The following are some of the issues to be considered regarding health and black children and families:

• Research has shown the link between poverty and ill-health. Although this is as true for the white community as it is for the black community there is evidence to suggest that black and minority ethnic people experience poorer health. There are, however, differences amongst the different ethnic groups. A study by Nazroo (1997) found that on the whole Pakistanis and Bangladeshis reported the poorest health during assessments of general health, with Caribbeans having the next worst state of health;
• There is a very strong correlation between the physical health of children of all ages and adverse social and economic conditions. This is particularly apparent in the infant mortality rate, which is directly affected by factors such as economic status, type of accommodation, access to basic amenities and access to preventative and supportive health care. A number of studies have shown a higher infant mortality rate amongst poorer black communities, particularly within families from Bangladesh, Pakistan and the Caribbean (Smaje, 1999);
• There are some diseases which are more common amongst black and minority ethnic people and some which are particular to black communities only. In relation to the latter sickle cell disorder is one such illness, affecting mainly children from the African Caribbean community but may occur in people from India and Pakistan. For those affected by it, the most difficult aspect of the disorder is the pain experienced during the crisis. Symptoms can include infections such as meningitis as well as strokes (NHS Executive, 1998). Professionals working with black children affected by sickle cell can get more information about the disorder from the Sickle Cell Society;
• Particular groups of children such as refugee children can suffer post-traumatic stress syndrome. This can be directly attributed to the past experiences of many of the children. They may have witnessed death, violence and war prior to their arrival in the U.K.

Sickle Cell

The haemoglobin (protein) in the red blood cell is affected and under certain conditions cause the normally round cell to change to the sickle shape. When the change takes place the cell becomes sticky, leading to the cells clumping together and blocking the blood vessels, resulting in excruciating pain. This is called 'a crisis'.

It is estimated that there are approximately 5,000 Afro-Caribbean Sickle Cell sufferers in the U.K but no figures indicating how many carriers there are of the Sickle Cell trait. However a rough estimate indicates that 1 in 10 Afro-Caribbean people are Sickle Cell trait carriers, with 1 in 4 West Africans being carriers.

Sickle Cell Anaemia is not an infection, it is inherited as a result of a child receiving sickle haemoglobin from both parents. These parents are usually healthy, silent carriers of the Sickle Cell trait or suffer from Sickle Cell Anaemia.

The symptoms very rarely start until the age of six months and these could include painful swelling of the hands and feet, infection and anaemia. The classic swollen hands and feet in a sickling child is sometimes mistaken for child abuse. This misdiagnosis too often causes untold unnecessary stress, anger and embarrassment to the parents or carers The illness may also cause frequent episodes of pain in the joints, abdomen and any other parts of the body, as well as problems in the spleen, jaundice, strokes, leg ulcers, blood in the urine, eye problems. Those affected with Sickle Cell Anaemia are more susceptible to infection and in some cases there is the increased risk of meningitis. In addition the child's growth may be delayed giving rise to teasing in school, leading to feelings of inadequacy, difficulties and embarrassment. Symptoms and their effects can vary from one individual to another. There is no cure for Sickle Cell Anaemia but there are various forms of treatment that can either prevent or relieve the symptoms.

Thalassaemia

The blood in this case cannot make enough haemoglobin, and because of this the bone marrow cannot produce enough red blood cells. The red blood cells that are produced are always nearly empty. It is estimated that there are about 200,000 people who carry Thalassaemia in Britain. Carrying Thalassaemia is sometimes called "Thalassaemia Minor" or "Beta Thalassaemia Trait". People who carry Thalassaemia are perfectly healthy themselves.

Beta Thalassaemia Major is a very serious blood disorder. Every year at least 100,000 children are born in the world with Beta Thalassaemia Major. In Britain there are about 600 young people with the disorder. Children with Beta Thalassaemia Major are normal at birth but become anaemic between the age of three months and eighteen months. They become pale, do not sleep well, do not want to eat, and may vomit their feeds. If children are not treated, they usually die between the ages of one and eight years old.

The only treatment for Beta Thalassaemia Major is regular blood transfusions, usually every four weeks for the rest of their lives, along with other treatment as well. Most children who are treated grow normally and live quite happily into their teens and beyond.

Mongolian Blue Spots

These are dis-colorations seen on children of Afro-Caribbean, Asian and Mediterranean descent. This is often mistaken for child abuse as the discoloration's look like bruising. It is commonly found over the scrotum or lower lumber spine, although they may be situated elsewhere. They usually fade as the child grows older.

Bruising

A bruise on dark skin may not be as easy to recognise by someone who is not used to looking after a Black child. It is therefore important to learn how to identify bruising on darker skin. If in doubt, seek advice from a doctor or health visitor on what you should be looking for.

Female Genital Mutilation

Female Genital Mutilation is practised by many ethnic groups in more than twenty African countries and affects more than 80 million women and girls world-wide. Outside Africa FGM is also practised in Omen, South Yemen and The United Arab Emirates. The form of FGM known as Sunna is practised by Moslem populations of Indonesia, Malaysia and by Bohra Moslems of India, Pakistan and East Africa.

In Britain, The Prohibition of Female Circumcision Act 1985 makes female circumcision, excision and Infibulation ("Female Genital Mutilation") an offence except on specific physical and mental health grounds.

There are three main types of types of mutilation carried out on a woman or child's vulva. These have been identified as:

• Circumcision itself is the cutting off of the prepuce or the hood of the clitoris, with the body of the clitoris remaining in tact. This removal is referred to as 'Sunna' in Moslem countries.
• Excision refers to the cutting of the clitoris with or without the removal of the labia minora.
• Infibulation or pharanoiac circumcision is the cutting of the clitoris, labia minora and much of the labia majora. This is followed by stitching together the two remaining sides of the vulva to close up the vagina and leaving a small opening.

Customs and Tradition

Part of a cultural tradition which is often based on superstition rather than rational argument, e.g. fertility and cleanliness. Up until the early 1930 in England and other European countries removal of the clitoris was seen as a way of curing women diagnosed as 'oversexed or neurotic'.

Religion may be cited as another reason for FGM although no major faiths makes any explicit reference to female circumcision. FGM may also emphasise the dominant role of the male within these cultures.

The age at which FGM is carried out differs. It varies from a few days old to just before marriage, or while a woman is pregnant with her first child. The most typical age for the practise seems to be between seven and twelve. Medical opinion and research shows that FGM is not good for the physical and mental health of girls and women and can have grave and permanent damage to their health. Numerous complications can arise from the operation including various gynaecological, obstetric, psychological and psychosexual disablement.

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