CONSANGUINITY AND INBREEDING COEFFICIENT IN TRIBAL PASHTUNS INHABITING THE TURBULENT AND WAR-AFFECTED TERRITORY OF BAJAUR AGENCY, NORTH-WEST PAKISTAN

Consanguinity in northwest Pakistan: evidence of temporal decline

Pakistan has a high burden of hereditary and congenital anomalies and their incidence rate almost doubles against the background of parental consanguinity. Consanguineous unions (CU) are customary in Pakistan and deeply rooted socio-cultural norms favour CU. This study aimed to elucidate the determinants and temporal change in CU in four northwestern populations of Pakistan. In a cross-sectional study, data on marital union types, bio-demographic factors, and paternal consanguinity were collected from 6,323 ever-married individuals in four districts of northwest Pakistan: Haripur, Muzaffarabad, Mansehra, and Shangla. We used descriptive statistics and multivariable logistic regression analysis. The CU were calculated to be 55%, and inbreeding coefficient F (ICF) was estimated to be 0.029. Eight factors, including district, rural origin, age of husband, occupational group of husband, literacy of husband, parental consanguinity, exchange marriage, and extended family type, were found to be significant predictors of consanguinity in the multivariable logistic regression analysis. The rate of consanguinity decreased significantly in the younger age categories of individuals. The rate of CU was seen to be declining over time and in marriages that started 'before 1980' and 'after 2010', respectively, and there was a decline in ICF from 0.030 to 0.027. These analyses also showed that the literacy rate improved, the average age at marriage increased, and the frequency of exchange marriages decreased over time. This study employs a sizable first-hand dataset to demonstrate a lowering CU rate in northwest Pakistan. It is anticipated that the burden of inherited and congenital anomalies may likely to diminish in the study populations along with the fall in ICF.

Burden of congenital and hereditary anomalies in the war-affected territory at Pakistan-Afghanistan border

Background

Pashtun populations of Pakistan are the victim of long-lasting military combats, rendering 1.9 million inhabitants internally displaced. Studies highlighting congenital and hereditary anomalies in these populations are deficient.

Objectives

To elucidate the spectrum anomalies in the north-western war-affected territories of Pakistan.

Methods

A cross-sectional study was carried out from 2017 to 2019 and individuals or families with anomalies were ascertained through convenience and cluster random sampling. Phenotypic and pedigree data and information on bio-demographic variables were collected. Descriptive statistics were applied.

Results

A total of 361 independent individuals or families with anomalies were recruited. The anomalies were grouped into 8 major and 72 minor entities. Among major categories, neurological disorders had the highest representation (n = 100; proportion: 0.277; 95% CI: 0.231-0.323), followed by sensorineural defects (n = 70; prop.: 0.194), limb defects (n = 60; prop.: 0.166), visual impairments (n = 55; prop.: 0.152), and musculoskeletal defects (n = 37; prop.: 0.102). Among the neurological disorders, intellectual disability had the highest occurrence (58%), whereas talipes and limb amputations were the most prominent in limb defects (22% and 20%, respectively). The anomalies had sporadic and isolated presentations most often (76% each), while parental consanguinity was observed in 34% of index cases.

Conclusions

The high incidence of neurological, sensorineural, and limb defects, the preponderance of sporadic cases, and low level of parental consanguinity may indicate a potentially high contribution of nongenetic factors in the etiology of anomalies. The majority of anomalies are the cause of severe disability.

Consanguinity, inbreeding coefficient, fertility and birth-outcome in population of Okara district, Pakistan

Objectives

This study was aimed to illustrate the determents of consanguinity and inbreeding coefficient-F (ICF) in the population of Okara district of Pakistan and to elucidate the impact of consanguinity on fertility and birth outcome.

Methods

Through a cross-sectional sampling design, 1,521 married women were recruited from Okara district during 2016-2017. Data on demographic variables, marital union types, subject's fertility, and reproductive outcome, were gathered in face-to-face interviews. Descriptive statistics and multivariable logistic regression were employed.

