Children Of Pakistani Origin Research Articles

Determination of reference interval (RI) of spot urinary oxalate to creatinine ratio in children of pakistani origin under six years of age: A cross-sectional study

BackgroundThe gold standard screening method of hyperoxaluria in children is using 24-hour urine collection. Urine collection may be cumbersome and challenging for children. Reference intervals (RI) of oxalate for the Pakistani population are not readily available. Therefore we aimed to determine the oxalate to creatinine ratio (Ox: Cr) for Pakistani children <6 years of age. Materials and MethodsA cross-sectional study was conducted at Aga Khan University from June 2018 to October 2019. Random urine samples from apparently healthy children < 6 years were collected and stored at -30°C until analysis after adding 6M HCl. Oxalate was measured on Micro lab 300 using a kit based on oxalate oxidase principle, while creatinine was measured by kinetic Jaffe reaction. Data was analyzed by EP evaluator and SPSS 23. Ox: Cr ratio was calculated and reported with 90% confidence interval (CI) and interquartile range (IQR). ResultsThe mean age of study subjects (n=120) was 29 ±22.3 months with an M: F ratio of 1:1. Children of various ethnicities were included from all over Karachi. The majority of the subjects were Urdu speaking (37.5%). Median Ox: Cr was 0.13(0.10). No significant difference was noted in the median Ox: Cr ratio between various ethnicities (p>0.05). It was significantly different in group I to V which was 0.25 (IQR: 0.06), 0.19 (IQR: 0.11), 0.15 (IQR: 0.04), 0.11 (IQR: 0.06) and 0.08 (IQR: 0.04) respectively (pvalue <0.001). ConclusionThe established RIs of Ox: Cr ratio was 0.05-0.34 (90% CI). Ox: Cr ratio showed a declining trend with age. Large scale reference interval studies are encouraged, taking diet and age into consideration.

Estimating the current and future prevalence of life-limiting conditions in children in England

Background: Previous studies showed increasing number of children with a life-limiting or life-threatening condition who may benefit from input from pediatric palliative care services. Aim: To estimate the current prevalence of children with a life-limiting condition and to model future prevalence of this population. Design: Observational study using national inpatient hospital data. A population-based approach utilizing ethnic specific population projections was used to estimate future prevalence. Setting/participants: All children aged 0–19 years with a life-limiting condition diagnostic code recorded in Hospital Episodes Statistics data in England from 2000/01 to 2017/18. Results: Data on 4,543,386 hospital episodes for 359,634 individuals were included. The prevalence of children with a life-limiting condition rose from 26.7 per 10,000 (95%CI 26.5–27.0) in 2001/02 to 66.4 per 10,000 (95% CI: 66.0–66.8) in 2017/18. Using a more restricted definition of a life-limiting condition reduced the prevalence from 66.4 to 61.1 per 10,000 (95%CI 60.7–61.5) in 2017/18. Highest prevalence was in the under 1-year age group at 226.5 per 10,000 and children with a congenital abnormality had the highest prevalence (27.2 per 10,000 (95%CI: 26.9–27.5)). The prevalence was highest among the most deprived group and in children of Pakistani origin. Predicted future prevalence of life-limiting conditions ranged from 67.0 (95%CI 67.7–66.3) to 84.22 (95%CI 78.66–90.17) per 10,000 by 2030. Conclusions: The prevalence of children with a life-limiting or life-threatening condition in England has risen over the last 17 years and is predicted to increase. Future data collections must include the data required to assess the complex health and social care needs of these children.

Association of food security status with overweight and dietary intake: exploration of White British and Pakistani-origin families in the Born in Bradford cohort

