Cohort Profile: Mandela's children: The 1990 birth to twenty study in South Africa

The late 1980s were a period of profound sociopolitical change in South Africa. It was clear that the Apartheid state was crumbling and amongst acts of civil disobedience which characterized the struggle Black Africansy began to disregard restrictive legislation that constrained where they lived and worked. Very rapid unplanned urbanization began and shanty towns mushroomed around formerly White cities and towns. It was anticipated that this rapid urbanization with urban growth estimated at the time to be 3.5% per year. would have profound effects on childrens health and development. While improved access to health care education and employment in urban areas could decrease preventable childhood morbidity and mortality the inability of government to establish and maintain services to meet the needs of the growing urban population could exacerbate existing infectious diseases such as HIV/AIDS and tuberculosis. Non-infectious conditions related to the interaction of lifestyle urban stressors and socio-cultural changes-for example childhood injuries substance use and obesity-were predicted to increase. In 1988 as a result of discussions on these issues Noel Cameron at the University of the Witwatersrand and Derek Yach at the South African Medical Research Council (MRC) approached the then MRC President Andries Brink for funds to begin a birth cohort study in Soweto-Johannesburg with Lucy Wagstaff also from the University of the Witwatersrand. The aim was to track a group of urban children for 10 years not knowing at the time that these children would also be the first cohort born into a democratic South Africa. At the start the study was called Birth to Ten (BT10) but changed to Birth to Twenty (BT20) in 2000 when we reached the 10-year follow-up goal and resolved to continue the study to age 20. The children came to be known colloquially as Mandelas Children because they were born in the 7 weeks following Nelson Mandelas release from prison on the February 11 1990 an event that heralded in radical social and political changes. Linda Richter was part of the original investigator group. Shane Norris has been the Project Manager since 2001. With seed funding we undertook several pilot studies to determine amongst other things the seasonality of births in the area and the optimum months for recruitment into a birth cohort study; the nature and accuracy of routinely collected health service data; and follow-up rates of children from birth to six months. The date for enrolling the birth cohort was set for February but a national hospital strike delayed enrolment which occurred from April 23 to June 8 1990. (excerpt)