RAJIV GANDHI UNIVERSITY OF HEALTH

SCIENCES, KARNATAKA BANGALORE.

PROFORMA FOR REGISTRATION

OF
SUBJECT FOR DISSERTATION

MS.VANI.R
1ST YEAR MSC NURSING
COMMUNITY HEALTH NURSING
2012-2014

SEA COLLEGE OF NURSING

K.R PURAM, BANGALORE 49

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION

1.

MS.VANI.R
NAME OF THE CANDIDATE AND st
1 YEAR M.SC NURSING,
ADDRESS
SEA COLLEGE OF NURSING, K.R.PURAM,
BANGALORE-560049

2.

NAME OF THE INSTITUTION

3.

COURSE
SUBJECT

4.

DATE OF ADMISSION OF THE

COURSE

5.

TITLE OF THE STUDY

OF

STUDY

SEA COLLEGE OF NURSING

AND IST YEAR M. Sc NURSING
COMMUNITY HEALTH NURSING
29-6-2012
A STUDY TO ASSESS THE KNOWLEDGE
& ATTITUDE REGARDING EFFECTS OF
CONSANGUINEOUS
MARRIAGE
ON
OFFSPRINGS AMONG THE PARENTS IN A
SELECTED RURAL AREA BANGALORE,
WITH A VIEW TO DEVELOP A
PAMPHLET.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY
A Happy marriage is a new beginning of life, a new starting point for happiness
& usefulness.
-Groucho mark
Marriage in Indian society is a religious duty. Consanguineous marriage is common,
where individuals prefer to marry within their clan. Consanguineous unions range
from cousin-cousin to more distant relatedness, & their prevalence varies by culture.
Consanguinity has been known to increase the chance of the husband & wife carrying
an identical gene derived from a common ancestor. Children of such a marriage,
therefore, are at greater risk of being homozygous for a harmful gene & consequently
suffer autosomal recessive genetic disorders. Pregnancy wastage has also been found
to be high for women marrying close relatives.1
Marriage is a social, religious, spiritual, and legal union of individuals. Wedding
ceremonies are an important feature of any culture. They mark the beginning of a
new life, the joining of two families, or act as a public confirmation of the love
between two people. The characteristics of a wedding can give us important insight
into the culture of the individuals involved in the wedding. Arranging a marriage is
the responsibility of Indian parents and other relatives of both bride and groom. In
India, there is no greater event in a family than a wedding. Indian culture is an
assimilation of diverse conventions, customs, rituals, and ideas harmonizing in one
central core of seal entity.2

Ayurveda clearly states that marriage within the Gotra is a consanguineous marriage
which can lead to many gestational and genetic problems in the fetus. According to
the World Health Organization Guidelines, a consanguineous marriage is defined as a
marriage between people who are second cousins or more closely related.3
Consanguineous marriage among Hindus in India has continued to occur despite the
Hindu marriage act of 1955 which prohibited uncle-niece marriages; one reason for
this is because consanguineous marriage is tolerated by the Hindu scriptures. There
are also a number of anthropological and biological surveys of consanguinity among
selected communities in southern India. More recent evidence of the incidence of
consanguineous marriage comes from the national family health survey 1992-93,
which collected data from 25 Indian states and interviewed 89,777 ever married
women aged 13-49. The rates of consanguineous marriage are as high as 52% in
Tamil Nadu and 37% in Andhra Pradesh and Karnataka. The practice also seems to
vary by religion. In India 23.3% of all Muslim marriages are consanguineous,
compared to 10.6% of all Hindus marriage, 10.3% of all Christian marriages and
17.1% of all Buddhist marriages.4
A descriptive study was conducted in the city of Tabriz, Iran, 6000 families were
selected and data was obtained via a questionnaire comprised of information
including marital ages, number of pregnancies, type of delivery, ratio of
consanguineous and non consanguineous marriages, jobs of parents, and effects on
child malformations. Consanguineous marriages of all types were related with
increased congenital malformations (with ratio 43/1000 for consanguineous marriages
and for non consanguineous marriages 28/1000).5