BackgroundFood insecurity has been associated with dietary intake and weight status in UK adults and children although results have been mixed and ethnicity has not been explored. We aimed to compare prevalence and trajectories of weight and dietary intakes among food secure and insecure White British and Pakistani-origin families.MethodsAt 12 months postpartum, mothers in the Born in Bradford cohort completed a questionnaire on food security status and a food frequency questionnaire (FFQ) assessing their child’s intake in the previous month; at 18 months postpartum, mothers completed a short-form FFQ assessing dietary intake in the previous 12 months. Weights and heights of mothers and infants were assessed at 12-, 24-, and 36-months postpartum, with an additional measurement of children taken at 4–5 years. Associations between food security status and dietary intakes were assessed using Wilcoxon-Mann-Whitney for continuous variables and χ2 or Fisher’s exact tests for categorical variables. Quantile and logistic regression were used to determine dietary intakes adjusting for mother’s age. Linear mixed effects models were used to assess longitudinal changes in body mass index (BMI) in mothers and BMI z-scores in children.ResultsAt 12 months postpartum, White British mothers reported more food insecurity than Pakistani-origin mothers (11% vs 7%; p < 0.01) and more food insecure mothers were overweight. Between 12 and 36 months postpartum, BMI increased more among food insecure Pakistani-origin mothers (β = 0.77 units, [95% Confidence Interval [CI]: 0.40, 1.10]) than food secure (β = 0.44 units, 95% CI: 0.33, 0.55). This was also found in Pakistani-origin children (BMI z-score: food insecure β = 0.40 units, 95% CI: 0.22, 0.59; food secure β = 0.25 units, 95% CI: 0.20, 0.29). No significant increases in BMI were observed for food secure or insecure White British mothers while BMI z-score increased by 0.17 (95% CI: 0.13, 0.21) for food secure White British children. Food insecure mothers and children had dietary intakes of poorer quality, with fewer vegetables and higher consumption of sugar-sweetened drinks.ConclusionsFood security status is associated with body weight and dietary intakes differentially by ethnicity. These are important considerations for developing targeted interventions.

Is small size at birth associated with early childhood morbidity in white British and Pakistani origin UK children aged 0\u20133? Findings from the born in Bradford cohort study

Low birthweight is associated with increased infant morbidity, poorer developmental outcomes and risk of adult disease and its prevention remains a public health priority. South Asian children are more likely to be born small and there is some debate around whether this is a normal phenomenon within this population or whether they have a greater risk of morbidity. We examined the association between small size at birth and morbidity in White British and Pakistani origin children aged 0–3 participating in the Born in Bradford cohort study. We included 4119 White British and 4731 Pakistani origin children and examined health service use (General Practitioner (GP) consultations, the most common prescribing categories (analgesics, antibiotics, bronchodilators), emergency and elective hospital episodes) as markers of morbidity, in children born small defined as: (i) low birthweight (< 2500 g) (ii) small for gestational age (SGA) using customised birth charts. We used negative binomial regression models to predict the adjusted incidence of morbidity markers. 8.7% of Pakistani and 5% of White British children were born with a low birthweight (< 2500 g). Using customised charts, these proportions were 15.3 and 6.2% respectively. Children born small in both groups irrespective of the criteria used, generally had a higher rate of episodes for morbidity markers compared to normal weight children. Incidence of GP consultations (IRR 1.48 (95% CI 1.27, 1.73) to 1.55 (95% CI 1.36, 1.76) depending on birthweight category), analgesic (IRR 1.76 (95% CI 1.37, 2.25) to 2.31 (95% CI 2.19, 2.45) and antibiotic prescriptions (IRR 1.13 (95% CI 0.08, 1.46) to 1.38 (95% CI 1.30, 1.48) and emergency hospital episodes (IRR 1.20 (95% CI 1.06, 1.36) to 1.46 (95% CI 0.92, 2.32), was higher in Pakistani origin children with either a low or normal birthweight. Being born small is associated with greater morbidity estimated by use of health services, in both White British and Pakistani origin children underlining the importance of public health policy to reduce low birthweight. Pakistani origin children access health services more frequently than White British children irrespective of birthweight and this has implications for health service planning in areas with South Asian populations.

Ethnic and socio-economic differences in the prevalence of wheeze, severe wheeze, asthma, eczema and medication usage at 4 years of age: Findings from the Born in Bradford birth cohort

BackgroundAsthma, wheeze and eczema are common in early childhood and cause considerable morbidity. Generally rates of these conditions are higher in high income compared to low income countries. Rates in developed nations are generally higher than in less developed countries. After migration to Western countries, differences in risks of developing these conditions may between migrant and non-migrant may diminish. MethodsA convenience sample of 1648 children of White British, Pakistani or Other ethnicity aged between 4 and 5 years were recruited from the main Born in Bradford cohort. Children's parents or guardians were asked to report on a range of potential risk factors and their associations with wheeze, asthma and eczema. Relationships between ethnicity and disease outcomes were examined using logistic regression after adjustment for other relevant risk factors and confounders. ResultsEthnic differences in doctor diagnosed asthma were evident, with children of other ethnic Origin being less likely and children of Pakistani origin more likely to have a diagnosis than White British or other origin children, although after adjustment for other risk factors this difference only remained significant for the Other Ethnic group. Ethnic differences were not observed in other outcomes including wheeze in the past 12 months, severe wheeze and taking medications for breathing problems. ConclusionsIn UK born children, traditional risk factors such as gender, family history, socio-economic status and child's medical history may be stronger risk factors than ethnicity or familial migration patterns.

