People Of Black African Descent Research Articles

Access to Mental Healthcare Services for Black Women during Perinatal Period – A Scoping Review

BACKGROUND: Black women in Canada are at higher risk of poor mental health outcomes; this is associated with disparities such as poor access to healthcare and aggravated by racial discrimination and poor living conditions.
 
 OBJECTIVES: This study aims to investigate the extent and nature of literature on access to mental healthcare services for Black women during the perinatal period in regions outside of Africa and the Caribbean. 
 
 METHODS: We conducted a systematic article search using Medline, Cumulative Index for Nursing and Allied Health Literature (CINAHL); PsycINFO; ProQuest Public Health Database. The search strategy based on the following aspects: 1) Perinatal mental health, specifically maternal mental health 2) People of color, specifically Black people of African descent, or the African diaspora 3) Experiences with mental healthcare, specifically access and utilization. Arksey & O’Malley’s framework for conducting scoping reviews was chosen. The included studies met the following criteria: 1) articles that focused on Black Women during perinatal period living in regions outside of African and the Caribbean, 2) studies with topics related to mental health services among Black women during perinatal period. 
 
 RESULTS: n=12 articles met the inclusion criteria. The following themes were identified from the analysis of literature: 1) Disparities in utilization of mental healthcare services, 2) Spirituality, Faith, and Religion, 3) Accessibility of mental healthcare services. 
 
 CONCLUSION: There is a paucity of evidence about the mental health of prenatal and postnatal Black women living outside Africa and the Caribbean in countries other than the US, the UK, and Canada. 

Sierra Leone: A Historical Cultural Capital of Pan-Africanism

This paper examines the concept of Sierra Leone serving historically as a cultural capital of Pan-Africanism. Culture is examined from the perspectives of race, language, formal educational attainment, and religion, especially Christianity. Racially and ethnically, the people of Sierra Leone today are the descendants of not just native Sierra Leoneans, but also natives of dozens of other Sub-Saharan African nations, and people of Black African descent from North America, the Caribbean and the United Kingdom. As a result, the Sierra Leone Krio/Creole language is a Pan-African Krio/Creole. Historically, Fourah Bay College in Sierra Leone has served as one of the most important academic/intellectual institutions in the Black world that have contributed to the brain thrust to Pan-Africanism. Finally, Sierra Leonean Christianity can be explained as a Pan-African Christianity.

One country, two crises: what Covid-19 reveals about health inequalities among BAME communities in the United Kingdom and the sustainability of its health system?

There has been mounting evidence of the disproportionate involvement of black, Asian and minority ethnic (BAME) communities by the Covid-19 pandemic. In the UK, this racial disparity was brought to the fore by the fact that the first 11 doctors to die in the UK from Covid-19 were of BAME background. The mortality rate from Covid-19 among people of black African descent in English hospitals has been shown to be 3.5 times higher when compared to rates among white British people. A Public Health England report revealed that Covid-19 was more likely to be diagnosed among black ethnic groups compared to white ethnic groups with the highest mortality occurring among BAME persons and persons living in the more deprived areas. People of BAME background account for 4.5% of the English population and make up 21% of the National Health Service (NHS) workforce. The UK poverty rate among BAME populations is twice as high as for white groups. Also, people of BAME backgrounds are more likely to be engaged in frontline roles. The disproportionate involvement of BAME communities by Covid-19 in the UK illuminates perennial inequalities within the society and reaffirms the strong association between ethnicity, race, socio-economic status and health outcomes. Potential reasons for the observed differences include the overrepresentation of BAME persons in frontline roles, unequal distribution of socio-economic resources, disproportionate risks to BAME staff within the NHS workspace and high ethnic predisposition to certain diseases which have been linked to poorer outcomes with Covid-19. The ethnoracialised differences in health outcomes from Covid-19 in the UK require urgent remedial measures. We provide intersectional approaches to tackle the complex racial disparities which though not entirely new in itself, have been often systematically ignored.

