Ethnicity and attitudes to deceased kidney donation: a survey in Barbados and comparison with Black Caribbean people in the United Kingdom.

BACKGROUND: Black minority ethnic groups in the UK have relatively low rates of deceased donation and report a higher prevalence of beliefs that are regarded as barriers to donation. However there is little data from migrants' countries of origin. This paper examines community attitudes to deceased kidney donation in Barbados and compares the findings with a survey conducted in a disadvantaged multi-ethnic area of south London. METHODS: Questionnaires were administered at four public health centres in Barbados and at three private general practices. Adjusted odds ratios were calculated to compare attitudinal responses with a prior survey of 328 Caribbean and 808 White respondents in south London. RESULTS: Questionnaires were completed by 327 respondents in Barbados (93% response); 42% men and 58% women, with a mean age of 40.4 years (SD 12.6). The main religious groups were Anglican (29%) and Pentecostal (24%). Educational levels ranged from 18% not completing 5th form to 12% with university education. Attitudes to the notion of organ donation were favourable, with 73% willing to donate their kidneys after their death and only 5% definitely against this. Most preferred an opt-in system of donation. Responses to nine attitudinal questions identified 18% as having no concerns and 9% as having 4 or more concerns. The highest level of concern (43%) was for lack of confidence that medical teams would try as hard to save the life of a person who has agreed to donate organs. There was no significant association between age, gender, education or religion and attitudinal barriers, but greater knowledge of donation had some positive effect on attitudes. Comparison of attitudes to donation in south London and Barbados (adjusting for gender, age, level of education, employment status) indicated that a significantly higher proportion of the south London Caribbean respondents identified attitudinal barriers to donation. CONCLUSIONS: Community attitudes in Barbados are favourable to deceased donation based on a system of informed consent. Comparison with south London data supports the hypothesis that the relatively high prevalence of negative attitudes to deceased donation among disadvantaged ethnic minorities in high income countries may reflect feelings of marginalization and lack of belonging.

Ethnicity and registration as a kidney donor: the significance of identity and belonging.

Studies of attitudes towards cadaveric organ donation have failed to adequately explain the disproportionately low rates of cadaveric organ donation among ethnic minorities. This may reflect an unhelpfully static and narrow definition of 'culture' entailing a collection of predefined cognitive 'beliefs' and 'attitudes.' This paper takes a more integrative approach and considers how ethnicity shapes perceptions of identity and belonging that underpin organ donation discourse among a section of Black British Caribbean people, one of largest migrant groups in the UK. The study is based on 14 in-depth interviews with men and women of Caribbean descent living in south London. Respondents' accounts identified their Caribbean heritage and racial identity as producing a divided sense of loyalty and belonging accompanied by perceptions of discrimination and exclusion from the mainstream society that may have contributed to their lack of trust in doctors and the medical system in relation to organ donation. Furthermore, despite being supportive of kidney donation, death appeared to take on special significance in reaffirming their ethnic identity. This was reflected in their view of the Caribbean as their ideal place of burial and desire that their body should return whole. The study underlines the need for a fresh approach to the understanding of organ donation based on greater knowledge of the construction and significance of ethnic identity and belonging.

A pharmacological and phytochemical investigation of the herb cerasee - a popular Caribbean folk remedy for hypertension

BACKGROUND: Cerasee (vines and leaves of the Momordica charantia Linn.) is used to prepare a tea employed in Caribbean folk medicine to treat hypertension. In one survey, it was found to be the most popular anti-hypertensive herb used on the island of St. Kitts, West Indies. There is also evidence that it is used by African Caribbean hypertensive patients living in the United Kingdom, and that reliance on this and other herbal remedies may interfere with adherence to prescribed anti-hypertensive therapy. AIMS: The broad aims of the project are (1.) examine the effects of cerasee tea on blood pressure and heart rate using a rat model in order to assess its potential hypotensive effects. (2.) determine the pharmacological mechanism by which any such effects are mediated. (3.) to isolate the phytochemicals present in cerasee tea which cause these effects. PRELIMINARY RESULTS: A sample of cerasee tea obtained in the United Kingdom was extracted with hot water. The "tea" was filtered, and serially diluted solutions administered to anaesthetised rats by intravenous infusion. Blood pressure and heart rate were monitored. Cerasee tea produced a transient fall in blood pressure. CONCLUSIONS: These pilot data support a claim for the pharmacological activity of cerasee tea. The data conform with a case report of hypotension in two children following consumption of the tea and with the traditional use, for high blood pressure, of M. charantia in the Caribbean, and the related species M. foetida in Southern Africa. FUTURE WORK: Funding is being sought for a larger project to confirm the preliminary data obtained above, and fulfil aims (2) and (3) listed above. Further studies are required to determine whether cerasee or its component phytochemicals have any therapeutic potential or toxic effects following acute or chronic administration. This will indicate whether cerasee consumption in conjunction with prescribed anti-hypertensive therapy should be discouraged. The work will complement a proposed parallel study examining the botanical and chemical variation of "cerasee" samples available in London and their parents of the use by the African Caribbean community. (AU)

Differences in potentially preventable risk factors for stroke amongst ethnic groups

