Black African Children Research Articles

The Burden of Pertussis Hospitalization in HIV-Exposed and HIV-Unexposed South African Infants.

Background. There are limited data on pertussis in African children, including among human immunodeficiency virus (HIV)–exposed infants. We conducted population-based hospital surveillance to determine the incidence and clinical presentation of Bordetella pertussis–associated hospitalization in perinatal HIV-exposed and -unexposed infants.Methods. Children <12 months of age hospitalized with any sign or symptom of respiratory illness (including suspected sepsis or apnea in neonates) were enrolled from 1 January 2015 to 31 December 2015. Detailed clinical and demographic information was recorded and respiratory samples were tested by polymerase chain reaction (PCR).Results. The overall B. pertussis PCR positivity was 2.3% (42/1839), of which 86% (n = 36) occurred in infants <3 months of age. Bordetella pertussis was detected in 2.1% (n = 26/1257) of HIV-unexposed and 2.7% (n = 16/599) of HIV-exposed infants. The incidence (per 1000) of B. pertussis–associated hospitalization was 2.9 (95% confidence interval [CI], 1.8–4.5) and 1.9 (95% CI, 1.3–2.6) in HIV-exposed and HIV-unexposed infants, respectively (P = .09). The overall in-hospital case fatality ratio among the cases was 4.8% (2/42), both deaths of which occurred in HIV-exposed infants <3 months of age. Among cases, presence of cough ≥14 days (20.5%) and paroxysmal coughing spells (33.3%) at diagnosis were uncommon. Only 16 (38%) B. pertussis–associated hospitalizations fulfilled the Centers for Diseases Control and Prevention case definition of “definite” pertussis.Conclusions. Bordetella pertussis contributed to a modest proportion of all-cause respiratory illness hospitalization among black-African children, with a trend for higher incidence among HIV-exposed than HIV-unexposed infants. Maternal vaccination of pregnant women should be considered to reduce the burden of pertussis hospitalization in this population.

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

BackgroundExcess childhood body fatness, overweightness, and obesity are a major public health challenge in the UK. Accurate assessments, usually based on body-mass index (BMI), are crucial. However, recent studies have demonstrated that BMI underestimates body fatness in South Asian children and overestimates it in black African children. These errors are a concern in these ethnic minority populations, particularly UK South Asians, who are at high risk of obesity, type 2 diabetes, and cardiovascular disease. We aimed to develop BMI adjustments for these children to ensure that BMI relates to body fatness in the same way as for white European children. MethodsFour recent UK population-based studies, which used deuterium dilution assessments of fat mass as a reference method, were pooled to include 1725 children (52% girls) aged 4–12 years (mean 9·3, SD 1·6) of white European, South Asian, and black African origins. A height-standardised fat-mass index (FMI) was derived to represent body fatness. Linear regression models were fitted, separately by sex, to quantify ethnic differences in BMI–FMI associations and to provide ethnic-specific BMI adjustments. FindingsThe FMI derived for this study population and used in analyses was fat mass/height5, which was independent of height for the 4–12-year age-group. BMI consistently underestimated body fatness in South Asians, requiring a BMI adjustment of +1·12 kg/m2 (95% CI 0·83–1·41) for boys and +1·07 (0·74–1·39) for girls, irrespective of age and FMI. BMI overestimated body fatness in black Africans. However, adjustments for black African children were more complex, with statistically significant interactions between black African ethnicity and FMI (p=0·004 boys, p=0·003 girls) and between FMI and age-group (p<0·0001 boys and girls). BMI adjustments therefore varied by age-group and FMI level, between −0·24 and −2·84 kg/m2 for boys and between −0·22 and −2·86 kg/m2 for girls for unadjusted BMI values of 13 kg/m2 in 10–12 year-olds and 25 kg/m2 in 4–6 year-olds, respectively. InterpretationBMI underestimated body fatness in South Asians and overestimated it in black Africans. Ethnic-specific adjustments—increasing BMI in South Asians and reducing BMI in black Africans—can improve the accuracy of body fatness assessment in these children. FundingThis work was supported by the British Heart Foundation (grant ref PG/15/19/31336) and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (South London) (grant ref CLAHRC-2013-10022). Primary data collection was funded by the British Heart Foundation (PG/11/42/28895), BUPA Foundation (TBF-S09-019), Child Growth Foundation (GR 10/03), and Wellcome Trust (WT094129MA). MF is supported by Great Ormond Street Hospital Childrens' Charity.

