Black African Children Research Articles

Paralytic Strabismus in South African Black and Mixed Race Children – A 15-year Clinic-based Review

Purpose: To describe the demographics and clinical profile of paralytic strabismus in South African black and mixed race children seen at a tertiary pediatric eye clinic.Methods: A retrospective, descriptive case series of patients younger than 14 years diagnosed with paralytic strabismus at the Red Cross War Memorial Children’s Hospital in Cape Town, between 1996 and 2010.Results: A total of 166 children were studied. Of these, 74% were of mixed race descent while 26% were black. The most commonly affected cranial nerve was the fourth (52%). The sixth nerve was involved in 39% of cases, while 5% and 4% had third nerve palsy and multiple cranial palsies, respectively. The majority of mixed race children (58%) had fourth cranial nerve palsies, while 54% of black children had sixth nerve palsies. The most common cause of paralytic strabismus was congenital (55%), followed by trauma (18%).Conclusion: In this clinic-based study, paralytic strabismus was more common in mixed race children. Fourth nerve palsies predominated in mixed race children, whereas the majority of black children had sixth nerve palsies. Further population-based research is necessary to identify the determinants of ocular cranial nerve palsy in African children.

OP29 Ethnic and Socioeconomic Influences on Childhood Blood Pressure: The Child Heart and Health Study in England (Chase)

BackgroundCompared to UK white European adults, UK black African-Caribbean adults have higher mean systolic (SBP) and diastolic (DBP) blood pressure; UK South Asian adults have higher mean DBP but lower...

Predicting the prevalance of Autism among ethnic groups

Objectives To investigate the prevalence of Autistic Spectrum Disorders (ASD) in children aged 0-19 across 7 major ethnic groups. Background In March 2009, researchers in the department of health in Minnesota, Minneapolis, USA reported that the number of Somali children, aged 3 to 4 years, who participated in the ASD special educational programs was significantly higher than for children from other ethnic backgrounds. A study from Sweden in 2008 estimated the prevalence of autism among Somali children in Stockholm County to be 3-4 times higher than children of other ethnic origin. In our Borough; Somali families observed higher occurrence of ASD in their children and also relatives living in other countries. Methods Children aged 0-19 years with a diagnosis of ASD were recruited from the databases of the local Special Educational Needs Department and the local Autism Service. Duplications were removed. Estimates of the total child population (aged 0-19 years) in the Borough were obtained from the local public health demographic data (November 2008), the Mayhew Harper Associates population report May 2010 and the local projected population (2011). The estimated number was 61773 children. These children were separated into 7 major ethnic groups (table 1 and figure 1). The ASD group (N=355) were separated into the same 7 major ethnic groups and analyses between the two groups was made (table 2 and figure 2). Results In our borough, the Black African, Somali and Black Caribbean children constitute the smallest proportion of the ethnic groups at 3% each. The Bangladeshi and white population made up the largest proportion at 55% and 18% respectively. The prevalence of autism in Somali and black African children was found to be 1.2% (12.1 per 1000). The prevalence of Autism in the black Caribbean population was 1.1% (11 per 1000). The prevalence in the remaining ethnic groups was 0.55% (5.5 per 1000) See figure 3. Conclusion The analysis shows a higher prevalence of autism in Somali, Black African and Black Caribbean children which is at least twice the prevalence in all other ethnic groups in our borough. This supports what has previously been reported by other authorities.

