Afro-centric Health Literacy Intervention Strategies for ... › global-coordination-mechanism › activities › wo… · factor: genital mutilation, breast ironing and certain rituals

Dr. KENNETH ANCHANG YONGABI, PHD, DR.PH,N.D,ANMA

ASSOCIATE. PROFESSOR OF PUBLIC HEALTH/INFECTIOLOGY

PRF RESEARCH INSTITUTE, SCHOOL OF HEALTH AND MEDICAL SCIENCES,CATHOLIC UNIVERSITY OF CAMEROON, BAMENDA. +237

67526612; [email protected]

Second Meeting of the WHO Global Coordination Mechanism (GCM/NCD) Working Group on health literacy for NCDs

12-13 June, 2017 – WHO/HQ, Geneva, SWITZERLAND

Afro-centric Health Literacy Intervention Strategies for better Health Outcomes in

Individuals, for the prevention and management of Non Communicable Diseases (NCDs) in Africa

Presentation outline cum Objectives

1. Remind ourselves of the basic understanding of burden and key risk factors for NCDs incidence, globally. To take a look at the growing epidemiological transition of NCDs in Africa.

2. Known risk factors for NCDs, but a re look at the traditional and local beliefs, culture that poses even a greater risk for NCDS in Africa

3. To join me to witness how linear health practices, predominantly, focused on therapeutics and lack of a resilient health Literacy has bred, is breeding over reliance on depleting health infrastructure in SSA and how it adversely affects the growing increase in the incidence of Chronic and non communicable diseases.

4. Join me to witness why health literacy at individual level is a key component of a health literate community in Africa. egs from our experiences and practical approach through a SWOT description and Afro centric health Literacy learning laboratory for potential control of NCDS in Africa

At the end of this presentation, you will be able to:

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Health Literacy Intervention at individual level to curb NCDs in Africa

• Majority of Africans live in communities guided by culture, by history, and with local governance

• It is individuals that make up the community.

• One individual affected, then the entire community is affected, eg we encounter this during birth and death celebrations in Africa etc

• Like the “Ubuntu” I am because you are”

Health Literacy intervention to curb NCDs must be centered on an African way of life

• Cultural practices at individual and family level that are a risk factor for NCDs must be re-examined

• Traditional knowledge systems that may pose any risk factor: genital mutilation, breast ironing and certain rituals that may predispose to NCDs are to form part of a health literacy intervention package.

• Health literacy is dependent on the communication skills of an individual and health professionals.

• Individuals and Communication skills are context- specific, and individual with wrong health knowledge is a liability to the next person, and the entire community.

Health Literacy in Africa : Person to Person or Digital communication? What’s the reality on ground?

Internet World Map (2007)

http://www.ipligence.com/worldmap/internet-map.jpg

More than 90% could manipulate Android Phones with a number of Apps than HL Health Literacy and Android Literacy

Global Literacy: a Huge disparity

Individual literacy (ability to read and write is comparatively lower in Africa) that invariably affects Health Literacy, even with the advent of the digital technology; digital technology usage still requires basic ability to read and write

(Zarcadoolas et al. 2006)

Consequences of Poor Health Literacy on NCDs , as a Public

Health Issue in Africa

• Financial burden on individuals and society

• Social inequity

• Lack of self-efficacy and self-esteem

• Poor self-management of chronic conditions

• Poor health outcomes

• Improper use of medication

• Inappropriate use or no use of health services

• Inadequate response to emergency situations

Healthcare Health

Societal Personal

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Health Literacy

Demographic

SES, Occupation, Income

Psychosocial

Social support

Cultural

Language,

Religious beliefs

General Literacy

Reading, Numeracy,

Prior experience with the

healthcare system

Individual Characteristics

Age, Gender

When an African individual is health t influences his or her thought

processes, A behavioral change can cascade onto one another

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Individual literacy is affected by the following attributes in the algorithm below:

What are the main noncommunicable diseases in Africa? Local and cultural perceptions attached to these diseases?

Heart disease and stroke

Diabetes

Cancer

Chronic respiratory disease

Taboos attached to these diseases

0 10 20 30 40 50 60 70

High-income

Upper middle-income

Lower middle-income

Low-income

Deaths from NCDs before the age of 70 as a percentage of total deaths from NCDs

Source: WHO Global Health Estimates 2014 (Year: 2012), Deaths by age group

The proportion of people who die prematurely from NCDs is highest in poorest countries as seen in the Fig. below

NCDs are not a "rich country" problem but the rich in Africa seek treatment in western hospitals

Cancer

NCDs and risk factors

“Lifestyle diseases” caused by “behaviors” and behavioral changes

Effects increase risk of heart attack, increase in certain cancers, and cardiovascular problems

Many African youths increasingly prefer exotic foods that

are high in fat, saturated fat and cholesterol.

Foods high in sugar often have too

many calories and not enough nutrients

Salty foods can

increase risk of high

blood pressure.

