Consanguineous marriages and child nutritional health—The moderating effect of household wealth

doi:10.21203/rs.3.rs-4813162/v1

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Consanguineous marriages and child nutritional health—The moderating effect of household wealth

https://doi.org/10.21203/rs.3.rs-4813162/v1

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Consanguineous marriages are prevalent in many societies especially in Asia and Africa, and are linked to various child nutritional health problems. The objective of this study is to investigate the relationship between consanguineous marriages and child nutritional health in Pakistan, and the moderating effect of wealth status on this relationship. Data from the Pakistan Demographic and Health Survey (PDHS) conducted in 2017–2018 were utilized. The sample includes 15,671 households, with 63.73% reporting consanguineous marriages. Binary logistic regression analysis was performed to examine the adjusted and unadjusted effect of consanguineous marriages and on children's nutritional health, and the moderating effect of household wealth was examined between consanguineous marriages and child nutritional health. The results revealed that consanguineous marriages were associated with increased odds of child wasting {OR 1.84(1.42–2.37)}, stunting {OR 1.23(1.08–1.41)}, and underweight {OR 1.61(1.38–1.88)}. While adjusted odds of stunting {AOR 1.03(0.90–1.19)} remain insignificant, the association between consanguineous marriages and child nutritional health was negatively moderated by household wealth. The study highlights the adverse impact of consanguineous marriages on child nutritional health, and the moderating effect of household wealth on child nutritional health. Efforts should be made to raise awareness about the health risks associated with consanguinity and promote interventions to improve child nutrition in consanguineous unions regardless of wealth status.

consanguineous marriages

nutritional health

stunting

wasting

underweight

household wealth

The marriage or union between individuals who have common ancestors has been prevalent in many parts of the world by different societies from ancient times[1] and is widely practiced in Asian and African countries [2] [3]. The typical form of this marriage is between the first cousin from the father’s side or mother side and is termed a consanguineous marriage [4]. Consanguineous marriage is a cultural and traditional practice around the world and it accounts for 10.4% of all marriages globally [5]. The percentage of consanguineous marriages in Muslim countries like Saudi Arabia, Egypt, Turkey, Iran, and Afghanistan were 50%, 20%, 30%, and 40%, respectively, while the consanguineous marriage practices in South Asian countries such as Bangladesh, India and Pakistan are ranging from 20–50% [6, 7] [8] [9] [10].

Malnutrition poses the critical nutritional health problems within the children and below the age of five years in under-developed countries comprising Pakistan[11]. The literature identifies that consanguinity is related to children’s nutritional health problems[12]. Child stunting, wasting, and being underweight, are critical malnutrition health issues[13] and can negatively affect the physical and cognitive development of children[14, 15]. The risk of underweight birth is 1.5 times higher for the children born in consanguineous marriages than in non-consanguineous marriages[10]. Literature from India and Pakistan documented that children underweight, stillbirth and newborn child mortality have been significantly associated with consanguinity [13, 16–18]. Moreover, consanguineous marriages are associated with the prevalence of recessive features and diseases some of which negatively affect the children height and weight[19]. Children born in consanguineous unions had a higher rate of wasting, epilepsy, diabetes, intellectual disability, and asthma compared to children born in non-consanguineous marriages[20] [21]. Likewise, Studies from 63 countries show the rising concerns that the offspring from consanguineous marriages have a higher rate of mortality and morbidity[22].

Household wealth is an important indicator of children’s nutritional health [23]. Wealthier households have greater resources to provide diverse and nutritious diets that potentially lowering the chances of child wasting, stunting, and underweight[24]. Number of studies exhibits that children from lower household wealth often experience more undernourishment than children from higher-income households [25, 26].A child's poor nutritional status has also been associated with social deprivation [23] [27]. People from countries with better economic conditions and equal wealth distribution have better health status for both mothers and newly born children[28, 29].The number of studies use the household wealth index to check the moderating effect on child mortality and child healthcare utilization[30, 31]. A study from Nigeria uses household wealth as a moderator to assess the relationship between maternal health autonomy and child healthcare[30]. Another study conducted in Pakistan uses household wealth to assess the moderating role between socioeconomic determinants and child mortality[31]. Based on existing literature we can assume that household wealth can play a moderating role between consanguineous marriages and child nutritional health.

