Transcript Chronic Conditions in African Communities

Central Northern Adelaide Health Service
Chronic Conditions in
African Communities
South Australian Refugee Health Network
(SAHRN) Panel 21st May 2009
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
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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
North African and Middle East Communities
North Africa and the Middle East(%)
(South Australian data)
85.7
90
80
70
58.9
60
50
50
40
30
20
10
0
0
Current smoker
daily
Risky/high risk
alcohol
consumption
Sedentary
Overweight/obese
Inadequate fruit
or vegetable
consumption
(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
AFRICAN
LANGUAGES
20%
SWAHILI
28%
AFRIKAANS
1%
AMHARIC
2%
SOMALI
8%
FRENCH
2%
Reference: Report extracted from CHIS data: One to one registered clients by CALD status
ARABIC
39%
Ages of registered clients within
region by African Language
35
30
25
20
15
10
5
0
Ages of Afric an Languages within Region
0 to 5 years 6 to 10 years 11to 20
years
21to 30 31to 40
years years
Reference: Report extracted from CHIS data: One to one registered clients by CALD status
41to 50
years
61to 70
years
Others
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
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
Changes Cited
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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
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:
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
What food or nutrition
information has been
requested?
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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)
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provide 1:1 sessions (Flinders Preventative Model)
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assist client in determining their goal(s) and developing an action
plan
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provide guidance and support to client to assist them in achieving
their goals
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referral to other programs/services as required
EP, PT etc)
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facilitate the Greater Green Triangle Program
(e.g.. Dietician,
(Aug 08)
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Use motivational interviewing & holistic approach
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Scope of practice – non clinical
Target Populations
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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
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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
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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