African Vernacular Symbols of Black Intersex Children in Sinethemba Ngubane's Installations (2007-2016)

With the vaccination program against hepatitis B virus (HBV) infection of new-born Black African babies not yet fully functional in sub-Saharan countries, we should remind ourselves of the frequency of chronic infection with this virus and its dire consequences, most notably the development of hepatocellular carcinoma (HCC), in the sub-Saharan Black population. Children are an early concern. Although HBV-induced HCC in sub-Saharan Black Africans occurs most often in young or middle-aged adults, the tumour also occurs in children, albeit in fewer numbers: in 1% of children less than 6 months of age, and 13% of children over one year of age [1]. The latter are, with few exceptions, aged between 5 and 15 years, and have a male/female ratio of 2 or 3:1 [1]. In common with the majority of Black African adults with HCC, most of the children with the tumour are born and live in rural areas [1-5], with the ratio of rural-born to urban-born being 4.8:1 [5]. The characteristics of HCC in children do not differ significantly from those in adults, with the possible exception of a higher incidence of an hepatic arterial bruit (66% cf 23%) [1]. The aetiology of HCC in Black African children has generally been less extensively investigated than that in adults, but those studied have shown that chronic HBV infection is the almost invariable cause of the tumour [1]. In parallel with the incidence of HCC, the presence of the virus in rural areas is appreciably greater than in urban areas: for example, Black males in the Johannesburg region have an incidence of only 1.5% and females of only 0.57% [5]. In an early study of Black African children with HCC, HBV surface antigen and antibody against the core antigen were present in the serum of all of the children, with antibody to hepatitis Be antigen being present in two-thirds [1]. These findings suggest the possibility that nearly all, or perhaps even all, Black African children with HCC are chronically infected with HBV at an early age and that the virus plays the same, if not a greater, role in causing HCC in children than it does in adults. Based on the ages of the published children with HBV-induced HCC, it seems likely that tumour formation may occur within 10 to 15 years of the initial infection. In the majority of Black children with HCC, cirrhosis is present in the non-tumorous liver. Evidence from sub-Saharan Africa and the Far East indicates that the route of acquisition of HBV in children is mainly ‘horizontal’ rather than ‘vertical’. An interval of approximately 10 years between HBV infection and the occurrence of HCC represents the usual time between exposure to the virus and the appearance of the tumour, although time spans may be as short as 6 years. The fact that the majority of Black children (and adults) with HCC live in a rural environment is attributed to the fact that the carcinogens exist in a rural to a significantly greater extent than in an urban environment. Black adults who leave the countryside to work in the cities develop the tumour at an older age (48 years) than those who remain in a rural environment (35 years) [1]. A likely co-carcinogen to HBV in the rural environment is dietary exposure to the fungal hepatocarcinogen, aflatoxin B1, and we should bear in mind that exposure to this agent remains an important cause of HCC in rural regions of subSaharan Africa, irrespective of what happens to HBV.

The outcome and response of idiopathic nephrotic syndrome (NS) to steroids have been linked to race. To determine the age of presentation, sex, race, histopathology, kidney function and disease status at the last hospital visit and correlate these with steroid response in Indian and black African children with idiopathic NS. This is a retrospective review of 231 children aged 1 - 14 years, who were seen at Inkosi Albert Luthuli Central Hospital, Durban, South Africa (SA) from 2003 to 2018. The mean (standard deviation (SD)) age of presentation was 6.2 (3.4) years, with the majority of children (n=107; 46.3%) presenting at an early age (1 - 3 years) with a mean (SD) follow-up of 3.0 (2.4) years. One-hundred and twenty-one (52.4%) were males and 110 (47.6%) were females, with a male/female ratio of 1.1:1. There were 166 (71.9%) black African and 65 (28.1%) Indian children. The latter presented at a younger age than black African children (p<0.001). Seventy-six (32.9%) children were steroid sensitive (SS) and 155 (67.1%) were steroid resistant (SR). Black African children were more likely to be SR (odds ratio (OR) 2.0; p=0.02; 95% confidence interval (CI) 1.1 - 3.7). A kidney biopsy was performed in 209 (90.5%) children. Minimal change disease (MCD) was observed in 32 (13.9%) children and 162 (70.1%) had focal segmental glomerulosclerosis (FSGS). Black African children were slightly more likely to have FSGS; this, however, did not reach statistical significance (122/166 (73.5%) v. 40/65 (61.5%); OR 1.73; p=0.08; 95% CI 0.94 - 3.18). On comparing disease status at last hospital visit by race, 49/65 (75.4%) Indian and 94/166 (56.6%) black African children were in remission. At last hospital visit, black African children were less likely to be in remission than Indian children (OR 0.47; p=0.02; 95% CI 0.2 - 0.9), while 15/65 (23.1%) Indian and 47/166 (28.3%) black African children had relapsed, with no significant difference between the two groups. One (1.5%) Indian child and 25 (15.1%) black African children had end-stage kidney disease (ESKD) (OR 9.27; p=0.03; 95% CI 1.2 - 70.4) ‒ the majority had FSGS. Sixteen (61.5%) received renal replacement therapy. Our study shows a rising incidence of FSGS, with the majority of patients having SRNS, particularly black African children. This highlights the need for alternative efficacious therapy in the management of this disease. Also, a higher percentage of black African children with both MCD and FSGS were SS on histopathological examination, which was in keeping with reports from other regions in SA. There are still major challenges for the inclusion of all children into a chronic dialysis and transplant programme.