There is a scarcity of population-based research in Pakistan on the relationship between consanguineous marriage and children's nutritional health namely stunting, wasting, and underweight [32]. Previous researches are limited to the consanguineous marriages and child stunting and underweight[12].whereas our study contributes to the existing literature by incorporating all three anthropometric measures i.e. stunting, wasting and underweight from the latest Pakistan demographic and health survey conducted between 2017–2018. Moreover, the moderating role of household wealth between parental consanguinity and the nutritional status of children remains largely unexplored and requires further investigation.

This study aims to measure the relationship between consanguineous marriage and child nutritional health. Moreover, this study also investigates the moderating role of the household wealth index between consanguineous marriage and child nutritional health in Pakistan. In this context, we propose the following hypotheses. Children born from consanguineous marriages are more likely to experience stunting, wasting, and being underweight contrasted to those born from non-consanguineous marriages. Moreover, poor household wealth is independently predictive of childhood undernutrition. We hypothesize that children from economically disadvantaged households have a higher likelihood of experiencing undernutrition compared to the children from wealthier households. This study extends the current body of literature by applying binary logistic regression to understand the relationship between cousin marriages and child nutritional health and also the moderating effect of wealth on child nutritional health in consanguineous marriages. The outcome of this study will guide further to prioritize public health campaigns to raise awareness about health issues of children born in consanguineous marriages and address economic disparities for improved child nutrition.

Data source and study design

The study utilizes the latest data from the fourth wave of the Pakistan Demographic and Health Survey (PDHS) conducted between 2017 and 2018. The survey was carried out by the National Institute of Population Studies (NIPS) in collaboration with ICF International (an international consulting firm) the survey included 15,671 households, out of which 15,051 were found to be occupied. The response rates were analyzed for three specific regions i.e. Pakistan, Azad Jammu and Kashmir, and Gilgit Baltistan. In Pakistan, 11,869 out of 12,338 occupied houses were effectively interviewed, yielding a 96% response rate. Similarly, the response rate in Gilgit Baltistan and Azad Jammu and Kashmir were 98% and 99%, respectively. 94% of Pakistani women who have ever been married and are between the age of 15–49, and 97% of women in Azad Jammu and Kashmir, and 94% of women in Gilgit Baltistan were successfully questioned for the survey. 87% of ever-married males in Pakistan, 94% in Azad Jammu and Kashmir, and 84% in Gilgit Baltistan were successfully questioned in the subsample of homes chosen for the male survey.

Study sampling and participants

A total of 50484 ever-married women participated in the 2017–2018 Pakistan demographics and health survey and were asked about their relationship with their husbands out of which 32,173 were involved in consanguineous marriage and 18,311 were involved in non-consanguineous marriage. Table 1. Shows the definitions and measurement of the variables

Table 1

Definition and measurement of variables.
Variables	Definition and measurement
Dependent variable Stunting underweight wasted	height-for-age z-score below − 2 standard deviations = yes; otherwise = no weight-for-age z-score below − 2 standard deviations = yes; otherwise = no weight-for-height z-score below-2 standard deviation = yes; otherwise = no
Independent variable Consanguineous marriage	Relationship with husband = yes otherwise = no
Moderating variable Wealth	Poorest = 1, Poorer = 2, Middle = 3, Richer = 4, Richest = 5
Covariates Age Region Place of residence Working status	15–19 = 1, 20–24 = 2 ,25–29 = 3, 30–34 = 4, 35–39 = 5, 40–44 = 6, 45–49 = 7 Urban = 1, Rural = 0 Punjab = 1,Sindh = 2,KhyberPakhtunkhwa = 3,Balochistan = 4,Gilgit-Baltistan = 5, Islamabad = 6, Azad Jammu and Kashmir = 7, fata = 8 Yes = 1; No = 0

Dependent variable

Our dependent variables consist of anthropometric data about height-for-age (stunting), weight-for-age (underweight), and weight-for-height(wasted). Women were questioned about their children’s nutritional condition during the survey, children under the age of five residing in the household was measured for height and weight. Following WHO guidelines, a child with a height-for-age z-score below − 2 standard deviations is categorized as “stunted”, while a weight-for-age z-score below − 2 standard deviations is classified as “underweight”. Same is the case for wasted if weight-for-height z-score is below − 2 standard deviation is termed as “wasted”. In this study our response variables are binary-coded. Children classified as “stunted” are assigned a code of ‘Yes’, while those who are not categorized as stunted are assigned a code of ‘No’. Similarly, children classified as “underweight” are coded as ‘Yes’, while those who are not categorized as underweight are coded as ‘No’ and children classified as “wasted” are assigned code of ‘Yes’, while those who are not categorized as wasted assigned a code ‘No’.