AIM: To assess the prevalence of risk factors for stroke potentially amenable to health service intervention (hypertension, diabetes, smoking, increased alcohol consumption, physical inactivity, atrial fibrillation, cardiac disease, previous TIA) in black Caribbean, black African and white population of an inner-city health authority. METHODS: A cross-sectional survey was conducted, involving 16 GP Practices serving an area with a high proportion of black residents as identified by the 1991 Census. The FHSA list for these practices was used as the sampling frame. A random sample of 8000 residents (45-74 years old) was selected for a postal survey, which collected data on age, sex, occupation and ethnic group. Responders were stratified by ethnic group. A random sample of 450 subjects in white and black Caribbean group was selected, and together with 193 black African responders invited for screening. RESULTS: There were 725 responders: 303 whites (41.8 percent), 316 black Caribbean (43.6 percent) and 106 black Africans (14.6 percent). Black Caribbeans and Africans were less likely to have a normal blood pressure than whites (OR=0.42, p=0.0001, and OR=0.39, p=0.001 respectively.) Black Caribbeans and were also less likely to have a normal ECG (OR=0.55, p=0.0011, and OR=0.41, p=0.007 respectively.) Left ventricular strain was more common in black Caribbeans (OR=15.81, p=0.008) and Africans (OR=19.97, p=0.007), ischaemic changes were more common in black Caribbeans (OR=2.8, p=0.0001) and myocardial infarction in Africans were found in the prevalence of reported risk factors, such as diabetes (5 percent, 15.2 percent, 10.4 percent respectively, p>0.00001), smoking (31.4 percent, 21 percent, 11.3 percent, p<0.00001, alcohol drinking (80.9 percent, 77.8 percent, 61.3 percent, p<0.00001) and physical activity (75.3 percent, 83.2 percent, 79.3 percent, p=0.048). No difference was found in prevalence of atrial fibrillation and previous TIA. CONCLUSION: Black Caribbeans and black Africans have significantly higher prevalence rates of the important risk factors for stroke. This may partially explain higher mortality rates for stroke in these ethnic groups. Strategies for stroke prevention will be considered in the context of the on-going study on cultural attitudes to risk factor reduction. (AU)

Controlling Hypertension among African-Caribbean patients

The older age groups of African-Caribbean people are at particular risk of hypertension and stroke, and comprise the original migrant group who came to the UK in the 1955's and 1960's as young adults. This raises questions of the significance of traditional cultural beliefs and practices for health behaviours and medication use. AIMS: to examine 1) the cultural beliefs and medication practices of African-Caribbean and "white" hypertensive patients treated by general practices in Lambeth and 2) GPs awareness of the beliefs of African-Caribbean patients. METHODS: Case note review and semi-structured interviews with 60 hypertensive patients treated by general practices in Lambeth, and with 22 GPs from the study practices. RESULTS: Most African-Caribbean patients were aware of the risk of high blood pressure, although often adopting a fatalistic attitude. They had high levels of uncontrolled blood pressure and reported low levels of adherence with the prescribed medication (16/30 regularly "left off" the medication or took a reduced dose). Major reasons were concerns about possible present or future side-effects, fears of becoming "addicted" or "dependent" on the drugs, worries about mixing tablets with alcohol, and questioning their needs for the drugs. Familiarity with traditional herbal remedies increased worries about power of prescribed drugs and formed an alternative resource for managing illness. "Cerasee"(Momordica charantia) obtained from the local market was often taken for blood pressure problems and perceived as "natural" and less harmful than prescribed drugs. GPs were not aware of African-Caribbean patients' beliefs and medication practices, with implications both for prescribing and patients's interpretation of the information provided for their own self management. Feedback of the study findings was helpful to GPs in reducing cultural barriers to communication and managing this patient group. CONCLUSIONS: Low levels of compliance with treatment is likely to contribute to uncontrolled blood pressures among African-Caribbean population, while health promotion strategies require to take account of cultural beliefs and practices prevalent among the older generation of African-Caribbean people. Further work is planned (with Kings) to examine the use of herbal remedies among larger population samples, the phytochemical properties of Momordica charantia obtained from different outlets and its possible hypotensive effects. (AU)

Ethnicity and attitudes to deceased kidney donation: a survey in Barbados and comparison with Black Caribbean people in the United Kingdom

Background: Black minority ethnic groups in the UK have relatively low rates of deceased donation and report a higher prevalence of beliefs that are regarded as barriers to donation. However there is little data from migrants' countries of origin. This paper examines community attitudes to deceased kidney donation in Barbados and compares the findings with a survey conducted in a disadvantaged multi-ethnic area of south London. Methods: Questionnaires were administered at four public health centres in Barbados and at three private general practices. Adjusted odds ratios were calculated to compare attitudinal responses with a prior survey of 328 Caribbean and 808 White respondents in south London. Results: Questionnaires were completed by 327 respondents in Barbados (93% response); 42% men and 58% women, with a mean age of 40.4 years (SD 12.6). The main religious groups were Anglican (29%) and Pentecostal (24%). Educational levels ranged from 18% not completing 5th form to 12% with university education. Attitudes to the notion of organ donation were favourable, with 73% willing to donate their kidneys after their death and only 5% definitely against this. Most preferred an opt-in system of donation. Responses to nine attitudinal questions identified 18% as having no concerns and 9% as having 4 or more concerns. The highest level of concern (43%) was for lack of confidence that medical teams would try as hard to save the life of a person who has agreed to donate organs. There was no significant association between age, gender, education or religion and attitudinal barriers, but greater knowledge of donation had some positive effect on attitudes. Comparison of attitudes to donation in south London and Barbados (adjusting for gender, age, level of education, employment status) indicated that a significantly higher proportion of the south London Caribbean respondents identified attitudinal barriers to donation. Community attitudes in Barbados are favourable to deceased donation based on a system of informed consent. Comparison with south London data supports the hypothesis that the relatively high prevalence of negative attitudes to deceased donation among disadvantaged ethnic minorities in high income countries may reflect feelings of marginalisation and lack of belonging.