Delay and poor diagnosis of Down syndrome in KwaZulu-Natal, South Africa: A retrospective review of postnatal cytogenetic testing.

Down syndrome (DS) is the most common chromosomal disorder in newborns. Until 20 years ago DS was considered rare in black African children in South Africa (SA). Lack of awareness of DS on the part of medical staff in SA, and difficulty in diagnosing it, appear to persist. To establish an epidemiological profile of DS and investigate the ability of clinicians in KwaZulu-Natal Province (KZN), SA, to make accurate clinical diagnoses of DS. Records at the South African National Blood Service cytogenetic laboratory in Pinetown, KZN, were examined for all tests for clinically suspected DS undertaken during January 2009 - December 2013 and all cytogenetically proven DS test results. Age at diagnosis, the hospital from where the test was sent and type of chromosomal pattern for each confirmed DS test result were recorded. Of a total of 1 578 tests requested, 875 confirmed DS, indicating that clinicians correctly clinically diagnosed DS 55.4% of the time. The average age of cytogenetic diagnosis of DS was 1 year and 20 days.The minimum population prevalence of DS was 0.8/1 000. The diagnosis of DS is a challenge in KZN, potentiating missed opportunities for early intervention. The relatively low population prevalence of DS may be attributable to a lack of confirmatory cytogenetic tests or missed clinical diagnoses. It may also be attributable to a high mortality rate for children with DS in the province.

Physical activity of children from a small rural town, South Africa

Introduction: Physical activity plays an integral role in the normal physical, mental, social and cognitive development of children. One of the main reasons for overweight children in low- and middle-income countries like South Africa is inactivity. This study’s aim was to describe the physical activity measured in boys and girls from section 21, quintile 5 pre-primary and primary schools in a small rural South African town and to compare it with recommended international physical activity levels.Method: Seventy-eight rural children, representing Caucasian and black African children, divided into three age groups, were issued a piezoelectric pedometer for seven complete days. Pedometer data obtained were total steps, aerobic steps, aerobic walking time, calories and distance. Steps per day were compared with international levels. Correlation statistics examined the association between physical activity and adiposity.Results: Boys in the age groups 9–11 and 12–14 years are statistically more active than girls of the same age (p = 0.005 and 0.045 respectively). Although girls’ physical activity levels tend to decrease with age, their aerobic activity levels increase with age. This group of rural children’s physical activity levels are far lower than the recommended international normative levels. No correlation was found between physical activity and adiposity.Conclusion: The pedometer data indicated that gender and age influence the activity of children. This group of rural children’s physical activity is far less than international normative levels. Nine to 11-year-old boys are the most active boys, and girls of 12–14 years old are the most aerobic active girls in this study, therefore the authors concluded that, to increase physical activity, the age group 9–11 may be the ideal age to focus on for gender-specific intervention programmes.

Physical activity of children from a small rural town, South Africa

Introduction: Physical activity plays an integral role in the normal physical, mental, social and cognitive development of children. One of the main reasons for overweight children in low- and middle-income countries like South Africa is inactivity. This study’s aim was to describe the physical activity measured in boys and girls from section 21, quintile 5 pre-primary and primary schools in a small rural South African town and to compare it with recommended international physical activity levels.Method: Seventy-eight rural children, representing Caucasian and black African children, divided into three age groups, were issued a piezoelectric pedometer for seven complete days. Pedometer data obtained were total steps, aerobic steps, aerobic walking time, calories and distance. Steps per day were compared with international levels. Correlation statistics examined the association between physical activity and adiposity.Results: Boys in the age groups 9–11 and 12–14 years are statistically more active than gi...

Ethnic differences in cognitive development in the first 7 years: does maternal generational status matter?

BackgroundDifferences in cognitive development have been observed across a variety of ethnic minority groups but relatively little is known about the persistence of these developmental inequalities over time or generations.MethodsA...

Article - a clinical update on paediatric lupus : continuing medical education

Systemic lupus erythematosus in children is a life-threatening chronic disease that is being increasingly recognised. More black African children are being diagnosed and the proportion of males affected is much higher than in adult-onset lupus. The presenting manifestations of childhood-onset lupus are variable and many systems are involved. Children with lupus often present late with severe disease, and in South African (SA) children severe lupus nephritis occurs commonly at presentation. The investigations for lupus should be performed in a three-step process - initial essential investigations, antibody and serological tests, and supplementary investigations. The most important factor in the management is to involve a multidisciplinary team as soon as possible. All cases of lupus in SA should be discussed with a paediatric specialist so that a tailored management plan can be made, depending on the presenting features and course of the disease.

