The prevalence of consanguinity varies among populations, religions, ethnicities, geographical locations, educational levels and, across time [3]. Some sociocultural factors, are common to all the populations, and most studies point towards common results on the nature of association between these factors and consanguineous marriages. This study aims to evaluate the prevalence of consanguineous marriage and its risk factors in Lebanon and to assess for the first time the knowledge and attitude of the Lebanese population towards this practice.
Our data showed that the consanguinity rate in the general population is around 24.5%, which is comparable to the findings reported by Khlat et al., in 1986 [17] and by Barbour and Salameh in 2009 [13], reporting consanguinity rates of 25% and 35.5%, respectively. Consanguinity was significantly higher among non-Christian participants which is consistent with the study reported by Barbour and Salameh [13]. This rate was also increased in some residency areas such as in the Bekaa, North Lebanon and South Lebanon areas. Indeed, regional factors have been correlated with the choice of spouse, as the neighborhood and standards of living of the woman played a role in her attitude and practice of consanguineous marriages [18]. These results were further corroborated by the logistic regression analysis which identified place of residence and religion. As significant predictors of consanguinity. Participants from Bekaa, North Lebanon, and South Lebanon had higher consanguinity rates, potentially due to traditional practices and social norms prevalent in these areas.
Concerning the knowledge of the participants towards consanguinity, our study shows that the majority of the participants have a good knowledge about consanguinity and premarital genetic testing. Participants from consanguineous parents demonstrated a higher understanding of consanguinity compared to those from non-consanguineous ones. However, the latter group had a better understanding of the genetic risks associated with consanguinity compared to those from consanguineous backgrounds. These findings suggest that while knowledge towards consanguinity is high among those directly experiencing it, understanding of its genetic implications is rather limited.
The knowledge related to the effect of consanguinity on the occurrence of diseases in general was poor in all participants who mistakenly assumed that consanguinity leads to genetic diseases irrespective of their type (monogenic, chromosomal, or multifactorial). Similar findings were reported by Sandridge and his colleagues where more than half of the Qatari participants believed that consanguinity increases the risk of Down syndrome [19]. Regarding the practice of premarital genetic testing, differences in the answers of participants shed the light on the importance of spreading the correct information about premarital tests available in Lebanon, as well as their advantages, and limitations. Overall, our results highlight significant gaps in knowledge about genetic risks associated with consanguineous marriages. On another note, the logistic regression analysis showed that higher education levels is an independent contributor to the participants’ knowledge about consanguinity and premarital genetic screening. These findings suggest that educational initiatives can effectively enhance knowledge about genetic risks and the importance of genetic counseling.
The assessment of the attitude and beliefs of participants with respect to consanguinity revealed differences in the perception of the participants, in particular those whose parents are related, with regard to whether consanguineous marriages are a normal and understandable practice. Interestingly, despite the fact that several studies have reported that consanguineous marriages preserve the wealth of the family and tighten the bonds among the families [20], most of the participants included in the current study disagreed with this statement. Overall, these results highlight varying degrees of acceptance of genetic risks and counseling. These attitudes are influenced significantly by the knowledge of the participants and whether they come from consanguineous unions or not.
On the other hand, unlike the findings reported by Barbour and Salameh [13] in Lebanon, and by Kaplan et al., in Turkey [21] ), this study reveals a concerning trend. Indeed, despite the young age and the high level of education of the participants, a notable portion of the participants express willingness to continue with a consanguineous marriage despite being aware of carrying a serious hereditary disease. These findings underscore the need for culturally sensitive genetic education and counseling initiatives tailored to address misconceptions and provide clear information on the genetic implications of consanguineous marriages.
This study faced several limitations due to its reliance on online survey distribution, which primarily reached a younger, educated demographic that predominantly consisted of unmarried individuals. Additionally, the recruitment process did not uniformly cover all geographical regions, particularly rural areas, which may affect the representativeness of the data.