A study in the State of Qatar showed rate of consanguineous marriage was 54% with
confidence limits of 52.3 55.7%. Bronchial asthma, mental retardation, epilepsy
and diabetes were significantly more common in offspring of the consanguineous than
non-consanguineous couples. Evaluation of stroke in children at King Khalid
University Hospital, Saudi Arabia showed that children with recurrent strokes were
significantly more likely to be the product of consanguineous marriages (P=0.04).6

An experimental study done on the effect of consanguineous marriage in the Arab

community on reading disabilities of offspring. It examined whether the rate of
reading disabilities was higher among offspring of first-cousin parents than offspring
of unrelated parents; and whether reading-disabled children of first-cousin parents
were more disabled in phonological awareness and phonological decoding than
reading-disabled children of unrelated parents and normally reading younger children.
These questions were investigated among 814 pupils of the 4th, 5th, and 6th grades,
using word recognition and reading comprehension tests. Two experimental groups
were chosen from this population. These were a reading-disabled group of 22 pupils
who were children of first-cousin marriages and 21 pupils who were children of
unrelated parents. A control group was also selected, consisting of 21 younger
normally reading pupils at the same reading level. All the groups were tested on nonwords, real words, phonological, orthographic and working memory measures. The
results indicated that the rate of reading disabilities among children of first-cousin
parents was higher than that of with children of second-cousin parents, distantly
related parents, or unrelated parents.7

A Pilot study conducted in India to study the association of consanguineous

marriage with depression. The odds ratio was 5.66 (CI: 2.42-13.54). The age and sex
had an association with depression,the age and sex adjusted odds ratio of
consanguineous marriage was 7.66 (CI: 3.93-19.45) indicating that it is independently
associated with depression.8
In

Bangalore, a study

to analyze the effect of consanguinity on chromosomal

abnormality (CA), reveals a total of 1465 cases with suspected genetic etiology like
bad obstetric history, mental retardation, multiple congenital anomalies, Down
syndrome, primary amenorrhea and primary infertility was referred to Division of
Human Genetics for karyotyping and genetic counseling. The information regarding
consanguinity was obtained through pedigree analyzes up to three generations from
all the patients, Chi-square test was applied & the results of Consanguinity was seen
in 427 cases (29.14%), 305 cases were confirmed to have CA, among them 240
(78.7%) had numerical abnormality and 65 (21.3%) had structural abnormality. The
effect of consanguinity on CA was almost significant ( P < 0.001).9

It is estimated that globally about 20% of the human population live in communities
with a preference for consanguineous marriage, and that at least 8.5% of children
have consanguineous parents. Prenatal mortality and infant mortality are important
indicators of community health, consanguineous marriage increases the risk of having
children with autosomal recessive disorders and may be a cause of prenatal and infant
death that cannot be prevented.11

The World Health Organization (WHO) has suggested that about 5% of the world
population are carriers for different inherited disorders of hemoglobin, WHO reports

also state that about 370,000 severely affected homozygotes or compound

heterozygotes of thalassemia are born every year. The UNICEF in 1998 estimated
that there were 29.7 million carriers of beta thalassemia trait in India and about 10,000
infants with homozygous beta thalassemia born every year. It is estimated that there
are about 65,000- 67,000 beta-thalassemia patients in India with around 9,000-10,000
cases being added every year. The carrier rate for beta-thalassemia gene varies from
1 to 3% in Southern India to 3 to 15% in Northern India.12
A Hospital based study in Dharwad, north Karnataka, the pediatric cases of
hemoglobinopathies were identified based on clinical data, family history, red blood
cell indices and hemoglobin electrophoresis. Out of the fifty cases, twenty children
were carriers of beta- thalassemia trait and fifteen children were suffering from betathalassemia major. Two cases of sickle cell trait and lone case of a compound
heterozygote for HbS/beta-thalassemia were also identified. Families of four cases of
hemoglobinopathies were studied in detail to identify the carriers of abnormal
hemoglobins. Ten out of fifty children of the study were products of consanguineous
mating.10

