Assessing Students’ Knowledge and Attitudes Regarding the Risks and Prevention of Consanguineous Marriage: A Cross-Sectional Online Survey

Figures & data

Table 1 Number and Percentages of the Questions on Demographics (n=667)

Demographics	Groups	Frequency	Percentages (%)
Age (mean ± SD)	31.0 ±7.0
Gender	Female	421	63.1
	Male	246	36.9
Study level	Last years	284	42.6
	First years	383	57.4
Major	Medical	454	68.1
	Non-medical	213	31.9
Nationality	Middle East	91	13.6
	Asia	127	19
	Africa	449	67.3
Parental history of consanguinity	Yes	338	50.7
	No	329	49.3
Family History of Consanguineous marriage	Yes	97	14.5
	No	570	85.5
Family History of Inherited disease	Yes	97	14.5
	No	570	85.5

Table 2 Number and Percentage of the Questions on Knowledge Items (n=667)

Knowledge Items	Incorrect Answer		Correct Answer
	F	%	F	%
1. Have an awareness of genetic disorders and their associated causes (yes)	78	11.7	589	88.3
2. Is there a proven link between consanguineous marriages and the birth of children with genetic disorders? (yes)	163	24.4	504	75.6
3. If both parents have a genetic disease, their child will be born with that disease (yes)	63	9.4	604	90.6
4. Are you aware that you can undergo an examination before marriage? (yes)	86	12.9	581	87.1
5. Are you aware of the potential risks on proceeding with a marriage after being made aware of positive test results? (yes)	93	13.9	574	86.1
6. Do you understand that marrying a second- or third-degree relative decreases the risk of genetic diseases? (yes)	388	58.2	279	41.8
7. Do you know that inherited diseases are life-threatening (yes)	93	13.9	574	86.1
8. Are you aware that inherited diseases cannot be treated? (yes)	362	54.3	305	45.7
9. Is pre-marriage examination limited to infectious diseases (such as AIDS and hepatitis) (no)	67	10.0	600	90.0
10. Do you understand that screening before marriage is important and something that should be seriously considered? (yes)	33	4.9	634	95.1

Abbreviations: F, frequency; %, Percentage.

Table 3 Number and Percentage of the Questions on Attitude Items (n=667)

Attitude Items	Strongly Disagree		Disagree		Neutral		Agree		Strongly Agree
	F	%	F	%	F	%			F	%
1. Consanguineous marriage is associated with a significant risk of health issues	98	14.7	43	6.4	83	12.4	165	24.7	278	41.7
2. If you are yet to marry, would you consider marrying a relative who you know has a family history of inherited disease?	308	46.2	212	31.8	129	19.3	6	0.9	12	1.8
3. Would you agree for your offspring to marry one of your relatives if you know he or she a family history of inherited disease?	420	63.0	170	25.5	65	9.7	12	1.8	0	0
4. Consanguineous marriage can be a safer option because you will be aware of health risks due to your knowledge of the families involved.	42	6.3	23	3.4	127	19.0	201	30.1	274	41.1
5. If you are planning on entering into a consanguineous marriage, pre-marital screening is very important	0	0	8	1.2	25	3.7	78	11.7	556	83.4
6. If you are planning on entering into a non-consanguineous marriage, pre-marital screening is very important	56	8.4	58	8.7	108	16.2	186	27.9	259	38.8
7. Consanguinity proliferates and sustains hereditary diseases	47	7.0	90	13.5	164	24.6	169	25.3	197	29.5
8. Pre-marital screening can help to reduce the incidence of some genetic health issues and sexually transmitted diseases (STDs)	50	7.5	50	7.5	137	20.5	230	34.5	200	30.0
9. Raising awareness of the importance of pre-marital screening can help to reduce the prevalence of genetic illnesses and STDs	110	16.5	36	5.4	46	6.9	79	11.8	396	59.4
10. There is a need for the introduction of a law that makes it compulsory for all couples to undergo pre-marital screening.	62	9.3	86	12.9	162	24.3	126	18.9	231	34.6
11. Genetic testing should not be compulsory; however, people should be actively encouraged to undergo tests.	337	50.5	227	34.0	89	13.3	10	1.5	4	0.6
12. If genetic tests reveals that one of the partners has or is carrying an STD, any decision as to whether to continue with the marriage should be left to the individuals concerned.	20	3.0	21	3.1	84	12.6	129	19.3	413	61.9
13. If genetic tests reveal that one of the partners has or is carrying an STD, the marriage should not go ahead.	54	8.1	61	9.1	140	21.0	101	15.1	311	46.6
14. A law should be put in place that if genetic tests reveals that one of the partners has or is carrying an STD, the marriage cannot go ahead.	43	6.4	98	14.7	335	50.2	107	16.0	84	12.6
15. Pre-marital screening is against privacy rights	395	59.2	186	27.9	77	11.5	9	1.3	0	0