Ethnic differences in growth in early childhood: an investigation of two potential mechanisms

There are clear ethnic differences in birthweight. This study examines whether and how these disparities are replicated in a later marker of physical development, height at 5 years. Observational data from the UK Millennium Cohort Study, constructed to over-represent ethnic minority (Indian, Pakistani, Bangladeshi, Black African, Black Caribbean and Other) children. Mean birthweight of ethnic minority children was lower than that of the ethnic majority (3.06-3.34 kg vs. 3.41 kg), but ethnic minority children were not shorter at 5 years. Pakistani, Caribbean and African children were actually taller on average (by 0.5 cm, 1.4 cm and 3.5 cm). Controlling for parental height and birthweight did not affect height differentials. Two mechanisms were hypothesized: (i) a cramped intrauterine environment given the short stature of some minority children's mothers resulted in catch-up growth; and (ii) conditions during the parents' childhood led to a reduced capacity to reach their height potential. A reparameterization of parent heights showed that mother's height contributed more to predicting child height than joint parental height alone. Birthweight was positively related to height and attenuated the extra contribution from mothers' heights. Decomposing the effects into their constituent parts found some support for both hypotheses. These results suggest that children from ethnic minority backgrounds are not disadvantaged with respect to height growth compared with the ethnic majority. However, if adiposity is more likely when children are tall for their age, then ethnic inequalities in adult health could increase as the current generation of children mature.

Ethnic differences in blood lipids and dietary intake between UK children of black African, black Caribbean, South Asian, and white European origin: the Child Heart and Health Study in England (CHASE)

Ischemic heart disease (IHD) rates are lower in UK black Africans and black Caribbeans and higher in South Asians when compared with white Europeans. Ethnic differences in lipid concentrations may play a part in these differences. The objective was to investigate blood lipid and dietary patterns in UK children from different ethnic groups. This was a cross-sectional study in 2026 UK children (including 285 black Africans, 188 black Caribbeans, 534 South Asians, and 512 white Europeans) attending primary schools in London, Birmingham, and Leicester. We measured fasting blood lipid concentrations and collected 24-h dietary recalls. In comparison with white Europeans, black African children had lower total cholesterol (-0.14 mmol/L; 95% CI: -0.25, -0.04 mmol/L), LDL-cholesterol (-0.10 mmol/L; 95% CI: -0.20, -0.01 mmol/L), and triglyceride concentrations (proportional difference: -0.11 mmol/L; 95% CI: -0.16, -0.06 mmol/L); HDL-cholesterol concentrations were similar. Lower saturated fat intakes (-1.4%; 95% CI: -1.9%, -0.9%) explained the differences between total and LDL cholesterol. Black Caribbean children had total, LDL-cholesterol, HDL-cholesterol, and triglyceride concentrations similar to those for white Europeans, with slightly lower saturated fat intakes. South Asian children had total and LDL-cholesterol concentrations similar to those for white Europeans, lower HDL-cholesterol concentrations (-0.7 mmol/L; 95% CI: -0.11, -0.03 mmol/L), and elevated triglyceride concentrations (proportional difference: 0.14 mmol/L; 95% CI: 0.09, 0.20 mmol/L); higher polyunsaturated and monounsaturated fat intakes did not explain these lipid differences. Only black African children had a blood lipid profile and associated dietary pattern likely to protect against future IHD. The loss of historically lower LDL-cholesterol concentrations among UK black Caribbeans and South Asians may have important adverse consequences for future IHD risk in these groups.

Ethnic Differences in the Prevalence of Myopia and Ocular Biometry in 10- and 11-Year-Old Children: The Child Heart and Health Study in England (CHASE)

Ethnic differences in childhood prevalence of myopia have not been well characterized in the United Kingdom. In this study, ethnic differences in refractive status and ocular biometry were examined in a multiethnic sample of British children. This was a cross-sectional study of 10- and 11-year-old school children of South Asian, black African Caribbean, and white European ethnic origin. Vision, open-field autorefraction (without cycloplegia), and ocular biometry were measured in each eye. Myopia was defined as spherical equivalent refraction of -0.50 D with unaided vision of 20/30 or worse (in one or both eyes). Ethnic differences in the prevalence of myopia were examined by using logistic regression, and multiple linear regression was used for ethnic differences in ocular biometry. All models were adjusted for age, sex, and clustering within school. Data were available for 1179 children. The prevalence of myopia was 25.2%, 10.0%, and 3.4%, respectively, in the South Asian, black African Caribbean, and white European children. Adjusted odds ratios (ORs) of myopia compared with the white European children were 8.9 (95% confidence interval [CI] 4.0 to 19.4) in the South Asian and 3.2 (95% CI, 1.4 to 7.2) in black African Caribbean children. Ethnic differences in the prevalence of myopia were largely accounted for by ethnic differences in axial length. The South Asian and black African Caribbean children had longer axial lengths (0.44 mm; 95% CI, 0.30 to 0.57 mm and 0.30 mm; 95% CI, 0.16 to 0.44 mm, respectively). Among British children exposed to the same schooling environment, the South Asians had the highest prevalence of myopia, followed by the black African Caribbeans compared with the white Europeans. A quarter of British South Asian children were myopic, which is strongly related to increased axial length.