The researcher herself, during her exposure in community, has come across many
cases of congenital deformities on children due to the effects of consanguineous
marriage and many studies have shown a positive association between parents
consanguinity and congenital

defects, palate, and neural tube defects. When

Investigator collected the history from parents and observed that the parents were
not aware about the effects of consanguineous marriage. The investigator felt that
there is lack of knowledge regarding the effects of consanguineous marriage on
offspring. A countrys destiny lies in its future, a future that relies on coming

generations made up of healthy children,the investigator then felt the need to conduct
a study & provide a pamphlet to parents on the ill effects of consanguineous marriage
so that people may change their attitude towards consanguineous marriage.13

6.2 REVIEW OF LITERATURE

Review of literature refers to a body of text that determines the aims to review the
critical points of current knowledge including substantive findings as well as
theoretical and methodological contributions on a particular topic.
Literature review is a critical summary of research on a topic of interest
to put a research problem in the context or as the basis for an implementation
project. 4
-Polit and Hungler
The present study is undertaken to assess knowledge of parents regarding
consanguineous marriage & provide pamphlet on the ill effects of consanguineous
marriage, the investigator did an extensive search of the existing literature and
organized it under the following headings:

1. Review related to complications of consanguineous marriage.

2. Review related to the parents knowledge regarding the effects of

consanguineous

marriage.
3. Review related to awareness of consanguineous marriage.

1. Review related to complications of consanguineous marriage:A case-control study done on pediatric patients at a tertiary care hospital, Aga Khan
University Hospital, located in Karachi, Pakistan on Risk factors predisposing to

congenital heart defects. A total of 500 patients, 250 cases and 250 controls were
included in the study. Amongst the 250 cases (i.e. those diagnosed with CHD), 122
patients (48.8%) were born of consanguineous marriages while in the controls (i.e.
non-CHD) only 72 patients (28.9%) showed a consanguinity amongst parents.

On

multivariate analysis, consanguinity emerged as an independent risk factor for CHD;

adjusted odds ratio 2.59 (95% C. I. 1.73 - 3.87).14

A clinical and biological studies showed that, twenty-six patients with xeroderma
pigmentosum (XP), who live in the Northeast (Tohoku) District of Japan, were
examined for the clinical characteristics of UV-induced DNA synthesis (unscheduled
DNA synthesis, UDS) and UV sensitivity of skin fibroblasts or lymphoblastic cells, or
both.

A history of consanguineous marriage within two generations was found in 19

of 26 cases (73). Two pairs of siblings showed similar manifestations and almost the
same levels of UDS and of UV sensitivity. Squamous cell carcinoma, basal cell
carcinoma, or both were observed on the exposed skin in 14 patients, but no
malignant melanoma was found. Cancer had developed in approximately 71% (10/14)
of the cancer-bearing patients by the age of 20, and 8 of them belonged to the UDSdeficient group.15

Tamim et al., 2003; Schulpen et al., studies have revealed that inbreeding resulting
from consanguinity contributes to elevated mortality levels of offspring through
congenital defects and recessive genetic disorders. It is found that the closer the
relationship between parents, the more severe the effect on offspring.16

In Iran conducted a study on the genetic mutations causing inherited factor XIII
(FXIII) deficiency in patients from Iran, Data were collected from 30 patients (18
males and 12 females) with FXIII deficiency, from 26 unrelated families. A total of 7
mutations consisting of 5 new mutations and 2 previously reported mutations were
identified. Of the 5 novel missense mutations, 2, Arg77His and Trp187Arg, were the
most common in Iranian FXIII-deficient patients. In regions like Iran with high rate of
consanguineous marriages, the identification of common mutations in disease like
severe FXIII deficiency increases the capacity to make a precise screening and
diagnosis assays to screen and diagnose families with high risk of FXIII deficiency
for prevention of clinical complications in them.17
An epidemiological study on consanguineous marriage among urban population in
Alexandria was carried out using a cross-sectional approach, involving interviews
with 500 households randomly selected from three urban areas in Alexandria (Bab
Sharki, El Gomrok and Karmouz).

A questionnaire interview was conducted with

married females in these households to determine prevalence of consanguineous

marriages and to study knowledge of married females about causes and effects of
consanguineous marriages.