Independent variable

Consanguineous marriage was taken as an independent variable in this study. The respondents were asked about their blood relationship with their spouse “was or is there a blood relationship between husband and you?” If the answer was yes, we coded it as “1” and if their answer was no, we coded it as “0”.

Moderating variable

In our study the moderating variable is the household wealth which shows the household economic status, and individuals were based on the ranked of their household scores and subsequently divided into quintiles. With each quintile representing 20% of the scores, ranging from the poorest to the richest households. The wealth quintiles were determined through access to the utilities, durable asset ownership, infrastructure and housing characteristics.

Covariates

Numerous socioeconomic and demographic factors are included in our study, including the age of the respondents in the five-year group (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49), the respondents place of residence (rural or urban), and whether or not they are working (yes, no). The national geography is categorized into Sindh, Punjab, Khyber Pakhtunkhwa, Gilgit-Baltistan, Baluchistan, federally administrated tribal areas (FATA) and Islamabad. These variables were chosen after thorough literature review (35, 36, 37, 38, 39, 40), and only those that showing the association were chosen for analysis.

Statistical analysis

In the initial stage, we performed descriptive statistics analysis of the study sample to measure the sample’s basic characteristics. In the second stage, to check the association between consanguineous marriages and child nutritional health, the binary logistic regression analysis was performed to calculate the adjusted and unadjusted odd ratios. In the last moderation analysis to check the moderating effect of wealth status between child nutritional health outcomes and consanguineous marriages all the analyses were performed in STATA/SE 16.0.

Descriptive statistics

Table 2, showcase the sample characteristics of the currently married women with background characteristics. Our results show that overall consanguineous marriages are dominant in Pakistan with almost 63.73 percent that is 32173 and the majority of the respondents are from age between 35–39 and are from Punjab (13.52%), rural area (36.38%) and are not working (54.09%) and about (31%) belongs to the poorest and poorer households.

Table 2

Sample distribution of currently married women by selected background characteristics
Background characteristics	% (N)	Consanguineous marriage		test of association
		Yes	No	Chi Square	P-Value
N		32,173	18,311
Women Age group (In years)
15–19	(0.78)393	0.48	0.30	48.07	0
20–24	(5.90)2978	3.91	1.98
25–29	(14.74)7445	9.49	5.26
30–34	(19.77)9982	12.47	7.30
35–39	(23.59)11911	14.81	8.77
40–44	(18.28)9232	11.37	6.91
45–49	(16.94)8554	11.21	5.74
Region
Punjab	(21.44)10825	13.52	7.93	1200	0
Sindh	(17.93)9052	12.98	4.95
KPK	(16.21)8185	9.81	6.39
Balochistan	(12.6)6363	9.06	3.55
Gb	(7.39)3734	3.47	3.93
ICT	(6.33)3195	3.47	2.86
AJK	(10.54)5324	7.06	3.48
FATA	(7.56)3817	4.37	3.19
Place of residence
Urban	(45.67)23059	27.45	18.23	242.11	0
Rural	(54.33)27436	36.28	18.05	242.11	0
Respondent Currently working
No	(85.19)43014	54.09	31.1	6.91	0.009
Yes	(14.81)7475	9.63	5.17	6.91	0.009
Wealth index
Poorest	(22.74)11,43	15.94	6.8	572.43	0
Poorer	(23.37)11,83	15.36	8
Middle	(20.08)10,10	13	7.09
Richer	(17.25)8,709	10.4	6.86
Richest	(16.56)8,360	9.04	7.52
GB = Gilgit Baltistan, ICT = Islamabad, AJK = Azad Jammu and Kashmir, FATA = Federally administered tribal area Regression result