Whither Epistemic Decolonization

Epistemic decolonization, in its various conceptual formulations and presentations, could be taken to hold promise for either the completion of the anti-colonial struggle or the self-re-discovery of the formerly colonized and oppressed. In Africa this project has had a long history as both a counter to hegemonic histories of claimed Western epistemological superiority as well as theories of racism and racist practices against black people of African descent. What is not entirely clear are the precise achievements of decolonial thought and practice. I interrogate the relevance, use and continuation of decoloniality as a genre of thought and practice on the African continent against the background of the perennial problems of material underdevelopment and stifled political spaces that render the supposed beneficiaries of decolonization hopeless subjects who continue to be disempowered and oppressed in their own home. This interrogation is to be carried alongside another inquiry aimed at evaluating the achievements of African philosophy as a form of epistemic decolonization. If African philosophy is a form of decolonization, as it should be, it should be able to clearly demonstrate its achievements and how they have had an effect on broader goals of decolonizing and empowering inhabitants of the African continent.

Century of Black Mormons: A Preliminary Interpretation of the Data

People of black-African descent have been members of the Church of Jesus Christ of Latter-day Saints from its founding in 1830 to the present yet their names and stories have been erased from public perception on the outside and collective Latter-day Saint memory on the inside. Century of Black Mormons is a digital history project designed to recover what was lost, the identities of Black Latter-day Saints during the faith's first 100 years, from 1830 to 1930. This paper offers an initial interpretation of the data collected thus far. It begins to document what life was like in the pews for Black Mormons and finds that integrated worship services varied across time and space. It demonstrates that kinship networks were important to Black Mormon conversions, and that pioneering black converts presided over multi-generational families of Black Mormons whose legacies stretch into the 21st century.

Contextual determinants on the meaning of the N word.

Use of the word nigger is very often castigated as slurring the referent, but this ignores the context of use. For many people the word itself is a slur no matter what the context, and such people argue for its eradication from the English language. Eradicationists confuse the form of the word with its frequent use as a slur that discredits, slights, smears, stains, besmirches people of black African descent. In this paper I discuss several occurrences of the N word in Quentin Tarantino’s film ‘Pulp Fiction’. At least one is a slur. As with many slurs, in-group usage by people who might themselves have been slurred with the term by out-groupers, nigger is used among African Americans to express camaraderie. Three instances of this are examined. Another instance is where black gangster millionaire Marcellus Wallace, after handing white boxer Butch Coolidge money to go down in the fifth round, tells him ‘You’re my nigger’ to which Butch replies ‘Certainly appears so’. Lastly I consider the tricky situation where a white uses the term nigger to a black friend, not as a term of address and not as a slur either, I argue. I discuss the composition of context and the semantics and connotations of nigger. I examine the place and function of the uses of nigger within the context of the film, ‘Pulp Fiction’, to demonstrate that the affective quality of a linguistic expression should never be judged without taking account of its intended perlocutionary effect within the context in which it is uttered. We see that the basic semantic content invariably contributes to the functional (compositional) meaning, but that pragmatic input from connotations is essential in determining the truth value of the utterance in which nigger appears.

African Caribbeans have greater subclinical cerebrovascular disease than Europeans

Stroke is elevated in people of black African descent, but evidence for excess subclinical cerebrovascular disease is conflicting, and the role of risk factors in determining any ethnic differences observed unexplored. We compared prevalence of brain infarcts, and severe white matter hyperintensities (WMHs) on cerebral MRI, in a community-based sample of men and women aged 58-86 of African Caribbean (214) and European (605) descent, in London, UK. Resting, central and ambulatory blood pressure (BP) were measured; diabetes was assessed by blood testing and questionnaire. Mean age was 70. Multiple (≥4) brain infarcts and severe WMH occurred more frequently in African Caribbeans (18/43%), than Europeans (7/33%, P=0.05/0.008). Separately, clinic and night-time ambulatory BP were significantly associated with severe WMH in both ethnic groups; when both were entered into the model, the association for clinic SBP was attenuated and lost statistical significance [1.00 (0.98-1.02) P=0.9 in Europeans, 1.00 (0.97-1.04) P=0.9 in African Caribbeans], whereas the association for night-time SBP was retained [1.04 (1.02-1.07) P<0.001 in Europeans, 1.08 (1.03-1.12), P=0.001 in African Caribbeans]. The greater age-adjusted and sex-adjusted risk of severe WMH in African Caribbeans compared with Europeans [2.08 (1.15-3.76) P=0.02], was attenuated to 1.45 [(0.74-2.83) P=0.3] on adjustment for clinic and night-time systolic pressure, antihypertensive medication use and glycated haemoglobin. African Caribbeans have a greater burden of subclinical cerebrovascular disease than Europeans. This excess is related to elevated clinic and ambulatory BP, and to hyperglycaemia.

