Sultan Qaboos University Med J, May 2014, Vol. 14 Iss. 2, p. e263, Epub. 7TH Apr 14
Submitted 20TH Dec 13 
Accepted 9TH Mar 13

رد: معّدل وفيات ما حول الوالدة كمؤشر على جودة الرعاية الصحية يف حمافظة 
الداخلية يف سلطنة عمان

Re: Perinatal Mortality Rate as a Quality 
Indicator of Healthcare in Al-Dakhiliyah Region, 

Oman

LETTER TO EDITOR

Sir,

With reference to the interesting study published in the SQUMJ November 2013 issue by Santosh et al.,1 I presume 
that consanguinity is closely linked to the preponderance of congenital anomalies (53.50%) and prematurity 
with its complications (23.56%) which are the leading causes of early neonatal deaths in their studied cohort. 
My assumption is based on the following evidence. First, the practice of consanguineous marriage has been 
the culturally-preferred form of marriage in Oman as more than half (52%) of the total marriages in Oman are 
consanguineous.2 First cousin unions are the most common type of consanguineous unions, constituting 39% of all 
marriages and 75% of all consanguineous marriages.2 Second, it is well-known that consanguineous couples have 
a higher risk of having children with congenital malformations than non-related couples. The consanguinity rate 
of 76% was reported among Omani births with major malformations.3 Third, infants of consanguineous parents 
has been shown to have a statistically significant 1.6-fold net increased risk of being born at less than 33 weeks’ 
gestation compared with infants of unrelated parents.4 Fourth, consanguinity has been noticed to significantly 
increase pregnancy loss and birth weight of <2,500 g.5 Accordingly, I presume that the continuing popularity of 
consanguineous marriage might have an important negative impact on the many effective measures suggested by 
Santosh et al. to reduce the perinatal mortality rate in Oman.1

Mahmood D. Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq  
E-mail: mdalmendalawi@yahoo.com

References
1. Santosh A, Zunjarwad G, Hamdi I, Al-Nabhani JA, Sherkawy BE, Al-Busaidi IH. Perinatal mortality rate as a quality indicator of healthcare 

in Al-Dakhiliyah Region, Oman. Sultan Qaboos Univ Med J 2013; 13:545–50.

2. Islam MM, Dorvlo AS, Al-Qasmi AM. The pattern of female nuptiality in Oman. Sultan Qaboos Univ Med J 2013; 13:32–42. 

3. Sawardekar KP. Profile of major congenital malformations at Nizwa Hospital, Oman: 10-year review. J Paediatr Child Health 2005; 41:323–
30. doi: 10.1111/j.1440-1754.2005.00625.x.

4. Mumtaz G, Nassar AH, Mahfoud Z, El-Khamra A, Al-Choueiri N, Adra A, et al. Consanguinity: a risk factor for preterm birth at less than 
33 weeks' gestation. Am J Epidemiol 2010; 172:1424–30. doi: 10.1093/aje/kwq316.

5. Bellad MB, Goudar SS, Edlavitch SA, Mahantshetti NS, Naik V, Hemingway-Foday JJ, et al. Consanguinity, prematurity, birth weight 
and pregnancy loss: a prospective cohort study at four primary health center areas of Karnataka, India. J Perinatol 2012; 32:431–37. 
doi: 10.1038/jp.2011.115.

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