Family Complexity in Rural South Africa: Examining Dynamism in Children’s Living Arrangement and the Role of Kin

It is well established that Black African children in South Africa live in complex living arrangements. Far less, however, is known about the dynamism in children’s living arrangements over the life course or the extent to which kin group characteristics influence the intensity of change in these arrangements. In this article, we draw on data collected on 337 children aged 0-21 embedded in 13 kin groups in Mpumalanga, South Africa to (a) describe the types of living arrangements that children are in at the time of birth and in 2002; (b) examine the extent of change and stability in living arrangements over two points in time; (c) describe the variation in the intensity of change in living arrangements over the life course; and (d) analyze the extent to which kin group characteristics help explain this variation. Our analysis shows that most children are in the same living arrangement at birth and in 2002 but that those born into a nuclear arrangement are most likely to change. Moreover, we also found considerable variation in the number of changes in living arrangements that children experience over the life course. The proportion of dependents in the kin group and the living arrangement at the time of birth explained some of this variation controlling for age and parental attributes.

A clinical update on paediatric lupus.

Systemic lupus erythematosus in children is a life-threatening chronic disease that is being increasingly recognised. More black African children are being diagnosed and the proportion of males affected is much higher than in adult-onset lupus. The presenting manifestations of childhood-onset lupus are variable and many systems are involved. Children with lupus often present late with severe disease, and in South African (SA) children severe lupus nephritis occurs commonly at presentation. The investigations for lupus should be performed in a three-step process – initial essential investigations, antibody and serological tests, and supplementary investigations. The most important factor in the management is to involve a multidisciplinary team as soon as possible. All cases of lupus in SA should be discussed with a paediatric specialist so that a tailored management plan can be made, depending on the presenting features and course of the disease.

Recalibration of overweight–obesity prevalence from body-mass index in UK children of South Asian and black African origin: cross-sectional study based on National Child Measurement Programme data

BackgroundThe accurate assessment of overweight–obesity prevalence in UK children of South Asian and black African origin (in whom its consequences are especially adverse) is an important challenge. However, body-mass index (BMI), the marker of body fatness used in most national surveys, differs in its association to body fatness between ethnic groups, which biases ethnic comparisons of body fatness based on BMI. We recalibrated BMI values for ethnicity to assess overweight–obesity prevalence more accurately in UK South Asian and black African children in recent survey data from the National Child Measurement Programme (NCMP), an inclusive assessment programme in English primary schools. MethodsDeuterium dilution measurements of body fat and BMI were collated from four recent UK population-based studies (three in schools selected to provide balanced ethnic representation) in 873 children of South Asian, black African, and white European origin aged 9−11 years. Data were analysed with linear regression models to determine the age-adjusted and sex-adjusted BMI differences in South Asian and black African children compared with white Europeans at an equivalent level of body fatness (denoted by fat mass index [kg/m5], which is uncorrelated with height). These BMI adjustments were applied to NCMP 2012–13 survey data in 489 146 children aged 10–11 years to determine ethnic-specific overweight–obesity prevalences; standard NCMP overweight–obesity definitions were used. FindingsBMI adjustments for equivalent body fatness were +1·11 kg/m2 and +0·98 kg/m2 for South Asian boys and girls, respectively, and −1·20 kg/m2 and −1·66 kg/m2 for black African boys and girls, respectively; these adjustments were applied to NCMP data for South Asian and black African children. Overweight–obesity was recorded in 14 538 of 38 201 South Asian children (38·1%, 95% CI 37·6–38·5) and 9839 of 22 672 black African children (43·4%, 42·8–44·0) before BMI adjustment and in 18 145 of 38 201 (47·5%, 47·0–48·0) and 7065 of 22 672 (31·2%, 30·6–31·8), respectively, after adjustment; overweight–obesity was recorded in 92 002 of 292 467 white European children (31·5%, 95%CI 31·3–31·6). InterpretationUse of ethnic-specific BMI adjustments to obtain comparable assessments of body fatness substantially changed observed overweight–obesity prevalences in ethnic minority groups. Adjusted BMI particularly emphasised the substantial overweight–obesity burden in South Asian children, an important priority for prevention. FundingThis research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London and by grants from the British Heart Foundation (PG/11/42/28895), the Child Growth Foundation (GR 10/03), and the Wellcome Trust (WT094129MA).

