title: Interplay of socio-economic factors, consanguinity, fertility, and offspring mortality in Monastir, Tunisia.
abstract: OBJECTIVE
  To assess the association among social status, prevalence of consanguineous marriages, and the effects of consanguinity on reproductive behavior and mortality in Tunisia.
  
  
  METHODS
  The study included data on a total of 1741 live-births born from November 1989 to October 1990 in the maternity ward of the University-Hospital Fattouma Bourguiba of Monastir, Tunisia. After delivery, women filled out a questionnaire on the age of the parents at marriage, the number of pregnancies and abortions, the number of neonatal and post-neonatal deaths, and deaths of children under 5 years. Three categories of marriages were distinguished as follows: marriages between first cousins, marriages between cousins of other degree, and non consanguineous marriages.
  
  
  RESULTS
  Consanguineous marriages represented 432 (24.81%) of the unions. Most consanguineous marriages were contracted between first cousins (n=303; 70.13%). Consanguineous couples had a lower age at marriage and a higher fertility index than non-consanguineous couples. The rates of spontaneous abortions and stillbirths were not correlated with consanguinity. However, higher rates of neonatal and post-neonatal deaths, and deaths of children younger than 5 years were observed in consanguineous couples.
  
  
  CONCLUSIONS
  Fertility index and mortality, especially in the first year of life, were significantly higher in consanguineous marriages. This important socio-economical factor needs to be considered in assessing equity on health in specific social and cultural contexts.
authors.affiliation: Laboratory of Genetics, University Medicinal School of Monastir, Monastir, Tunisia. Hassen.BenCheikh@fmm.rnu.tn
authors.forename: Emna
authors.initials: E
authors.lastname: Kerkeni
authors.forename: Kamel
authors.initials: K
authors.lastname: Monastiri
authors.forename: Besma
authors.initials: B
authors.lastname: Saket
authors.forename: Mohamed Neji
authors.initials: MN
authors.lastname: Guediche
authors.forename: Hassen
authors.initials: H
authors.lastname: Ben Cheikh
mesh_terms: D017677:Age Distribution; D015984:Causality; D046688:Child Mortality; D002675:Child, Preschool; D003241:Consanguinity; D005260:Female; D005298:Fertility; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008393:Marriage / Q000706:statistics & numerical data; D011247:Pregnancy; D015995:Prevalence; D012959:Socioeconomic Factors; D014416:Tunisia / Q000453:epidemiology