The genesis of Perthes' disease: does it lie in hips with reduced ranges of movement?

Noting that Perthes' disease is relatively common in Caucasian British children compared with black African children, this study was carried out to compare the range of hip movements in a series of 100 normal Ghanaian children and 182 normal British children, between 5 and 6 years of age. A significantly increased range of movement was found in the African group in all parameters, (P<0.001). The changes were even more marked when sex was taken into consideration, female children having a much bigger range of movement than the males in both racial groups. The unaffected hips in a series of 51 Caucasian children presenting with unilateral Perthes' disease were then analysed and were found to have a reduced range of movement compared with normal, in flexion, abduction, internal rotation in flexion and external rotation in extension (P<0.001). It is suggested that one of the reasons why some hips are vulnerable to Perthes' disease could be a preexisting restricted range of movement, which renders them more susceptible to strain injuries.

Prospective, National Clinical and Epidemiologic Study on Imported Childhood Malaria in the United Kingdom and the Republic of Ireland

Current knowledge of clinical features of imported childhood malaria is largely limited to small, retrospective, and/or single-center case series. This prospective, population-based study describes the epidemiology and clinical features of imported childhood malaria in children <16 years in the United Kingdom and Republic of Ireland. Active prospective national surveillance with clinical data collection was performed between January 1, 2006 and January 31, 2007 through the British Pediatric Surveillance Unit and capture-recapture analysis using cases reported independently to respective national surveillance centers. There were 290 cases, including 186 reported through the British Pediatric Surveillance Unit with clinical details. Capture-recapture analysis estimated the burden of imported childhood malaria to be 2.8/100,000 per year for the United Kingdom and 4.6/100,000 per year for Ireland. Black-African children born in the United Kingdom and Ireland and traveling to West Africa during school holidays without antimalarial prophylaxis accounted for the majority of cases. Thirty of 117 children (26%) who had traveled to a malaria-endemic country had previously been diagnosed with malaria, reflecting missed opportunities to educate families on malaria prevention. A third of children (46/148) with Plasmodium falciparum malaria fulfilled World Health Organization criteria for severe or potentially complicated malaria, although only 11/46 (24%) required intensive care. The choice of antimalarials varied considerably among hospitals and within the same hospital. However, recrudescence occurred in only 1 child and none died. Interventions to prevent imported childhood malaria should focus on Black-African families traveling to West Africa, while pediatricians should be offered clearer guidance on the treatment of childhood malaria.

Nutritional composition of the diets of South Asian, black African-Caribbean and white European children in the United Kingdom: The Child Heart and Health Study in England (CHASE)