Body-mass index adjustments to increase the validity of body fatness assessment in UK black African and South Asian children: a cross-sectional calibration study

In black African children with focal segmental glomerulosclerosis (FSGS) there are high rates of steroid resistance. The aim was to determine genetic associations with apolipoprotein L1 (APOL1) renal risk variants and podocin (NPHS2) variants in 30 unrelated black South African children with FSGS. Three APOL1 variants were genotyped and the exons of the NPHS2 gene sequenced in the cases and controls. APOL1 risk alleles show a modest association with steroid sensitive nephrotic syndrome (SSNS) and steroid resistant nephrotic syndrome (SRNS). The NPHS2 V260E variant was present in SRNS cases (V/V = 5; V/E = 4; E/E = 11), and was absent in SSNS cases. Haplotype analysis suggests a single mutation origin for V260E and it was associated with a decline in kidney function over a 60-month period (p = 0.026). The V260E variant is a good predictor of autosomal recessive SRNS in black South African children and could provide useful information in a clinical setting.

My paper offers an interpretative approach using visual analysis. In doing so, the paper contributes a discourse on artworks by the South African artist, Nelson Makamo, and focuses on the images drawn from black children. And ‘the predominant theme, black child, is examined as African vernacular rooted images. He uses the motif of the African child to reflect on different’lived experiences of black children in South Africa. Thus, his paintings and drawings were selected and ‘analysed for their formal content and contexts, and the discussion is framed by the insight gained through interviews with the artist’. While several ideas are reflected in each of the works analysed, the works highlight the contemporary social issue of homelessness experienced by rural-urban migrants, the early training of a black child in carrying out responsibility, the socio-ethical humanism in African communities, especially in the upbringing of black African child, and the effects of technology on regard for African cultural values in a young African child who adopts headphone in the postcolonial era. Through these, it is argued that Makamo’s representations of ‘black African children engage a discourse that contributes to global contemporaneity’.

BackgroundHigh body fat (BF) levels in UK children are a major problem, with particular concerns about children of South Asian and Black (presumed African) origin. However, available national data are...

Cystic fibrosis in black African children in South Africa: a case control study

Made Visible: Contemporary South African Fashion and Identity curated by Kathryn Gunsch

