Vol 41 # 3 September 2009 - Kma.org.kw

188 Population Health Genomics in Member Countries of the Cooperation Council for the Arab...
September 2009
Table 1: Demographic indicators of member countries of the GCC
Country Population Population density Annual live Gross national Total health
(persons) (persons/km 2 ) births (1000s) product per capita expenditure per capita
(international $) (international $)
Bahrain 742,562 1010 14 34,310 933
Kuwait 3,051,845 171 48 48,310 490
Oman 2,577,062 8 40 19,740 390
Qatar 838,065 72 13 24,890 1283
Saudi Arabia 23,678,849 11 500 22,300 570
United Arab Emirates 4,229,000 51 65 31,190 625
Total 35,117,383 – 680 – –
that facilitated immigration was trade between the
GCC countries and India and other Asian countries
in pearls, fish, coffee, and foodstuffs such as spices [1] .
The original people of the GCC countries were
organized into tribes that tended to have similar
cultural and social characteristics and hence a high
degree of social cohesion and tribal loyalty [2-4] .
During the last century the discovery of oil
accelerated economic development spectacularly,
and the GCC countries have become one of the
main producers of oil and oil products worldwide.
According to the World Health Organization, the
gross national product per capita of GCC countries
ranges from 19,740 to 48,310 international dollars
(Table 1), and total per capita expenditures on
health care range from 390 to 1283 international
dollars. (The international dollar, a unified adjusted
figure closely equivalent to the US dollar, is used
by international bodies such as the World Health
Organization for the purpose of comparison
between countries [5–10] .
Health services are provided by the
government and by the private sector. Health
services provided by the government entail no
cost to the patient at the point of care. There is no
mandatory health insurance plan for GCC citizens.
According to 2004 statistics, there are currently
372 government and 165 private hospitals in the
GCC countries, with a total of 75,000 beds. There
are 2221 government primary health care centers
providing curative and preventive services to the
general community [5] .
The Arab population in general and the GCC
countries in particular have distinct socio-cultural
Table 2: Consanguineous marriages in the GCC countries [11–19]
Country Overall First-cousin Inbreeding
consanguinity (%) consanguinity (%) coefficient
Bahrain 20–25 12.5 0.0165
Kuwait 54.3 30 0.0210
Oman 36–50 23.5 0.0169
Qatar 51–54 33.5 0.0237
Saudi Arabia 57.7 31 0.0226
United Arab
Emirates 50 30 0.0223
characteristics, which include marriage at a young
age (sometimes even at less than 15 years of age),
child-bearing until menopause, a high birth rate
(16 - 43 births/1000 population), large family size
as a result of the high fertility rate (2 - 7 children
per woman) and a high rate of inbreeding or
consanguineous marriage (up to 58% of marriages in
some areas). In addition, few public health measures
are directed toward the control of congenital and
genetically determined disorders [11,12].
Consanguineous marriages
Although there is no consistent definition of
consanguineous marriage in the literature, from
the Islamic and Arabic perspective consanguineous
marriage is considered marriage between
individuals with a recent common ancestor, as
between first and second cousins; marriage to a
closer relative is prohibited by Islamic regulation.
Consanguineous marriage is a traditional custom
practiced within the same tribe, village, or social
unit. It is frequent in all of the GCC countries;
various surveys, including national and hospitalbased
studies, report a frequency ranging from 20
to 58% of marriages, and even up to 80% in some
isolated areas among selected tribes [11–19] . The most
common form is first-cousin marriage, followed
by marriage between second cousins [11–19] (Table
2). Consanguineous marriage is encouraged in
these societies, as it is considered to increase family
cohesion, minimize marital burdens (in particular,
the financial burden on the husband), assure cultural
and social compatibility, and safeguard inheritance
within wealthy families [20] .
However, consanguinity has deleterious effects
on the health of the children that result from these
marriages, among whom there is an increased
frequency of homozygosity for autosomal recessive
traits such as cystic fibrosis, sickle cell anemia, and
Tay-Sachs disease (Table 3). The risk of genetic
disorders is increased by 2.5 times for children of
first-cousin marriages in comparison to children
of non-consanguineous marriage [1,6,11,12,17,18,21] .
Consanguineous marriage is also associated with
a higher prevalence of mental retardation and
disability and increased risk of miscarriage,