In the UK, South Asian adults have increased risks of CHD, type 2 diabetes and central obesity. Black African-Caribbeans, in contrast, have increased risks of type 2 diabetes and general obesity but lower CHD risk. There is growing evidence that these risk differences emerge in early life and that nutritional factors may be important. We have therefore examined the variations in nutritional composition of the diets of South Asian, black African-Caribbean and white European children, using 24 h recalls of dietary intake collected during a cross-sectional survey of cardiovascular health in eighty-five primary schools in London, Birmingham and Leicester. In all, 2209 children aged 9-10 years took part, including 558 of South Asian, 560 of black African-Caribbean and 543 of white European ethnicity. Compared with white Europeans, South Asian children reported higher mean total energy intake; their intakes of total fat, polyunsaturated fat and protein (both absolute and as proportions of total energy intake) were higher and their intakes of carbohydrate as a proportion of energy (particularly sugars), vitamin C and D, Ca and haem Fe were lower. These differences were especially marked for Bangladeshi children. Black African-Caribbean children had lower intakes of total and saturated fat (both absolute and as proportions of energy intake), NSP, vitamin D and Ca. The lower total and saturated fat intakes were particularly marked among black African children. Appreciable ethnic differences exist in the nutritional composition of children's diets, which may contribute to future differences in chronic disease risk.

Nutritional composition of the diets of South Ssian, black African Caribbean and white European children in the UK: the Child Heart and Health Study in England

Compared with UK white Europeans, South Asian adults have increased risks of obesity, type 2 diabetes, stroke and coronary heart disease (CHD); black African-Caribbean adults have increased risks of obesity,...

Total IgE in urban Black South African teenagers: The influence of atopy and helminth infection

Total IgE levels are usually elevated in allergic diseases, being highest in atopic eczema, followed by atopic asthma and allergic rhinitis. Genetic factors are believed to play a role in total IgE levels, with higher levels seen in Black African subjects. Total IgE is also raised in parasite infection. Thus, the higher total IgE levels in Black Africans could be because of environmental rather than genetic factors. Few studies have investigated the usefulness of total IgE levels in the evaluation of atopy in Black Africans. The objective of this study was to determine the total IgE levels in unselected urban Black African high school children and to correlate this with atopy and ascaris sensitization. Atopic status was assessed by means of specific allergen sensitization (skin prick tests to eight inhalant and four food allergens), self-reported asthma and bronchial hyper-responsiveness measured by methacholine challenge. Ascaris sensitization was assessed by means of ascaris IgE measured by CAP-RAST. Total IgE levels were markedly skewed toward the left and were not distributed in a Gaussian or a log-normal distribution. Skin prick tests were positive for aeroallergens in 32.3% of subjects. Thirty four percent had elevated ascaris IgE. Total IgE was higher in atopic vs. non-atopic subjects and correlated with the number of positive skin prick tests, self-reported asthma and bronchial hyper-responsiveness. Subjects without allergy (or) atopy had a median total IgE of 80-90 kU/I. In addition total IgE correlated with ascaris IgE. Subjects with no ascaris sensitization had median total IgE of 77.1 kU/l. Subjects with neither atopy/asthma nor ascaris sensitisation had a median total IgE of 69.9 kU/I, similar to the levels seen in people of other genetic origins. This study suggests that helminthic infection rather than genetic differences, may be the major determining factor of IgE levels in certain populations.

Timing of human mandibular third molar formation

Background: Population differences in tooth formation using radiographs can be determined if the entire developmental sequence of a single tooth is studied. The only developing tooth visible radiographically from initiation to root completion is the third molar or wisdom tooth.Aim: The timing of mandibular third molar formation was documented for two groups of children in England and two in South Africa.Subjects and methods: Panoramic radiographs of White and Bangladeshi children from London and Black African and Cape Coloured children from South Africa were examined (age 5–24). Mean age of entering third molar stages (crypt appearance to root completion) was calculated using logistic regression and compared between sex and group using a t-test.Results: Average age of third molar stages was significantly (p < 0.001) later in three groups for almost all stages of the third molar compared to Black children. The average age of entering initial mineralization ranged from 7.97 to 9.74 years while average age of apex closed was 19.27–20.88.Conclusion: These results show for the first time a significant difference in the timing of maturation of the mandibular third molar between groups with South African Black children being earlier than other groups.

Estimating the burden of disease attributable to indoor air pollution from household use of solid fuels in South Africa in 2000.