Results

The prevalence of consanguineous unions (CU) was calculated to be 61% yielding ICF=0.0356. Multivariable regression analyses revealed that six variables including younger age at marriage, joint family structure, caste-system of spouse, exchange marriage, matrimonial distance, and parental consanguinity, were significant predictors of consanguinity. The women having CU had significantly higher mean fertility, mean live-births and mean live-born sons compared with subjects having non-consanguineous unions (NCU). However, there were no significant differences in the average mortalities, i.e., prenatal, postnatal and <5 years, between the mothers with CU and NCU.

Conclusion

The prevalence of consanguineous unions (CU) in Okara district is quite high like other inbred populations of Pakistan. The striking findings of this study are the higher mean fertility and mean live-births in women with CU. The likely reasons underlying this phenomenon have been discussed.

Exploring the Genetic Landscape of Retinal Diseases in North-Western Pakistan Reveals a High Degree of Autozygosity and a Prevalent Founder Mutation in ABCA4

Variants in more than 271 different genes have been linked to hereditary retinal diseases, making comprehensive genomic approaches mandatory for accurate diagnosis. We explored the genetic landscape of retinal disorders in consanguineous families from North-Western Pakistan, harboring a population of approximately 35 million inhabitants that remains relatively isolated and highly inbred (~50% consanguinity). We leveraged on the high degree of consanguinity by applying genome-wide high-density single-nucleotide polymorphism (SNP) genotyping followed by targeted Sanger sequencing of candidate gene(s) lying inside autozygous intervals. In addition, we performed whole-exome sequencing (WES) on at least one proband per family. We identified 7 known and 4 novel variants in a total of 10 genes (ABCA4, BBS2, CNGA1, CNGA3, CNGB3, MKKS, NMNAT1, PDE6B, RPE65, and TULP1) previously known to cause inherited retinal diseases. In spite of all families being consanguineous, compound heterozygosity was detected in one family. All homozygous pathogenic variants resided in autozygous intervals ≥2.0 Mb in size. Putative founder variants were observed in the ABCA4 (NM_000350.2:c.214G>A; p.Gly72Arg; ten families) and NMNAT1 genes (NM_022787.3:c.25G>A; p.Val9Met; two families). We conclude that geographic isolation and sociocultural tradition of intrafamilial mating in North-Western Pakistan favor both the clinical manifestation of rare “generic” variants and the prevalence of founder mutations.

Traditional uses of medicinal plants practiced by the indigenous communities at Mohmand Agency, FATA, Pakistan

BACKGROUND

Plant-derived products have an imperative biological role against certain pathogenic organisms and were considered to be a major source of modern drugs. Rural people residing in developing countries are relying on traditional herbal medical system due to their strong believe and minimum access to allopathic medicines. Hence, ethnomedicinal knowledge is useful for the maintenance of community's based approaches under this medical system. Present study was carried out in an unexplored remote tribal area of Pakistan to investigate and document the existing ethnomedicinal knowledge on local flora.

METHODS

Data was collected through semi-structured questionnaires from the community members and local herbalists. Use reports (URs) were counted for each species and analyzed through Linear Regression between the number of URs per family and number of plant species per family.

RESULTS

A total of 64 medicinal plant species were recorded belonging to 60 genera and 41 families. Most frequently used plant families in ethnomedicines were Lamiaceae (8 species) and Asteraceae (7 species). Highest URs were recorded for Caralluma tuberculata N.E. Br. (49 URs) being followed by Thymus serphyllum L. (49 URs), Fagonia cretica L. (47 URs), Plantago lanceolata L. (45 URs), Periploca aphylla Decne. (44 URs), Citrullus colocynthis (L.) Schrad. (44 URs), and Sideroxylon mascatense (A.DC.) T.D.Penn. (44 URs). New ethnomedicinal uses were reported for Boerhaavia elongata Brandegee and Fumaria officinalis L. with confidential level of URs from the study area. Nineteen groups of health conditions were recorded during the course of study being treated with medicinal plants. Maximum number of 30 plant species was used to treat digestive problems. Most widely practiced mode of drugs' preparation and administration was powder. Leaves (30% plants) were the most frequently used plant parts in the preparation of ethnomedicinal recipes.

CONCLUSIONS

Current study is an important addition to the field of ethnomedicines. The study reports important medicinal plants from an area, which has not been investigated previously. Traditional knowledge is restricted to health practitioners and elder community members. This knowledge is at the verge of extinction because younger generation is not taking interest in its learning and preservation process. Hence, there is a dire need to phytochemically and pharmacologically test the investigated taxa for the validation of traditional knowledge.