G.P.311: A new homozygous ISPD mutation is associated with either early limb-girdle or congenital muscular dystrophy within the same family depending on different levels of alpha-dystroglycan glycosylation

Dystroglycanopathies represent an important subgroup of recessively inherited disorders within the group of muscular dystrophies. Their severity may vary from the mild forms of adult-onset limb-girdle muscular dystrophy (LGMD), to the severe congenital muscular dystrophies with cerebral and ocular involvement. Although mutations in at least 17 genes have been identified so far, about 50% of the cases with dystroglycanopathy still remain unsolved. Recently, mutations in the isoprenoid synthase domain containing (ISPD) gene have been reported as a common cause of congenital muscular dystrophy and LGMD. We report clinical, histopathological, immunochemical, genetic and muscular MRI findings in 2 consanguineous children of Pakistani origin, carrying a new homozygous missense mutation (Gly123Arg) in the ISPD gene. Case 1 is a 8year-old female with an early limb-girdle phenotype, who lost ambulation at the age of 7.5years. Case 2 is a 2.5year-old male and second degree cousin of case 1, showing a congenital muscular dystrophy phenotype. Cognitive development, brain MRI, eye examination, electrocardiogram and echocardiogram were normal in both the patients. Western blot showed greater reduction of alpha-dystroglycan glycosylation in patient 2, and may be responsible for the greater severity of his clinical presentation. To our knowledge, this is the first report on the co-occurrence of both early limb-girdle and congenital muscular dystrophies within the same family carrying a new homozygous ISPD mutation.

Risk factors for congenital anomaly in a multiethnic birth cohort: an analysis of the Born in Bradford study

Congenital anomalies are a leading cause of infant death and disability and their incidence varies between ethnic groups in the UK. Rates of infant death are highest in children of Pakistani origin, and congenital anomalies are the most common cause of death in children younger than 12 in this ethnic group. We investigated the incidence of congenital anomalies in a large multiethnic birth cohort to identify the causes of the excess of congenital anomalies in this community. We obtained questionnaire data from the mothers of children with one or more anomalies from the Born in Bradford study, a prospective birth cohort study of 13,776 babies and their families in which recruitment was undertaken between 2007 and 2011. Details of anomalies were prospectively reported to the study and we cross checked these details against medical records. We linked data for anomalies to maternal questionnaire and clinical data gathered as part of the Born in Bradford study. We calculated univariate and multivariate risk ratios (RRs) with 95% CIs for various maternal risk factors. Of 11,396 babies for whom questionnaire data were available, 386 (3%) had a congenital anomaly. Rates for congenital anomaly were 305·74 per 10,000 livebirths, compared with a national rate of 165·90 per 10,000. The risk was greater for mothers of Pakistani origin than for those of white British origin (univariate RR 1·96, 95% CI 1·56-2·46). Overall, 2013 (18%) babies were the offspring of first-cousin unions. These babies were mainly of Pakistani origin--1922 (37%) of 5127 babies of Pakistani origin had parents in first-cousin unions. Consanguinity was associated with a doubling of risk for congenital anomaly (multivariate RR 2·19, 95% CI 1·67-2·85); we noted no association with increasing deprivation. 31% of all anomalies in children of Pakistani origin could be attributed to consanguinity. We noted a similar increase in risk for mothers of white British origin older than 34 years (multivariate RR 1·83, 95% CI 1·14-3·00). Maternal education to degree level was protective (0·53, 95% CI 0·38-0·75), irrespective of ethnic origin. Consanguinity is a major risk factor for congenital anomaly. The risk remains even after adjustment for deprivation, and accounts for almost a third of anomalies in babies of Pakistani origin. High levels of educational attainment are associated with reduced risk in all ethnic groups. Our findings will be valuable in health promotion and public health, and to those commissioning antenatal, paediatric, and clinical genetic services. Sensitive advice about the risks should be provided to communities at increased risk, and to couples in consanguineous unions, to assist in reproductive decision making. National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care programme.

