Chronic Conditions in African Communities

South Australian Refugee Health Network (SAHRN) Panel 21st May 2009

Central Northern Adelaide Health Service

Risk profile in African migrants

> Pre-migration• Chronic poverty

• High prevalence of intra-uterine growth retardation

• Coexistence of child under-nutrition /overweight /obese

• High prevalence of infectious disease

• Poor sanitation

• Those who come via refugee camps or transitions countries

> Protective factors • Very active, cultural activities, ADL, walking long

distances, domestic duties

• Few sedentary activities eg TV, computers, electronic games

Predisposition in migrants

> Under-nutrition in children correlates with risk of obesity and chronic disease in adults (Sawaya et al 1995)

> Rapid weight gain within first 5 years of arrival (Yip 1992)

> Following migration, dietary acculturation> Decline in Physical Activity> Increased sedentary behaviours> Increased risk of obesity> Increased prevalence of T2 Diabetes

Dietary Acculturation

> Study of Ghanaians in Sydney> Much reduced fruits and fish> Tropical root crops almost exclusively replaced by

potato starch> Deakin Uni study obesity in Sub-Saharian African

Children• New foods adopted: pizza, breakfast cereals, fast foods

and some new fruits and vegetables• Frying and boiling most common cooking methods

adopted• Inclusion of breakfast was a significant change• Top 5 energy sources included meat, biscuits, bread,

potato chips, breakfast cereal

> Intergenerational conflicts as acculturation occurs at different rates in different generations

0

58.9

50

85.7

0

10

20

30

40

50

60

70

80

90

Current smokerdaily

Risky/high riskalcohol

consumption

Sedentary Overweight/obese Inadequate fruitor vegetableconsumption

North African and Middle East CommunitiesNorth Africa and the Middle East(%)

(South Australian data)

(Where nil values: either data not available or rounding to null values has occurred)

Reference: ABS 43620DO004_200708 National Health Survey: Summary of Results; State Tables, 2007-08Table 13.3 SELECTED HEALTH RISK BEHAVIOURS, Persons aged 15 years and over, Persons - percents - estimates

Percentage of registered clients within region by African Language

Percentage % of of African clients by language

AFRI CAN LANGUAGES

20%

AFRI KAANS1%

AMHARI C2%

FRENCH2%

SOMALI8%

SWAHI LI28%

ARABI C39%

Reference: Report extracted from CHIS data: One to one registered clients by CALD status

Ages of registered clients within region by African Language

Reference: Report extracted from CHIS data: One to one registered clients by CALD status

Ages of African Languages within Region

05

1015

20253035

0 to 5 years 6 to 10 years 11 to 20years

21 to 30years

31 to 40years

41 to 50years

61 to 70years

Others

African Communities Food and Nutrition Survey Results

A collection of surveys and information about Food & Nutrition in South Australian African Communities

Danielle ProudDietitian, African Foodies NetworkEnfield Primary Health Care Services

Questions within the Survey:

What changes have been made to the types of foods being eaten? Have there been any changes in preparing food? How do you access traditional foods ?

What information are you/your community looking for about foods and health?

What would be the best way to provide this information?

Survey Results: Changes to food intake

> Increased intake of high sugar foods> Increased intake of soft drink > Increased use of meat/chicken and sauces as more readily

available> Increased intake of high fat fried and takeaway foods> Preference of foods that are cooked rather than raw,

others prefer more salads> Children ask for ‘Australian’ foods and takeaway> Some traditional foods are available dried, salted or frozen> Eating white breads and (sugary) cereals, pasta and rice

dishes> Eating more/ diverse range of snacks> Lack of appetite

Changes Cited

Survey Results: Changes to food preparation

Changes Cited

> Now preparing school lunches, sometimes it is hard to know what to prepare

> Using fresh cuts of meat so able to fry/ use more > Have less time to prepare meals> Many mentioned that ingredients and methods of

cooking had changed without specifics> Younger adults may not have had the opportunity to

learn from older adults how to prepare food and now are unsure how to prepare traditional foods

> Sometimes more sweetening of foods/drinks eg tea and other hot drinks

Survey Results:Access to traditional foods:

ExpenseDifficult to findSome products are available but are cured/salted/dried/frozenDifficult to know what to alternative ingredients can be addedUnsure of how to modify to make healthyUsually found in African food shops, chinese supermarkets and/or Central Markets. Otherwise shop in usual supermarkets

Changes Cited

What food or nutrition information has been requested?

• Food Safety and Storage• Label Reading• What to pack for school

lunches? General childrens foods

• Budgeting• Link with food &

disease/good health/ weight gain

• Salt and Fat • Safety of

tinned/preserved foods • Modifying traditional

recipes• Learning to cook different

vegetables• Cooking quick/healthy

meals

How to provide this information?

•Cooking Demonstrations/ Taste Testing•Cooking Classes•Supermarket Tours•Group activities •Practical Activities eg Label Reading, Packing a Lunchbox, Budgeting•Posters with many pictures•Handouts: Pictures/ Written•Note:May not be able to read recipes

…..When we first come to Australia we eat food because it is available, because it is easy to get and it tastes good, we do not know what is not good, or what makes you fat….” anonymous

Primary Prevention

> Health promotion activities should reinforce healthy traditional dietary and physical activity habits

> Important to provide input within the first few years of arrival in Australia

> Children are particularly predisposed to rapid weight gain within a few years of arrival, so early interventions with families important

> A range of health promotion issues exist, so should work with other services

> Appropriate communication strategies are vital in conveying health promotion messages

SA Health

‘Do It For Life’ Program

> Fully State funded

> Statewide consistent model that will meet the National Standards

> SA targeting all the SNAPS not just risk factors for Diabetes

> 50 FTE across the state by 2011

• 24 of these will be in CNAHS currently 14 FTE

> including ATSI specific, Women specific & Youth specific positions

Lifestyle Advisors & Lifestyle Support Officers> Role (upon assessment and entry into the program)

• provide 1:1 sessions (Flinders Preventative Model)

• assist client in determining their goal(s) and developing an action plan

• provide guidance and support to client to assist them in achieving their goals

• referral to other programs/services as required (e.g.. Dietician, EP, PT etc)

• facilitate the Greater Green Triangle Program (Aug 08)

> Use motivational interviewing & holistic approach

> Scope of practice – non clinical

Target Populations

> Migrant from Non-English Speaking Background / Refugee> Aboriginal or Torres Strait Islander> Low income earner / holds concession / health care card> Living in remote / rural area

Eligibility

> Working age (18 +)> Standard risk score (15 +, OR 13 with alcohol and/or stress)> Have one or more SNAPS risk factors> One of the target population groups> Not be diagnosed with a chronic disease

Must meet all criteria

Issues to consider

> Engaging appropriate interpreters at all stages• Understanding that compliance with treatment

recommendations relies on good communication that is well understood

> Financial constraints may impact on compliance > Keep messages simple> Utilising Team Care Arrangements to provide comprehensive

response to health issues, involving all members of multi-d team, our health care systems are complex to navigate

> Management involves the family> Use occasions of service opportunistically to screen for other

health issues (eg Vit D, dental health, other risk factors for chronic disease)

> Remember that small changes are significant eg diet, exercise