To estimate the burden of respiratory ill health in South African children and adults in 2000 from exposure to indoor air pollution associated with household use of solid fuels. World Health Organization comparative risk assessment (CRA) methodology was followed. The South African Census 2001 was used to derive the proportion of households using solid fuels for cooking and heating by population group. Exposure estimates were adjusted by a ventilation factor taking into account the general level of ventilation in the households. Population-attributable fractions were calculated and applied to revised burden of disease estimates for each population group. Monte Carlo simulation-modelling techniques were used for uncertainty analysis. South Africa. Black African, coloured, white and Indian children under 5 years of age and adults aged 30 years and older. Mortality and disability-adjusted life years (DALYs) from acute lower respiratory infections in children under 5 years, and chronic obstructive pulmonary disease and lung cancer in adults 30 years and older. An estimated 20% of South African households were exposed to indoor smoke from solid fuels, with marked variation by population group. This exposure was estimated to have caused 2,489 deaths (95% uncertainty interval 1,672 - 3,324) or 0.5% (95% uncertainty interval 0.3 - 0.6%) of all deaths in South Africa in 2000. The loss of healthy life years comprised a slightly smaller proportion of the total: 60,934 DALYs (95% uncertainty interval 41,170 - 81,246) or 0.4% of all DALYs (95% uncertainty interval 0.3 - 0.5%) in South Africa in 2000. Almost 99% of this burden occurred in the black African population. The most important interventions to reduce this impact include access to cleaner household fuels, improved stoves, and better ventilation.

Black African Children and the Child Protection System

This paper explores black African children’s experiences of the child protection system in the UK. The central focus of the paper is a review of the available literature on the social circumstances and environmental influences affecting many black African families involved in the child protection system; specific parenting practices and care-giving environments; and their experiences of social work and other professional interventions aimed at safeguarding and promoting the needs of African children. This paper examines these themes to elucidate the factors that contribute to the provision of effective, culturally competent interventions with black African children at risk of significant harm. It suggests that there are a number of tensions inherent for professionals in working with culturally diverse African families such as reconciling different beliefs and behaviours concerning child-rearing practices; affirming the parenting practices of these families in the engagement process; adopting a strengths-based orientation whilst at the same time safeguarding and promoting the welfare of vulnerable children. The paper concludes with a discussion of the implications for practice.

Ethnic differences in achievement of developmental milestones by 9 months of age: the Millennium Cohort Study

This paper examines ethnic differences in the attainment of developmental milestones during infancy and possible explanations for observed differences are investigated. Data from the first survey of the Millennium Cohort Study (n=15 994; 8212 males, 7782 females; mean age 9.2mo [SD 0.5]) were examined. We found that Black Caribbean (odds ratio [OR]=0.23, 95% confidence interval [CI]=0.11–0.48), Black African (OR 0.31, 95% CI 0.18–0.55), and Indian (OR 0.55, 95% CI 0.33–0.93) infants were less likely to show delay in the attainment of gross motor milestones compared with White infants after adjustment for a range of explanatory variables. Pakistani and Bangladeshi infants were more likely to have delays in fine motor development (OR 1.69, 95% CI 1.21–2.35 and OR 2.17, 95% CI 1.17–4.02 respectively) and communicative gestures (OR 4.19, 95% CI 1.47–11.94 and OR 7.64, 95% CI 3.96–14.76 respectively), but these differences were explained by socioeconomic factors and markers of cultural tradition. In conclusion, unexplained ethnic differences were seen in the attainment of gross motor milestones, with Indian, Black Caribbean, and Black African children less likely to be delayed (in adjusted models). Increased likelihood of fine motor and communicative gesture delays among Pakistani and Bangladeshi infants, that disappear when socioeconomic factors are taken into account, point to the need to address deprivation among these groups to reduce the likelihood of developmental delay and possible longer term behavioural and cognitive problems and consequent opportunities throughout life.

