Chronic Conditions in African Communities

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Chronic Conditions in African Communities
Central Northern Adelaide Health Service

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

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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

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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

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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

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Percentage of registered clients within region by
African Language
Reference Report extracted from CHIS data One to one registered clients by CALD status
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Ages of registered clients within region by
African Language
Reference Report extracted from CHIS data One to one registered clients by CALD status
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African Communities Food and Nutrition Survey
Results

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

Danielle Proud Dietitian, African Foodies
Network Enfield Primary Health Care Services
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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?
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Survey Results Changes to food intake
Changes Cited

• 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

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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

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Survey ResultsAccess to traditional foods
Changes Cited

• Expense
• Difficult to find
• Some products are available but are
  cured/salted/dried/frozen
• Difficult to know what to alternative ingredients
  can be added
• Unsure of how to modify to make healthy
• Usually found in African food shops, chinese
  supermarkets and/or Central Markets. Otherwise
  shop in usual supermarkets

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What food or nutrition information has been
requested?
How to provide this information?

• 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

• 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
• NoteMay not be able to read recipes

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• ..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

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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

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SA HealthDo 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

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Lifestyle Advisors Lifestyle Support Officers

• Role (upon assessment and entry into the
  program)
• provide 11 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

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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

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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

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