Prevalence of consanguineous marriages among 500

married females was 22.8% with the highest frequency among marriage between first
cousins (15.8%). Average inbreeding coefficient up to the marriage between second
cousins equals to 0.01172.18

A study conducted on Prevalence Of Consanguineous Marriages in a Rural

Community And its Effect On Pregnancy Outcome, The findings showed that

the

frequency of consanguinity in the study was 36% which is less than that observed in

other studies in South India, Muslims showed a higher frequency of consanguinity as

compared to Hindus.

The most frequent type of consanguineous marriage in the

study was between first cousins (54.44%).

All the cousin marriages were between

cross cousins. Foetal losses before 28th weeks were higher in consanguineous group
as compared to non consanguineous group, and this difference was statistically
significant.19

In Mumbai, studies showed that 7.7% of Hindus married to a second cousin or

closer, in the northern city of New Delhi only 0.1% of Hindus were married to a first
cousin. At the other extreme, studies done in the South Indian province of Karnataka,
which contains Bangalore, Madhya Pradesh, from which Chhattisgarh has now split,
and Maharashtra, which contains Mumbai, are provinces that are intermediate in their
kinship practices.20

A Field study conducted in Andrapradesh on Effects of consanguineous marriages on

fertility among three endogamous groups to assess interrelationships between
consanguineous marriage and fertility, 3 caste groups in Andhra Pradesh--the Desuri
Kapu, the Devanga, and the Mala, a scheduled caste at the bottom--were selected for
field study.

A total of 2524 marriages were analyzed, of which 46% were

consanguineous. 19% of consanguineous marriages were between uncle and niece,

22% were between 1st cousins, and 5% were between more distant cousins. The
Devanga had the highest rate of related marriages (48%), followed by the Desuri
Kapu (47%) and the Mala (41%). The mean number of pregnancies, live births, and
surviving offspring was 4.85, 4.44, and 2.99 among consanguineous couples
compared with 3.41, 3.32, and 2.87, among nonconsanguineous couples. Although the

number of pregnancies and live births was significantly higher among consanguineous
couples in all 3 castes compared with nonconsanguineous couples, the difference in
the number of surviving children in consanguineous marriage is low. This suggests
that child mortality is higher among the offspring of consanguineous unions.19

The case-control study was carried out , among diabetic patients and healthy subjects
at the Primary Healthcare Clinics (PHCs) in Quatar, The study included 338 cases
(with diabetes) and 338 controls (without diabetes).. The mean age (in years-/
+standard deviation) of cases versus controls was 45.5-/+8.9 vs 42.4-/+8.0, P<0.001.
The study revealed that, the diabetes was significantly common among the
consanguineous marriages of the first degree relatives compared with the control
group (33.1% vs. 24.6%, OR=1.59, 95% CI=1.11-2.29), P=0.008). Systolic blood
pressure (P=0.023) and glucose fasting (P<0.001) levels were significantly higher in
diabetic patients than in control subjects.16

In India, Tamilnadu state to examine consanguinity and pregnancy outcomes

among married women, a study was conducted from the National Family Health
Survey among a sample of 3948 married women aged 13-49 years. Consanguineous
marriage was highest in Tamil Nadu, where 48.2% of marriages were between
relatives. Other states with high consanguinity were Karnataka, Andhra Pradesh, and
Maharashtra. Findings reveal that about 50% of the samples were women aged less
than 30 years, 70.2% lived in rural areas. Pregnancy wastage was 22.7% for women
marrying close relatives, 21.6% for women marrying distant cousins, and 18.7% for
women marrying nonrelatives. The odds of pregnancy wastage were 1.3 times higher
for women marrying close relatives.