Determinants of consanguinity and inbreeding coefficient in the multiethnic population of Mardan, Khyber Pakhtunkhwa, Pakistan

Background

Despite the high sociocultural preferences in contracting marriages among close relatives in Pakistan, marked regional differences exist in the prevalence of consanguinity. There is great interest to elucidate the sociodemographic variables underlying the heterogeneity in consanguinity prevalence in the various populations. The present study was conducted in the Mardan district of Pakistan, the second largest multiethnic Pashtun metropolis.

Objective

To find determinants of consanguineous unions.

Methods

In a cross-sectional study design, a convenience sample of 1,202 ever-married men from 3 tehsils of Mardan district was recruited in an unselected manner and data regarding their marital union types and sociodemographic variables were obtained by a structured interview. Descriptive statistics and multivariable logistic regression analyses were used.

Results

Consanguineous unions accounted for 44% of all marriages, and the inbreeding coefficient was calculated as 0.0258. Regression analyses revealed that 6 variables were significant predictors of consanguinity, namely, tehsil, age, year of marriage, caste (zaat/biradari) system, area of house, and marriage arrangement of the respondent, while 6 other variables, namely, rural/urban origin, literacy, occupation, monthly income, household type, and number of family members, were not found to be significant. Regression analyses showed that there were different combinations of variables predictive of consanguinity among the various tehsils.

Conclusions

The prevalence of consanguinity in the Mardan district was found to be lower than that in many other districts of Pakistan. National regional differences exist in consanguinity, and the combination of predictive factors varies greatly.

Consanguinity and its socio-biological parameters in Rahim Yar Khan District, Southern Punjab, Pakistan

BACKGROUND

Rahim Yar Khan (RYK) District is a multi-ethnic assemblage of both ancient and migrated communities in Southern Punjab, Pakistan. There is a paucity of knowledge on the bio-demographic structure of this endogamous population.

METHODS

We have carried out a cross-sectional epidemiological study in RYK District and recruited 2174 random Muslim married females. Detailed account of marital union types, level of consanguinity, and subject's fertility, was taken.

RESULTS

The analyses of these data revealed that consanguineous unions (CU) were 58.46 %, rendering an inbreeding coefficient (IC-F) = 0.0355. The CU were observed to be significantly higher in subjects originating from rural areas, speaking Saraiki language, illiterate or having a religious/Madarsa education only, and belonging to nuclear family type. The rate of consanguinity was also higher in subjects whose husbands were engaged in unskilled manual or skilled manual jobs, and had consanguinity in the parental generation. Multivariate logistic regression analyses revealed that variables like Saraiki language, illiteracy, reciprocal marriages, and parental consanguinity, were the significant predictors of CU in the subject. Among the first cousin unions (which constituted 52 % of all marriages), parallel-cousin and patrilineal unions were in the majority (54 and 57 %, respectively), and father's brother's daughter type had the highest representation (31 %). The analyses further demonstrated that fertility and mean live-births were significantly higher in women who had CU compared to the non-consanguineous (NCU) group (p < 0.006); and significantly higher number of sons per women were born to the mothers who had CU compared with the NCU sample (p = 0.0002). However, there were no differences in the CU and NCU samples with respect to pre- or post-natal mortalities and child morbidities.

CONCLUSIONS

The scientific findings in RYK District are distinct from the observations in other Pakistani populations and clue to a unique nature of this population. This study presents a comprehensive account of consanguinity and IC-F in RYK District and would be helpful in getting an insight into the structure of this population.

RBBP8 syndrome with microcephaly, intellectual disability, short stature and brachydactyly

Primary microcephaly is clinically variable and genetically heterogeneous. Four phenotypically distinct types of autosomal recessive microcephaly syndromes are due to different RBBP8 mutations. We report on a consanguineous Pakistani family with homozygous RBBP8 mutation c.1808_1809delTA (p.Ile603Lysfs*7) manifesting microcephaly and a distinct combination of skeletal, limb and ectodermal defects, mild intellectual disability, minor facial anomalies, anonychia, disproportionate short stature and brachydactyly, and additionally talipes in one patient.