Table 3, results showcase the adjusted and unadjusted odds ratios and corresponding confidence intervals, examining the relationship between consanguineous marriages and child wasting, stunting, and underweight using binary logistic regression. The unadjusted odd ratio of wasting 1.84 (95% CI: 1.42–2.37) shows that women who are in a blood relationship with their husband are 1.8 times more likely to have a wasted child compared to those in no consanguineous marriage. The adjusted odd ratio 1.53 (95% CI: 1.17–1.99) shows the association remains significant after adjusting for other factors. Similarly in stunting the unadjusted odd ratio 1.23 (95% CI: 1.08–1.41) shows a woman who is in a blood relationship with their husband is 1.23 times more likely to have a stunted child as compared to a woman who is not in such relationship, whereas in adjusted odd ratio 1.03 (95% CI: 0.90–1.19) the association becomes statistically non-significant. In the case of underweight, the unadjusted odd ratio 1.61 (95% CI: 1.38–1.88) shows that women who are in a blood relationship with their husbands are 1.6 times more likely to have underweight children as compared to women who are not in such relationship. Similarly, the adjusted odd ratio 1.24 (95% CI: 1.05–1.46) shows the association remains significant after adjusting for other factors.

Socio-demographic factors are also associated with a child's nutritional health. Children born in the richest household compared to those who were born in relatively poor households were less likely to be stunted (AOR:0.20,95%CI:0.15–0.26), underweighted (AOR:0.16, 95%CI:0.11–0.23) and wasted (AOR:0.51,95%CI:0.31–0.83) respectively.

Table 3

Unadjusted odd ratios (UOR) and adjusted odd ratios (AOR) from binary logistic regression on child nutritional health in Pakistan
Variables	Wasting		Stunting		Underweight
Variables	UOR [95% CI]	AOR [95% CI]	UOR [95% CI]	AOR [95% CI]	UOR [95% CI]	AOR [95% CI]
Marriage type
Ref (non-consanguineous)	1.00	1.00	1.00	1.00	1.00	1.00
Consanguineous marriage	1.84(1.42–2.37) ***	1.53(1.17–1.99) **	1.23(1.08–1.41) ***	1.03(0.90–1.19)	1.61(1.38–1.88) ***	1.24(1.05–1.46) ***
Wealth index
Ref (Poorest)	1.00	1.00	1.00	1.00	1.00	1.00
Poorer	1.19(0.88–1.60)	1.31(0.95–1.80)	0.49(0.41–0.59) ***	0.53(0.43–0.64) ***	0.49(0.40–0.59) ***	0.58(0.47–0.72) ***
Middle	0.68(0.48–0.98)	0.77(0.52–1.14)	0.38(0.31–0.46) ***	0.43(0.34–0.53) ***	0.31(0.25–0.39) ***	0.38(0.30–0.49) ***
Richer	0.72(0.50–1.04)	0.79(0.52–1.21)	0.29(0.24–0.36) ***	0.32(0.25–0.41) ***	0.29(0.23–0.37) ***	0.34(0.26–0.45) ***
Richest	0.42(0.27–0.64) ***	0.51(0.31–0.83) **	0.17(0.14–0.22) ***	0.20(0.15–0.26) ***	0.13(0.09–0.17) ***	0.16(0.11–0.23) ***
Women age group
Ref (15–19)	1.00	1.00	1.00	1.00	1.00	1.00
20–24	1.05(0.52–2.09)	1.31(0.64–2.66)	1.05(0.71–1.5)	1.24(0.82–1.88)	0.73(0.48–1.12)	0.88(0.56–1.39)
25–29	0.96(0.48–1.88)	1.15(0.57–2.31)	1.08(0.73–1.59)	1.34(0.90–2.02)	0.76(0.50–1.15)	0.94(0.60–1.46)
30–34	0.94(0.47–1.87)	1.28(0.63–2.60)	0.94(0.63–1.39)	1.20(0.79–1.81)	0.75(0.49–1.14)	1.01(0.64–1.57)
35–39	0.86(0.42–1.77)	1.00(0.47–2.09)	0.99(0.66–1.49)	1.13(0.74–1.74)	0.75(0.49–1.17)	0.83(0.52–1.33)
40–44	1.28(0.56–2.28)	1.48(0.64–3.42)	1.14(0.70–1.84)	1.27(0.77–2.10)	1.07(0.64–1.78)	1.22(0.71–2.10)
45–49	0.60(0.16–2.28)	0.54(0.14–2.09)	0.87(0.45–1.68)	0.65(0.33–1.30)	1.08(0.55–2.13)	0.73(0.36–1.51)
Region
Ref (Punjab)	1.00	1.00	1.00	1.00	1.00	1.00
Sindh	2.58(1.7–3.84) ***	2.38(1.58–3.59) ***	2.03(1.66–2.48) ***	1.64(1.32–2.03) ***	3.25(2.57–4.11) ***	2.55(1.99–3.27) ***
KPK	1.96(1.28-3.00) ***	1.84(1.19–2.84) ***	1.26(1.02–1.56) **	1.21(0.97–1.50)	1.35(1.03–1.75) **	1.31(1.00-1.73) *
Balochistan	5.96(4.03–8.82) ***	4.87(3.21–7.38) ***	2.27(1.81–2.85) ***	1.67(1.30–2.13) ***	4.32(3.35–5.58) ***	3.05(2.32–4.01) ***
GB	0.24(0.07–0.81) **	0.21(0.06–0.69) ***	1.52(1.15–2.02) ***	1.15(0.86–1.54)	0.84(0.56–1.26)	0.61(0.40–0.93) **
ICT	1.02(0.50–2.09)	1.15(0.55–2.38)	0.74(0.53–1.03)	0.98(0.69–1.39)	0.59(0.37–0.96) *	0.84(0.51–1.37)
AJK	1.44(0.86–2.41)	1.31(0.77–2.20)	0.90(0.70–1.16)	0.81(0.62–1.05)	0.97(0.70–1.34)	0.89(0.63–1.25)
FATA	1.40(0.80–2.45)	1.11(0.62–1.97)	2.61(2.02–3.38) ***	1.77(1.35–2.32) ***	2.12(1.57–2.86) ***	1.39(1.01–1.91) *
Place of residence
Ref (Urban)	1.00	1.00	1.00	1.00	1.00	1.00
Rural	0.92(0.73–1.15)	0.86(0.65–1.12)	1.49(1.31–1.70) ***	0.91(0.78–1.07)	1.45(1.26–1.68) ***	0.92(0.76–1.10)
Respondent currently working
Ref (No)	1.00	1.00	1.00	1.00	1.00	1.00
Yes	0.87(0.60–1.26)	0.76(0.51–1.12)	1.32(1.09–1.61) ***	1.13(0.92–1.40)	1.61(1.31–1.98) ***	1.23(0.97–1.55)
Note: AOR = adjusted odds ratio; UOR = unadjusted odds ratio; 95% confidence intervals in brackets. * p < .05, p < .02, * p < .001, Gb = Gilgit Baltistan, ICT = Islamabad, AJK = Azad Jammu and Kashmir, Fata = federally administered tribal area

