Hernias Through the Umbilical Region: Exploring Institutional Biases, Traditional Beliefs, and Pediatric Surgical Practices
In the 1950s, Dr. E. Perry Crump's study in Nigeria revealed a striking 97% prevalence of umbilical hernia among neonates of low-income parents. This high rate was found to decrease with age and socioeconomic status. Interestingly, American authorities, when consulted by Dr. Jelliffe, confirmed a similar high rate in Black American children, yet asserted no correlation with poverty or malnutrition.
Fast forward to 1952, Dr. Crump's study found a prevalence of 26.6% among Black children, compared to the 3% prevalence described in white children at the time. His research suggested malnutrition as a potential mechanism for the increased prevalence. However, recent studies in the United States have not been found to examine this potential association between malnutrition and umbilical hernias in Black children.
Several Nigerian investigators, including Dr. Ebomoyi, have corroborated Dr. Crump's initial findings, stating that umbilical hernias are much more common among African children compared to Caucasian children. Dr. Ebomoyi's study found a significant difference in prevalence according to parental occupation, a marker of class.
Moreover, a recently published study states that umbilical hernias are 8-9 times more prevalent among Black children in the United States, with "degree of African ancestry" as a contributing factor. This finding is concerning, as Black children in the U.S. are more likely to receive treatment which deviates from the standard of care - undergoing hernia repair at an early age (<3 years old), which is associated with more complications.
Other factors like public insurance and lower income were also associated with early umbilical hernia repair in the U.S. This suggests a need for a comprehensive approach to address this health disparity. The U.S. medical system needs to completely overhaul its view on race, racism, and white supremacy, and invest in social programs, better nutrition in schools, and addressing wealth and income inequality.
It's worth noting that the health professions commonly note that hypertension, diabetes, heart disease, and most cancers disproportionately affect Black Americans. The literature has tended toward conclusions that perpetuate scientific racism and naturalized inferiority, asserting that Black people have almost ten-fold the rate of disease compared to white people without examining structural factors.
In contrast, a conspicuous absence of studies in the American medical literature examines the phenomenon of childhood poverty and food insecurity that disproportionately affects children of colour. This underscores the need for more research in this area.
In 2004, Dr. Uba found a strikingly low prevalence of umbilical hernia among Nigerian children applying to private school, suggesting a potential role of socioeconomic factors in the prevalence of umbilical hernia. In 1971, Dr. S.O. Oduntan evaluated the prevalence of umbilical hernia among school-aged children in various groups in Nigeria, finding the highest prevalence among non-school going children and rural primary school children.
In conclusion, while umbilical hernia is almost always a benign condition, it is clear that Black children in the U.S. are disproportionately affected. Addressing this health disparity requires a multi-faceted approach, including more research, investment in social programs, and a reevaluation of the medical system's approach to race and socioeconomic status.