Adiposity and blood pressure in 7‐ to 11‐year‐old children: Comparison of British Pakistani and white British children, and of British Pakistani children of migrant and British‐born mothers

This study tested hypotheses that: (1) levels of adiposity, as assessed by triceps and subscapular skinfold thicknesses (SFTs), and blood pressure would be higher in British Pakistani children than in white British children; and (2) British Pakistani children of mothers born in the UK would have smaller SFTs and lower blood pressure than children of mothers born in Pakistan. Participants aged 7 to 11 years were recruited from five primary schools in a deprived urban area. BMI, waist circumference, triceps and subscapular SFT, and blood pressure were measured. Participants comprised 209 white British and 132 British Pakistani children, including 79 children born in the UK to migrant mothers and 49 children born to British-born mothers. In comparisons by ethnic group, triceps SFT was significantly higher in British Pakistani children only after controlling for BMI. Subscapular SFT was higher in British Pakistani children, a finding strengthened after controlling for BMI. Systolic blood pressure was significantly higher in British Pakistani children, but not after controlling for socioeconomic status (SES). There were no significant differences between British Pakistani children born to migrant or British-born mothers, except that systolic blood pressure was lower in children of British-born mothers after controlling for SES, a finding that was not significant after controlling for BMI. This study confirms previous findings of larger SFTs and higher blood pressure in British children of Pakistani origin than in children of white European origin. Further work with larger sample sizes is needed to investigate differences between generations.

The British Infantile and Childhood Glaucoma (BIG) Eye Study

Pediatric glaucoma is a rare, potentially blinding condition, yet, in the United Kingdom, there is a paucity of contemporary epidemiologic and clinical data regarding this condition. The British Infantile and Childhood Glaucoma (BIG) Eye Study is the first national population-based study conducted to examine the incidence, detection patterns, current management, and intraocular pressure (IOP) control at 1 year in children with newly diagnosed glaucoma in the United Kingdom. A prospective study was conducted wherein children in the United Kingdom and Republic of Ireland aged <or=16 years with newly diagnosed primary or secondary glaucoma, were identified by consultant ophthalmologists through active surveillance from December 2001 until November 2002. Eligible cases were re-evaluated 12 months after notification. Of the 99 eligible children with newly diagnosed glaucoma, 47 had primary and 52 secondary glaucoma. The annual incidence of diagnosis of primary congenital glaucoma (PCG) in Great Britain was 5.41 in 100,000 (1/18,500) live births and in the Republic of Ireland, 3.31 in 100,000 (1/30,200). The incidence of PCG in children of Pakistani origin was almost nine times that of Caucasians. IOP control of <or=21 mm Hg was achieved in 94% with medications (60% without medications) in cases of PCG and in 86% with medications (28% without medications) in cases of secondary glaucoma. The British annual incidence of PCG diagnosis is comparable to that reported for other similar populations. Ethnic minorities from South Asia are at significantly increased risk of PCG. Successful IOP control in PCG after surgery in Britain is comparable to that in the published literature.

Survey of school children with visual impairment in Bradford.

This work was presented as a poster at the Institute of Health Research Conference 2000: Health of Children and Young People: Research Perspectives. University of Bradford 15th of September 2000. The aim of this survey was to determine the prevalence and aetiology of visual impairment in school children in Bradford. The case notes of school children with predominantly uncomplicated visual impairment were reviewed. Data including age, sex, race and information on visual diagnosis, heredity, degree of visual impairment and additional morbidity were collected. Seventy-two children between the ages of 5 and 16 years were included in this survey. The male: female ratio was 2.1: 1. Twenty-one children were Caucasian, 42 were of Pakistani and nine of other racial origin. The most common diagnoses were congenital nystagmus (19), ocular albinism (6), myopia (4), cataract (4) and microphthalmia (4). Twenty-five children had a genetically linked visual diagnosis and 31 had a family history of the same visual disorder. This survey showed similar causes of visual impairment as described in other studies on children with uncomplicated visual impairment and confirmed the previously described preponderance of boys. The proportion of Pakistani children in our study population was significantly higher than that in the general Bradford population, indicating a higher prevalence of visual impairment in this group. Children of Pakistani origin were significantly more likely to have genetically linked visual disease and a positive family history of the same visual disorder than children of Caucasian origin. This is probably due to genetic factors and a higher proportion of consanguineous marriages in this population. Information about the prevalence and causes of visual impairment is important for adequate provision of special services and for developing preventive strategies.