Interaction effect

As shown in Fig. 1, the relationship between consanguineous marriages and the stunting of children is positively moderated by the household wealth index. Children born in the poorer and poorest households were more prone to suffer from stunting compared to children born in relatively wealthy families.

As shown in Fig. 2, the relationship between consanguineous marriages and the wasting of children is positively moderated by the household wealth index. Children born in poorer households were more prone to suffer from wasting compared to children born in relatively richest families.

As shown in Fig. 3, the relationship between consanguineous marriages and underweight children is positively moderated by the household wealth index. Children born in the poorer household were more prone to suffer from underweight as compared to children born in relatively richest families.

This study is a comprehensive attempt to investigate the relationship between consanguineous marriages and child nutritional health and the moderation effect of household wealth on the nutritional health of the child using the most recent national-level data and applied binary logistic regression to analyze the results. Our study finds that consanguineous marriages in Pakistan account for almost more than half of the marriages. Moreover, our results also show that the risk of stunting, wasting, and underweight is higher in consanguineous marriages compared to non-consanguineous marriages.

We found that consanguineous marriages in Pakistan are positively associated with child stunting, wasting, and being underweight, one of the main reasons for consanguineous marriages is that parents are the sole decision makers for the marriage of their sons and daughters, because of the socioeconomic factors such as the lower price of dowries, strengthening of family wealth or to preserve ethnic affiliation[33]. All of these practices lead to child wasting, stunting and underweight, and our result illustrate almost the same pattern that was complimented by a study which shows that there is a higher likelihood of underweight children among first-cousin couples compared to non-related couples in Sindh[33]. Another study exhibits the same kind of results by using a Pakistan demographic and health survey[34]. Moreover, a study conducted in Libya also revealed similar findings [35]. Consanguineous marriage can also increase the risk of still birth[17], infant mortalities[5, 6, 36], and morbidities[22] all of these outcomes from consanguineous marriages can affect the health of the children in the later stage.