Sleep duration and risk markers for type 2 diabetes: a cross-sectional study in children aged 9–10 years

BackgroundShorter sleep duration has been associated with obesity, increased cardiovascular morbidity, and mortality in adults and with obesity in children. However, effects on childhood risk markers for cardiometabolic disease have been little studied. We examined associations between self-reported sleep duration and cardiometabolic risk markers in children and whether sleep duration might explain ethnic differences in insulin resistance. MethodsThis was a cross-sectional study of 4560 children aged 9–10 years, predominantly of white European, South Asian, and black African origin, from 200 UK primary schools. Children were asked to recall usual time of going to sleep and awakening on a school day. Fasting blood samples provided concentrations of serum insulin, plasma glucose, HbA1c, and serum lipids. Physical measures included height, weight, bioimpedance, and blood pressures. Multilevel linear regression models examined the association of sleep duration (in hours) with blood markers and anthropometric measures, adjusted for sex, age quartiles, month, ethnicity, socioeconomic status, observer (physical measures only), and random effect for school; percentange changes are given for log transformed outcomes. Informed consent was obtained from parents or children, and ethics approval was given by the Multicentre Research Ethics Committee (Wales). FindingsMedian sleep duration was 10·5 h (95% central range 8–12). On average, white European children slept longer than South Asian and black African children (10·4 h/night, 10·2, and 10·1, respectively). There were strong inverse graded associations between sleep duration, adiposity, and diabetes risk markers. Per hour increase in sleep duration was associated with 0·8 kg/m3 lower ponderal index (95% CI 1·2–0·3), 0·03 kg/m5 lower fat-mass index (0·05–0·0), 1·73% lower HOMA (homoeostatis model assessment) insulin resistance (0·50–3·91), 2·43% lower fasting glucose (0·86–3·97), and 0·19% lower HbA1c (0·0–0·39) after adjustment. Associations with diabetes risk markers remained after adjustment for adiposity and objective measures of physical activity. Sleep duration did not account for ethnic differences in insulin resistance, and was unrelated to blood pressure and serum lipids. InterpretationThe inverse association between type 2 diabetes risk markers and sleep duration in childhood is novel. Intervention studies are needed to establish causal associations, especially since increased sleep duration might offer a strategy for early prevention of type 2 diabetes. FundingThis research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (South London) and by grants from Diabetes UK and the Wellcome Trust.

The Educational and Employment Aspirations of Adolescents from Areas of High Deprivation in London.

Adolescents from areas of high deprivation are often assumed to have low aspirations for the future. However, recent research has suggested otherwise and there have been calls for more substantial investigation into the relationship between poverty and aspiration. This article reports levels and variation in aspiration from 1214 adolescents (49.5% male; 50.5% female) living in areas of high deprivation across 20 London boroughs. A strength of this study is our large and diverse population of low socio-economic status (SES) adolescents, comprising of white British (22%), black African (21%), black Caribbean (9%), Indian/Pakistani/Bangladeshi/Other Asian (24%), mixed ethnicity (9%), and 15% defining themselves as Other. Our measures indicated a high group level of reported aspiration with notable variations. Females reported higher educational (but not occupational) aspirations than males; white British students reported lower educational and occupational aspirations than other ethnic groups; and black African children reported the highest educational aspirations. Perceived parental support for education had the largest positive association with aspirations. In contrast to previous findings from studies carried out in the United States, aspirations were found to be negatively associated with perceptions of school and school peer environment. These measures explored feelings of safety, happiness and belonging within the school environment and school peer group. We discuss possible explanations for this unexpected finding within our population of adolescents from UK state schools and how it might affect future policy interventions. This study makes an important contribution to the literature on adolescent aspirations because of the unique nature of the data sample and the multiple domains of functioning and aspiration measured.

Prominent ears: Anthropometric study of the external ear of primary school children of Harare, Zimbabwe.