Abbreviations: F, frequency; %, Percentage.

Table 4 Comparing Knowledge and Attitude According to Demographics

Demographics	Knowledge Scores (10 Items)				Attitude Scores (15 Items)
	Mean	95% CI		P-value	Mean	95% CI		P-value
Gender
Male	7.49	7.24	7.73	<0.001*	58.60	57.54	59.67	0.003*
Female	8.08	7.94	8.21		60.50	59.78	61.23
Study level
Last years	8.0	7.81	8.19	0.055	61.46	60.61	62.31	<0.001*
First years	7.76	7.58	7.93		58.57	57.75	59.40
Major
Medical	7.96	7.81	8.12	0.016*	60.45	59.70	61.20	0.002*
Non medial	7.63	7.40	7.85		58.42	57.42	59.42
Nationality
Middle East	7.97	7.70	8.25	0.007*	61.20	60.55	61.86	<0.001*
Asia	7.93	7.78	8.08		56.18	54.58	57.78
Africa	7.35	6.94	7.76		57.94	56.16	59.72
Parental history of consanguinity
Yes	8.03	7.86	8.19	0.009*	61.52	60.74	62.30	<0.001*
No	7.69	7.49	7.88		58.04	57.15	58.93
Family History of Consanguineous marriage k1
Yes	9.73	9.64	9.82	<0.001*	60.86	58.93	62.79	0.157
No	7.54	7.41	7.67		59.62	58.99	60.25
Family History of Inherited disease p1
Yes	8.38	8.07	8.68	0.001*	69.32	68.75	69.90	<0.001*
No	7.77	7.63	7.91		58.18	57.57	58.79

Notes: *P-values < 0.05 are considered statistically significant, P-values obtained from independent t-test and One-Way ANOVA.

Table 5 Multivariate Analysis for the Factors That Associated with Knowledge and Attitude About Consanguineous Marriage Risk and Prevention

Demographics	Good Knowledge ≥ 8				Positive Attitude ≥ 61
	OR	95% CI		P-value	OR	95% CI		P-value
Gender (Ref. Male)
Female	1.698	1.481	1.946	<0.001*	1.354	1.289	1.423	0.001*
Study level (Ref. First years)
Last years	1.131	0.991	1.290	0.067	1.244	1.186	1.306	<0.001*
Major (Ref. Non-medical
Medical	1.120	0.975	1.286	0.109	2.907	1.862	3.953	0.014*
Nationality (Ref. Africa)
Middle East	1.134	0.964	1.334	0.44	3.739	1.699	4.781	<0.001*
Asia	1.079	0.888	1.310	0.130	0.930	0.864	1.001	0.065
Parental history of consanguinity (Ref. No)
Yes	1.337	1.174	1.523	<0.001*	1.228	1.172	1.286	<0.001*
Family History of Consanguineous marriage (Ref. N0)
Yes	5.183	2.197	7.107	<0.001*	1.097	1.028	1.170	0.005*
Family History of Inherited disease (Ref. No)
Yes	1.528	1.256	1.860	<0.001*	3.652	3.326	4.009	0.001*
Age	1.014	1.004	1.024	0.005*	1.019	1.015	1.023	<0.001*

Notes: *P-values < 0.05 are considered statistically significant. Good knowledge and positive attitude scores were generated by finding the median score.