Commentary: Shaper and Jones, 'Serum-cholesterol, diet and coronary heart-disease in Africans and Asians in Uganda': 50-year-old findings only need interpretational fine tuning to come up to speed!

Commentary: Shaper and Jones, 'Serum-cholesterol, diet and coronary heart-disease in Africans and Asians in Uganda': 50-year-old findings only need interpretational fine tuning to come up to speed!

Abstract 2568: Cerebral Infarcts in Blacks vs Whites: the Southall and Brent REvisited (SABRE) Multi-ethnic Cohort Study

Introduction: Stroke mortality is doubled in people of Black African descent compared with Whites, but factors responsible for this excess are unclear. We wished to compare infarct like lesions (ILL) on MRI by ethnicity and the role of risk factors. Methods: SABRE is a UK community based multi-ethnic cohort of men and women aged 40-69 years at baseline (1988-1990), and 58-86 years at follow up (2008-2011). At follow up, a questionnaire was completed and investigations performed including resting and ambulatory BP, anthropometry, and bloods for glucose and lipids. Cerebral MRI scans were scored for infarcts independently by two readers according to the Cardiovascular Health Study protocol. Results: Of 2346 Whites, 684 attended follow up, and 590 completed cerebral MRI. Of 801 Blacks (first generation migrants of Black African descent to the UK), 232 attended clinic and 207 completed MRI. Mortality loss was greater in Whites (605, 25%) than Blacks (121, 15%)(p&lt;0.0001), although stroke was more likely the underlying cause in Blacks (23, 19%), than Whites (43, 7%)(p&lt;0.0001) . Baseline systolic/diastolic BP was similarly higher in Blacks than Whites in attendees (8/5 mmHg), non-responders (7/6 mm Hg), and those who died (8/5 mmHg). At follow up stroke risk factors were adverse in Blacks, apart from smoking ( table ). Prevalence of ILL was similar by ethnicity, not differing when those &lt;65 years were analysed separately, or when those with stroke/TIA history were excluded. Associations between ILL and risk factors did not differ by ethnicity. But prescribed treatment in those with elevated clinic BP (≥140 mmHg systolic, or ≥90 mmHg diastolic) was 83% in Blacks, 63% in Whites (p&lt;0.0001). Further, in those with an ILL, 95% of Blacks, and 69% (p&lt;0.0001) of Whites were on treatment. Conclusion: Equivalence of ILL rates in Blacks and Whites was unanticipated, given the greater stroke mortality in Blacks. Mitigating against selective mortality as the explanation of our findings is the similar ethnic differential in baseline BP in survivors and non-survivors, the lower overall mortality in Blacks, and overall small numbers of stroke deaths. A more likely explanation is that better targeted more aggressive treatment is now occurring in Blacks than Whites, reducing their potential burden of ILL.