Fifty years ago, the Supreme Court ruled in Brown v. Board of Education that: Segregation of white and Negro children in the public schools of a State solely on the basis of race, pursuant to state laws permitting or requiring such segregation, denies to Negro children the equal protection of the laws guaranteed by the Fourteenth Amendment--even though the physical facilities and other 'tangible' factors of white and Negro schools may be equal. (1) Even with a half-century to digest this notion and implement and enforce policies to make equality a reality, the United States today is still a country of separate and unequal. In fact, there is a growing gap between rich and poor children, and between black, white, and Latino children. The United States is top of the list of industrialized nations when it comes to the number of poor children. (2) There are more children living in poverty today than there were 40 years ago when the war on poverty was officially declared. As noted in the article by Nightingale and Fix in this journal issue, black children are still twice as likely as white children to be poor, and a record number of black children are living in extreme poverty. In 2001, nearly one million black children lived in families with an annual income of less than half the federal poverty level (disposable income below $7,064 for a family of three)--the highest number in 23 years. (3) The portrait of inequality is astounding. (See Box 1.) Poverty accentuates racial disparities in children's health, and poor health and poverty spiral together in a vicious cycle that injures all children. The situation in the classroom reflects a similar gaping demographic schism. Fifty years after the Brown decision, black children are still almost twice as likely as their white peers to become dropouts. (See the article by Fuligni and Hardway in this journal issue.) Box 1 A Portrait of Inequality Health: * Young black children are twice as likely as white, Native American, Asian American, or Latino babies to be born with low birth weight. * Babies born to Latinas and Native Americans are twice as likely as those born to whites to have mothers who receive late or no prenatal care. * Young black children are twice as likely as their white peers to die from influenza or pneumonia. * Black young adults are three times as likely as white young adults to die from complications of diabetes. * Black children and teens are five times as likely as their white peers to die of chronic lower respiratory disease, and almost twice as likely to die of heart disease. Education: * Latino fourth graders are two to three times as likely as their white classmates to be performing below the basic level in mathematics. * White fourth graders are three to four times as likely as their black and Latino classmates to be reading at the proficient level. Juvenile Justice: * Black juveniles are about four times as likely to be arrested as their white counterparts. * Black males ages 15 to 19 are four times as likely as their white peers and twice as likely as their Latino peers to die from firearms injury. * Black juveniles are five times as likely as white youths to be incarcerated. Source: Children's Defense Fund. The state of America's children: Yearbook 2004. Washington, DC: CDF, 2004. The result of this disparity is a direct pipeline from school to prison. Many high schools have become prep schools for jail. Pushouts, dropouts and expulsions all create an underclass of children who are ready-made for prison cells rather than dorm rooms. Society can no longer feign surprise when confronted with glaring overrepresentation of children of color in our juvenile justice system. A black boy today has one chance in 55 of earning a master's degree, but one chance in 5 of going to prison before age 30. (4) It is reprehensible that a country such as the United States is home to more than 12 million children who live below the poverty line, (5) and more than 9 million children who lack health insurance. …

The Fourth Industrial Revolution (4IR) is the fourth major industrial event since the 1980s. This event affected everyone and changed the world. It's a dilemma in a world where the wealthy are advancing but the poor are falling behind, especially in rural areas. In a third-world country with a rural majority, like South Africa, many black people will be disadvantaged by the 4IR. The 4IR has implications for people in rural areas. The rich make up the economy of the first world, whilst the third world is largely rural. Rural areas frequently lag in development. For instance, mobile phone coverage is patchy in many rural areas while being available in suburban and semi-suburban areas. The 4IR, which is technology-based, has socio-economic effects on those who live in rural areas. Rural communities are unable to function in a 4IR world, so they are not profiting from it. One of the implications of the 4IR is job loss and an increased unemployment rate due to a deficiency of necessary and potential technical skills. Thus, this article intends to explore the proliferation of the 4IR and its implications on rural areas in South Africa. To realize this, the authors employed a qualitative research approach in the form of a document review. The economics theory of Asymmetric Information (AI) was applied to support the argument and ground of this article. The AI theory was established by George Akerlof, Michael Spence, and Joseph Stiglitz in the 1970s. The AI theory enables those with information to make wise judgments while those without are at a constant disadvantage. In terms of participation, rural communities will be excluded, not through their fault, but due to technological advances. The study concludes by highlighting the implications of the 4IR in rural areas. One of the implications found in this article is increased inequality. Recommendation: To ensure that all citizens have access to information on an equal basis, it is necessary for the government and business to work toward restoring economic competitiveness and improving the quality of governance. The disclosure of information and increased openness on information can help to narrow the information gap that exists between those who are informed (urban) and those who are not informed (rural) residents.

This working paper covers a survey conducted between 16 and 30 January 1980 of 3 171 black Sub A and Sub B pupils 8 years old or younger, at schools in both the rural and urban areas of the Albany Magisterial District, Eastern Cape. The survey, under the auspices of the Institute of Social and Economic Research (ISER), Rhodes University, was carried out as a result of a request from Dr J. D. Krynauw, Regional Director of Health Services in the Eastern Cape, to assess levels of nutrition of black children. Newspaper reports (see Appendix 1) of low levels of nutrition and high infant mortality rates among young black children in the Eastern Cape appeared to suggest a chronic nutritional situation, a situation not perceived as such by the Department of Health. A comprehensive pilot study was instituted on written request from Dr Krynauw in late October 1979. A report of the pilot study findings was presented in May 1980 to the Department of Health (Fincham, 1980). The present paper elaborates on that report and also includes analyses of data not presented before.