18

A study conducted on Neural tube defects in Pondicherry, showed that a total of

310 babies were born with neural tube defects with the overall frequency of 5.7/1000
births compared to 2.3/1000 births observed earlier in our hospital. The most common
defect was spina bifida (54.8%) followed by anencephaly (31.6%), and encephalocele
(11.6%). Neural tube defect was significantly higher among babies born to parents of
consanguineous marriage (p< 0.01). Associated congenital defects were observed in
thirty nine (12.6%) cases.17
A genetic study findings on Problems with consanguineous marriage, showed that
consanguinity could increase the incidence of many blinding disorders like retinitis
pigmentosa, Leber congenital amaurosis, Lawrence-Moon-Bardet-Biedl syndrome,
Stargardt disease, Usher syndrome,Consanguinity could increase the risk of inheriting
any one of the 4968 (autosomal recessive) genetic diseases that could affect any part
of the body from head to foot.21

2. Review related to the parents knowledge regarding effects of consanguineous

marriage.
A Cross-sectional study on Prevalence of consanguineous marriages in a rural
community of shindoli village of Belgaum district in which 500 married women
residing in the rural field practice were interviewed, the prevalence of consanguinity
was found to be 36%. Majority of the marriages were between first cousins (54.44%).
Fetal loss was seen to be significantly higher in the consanguineous group as
compared to non-consanguineous group(p<0.001). Only 7.6% of the women were
aware about the hazards of a consanguineous marraige.22

A Descriptive-analytic study on knowledge & attitude of parents on/ towards

consanguineous marriage in Iran, was carried out on 250 young people (125 couples)
in Northern Iran.

The information was obtained by a direct interview and the

questionnaire included four sections which comprised of 39 closed questions. The

data was analyzed by using SPSS, version 11.5 and the Chi-Square test.
Consanguineous marriages were observed in 32.5% of the couples. Consanguineous
marriages were determined in 20.87% and 11.63% of the rural and the urban residents
respectively. The knowledge was poor (49.2% of the females and 40% of the males)
on the genetic consequences of inbreeding. The results on the attitude of parents
showed that 38.8% of the subjects had agreed and that 61.2% of them had disagreed
on consanguineous marriages. This study showed that the knowledge of the couples
towards consanguineous marriages was poor.19
3. Review related to awareness of consanguineous marriage
A Survey study conducted in Iran on trend in consanguineous marriage across three
generations of Iranians, consisting of 400 individuals attending the diabetes and
osteoporosis clinic in Shariati Hospital, were interviewed. Data on consanguinity
status for 1789 marriages within the index cases' families were obtained. Generation 1
consisted of marriages contracted before 1948, Generation 2 consisted of marriages
contracted between 1949 and 1978, and Generation 3 consisted of marriages
contracted after 1979. Prevalence of consanguineous marriage within these three
generations was 8.8%, 16.6% and 19%, respectively, and represented a significant

trend (p < 0.001). First cousin marriage was the most common type of consanguinity
(69%).20

Another study was conducted in Iran, on youths knowledge, behavior, and attitude
towards consanguineous marriages. The study revealed that most of the youth did not
have favorable information about the consequences of inherited genetic disorders of
inbreeding in an autosomal receive pattern.22

A study was conducted on awareness about the problems associated with

consanguineous marriages among Israeli Arab adults. The results show that one
Quarter of the adults 24.5 percent demonstrated a high level of knowledge, whereas
29.7 percent had a moderate level, and 45.8 percent a low level. Efforts have been
made to increase the knowledge of adults along with parents who have a lower level
of education, who are consanguineous, and who have extreme religious attitudes.21

6.3 PROBLEM STATEMENT

A study to assess the knowledge & attitude regarding effects of consanguineous
marriage on offsprings among the parents in selected rural area at bangalore, with a
view to develop a pamphlet.

6.4 OBJECTIVES OF THE STUDY:1. To assess the knowledge regarding effects of consanguineous marriage on
offspring among parents.
2. To assess the attitude regarding effects of consanguineous marriage on
offspring among parents.

3. To determine the association between knowledge & attitude regarding

effects of consanguineous marriage among parents with selected demographic
variables.