Hereditary haemorrhagic telangiectasia in a black adult male: case report

Hereditary haemorrhagic telangiectasia, (HHT) or Rendu-Osler-Weber disease is a genetic autosomal dominant disorder that is characterised by telangiectasias, (small vascular malformations), in mucocutaneous tissues and arterial venous malformations, (AVMs), in various internal organs. Although HHT is relatively common in whites, the disorder has been reported to be rare in people of black African descent. Majority of HHT patients present with recurrent epistaxis, which in a significant proportion of patients is severe, warranting repeated blood transfusions and iron supplementation. Telangiectasias are most frequent on the tongue, hands, nose, lips and the gastrointestinal tract (GIT). AVMs occur in internal organs, particularly the lungs, brain, and the liver. Early and correct diagnosis of HHT is crucial as patients derive benefit from certain specific treatment modalities. Besides, AVMs which occur in various organs pose serious complications that may lead to death and therefore require early detection. We report a 55 year old black African male with HHT who presented with severe recurrent epistaxis and haematochezia leading to severe anaemia requiring repeated blood transfusions. His son, daughter and a maternal uncle experience milder recurrent epistaxis. The management of this patient and a brief review of the clinical features and management of HHT is presented. Our aim is to raise awareness of the occurrence of HHT in Kenya, in order to enhance early diagnosis and appropriate management.

Life Expectancy, Death Rates, Geography, and Black People

Just as Black Americans have the lowest life expectancy and highest death rates among the many racial and ethnic groups in the United States, so also are Black Africans in Africa the racial group with the lowest life expectancy and highest death rates among all the nations of the world. This article presents a statistical world overview of the life expectancy and death rates of people of Black African descent.

Management of pregnancy complicated by anti-hrB/anti-HrB

Abstract Anti-hrB and anti-HrB are rare alloantibodies found predominantly in people of Black African descent. It has been assumed that strongly reacting examples of anti-hrB may cause hemolytic transfusion reactions, but precise information is limited. Anti-HrB is a clinically significant antibody and may cause hemolytic transfusion reactions and HDN. Selection of blood for transfusion support for patients with these alloantibodies, and especially with anti-HrB, imposes a special challenge in the United Kingdom. We report two antenatal patients (both patients were of the partial D phenotype DIII), one with anti-hrB, anti-Ce, and anti-D; the other, with anti-hrB and anti-D, who later formed anti-HrB. Transfusion support and the outcome of the pregnancies are discussed. A literature search confirms that, apart from some publications in abstract form, there is not much detailed clinical information available for either anti-hrB or anti-HrB. Further information and publications are warranted to gain more knowledge of these rare antibodies. Immunohematology 2007;23:143–5.

P34 Management of Pregnancy Complicated by Anti‐hrB and/or Anti‐HrB.

Anti‐hrB and anti‐HrB are rare alloantibodies, so far found exclusively in people of Black African descent. There is no data available regarding haemolytic transfusion reactions in association with anti‐hrB, and precise information is limited. Anti‐HrB may cause transfusion reactions, but no data is available. Selection of blood for transfusion support for patients with these alloantibodies imposes a special challenge in the UK, as, in the case of anti‐hrB (if accompanied with anti‐D) it is difficult to locate suitable antigen negative blood, whilst HrB‐ blood is almost unknown amongst the UK donor population. Two antenatal cases are reported, one with anti‐hrB, and one with anti‐HrB. Weak anti‐D was also identified in the serum in both cases. For the former case, r“r” ( dcE/dcE) units were provided to cover the delivery. The baby was delivered by vaginal route. Cord sample DAT was negative, with no evidence of haemolytic disease of the newborn (HDN). The patient did not require transfusion. The patient was known to have anti‐hrB in her previous pregnancy, and there was no evidence of HDN in that pregnancy. Anti‐HrB may cause haemolytic transfusion reaction. In the latter case, there are two options: either to import extremely rare D‐, HrB blood from South Africa or to provide rare Rhnull units. The patient received two Rhnull units to cover for Caesarean Section and transfusion was uneventful. Although the cord sample DAT was positive (Anti‐IgG 2+, ‐C3d1+) the infant's delivery Hb level was 15.2 g dL‐1 and bilirubin was within the normal range. No therapy was required. A literature search confirms that there is not much data available regarding the clinical significance of anti‐hrB and anti‐HrB. The few previous reports indicate that both anti‐hrB and anti‐HrB appear not to cause HDN. Our cases supported that HDN is not associated with both anti‐hrB and anti‐HrB. The cases reported here illustrate the complexity in providing transfusion support for these patients. Further case reports are warranted to establish the clinical relevance of these rare antibodies.