Nutrition knowledge and barriers to good dietary practices among primary school children in a farming community

This article examines the nutrition practices of black African children attending farm schools and looks at what they know about nutrition. The research was part of the Farm Labour and General Health (FLAGH) project of the North-West University (Potchefstroom Campus), South Africa. Two schools participated in the study, which involved 132 primary schoolchildren aged 8 to 16 years. A structured questionnaire revealed the children's knowledge about nutrition related issues, and focus group discussions brought to light attitudes and barriers to sound dietary practices. This study provided insight into the lives of children living on commercial farms in the North West Province. The findings provide strong support for the view that while nutrition education is important to children's development of nutrition knowledge, good dietary practices and overall nutritional status, so also are influences from the children's social, economic and psychological environment.

Ethnic differences in achievement of developmental milestones by 9 months of age: the Millennium Cohort Study

This paper examines ethnic differences in the attainment of developmental milestones during infancy and possible explanations for observed differences are investigated. Data from the first survey of the Millennium Cohort Study (n = 15,994; 8212 males, 7782 females; mean age 9.2 mo [SD 0.5]) were examined. We found that Black Caribbean (odds ratio [OR] = 0.23, 95% confidence interval [CI] = 0.11-0.48), Black African (OR 0.31, 95% CI 0.18-0.55), and Indian (OR 0.55, 95% CI 0.33-0.93) infants were less likely to show delay in the attainment of gross motor milestones compared with White infants after adjustment for a range of explanatory variables. Pakistani and Bangladeshi infants were more likely to have delays in fine motor development (OR 1.69, 95% CI 1.21-2.35 and OR 2.17, 95% CI 1.17-4.02 respectively) and communicative gestures (OR 4.19, 95% CI 1.47-11.94 and OR 7.64, 95% CI 3.96-14.76 respectively), but these differences were explained by socioeconomic factors and markers of cultural tradition. In conclusion, unexplained ethnic differences were seen in the attainment of gross motor milestones, with Indian, Black Caribbean, and Black African children less likely to be delayed (in adjusted models). Increased likelihood of fine motor and communicative gesture delays among Pakistani and Bangladeshi infants, that disappear when socioeconomic factors are taken into account, point to the need to address deprivation among these groups to reduce the likelihood of developmental delay and possible longer term behavioural and cognitive problems and consequent opportunities throughout life.

Active surveillance for tuberculosis in Wales: 1996–2003

Aims: To estimate the incidence of active tuberculosis (TB) and study the use of chemoprophylaxis for latent TB in children in Wales, and to identify potential areas for improving prevention...

Arthritis in association with human immunodeficiency virus infection in Black African children: causal or coincidental?

To compare human immunodeficiency virus (HIV)-infected and HIV-uninfected children with arthritis of unknown origin to determine whether the association between HIV infection and arthritis is causal or coincidental. Retrospective review of 132 children with arthritis who were tested for HIV infection. Thirty-five (27%) of the children were HIV infected and the male to female ratio was 2.5:1 (P = 0.02). Arthritis was the presenting feature of HIV infection in 78% of these children. The remaining 97 (73%) were diagnosed as having juvenile idiopathic arthritis. 'Spondyloarthropathy-like' features were found in 34% of HIV-infected children compared with 5% of uninfected children. The high prevalence of HIV infection in 27% of children, the predominance of males and the increased prevalence of 'spondyloarthropathy-like' features, supports a causal relationship between HIV infection and arthritis.

Health behaviour and school environment among school-aged black and white South African children in the Limpopo Province

The main objective of the ‘Health Behaviour among School-Aged Children’ (HBSC) study was to collect information on health-related behaviour of South African youth.&#x0D; &#x0D; Opsomming&#x0D; Die hoofdoelwit van die studie “Health Behaviour among School-aged Children” (Gesondheidsgedrag van skoolgaande kinders) studie is om inligting in te samel ten opsigte van gesondheidverwante gedrag van die Suid-Afrikaanse jeug.&#x0D; &#x0D; *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.