6.5 OPERATIONAL DEFINITIONS

KNOWLEDGE:In this study knowledge refers to the information & awareness the parents possess on
the effects of consanguineous marriage on offspring as verbalized to specific items on
the questionnaire & scored.
ATTITUDE :In this study attitude refers to the reflection of the parents innermost conviction
about consanguineous marriage, which is measured by using a likert scale.
CONSANGUINEOUS MARRIAGE:-

A consanguineous marriage refers to individuals who prefer to marry within their

clan, unions range from cousin-cousin to more distant relatedness, & their prevalence
varies by culture.
OFFSPRING:In this study offspring refers to children who will be born to a parent or progenitor
PARENTS:In this study parents refers to a father or a mother who have children between the age
group of 15 -30years.
EFFECTS OF CONSANGUINEOUS MARRIAGE:-

Refers to congenital malformations, fetal loss, still birth on the offspring of

those parents who prefer to marry within their clan.
PAMPHLET:-

In this study, it refers to a single sheet of paper that is printed on both sides &
folded in half, in thirds or in fourths consist of information regarding the
effects of consanguineous marriage on offspring.
6.6 ASSUMPTIONS:-

Parents may have inadequate knowledge regarding the ill effects of

consanguineous marriage.

Parents attitude may vary with selected demographic variables.

6.7 HYPOTHESIS:H1:-There will be significant association between knowledge scores of parents with
selected demographic variables.

6.8 RESEARCH VARIABLES:Variables are qualities, properties or characteristics of a person, things or situation that
can change or vary.

Dependent variables: Knowledge of parents regarding consanguineous

marriage.

Demographic variables:- age, sex, education, occupation, place of

residence, religion.

6.9 PROJECTED OUTCOME:The study will help the parents to understand the effects of consanguineous marriage
through the prepared pamphlet which will help to promote awareness to parents
regarding the cause, ill effects & prevention of consanguineous marriage.

7. MATERIAL & METHODS:7.1 SOURCE OF DATA

Data will be collected from Parents having children aged between 15-30 years in a
selected rural area at Bangalore.

7.1.1 RESEARCH DESIGN:-

DESCRIPTIVE DESIGN.

7.1.2 SETTING: The study will be conducted in a selected rural area at Bangalore.
7.1.3 POPULATION:The study population comprises of father & mother, having children between age
group of 15-30 yrs in a selected rural area at Bangalore.

7.2 METHOD OF DATA COLLECTION:7.2.1 SAMPLING PROCEDURE:Purposive sampling technique will be used to select the subjects for the study.
7.2.2 SAMPLE SIZE:The sample for the study consists of 100 parents, having children in the age between
(15-30yrs).
7.2.3 INCLUSION CRITERIA FOR SAMPLING:1. Parent having children between the age group of 15-30 years.
2. Parent who are willing to participate in this study.
3. Parent include either father or mother.
4. Parents who are available at the time of data collection
7.2.4 EXCLUSION CRITERIA FOR SAMPLING:1. Parents who does not understand English, kannada.

7.2.5 INSTRUMENTS USED

Tool will be divided into 2 sections:o Section A: Demographic variables
o Section B: 1. Structured knowledge questionnaire to assess knowledge.
2. Three part likert scale to assess the attitude of parents regarding
consanguineous marriage.

7.2.6 DATA COLLECTION METHOD

Prior to the data collection, written permission will be obtained from the respective
family based on inclusion & exclusion criteria. The subjects will be selected &
informed consent will be taken from the selected subjects after explaining study, data
will be collected using the structured questionnaire.
7.2.7 DATA ANALYSIS METHOD:Descriptive & inferential statistics will be used to analyse the data according to the
objectives. The descriptive statistics like mean, standard deviation, frequency
distribution & percentage will be used to assess the demographic variables. The
inferential statistics like chi-square will be used to determine the association between
knowledge & attitude of parents regarding effects of consanguineous marriage with
selected demographic variable.
7.3 Does The Study Require Any Investigations Or

Interventions To Be

Conducted On Patients Or Other Human Or Animals?

No invasive procedure will be administered as the part of the study. Only
questionnaire will be used to collect the data.
7.4

Has Ethical Clearance Been Obtained?

YES, ethical clearance will be obtained & individual consent will be taken from

the participants prior to the study.

7.5 LIST OF REFERENCE:1

T K Indrani.Text book of Sociology for Nurses.1sted.Jaypee brothers Medical

publishers (p) Ltd;1998.

H.R Mukhi.Principles of Sociology. 6thed.SBD publishers & distributers;2003.