Roles of large and small arteries in vascular disease

Roles of large and small arteries in vascular disease

Ethnic differences in skin microvascular function and their relation to cardiac target-organ damage

People of Black African descent have increased risks of vascular target-organ damage not explained by greater blood pressures. To study ethnic differences in the microvasculature. Flow (flux) in microcirculatory skin vessels was assessed using laser Doppler fluximetry in 181 Afro-Caribbean and European men and women aged 40-65 years from the general population in London, UK. Flux in response to maximal heating (maximal hyperaemic response) was measured and minimum vascular resistance calculated. Peak flux and time to peak after an ischaemic stimulus were also measured. Target-organ damage was assessed using echocardiographic interventricular septal thickness (IVST). In men, maximum hyperaemic response was attenuated in Afro-Caribbeans [109 arbitrary units (au), 25th and 75th percentiles 101, 117] compared with Europeans [165 (155, 179) au; P = 0.008]. Minimum vascular resistance was greater in Afro-Caribbeans, significantly so in men [(1.22 (1.18, 1.28) au/mmHg compared with 0.80 (0.77, 0.83) au/mmHg; P = 0.006]. Peak ischaemic response was attenuated in Afro-Caribbean men and women compared with Europeans (35.6 au compared with 49.5 au; P < 0.001) and time to peak was prolonged (14.1 s compared with 12.5 s; P = 0.07). These ethnic differences could not be accounted for by standard cardiovascular risk factors. IVST was greater in Afro-Caribbeans than in Europeans. Minimum vascular resistance and peak response accounted for a small proportion of this ethnic difference, in addition to conventional factors. Afro-Caribbeans have poorer microvascular structure and function, unexplained by conventional risk factors, which may contribute to greater rates of vascular target-organ damage.

Ethnic differences in vascular stiffness and relations to hypertensive target organ damage.

People of Black African descent have greater risks of hypertensive target organ damage than would be anticipated for given levels of blood pressure. Arterial stiffness may further account for ethnic differences in risk. Cross-sectional study. Population based, London, UK. One hundred and three Europeans and 99 African Caribbeans aged 40-64 years. We measured resting and ambulatory blood pressure, and pulse wave velocity (PWV) of elastic and muscular arteries. Echocardiography measured interventricular septal thickness (IVST). PWV, IVST. Carotid-femoral PWV was 12.7 m/s [95% confidence interval (CI) 12.3, 13.1] in African Caribbeans and 11.2 m/s (10.9, 11.6) in Europeans (P < 0.0001). This difference persisted on adjustment for resting and ambulatory blood pressure, 12.4 versus 11.5 m/s (P = 0.003). The greater IVST in African Caribbeans (9.6 mm) compared to Europeans (9.1 mm, P = 0.0005), could only in part be accounted for by differences in carotid*femoral PWV. Stiffness in the muscular carotid-radial segment did not differ by ethnicity, but was positively associated with systolic pressure in Europeans (beta regression coefficient 0.033, P = 0.04), and negatively associated in African Caribbeans (-0.036, P = 0.04, and P = 0.02 for interaction). Aortic stiffness is increased in African Caribbeans compared to Europeans, even when higher blood pressures are accounted for. It is most closely related to IVST, but contributes little to explaining ethnic differences. Stiffness of the upper limb muscular arteries did not differ by ethnicity, but remained favourable in the presence of hypertension in African Caribbeans, while being increased in Europeans. We suggest that this is due to ethnic differences in vascular remodelling.

Ethnic differences in microvasculature: a possible explanation for the greater vulnerability of people of black African descent to hypertensive target organ damage

Ethnic differences in microvasculature: a possible explanation for the greater vulnerability of people of black African descent to hypertensive target organ damage

Ethnicity and risk of diabetes-related lower extremity amputation: a population-based, case-control study of African Caribbeans and Europeans in the United kingdom.