BackgroundProminent ear is the most common congenital ear deformity affecting 5% of children in the Western world and has profound psychosocial effects on the bearer. It is important to know the prevalence in the local population to have a better appreciation of the local burden of the abnormality as well as to know the parameters of ear morphology locally. These parameters can be useful in the diagnosis and evaluation of ear anomalies and may help reconstructive surgeons in reproducing an anatomically correct ear of an African/Zimbabwean child.ObjectivesTo evaluate the frequency of prominent ears in black school going children in Zimbabwe and to establish morphometric properties of the ear.DesignProspective observational, cross sectional study.SettingThree Primary schools in Harare. Two in a high density area and one in a low density area.Materials and methodsThree Primary schools in Harare were selected at random. The following measurements were taken: ear lengths, ear projection and face height using a sliding caliper. Three hundred and five healthy pupils of the age range 9–13 years of both sexes were included in the study, whilst children with congenital anomalies, ear tumours and history of ear trauma were excluded.ResultsThe mean ear height across the cohort was 56.95 ± 5.00 (right ear) and 56.86 ± 4.92 (left ear). Ear projection was 19.52 ± 2.14 (right ear) and 19.59 ± 2.09 (left ear). Gender related differences were noted. Mean ear height was significantly higher in males (p-value = 0.000). Ear projection was higher in males compared to females. A total of 6.89% had prominent ears. Among males, 7.69% had prominent ears whilst 6.17% of females had prominent ears.ConclusionThe prevalence of prominent ear among black African children in the studied population is comparable to that of Caucasians. The study provides a set of biometric data of auricular dimensions for normal black African children aged 9–13 years.

Time of mineralization of permanent teeth in children and adolescents in Gaborone, Botswana

The mineralization sequence of permanent dentition can be used to assess the stage of development and age of individuals. The most commonly used methods are based on the assessment of developmental stages of target groups of teeth on one side of the lower jaw. When compared with the rest of the world, fewer studies have been done on dental age in Sub-Saharan Africa, particularly in the region of Southern Africa.The aim of this study was to determine the chronology of mineralization of permanent teeth by the evaluation of developmental stages according to the Demirjian's method from 1973 and to evaluate dental age by using sex-specific self-weighted scores for dental stages and 50th percentile conversion tables of total maturity scores of seven mandibular teeth. We used a sample of panoramic radiographs (OPTs) of black African children and adolescents from the city of Gaborone, Botswana, with the aim of forming an appropriate sample to evaluate the development of the teeth in this socio-geographic environment.The final sample consisted of 1760 OPTs (807 males and 953 females) of individuals aged 6–23 years. The developmental stages of the all permanent teeth in the left side of the maxilla and the mandible were evaluated.Comparing the maxilla and the mandible, we found similar development within different stages for most of the teeth. In comparison to the average age at each stage of development, including the third molars between males and females, it is evident that females are slightly faster in developing permanent teeth, but without statistical significance for most of the developmental stages.Applying 50th percentile conversion tables for calculating the dental age for the first seven mandibular teeth, 616 OPTs of the children (299 males and 317 females), aged 6.08–16.80 years, were evaluated and their dental age was calculated. Mean dental age was overestimated in comparison to chronological age by 1.25±1.11 years and 0.72±1.02 years for males and females, respectively (p<0.001).These findings indicate that Demirjian's method from 1973 is not suitable for routine use and that there is a need for establishing specific standards for Botswana children of black African origin for dental age estimation.

Ethnic differences in children's socioemotional difficulties: Findings from the Millennium Cohort Study

This paper investigates ethnic differences in children's socioemotional difficulties and possible explanations for any observed inequalities. We used data collected from the fourth sweep of the Millennium Cohort Study when children were aged 7 years. We found that Pakistani, Bangladeshi, and Black Caribbean children had significantly more socioemotional difficulties than White children. These differences were partially explained by the relative socioeconomic disadvantage of their families. After accounting for maternal and family environment factors, the differences for Pakistani children remained unexplained. In contrast, Black African children were the only ethnic minority group to have significantly fewer socioemotional difficulties. We investigated the role of four indicators of socioeconomic position in explaining these differences and found equivalised household income had the strongest influence on socioemotional difficulties, and that socioeconomic position associations with socioemotional difficulties were less apparent among Pakistani and Bangladeshi children. The association between adverse economic conditions and socioemotional difficulties was partially mediated by maternal psychological distress. In conclusion, unexplained ethnic differences in socioemotional difficulties were seen, with a disadvantage among Pakistani children and an advantage among Black African children. Our results point to the need to address economic deprivation among ethnic minority groups to reduce children's socioemotional difficulties.

