health needs o f black and ethnic minority groups. The report drew attention to considerable variation in patterns of health within and between ethnic groups.
Concern for the health status o f infants of Asian families has focused on the decrease in growth velocity observed during the first year and on early feeding practices (Hunt, 1976; Jivani, 1978; Sahota,1990). The onset o f feeding problems reported in the Asian community has often been attributed to the later introduction o f solid food to the infant's diet, a practice that is reported as normal in Pakistan, India and
Bangladesh. Evidence o f differences in the height o f Asian children when compared to the general population, came from the National Study o f Health and Growth (Rona and Chinn, 1986) which showed that at 5 years of age, school children fi'om Asian groups o f the Indian subcontinent were shorter than other children in the population.
It has been suggested that the observed differences in anthropometry in the Bangladeshi population may be due to relative environmental deprivation in the parent's country. Williams, Bhopal and Hunt (1993) concluded that differences in the physical development o f members of the Punjab population in Glasgow, compared with the white population, were the result of childhood environmental deprivation in the Punjab. Evidence from the US supports this hypothesis and suggests that, within one or two generations, the health o f ethnic minority populations becomes similar to that o f the general population in the country to which they migrated (Gordon, 1982).
Another explanation for the observed differences could be differential access to health care. Are those families that have recently migrated less likely to consult their local health services than the general population? Most of the studies, that have attempted to explore variations in health service use, have found that on the whole, ethnic minorities groups make greater use of the health services than the white population and are more likely to be registered with their GP, the only exception being Caribbean men (Rudat, 1994). A number o f studies have identified that specific ethnic groups (Pakistanis and Bangladeshis) also have higher consultation rates with their GP than the general population (Balarajan, Yuen and Botting, 1989, McCormick and Rosenbaum, 1990). However, service use may just reflect the greater health needs of these populations.
4.4.3 Variations in Asian Infant Feeding Practices in the UK
The Department of Health survey of Infant Feeding (OPCS,1992) did not give separate analyses of infant feeding practice in specific black and minority ethnic groups as the samples never included sufficient numbers to allow such analyses. Since this project was undertaken, the Department (ONS, 1997) has commissioned a nationally representative survey 'Infant Feeding in Asian Families' and its findings are discussed in the concluding chapter of this dissertation. The data available prior to the national survey came primarily from smaller local studies and were the motivation for this study
The present picture of breastfeeding in Asian groups is incomplete. Sillett and McFayden(1981) reported the majority o f Asian mothers in Brent and Harrow to be breast feeding or breast-and-bottle feeding, yet bottle feeding was highly prevalent among mothers originating from rural India (mainly Punjab) resident in
Wolverhampton (Evans et al, 1976) and those from Bangladesh living in Tower Hamlets (Jones, 1987). Some studies have compared the proportions of mothers within the same locality who never breastfed. Warrington and Storey's (1988) study
in Rochdale found fewer Asian than White UK mothers never breast fed (39% and 43% respectively). Treuherz, Cullinan and Saunders (1982) study in East London found 54% o f Asians and 65% of the White UK mothers never breast fed.
A number o f studies have explored if different patterns of feeding were associated with duration o f residence in the UK. Goel et al (1981) studied the infant feeding practices o f 172 families from various communities in Glasgow, including 206 Asian, 99 African, 99 Chinese and 102 Scottish infants. They found that after mothers arrived in Britain, the proportions wanting to breast feed declined. Those children that had been bom outside Britain were more likely to have been breast fed than those bom within: 83.7% of Asian, 79.2% of African and 80.9% of Chinese children bom abroad had been breast fed, while o f those bom in Britain only 20.9% of the Asian, 48% o f the African and 2% of the Chinese had been breast fed.
Although all three groups showed reduced proportions for breast feeding their UK bom children, the African mothers were those most likely to maintain the practice of breast feeding. There were also differences in the timing o f the introduction o f solids according to matemal place of birth: Asian infants bom in the UK had usually received solids by 6 months compared to those Asian infants bom abroad who were first given solids at 1 year of age.
The observation o f changes in infant feeding practices associated with migration and acculturation have been reported in several other studies of the Asian conununity. Harris et al (1983), studied a group of mothers in Tower Hamlets, a deprived inner city area with a large immigrant community. The study was undertaken because of the concern o f local paediatricians and dieticians about the high number o f
Bangladeshi infants and children presenting to hospital outpatient departments and community welfare clinic with nutritional problems. The most conunon were rickets, iron deficiency anaemia, gastro-enteritis and difficulties with weaning. The authors found that the introduction o f solid food to the infant occurred at an older age if mothers had only spent a short time in this country (a mean of 2.7 years o f residence
in the UK for introducing solids at or after the infant was 12 months of age),
compared to those mothers who had lived in the UK for longer (a mean of 4.4 years of UK residence for those introducing solids to their infants at 3 to 4 months). The tendency for recently immigrated Asians to wean later has also been observed by Jivani (1978) and Evans et al (1976).
Jones and Belsey (1977) found breast-feeding to be common among Asian families in Lambeth, South London where 77% of the Asians, compared to 58% British and 86% Africans attempted breast feeding. However, they reported that the numbers continuing to breast-feed beyond the first two weeks after the birth declined rapidly among the Asians population. Unlike the studies already cited, the authors did not compare the feeding practices of those infants bom outside and those bom inside the UK.
The weaning diet of Asian infants has been reported as a cause for concem because of the later timing of weaning and dependence on sweet foods (Jivani, 1978; Harris et al, 1983; Jones, 1987; Warrington and Storey, 1988; Williams and Sahota,1990). Among people o f Asian origin, nutritional disorders, such as iron deficiency anaemia and rickets, have been identified in infancy and childhood, with tuberculosis
increasingly common in both adults and children (Black, 1991). These finding are supported by a number of other studies that have identified iron deficiency as
common in children of Asian parentage (Harris et al, 1983; Erhardt, 1986; Grindulis, Scott, Belton and Wharton 1986). The problem was quantified by Duggan, Steel, Helwys, Harbottle and Noble (1991) who found that 35% o f their sample o f Asian infants in Sheffield were iron deficient and proposed that screening for iron
deficiency in vulnerable groups should become routine. The Department of Health (1997) has responded to these concems by including in the data collection o f their recent survey o f Asian Families, the analysis of blood samples for iron and vitamin D levels. The results o f the blood analysis are due to be reported.
4.4.4 Variations in infant patterns of growth in ethnic minorities in the UK