The Black pediatric population is one that has been historically underserved and continues to have unmet needs. Factors including lack of diversity in orthopaedic studies and in historical standards, such as bone age, may inadvertently lead to inferior care. There are certain conditions in this population for which the practicing orthopaedic surgeon should have a higher degree of suspicion, including slipped capital femoral epiphysis, Blount disease, and postaxial polydactyly. Systemic diseases with higher rates in this population have orthopaedic manifestations, including sickle cell disease, vitamin D deficiency, and obesity. Racial discrepancies in access to prenatal care can have orthopaedic consequences for babies, especially cerebral palsy and myelodysplasia. Racial discrepancy exists in evaluation for nonaccidental trauma. Increased awareness of these issues better prepares practitioners to provide equitable care.

School choice and commuting in Ladybrand’s three high schools was explored. While all were numerically dominated by Black African children, only the fee-charging former whites-only public school, in the heart of Ladybrand, had a multiracial learner profile. Black African learners enrolled in this school hailed from mostly middle-class homes in the neighbouring Black African township of Lesotho. The homes are financially resourced. Parents are educated, married and employed in skilled or professional jobs. These learners passively commuted to school. The profile of the two no-fee schools, located in the former ‘black only’ designated peripheral townships, was different. Here learners are almost exclusively Black South Africans, living in poorly educated, single-parent homes. Household finances were weak with parents either unemployed or working in semi-skilled or unskilled jobs. These learners either used a subsidized government bus, mini-bus taxis or walked (in some cases long distances from neighbouring farms) to school. Parents said they selected no-fee schools on geographical proximity and low cost; whereas education quality drove choice for the former white school. The socio-economic and demographic profile of learners in no-fee versus fee-paying schools was statistically significant. Ladybrand’s high schools are segregated by class, a situation reflecting much of urban South Africa.

There is a paucity of data identifying genetic mutations that account for the high rate of steroid-resistant nephrotic syndrome (SRNS) in a South African paediatric population. The aim was to identify causal mutations in genes implicated in SRNS within a South African paediatric population. We enrolled 118 children with primary nephrotic syndrome (NS), 70 SRNS and 48 steroid-sensitive NS. All children with SRNS underwent kidney biopsy. We first genotyped the NPHS2 gene for the p.V260E variant in all NS cases (n = 118) and controls (n = 219). To further identify additional variants, we performed whole-exome sequencing and interrogated ten genes (NPHS1, NPHS2, WT1, LAMB2, ACTN4, TRPC6, INF2, CD2AP, PLCE1, MYO1E) implicated in SRNS with histopathological features of focal segmental glomerulosclerosis (FSGS) in 56 SRNS cases and 29 controls; we also performed exome sequencing on two patients carrying the NPHS2 p.V260E mutation as positive controls. The overall detection rate of causal and putative pathogenic mutations in children with SRNS was 27/70 (39%): 15 (21%) carried the NPHS2 p.V260E causal mutation in the homozygous state, and 12 (17%) SRNS cases carried a putative pathogenic mutation in the heterozygous state in genes (INF2 (n = 8), CD2AP (n = 3) and TRPC6 (n = 1)) known to have autosomal dominant inheritance mode. NPHS2 p.V260E homozygosity was specifically associated with biopsy-proven FSGS, accounting for 24% of children of Black ethnicity (15 of 63) with steroid-resistant FSGS. No causal or putative pathogenic mutations were identified in NPHS1, WT1, LAMB2, PLCE1, MYO1E and ACTN4. We report four novel variants in INF2, PLCE1, ACTN4 and TRPC6. Conclusion: We report putative missense variants predicted to be pathogenic in INF2, CD2AP and TRPC6 among steroid-resistant-FSGS children. However, the NPHS2 p.V260E mutation is a prevalent cause of steroid-resistant FSGS among Black South African children occurring in 24% of children with SRNS. Screening all Black African children presenting with NS for NPHS2 p.V260E will provide a precision diagnosis of steroid-resistant FSGS and inform clinical management. What is Known: •Limited data is available on the genetic disparity of SNRS in a South African paediatric setting. • The high rate of steroid resistance in Black South African children with FSGS compared to other racial groups is partially explained by the founder variant NPHS2 p.V260E. What is New: •We report putative missense variants predicted to be pathogenic in INF2, CD2AP and TRPC6 among steroid-resistant FSGS children. • NPHS2 p.V260E mutation remains a prevalent cause of steroid-resistant FSGS among Black South African children, demonstrating precision diagnostic utility.

Study Finds Childhood Adversity Linked to Brain Differences in White, Black Children