In the United States, people of black African descent with diabetes have 2 to 3 times the amputation risk of whites. This may be due to differences in care or pathophysiological characteristics. We therefore determined diabetes-related amputation rates in African Caribbeans vs Europeans in the United Kingdom, where care delivery is more equitable. We conducted an incidence and case-control study, based in London, England. All diabetes-related amputations performed between 1992 and 1997 were identified. Controls, those with diabetes but no amputation, were sampled from family practitioners. Risk factor data were abstracted from medical records. Incident diabetes-related amputation occurred in 67 Europeans and 19 African Caribbeans. Amputation rates, age standardized to the diabetic population, were 147 per 100 000 and 219 per 100 000 in African Caribbeans and Europeans, respectively (relative risk, 0.67; 95% confidence interval [CI], 0.32-1.40; P =.2). Case-control analyses were performed on 178 cases and 350 controls. The ethnic difference in amputation risk differed significantly by sex (P =.009 for interaction). The unadjusted odds ratio comparing African Caribbeans with Europeans in men was 0.31 (95% CI, 0.17-0.57; P<.001), and in women was 0.97 (95% CI, 0.49-1.85; P =.9). Adjustment for smoking attenuated the odds ratio in men to 0.45 (95% CI, 0.23-0.89, P =.02); adding neuropathy, peripheral vascular disease, and age attenuated the odds ratio further to 0.97 (95% CI, 0.34-2.73; P =.9). In contrast to the United States, we find no ethnic difference in diabetes-related amputation in women in the United Kingdom, but in men, amputation risk in African Caribbeans is one third that of Europeans. This was wholly accounted for by low smoking, neuropathy, and peripheral vascular disease rates.

The color line: race matters in the elimination of health disparities.

The “color line” is not fixed but ripples through time, finding expression at distinct stages of our development as a nation. As the meaning of race has changed over time, its burdens and privileges have shifted among population groups. At one time in our history, for instance, the Irish and Italians were considered “non-White,” along with other immigrants who were not descendants of the early Anglo-Saxon Protestant settlers. In this issue of the Journal, Gerald Oppenheimer traces the color line through the course of American history.1 He demonstrates how the original language of White racial differences began with the anxious response of early Americans to waves of immigration, beginning in the 1840s when the Irish (or Celts) entered US ports, followed by nationals from Central, Southern, and Eastern Europe. Over time, the descendants of these “White ethnic groups” became the monolithic Caucasian race, the majority population, superior in all respects to the Black people of African descent.1

Hypertensive retinopathy in Afro-Caribbeans and Europeans. Prevalence and risk factor relationships.

The prevalence of hypertension is particularly high in people of black African descent throughout the world, and the consequences of hypertension, such as hypertensive heart and renal disease and stroke, are also more common. But there is little consensus on whether hypertensive retinopathy follows a similar pattern. We determined the prevalence of hypertensive retinopathy and its relationships with resting and ambulatory blood pressure in a population study of Afro-Caribbeans and Europeans aged 40 to 64 years in London, UK. Retinal photographs of 651 participants were graded for hypertensive retinopathy. Age- and sex-standardized prevalence of retinopathy was 11% (95% confidence interval, 8% to 14%) in Europeans and 21% (95% confidence interval, 16% to 26%) in Afro-Caribbeans (P < .001), respectively. This ethnic difference in prevalence was greatest in normotensive women (8% in Europeans versus 20% in Afro-Caribbeans, P < .001). Resting systolic pressure was 8 mm Hg higher in normotensive Afro-Carribean compared with European women, but this could not fully account for the ethnic difference in the prevalence of retinopathy. Examination of the different relationships of age and resting and ambulatory blood pressures with hypertensive retinopathy showed that these relationships were strongest in European women and weakest in Afro-Caribbean women. We conclude that hypertensive retinopathy is more common in Afro-Caribbeans, particularly women, and that ethnic differences in resting blood pressure cannot fully account for this. The relatively weak relationship between resting and ambulatory blood pressures and retinopathy in Afro-Caribbeans suggests that factors other than blood pressure determine the high rates of hypertensive retinopathy in this group.