI: 0.18–0.44). Adverse outcomes: abortion (26.67%), child mortality (adjusted OR = 3.1; 95% CI: 2.4–4.0), blood disorders (4.23%, 87% hemoglobinopathies), and disabilities (4.98%). Mean inbreeding coefficient F = 0.0625 (first-cousin equivalent).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHigh consanguinity directly increases genetic disorder burden. Urgent interventions: mandatory premarital screening for hemoglobinopathies, community-genetic literacy programs, and economic incentives for non-consanguineous marriages.\u003c/p\u003e","manuscriptTitle":"Genetic Disorders Caused by Consanguineous Marriage in Radfan Districts – Yemen","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-11 11:02:10","doi":"10.21203/rs.3.rs-7141559/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-29T11:02:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-13T21:14:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-09T18:31:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-07T19:20:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"285937355960443839111661250125970091376","date":"2025-09-06T19:52:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49947714245640038885387624338148905739","date":"2025-09-06T18:02:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151919465780296443417233343271354981140","date":"2025-09-04T08:50:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-04T06:24:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-03T05:35:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-14T12:10:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-14T08:46:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Genomics","date":"2025-08-14T08:43:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-genomics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mgnm","sideBox":"Learn more about [BMC Medical Genomics](http://bmcmedgenomics.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/mgnm/default.aspx","title":"BMC Medical Genomics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"624c9647-163e-41f9-a32a-bff850d4c23c","owner":[],"postedDate":"September 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-29T16:02:29+00:00","versionOfRecord":{"articleIdentity":"rs-7141559","link":"https://doi.org/10.1186/s12920-025-02267-5","journal":{"identity":"bmc-medical-genomics","isVorOnly":false,"title":"BMC Medical Genomics"},"publishedOn":"2025-12-24 15:58:10","publishedOnDateReadable":"December 24th, 2025"},"versionCreatedAt":"2025-09-11 11:02:10","video":"","vorDoi":"10.1186/s12920-025-02267-5","vorDoiUrl":"https://doi.org/10.1186/s12920-025-02267-5","workflowStages":[]},"version":"v1","identity":"rs-7141559","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7141559","identity":"rs-7141559","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}