Our moderation analysis indicates the negative association between consanguineous marriage and child stunting, wasting and being underweight. Children from wealthier families have relatively lower chances of experiencing stunting, wasting and being underweight in consanguineous marriages. This suggests that wealth acts as a protective factor in reducing the likelihood of negative nutritional health outcomes, previous studies show that child health improves when the mother's socioeconomic factors such as education and household wealth status was better [33, 37, 38].

Moreover, socio-demographic factors like place of residence(rural/urban), region, and currently working women show that there is no association between child stunting, wasting, and underweight, the finding of our study is consistent with the previous study conducted in Pakistan [39].

Strength and limitation

The strength of our study is that we used the national level large representative dataset which helped us to generalize our results, further mover we used the appropriate statistical method to analyze the results. however, there are some limitations in our study that our study implies cross-sectional data that doesn’t allow us to depict any causal conclusion.

Conclusion and recommendation

The results of this study conclude that children born in consanguineous unions were more likely to experience stunting, wasting, and being underweight compared to those born in non-consanguineous unions. Moreover, the relationship between consanguineous marriages and child nutritional health was significantly negatively moderated by household wealth. To avoid the negative consequences of consanguineous marriages state-level policies, and strategies need to be crafted to scientifically check the issues associated with expected offspring from consanguineous marriages. Furthermore, the government should start a social benefits program for underprivileged and economically marginalized families to mitigate the risk of child undernourishment associated with economic factors. Additionally, government can provide education and counseling to consanguineous couples about the potential risks of inherited genetic disorders in offspring and the importance of genetic testing. Offering nutritional counseling and support to ensure optimal maternal and child nutrition before, during, and after pregnancy. Implementing the programs for early detection and management of nutritional deficiencies and developmental delays in children born to consanguineous couples. Conducting public awareness campaigns to educate communities about the potential health risks associated with consanguineous marriages and the importance of preconception and prenatal care. Developing policies that promote access to healthcare services, genetic testing, and counseling for consanguineous couples, and integrating these services into existing healthcare systems. By implementing these recommended policies, public health authorities can mitigate the risks associated with consanguineous marriages and improve the nutritional health and well-being of children from these unions.

In future research, it is recommended that longitudinal studies be conducted to follow children from birth, assessing their nutritional outcomes over time. Such studies would provide more robust evidence on the causal relationship between consanguinity and child nutritional health. Longitudinal designs offer the advantage of tracking how consanguineous marriages impact child nutritional health over time while controlling for potential confounding factors.

Author’s contribution statement

The authors' contributions to this work are as follows: Muhammad Usman Saleem conceived the study, Muhammad Usman Saleem and Abdul Ghani Khatir collected and analyzed data, [Muhmmad Usman Saleem, Abdul Ghani Khatir, drafted the manuscript, and Jiang Quanbao critically reviewed it. All authors approved the final version and are collectively accountable for the research's content and integrity.

Declaration of conflict of interest

The authors declare no conflict of interest. We are committed to transparency and ethical conduct, and will promptly disclose any conflicts that may arise.

Ethical approval

The PDHS 2017–2018 has taken into account the standard ethical guidelines of the measure DHS program. The authors have obtained the data from DHS website (URL: https://www.dhsprogram.com/data/available- datasets.cfm) following their data obtaining procedure. However, no formal ethical clearance was obtained because the study involved secondary analysis of publically available data.

Funding statement

Key project of the National Social Science Foundation of China, grant number 23&ZD185.

Author Contribution

Author’s contribution statement The authors' contributions to this work are as follows: Muhammad Usman Saleem conceived the study, Muhammad Usman Saleem and Abdul Ghani Khatir collected and analyzed data, [Muhmmad Usman Saleem, Abdul Ghani Khatir, drafted the manuscript, and Jiang Quanbao critically reviewed it. All authors approved the final version and are collectively accountable for the research's content and integrity.

Acknowledgement

The author would like to thank Xi’an Jiao tong University for all the support and assistance to conduct this research.

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No competing interests reported.

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Consanguineous marriages and child nutritional health—The moderating effect of household wealth

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Abstract

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Introduction

Methods

Data source and study design

Study sampling and participants

Dependent variable

Independent variable

Moderating variable

Covariates

Statistical analysis

Results

Descriptive statistics

Interaction effect

Discussion

Strength and limitation

Conclusion and recommendation

Declarations

Author’s contribution statement

Declaration of conflict of interest

Funding statement

Author Contribution

Acknowledgement

References

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