Chronic hepatitis B virus infection and hepatocellular carcinoma in Sub-Saharan Black African children: The pre-vaccination era

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.

Weak D Type 4.2.2 (DAR1.2) in an African child: Serology and molecular characterization

The weak D phenotype is represented by a group of RHD genotypes that code for alterated RhD proteins associated with a reduced RhD expression on red blood cell. By routine serology, some partial D variants are likely to be missed.In this report we describe the case of a three-year-old Black African child with a “unclear” reaction with monoclonal anti-D. We analyzed the blood sample of the child with different methods to conclude that it is a case of DAR 1.2 (weak D 4.2.2) and that it must be transfused with D negative erithrocytes.

Race/ethnic disparities in early childhood BMI, obesity and overweight in the United Kingdom and United States.

Objective:Racial/ethnic patterning in the risk of obesity and overweight has been observed in early childhood; however, little research has compared these disparities between the United Kingdom (UK) and United States (US) using detailed ethnic classifications. We use comparable nationally representative cohort studies to examine racial/ethnic disparities in mean body mass index (BMI) and in the odds of obesity/overweight in the UK and US. The contribution of sociodemographic, cultural and family routine factors are assessed.Methods:Data on BMI, obesity and overweight in 5-year-old children from the MCS (Millennium Cohort Study) and ECLS-B (Early Childhood Longitudinal Study, Birth Cohort) were examined. We investigated race/ethnic disparities in mean BMI and in the odds of obesity and overweight, as compared to normal weight. We assessed the independent contribution of sociodemographic, cultural and family routine factors to observed disparities.Results:In the UK, after adjustment for sociodemographic, cultural and family routine factors and maternal BMI, we found Black Caribbean children to have higher odds ratio (OR=1.7, confidence interval (CI)=1.1–2.6), Pakistani children to have lower odds of obesity (OR=0.60, CI=0.37–0.96) and Black African children were more likely to be overweight (OR=1.40, CI=1.04–1.88). In the US, in fully adjusted models, there were no race/ethnic disparities in children's odds of obesity and overweight.Conclusion:Disparities for Bangladeshi children in the UK and Mexican, other Hispanic and American Indian children in the US can be explained by socioeconomic disadvantage, whereas a range of cultural and family characteristics partially explain disparities for other groups in the UK. Future public health initiatives focused on reducing risk of overweight and obesity should consider the diverse socioeconomic and cultural profiles of all race/ethnic groups.

Ethnic variations in overweight and obesity among children over time: findings from analyses of the Health Surveys for England 1998–2009

BackgroundThe increase in the prevalence of obesity among children and adolescents in England since the mid-1990s has been dramatic. Cross-sectional evidence suggests ethnic variations in childhood obesity prevalence.ObjectivesThe objective of the study was to examine whether and how ethnic variations in childhood overweight/obesity have changed over time, and are affected by socioeconomic factors.MethodThis study uses logistic regression to analyse ethnic differences in the relative likelihood of being at or above the age- and gender-specific thresholds for overweight and obesity developed by the International Obesity Task Force among children aged between 2 and 15 from 11 ethnic groups included in the Health Surveys for England between 1998 and 2009, adjusting for age, gender, year of data collection and equivalized household income. We separately analyse the likelihood of being at or above the thresholds for overweight (but below those for obesity) and obesity.ResultsTrends in overweight/obesity over time among ethnic minority groups do not follow those of white English children. Black African children had higher rates of overweight and obesity, which appear to have peaked, and black Caribbean children had higher rates of obesity than other groups examined, which appear to continue rising. These differences were not explained by socioeconomic variations between groups.ConclusionPolicies are required that encourage healthy lifestyles among ethnic minority young people, while engaging with the complexities associated with these choices during childhood and adolescence.

Environmental and occupational respiratory diseases – 1040. Associations between asthma and bronchial hyper-responsivness with allergy and atopy phenotypes in urban black South African teenagers

Background Epidemiological studies in South Africa show increasing prevalence rates of asthma and allergic sensitisation in both urban and rural Black African communities, and narrowing of the urban-rural gradient. There is a paucity of current data on bronchial hyperresponsiveness (BHR) in urban Black African children, associations between asthma and BHR and the relationship between BHR, allergen sensitisation and other atopic diseases.