K.Park.Parks textbook of preventive and social medicine.19thed.Banarsidas

Bhanot publishers; 2007.

Polit D Beck C T. Nursing Research Priciples & Methods.7 th ed. Philadelphia:

Lippincott Williams & Wikkins; 2004.

Matchmaking within commuinty or in cyber space. www.hinduonline.com,

3.11.2008.

Shivashankara A.R, Jailkhani.R. Trends in consanguineous marriage in

Karnataka. south India: Journal of biosocial science 1993 January; 25(1) : 111115

UL Haq F, Jalil F. Community perceptions of reasons for reference for

consanguineous marriages in Pakistan: www.pubmed.com.3.11.2008.

Problems with consanguineous marriage: www.google.com. 04.10.2008.

Jaber O R.Awareness about problems associated with consanguineous marriages.

survey among Israeli arab adults.Journal of adults health vol 36, issue 6:530534

10 World

Health

Organization

eastern

Mediterranean

health

journal;

www.emro.who.int.vol 13 no.6 : December 2007.

11 Study of youths knowledge, behavior and attitude towards consanguineous
marriages: Iranian journal on public health vol 35, no.3 2006.
12 Eshghi P,Cohan N Lak.The effect of consanguineous marriages on congenital
malformation.Journal of research in medical sciences;vol 10, no.5,october 2005.
13 Prevalence of consanguineous marriages in a rural community and its effect on
pregnancy outcome.Indian journal of community medicine vol.29, no.1, January,
2004.
14.Bittles AH,Consanguinity And Its Relevance To Clinical Genetics.Clinical
Genetics 2001,60, 89-98.

15. Eraksoy M, Kurtuncu M.Clinical outcomes of consanguineous marriages in

Turkey Turkish:Journal Of Paediatrics 2001 Oct Dec; vol 43(4): 277-279
16. Nath. A, Patil.C, V.A.Naik.Prevalence Of Consanguineous Marriages in a Rural
Community And its effect On Pregnancy Outcome;Vol 29 No.1 (2004-01 2004-03).
17. Keshav Swarnakar.community health nursing.1sted.200; Kumar Publishers House;
499- 500
18.Dr.Rajesh Kumar.Indian Journal Of Community medicine official publication of
indian association of preventive and social medicine.Vol 31, No 2, April-May 2006
19.Bittles AH, Neel JV. The costs of human inbreeding and their implications for
variations at the DNA level. Nature Genetics1994, 8, 117-121.
20.Bittles AH.Consanguinity and its relevance to clinical genetics. Clinical
Genetics2001,60, 89-98.
21.Modell B,Darr A.Genetic counseling and customary consanguineous marriage.
Nature Reviews Genetics ,2002 ;3:225-229.9
22.http://www.sawnet.org/health/abstracts.html
23.. Health effects of consanguinity in pondicherry. www.pubmed.com,.25.10.2008.

8.
9.
10.

SIGNATURE OF THE
CANDIDATE
REMARKS OF THE
GUIDE
NAME AND
DESIGNATION

THE TOPIC SELECTED FOR THE

STUDY IS RELEVANT AND NEED
BASED
MRS. DEEPA.S.NAIR
ASSISTANT PROFESSOR
HOD,COMMUNITY HEALTHNURSING

11.

11.1 GUIDE

SEA COLLEGE OF NURSING

MRS. DEEPA.S.NAIR
HOD,COMMUNITY HEALTH NURSING

11.2 SIGNATURE
11.3 CO-GUIDE

MR.KUMAR SHREE HARSHA

LECTURER
COMMUNITY HEALTH NURSING.

11.4 SIGNATURE
11.5 HEAD OF

MRS. DEEPA.S.NAIR

DEPARTMENT

ASSISTANT PROFESSOR
HOD,COMMUNITY HEALTH NURSING

11.6 SIGNATURE

12.

12.1 REMARK OF THE

CHAIRMAN AND
PRINCIPAL

THE TOPIC SELECTED FOR THE

STUDY IS RELEVANT AND CAN BE
FORWARDED FOR NEEDFUL ACTION

12.2 SIGNATURE