Alcohol consumption is

high, besides high in

calories and provides

little or no nutrition. How do we get our indigenous people to get this sink into them? Local liquor, Palm beer etc are also risk factors.

Alcohol consumption is increasing and is considered fun, creates social acceptability among African peers

The epidemiologic transition with NCDs in Africa

Perceptional belief in Africa about exotic Diets • Change in the balance of disease in a population • from communicable diseases to Non communicable disease • Things are getting worse not better

• Africans generally feel exotic diets means modernization;

These foods makes them feel belong, They see it on CNN, “My siblings in the US sent me nice photos of themselves in Macdonalds, Woolworts markets, David Jones.”

They feel they are safe still because the westerners now have a comparatively longer life span than Africans, and they eat these foods. How then can one justify that these foods are unhealthy?

African Perceptions about NCDs: But Local diets and African customs must be examined again

• Majority Africans still think that NCDS are a Western problem • They think that it is a disease of Affluence

But the Anathema is broken!

• Africans, 2-3 centuries ago lived more natural life styles, more natural

diets than we have today. NCDS are no respecter of continents. • . Some Cultural habits are now diluted

• We do generate evidence base knowledge on local diets to further build Health literacy that would curb the incidence of NCD at individual level.

• I’ll discuss some case studies of our work showing how local customs in Cameroon, Nigeria and Ghana are intrinsic risk factors for NCDs hike. In the following slides.

Local customs and NCDs in North West Region of Cameroon (Traditional marriage in Kom, North West of Cameroon)

On this Occasion, the bride price and nuptial meal is Palm oil, and maize baked flour called fufu. The fufu is served with plenty of palm oil not well heated, mixed high quantity of salt. Salt and palm oil are risk factor for blood pressure and CVDs, while the corn fufu-starch a risk factor for Diabetes

We observed Local diets and traditional foods during

rituals.These delicacies presents a risks to increased incidence of

NCDs in Africa

A Traditional ritual where the bridesmaid perform as farewell to the bride in Cameroon

They feed all night on heavy lumps of corn fufu and drink traditional heavy carbohydrate liquor rich in alcohols and sugars. Let’s try estimate the BMI values for these women???? Exposing breast that is being painted with wood exudates rubbed on their breasts; These are risk factors for NCDs

Potential risk for cancer, potential risk for Diabetes and cardiovascular diseases

Even Educated individuals have a strict adherence to traditional /cultural diets

Same Starch and oil based diets eaten daily are risk factor. In the above guests at traditional wedding obliged to eat traditional meals high in starch, oil (high cholesterol)

Heavy carbohydrate and Fatty staple foods and local traditional recipes in the Igbo land in Eastern Nigeria and Volta Region in

Ghana (risk factor for NCDs)

An analyses of these local staple diets revealed that the palm oil quantity is profuse and high in cholesterol, triglycerides and the starch is high. The indigenous people eat heavy quantities of this with little or no varieties almost on a daily basis.

Diet: Perceptions on Fruits and vegetable

In many parts of Africa , indigenous people raise fruits and vegetables and rather sell them There is a cultural perception with eating vegetables- and Salads!!!! With nomadic pastoralists, vegetables and salads are food for ANIMALS and not for human worth the dignity

Vegetables considered Food for herbivores in a local slogan “ Cow eat grass”

The maps shows the RED portion on Africa implies Africans eat less vegetables comparatively

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These are afro specific cultural risk factors and drivers of the epidemiological transition in low income countries

More than 70% of Africans live in rural areas with generally poor health literacy/ knowledge with more than 250 tribes, With increased harmful customs there is increased risk for NCDs

• because of change in lifestyles (urbanisation) The youth migrate to cities and prefer exotics foods, while in villages local foods and at times exotic food pose a double risk

• Cultural habits in village and cities plus exotic life styles critical risk factors have very large effects.

• In our field survey, we notice that this partly responsible for the increase NCDs observed. In the villages in the North West part of Cameroon, High blood pressure and Diabetes is steeply rising with many people who do not know their health status. – In a survey of 250 people in a local community based groups, not up to

30% had done a blood sugar test in 24 months except those that are already known diabetics. Not up to 20% had gone in for a voluntary cancer check up

We observed Important African traditional and healthy diets ( low in cholesterols and fats etc in

Cameroon abandoned in lieu of exotic foods Picture of some traditional cereals that presents less risk to NCDs. More evidence based research to form part of a health Literacy approach s needed.

Local wild yam (itu)rich in selenium and minerals abandoned as poor man’s meal. Mushrooms with essential amino acids 21-45% protein by dry weight, no cholesterol, with essential amino acids and even have blood sugar lowering effects, regarded as food for poor people!!

Pumpkin seeds and fruits are local delicacy that are abandoned in lieu of Burger and Sausages today

Poor Indoor air quality a risk factor for Respiratory Disorders (COPD) ,90% of Africans do cook using firewood in rather poorly ventilated kitchens; Increased in indoor air

pollution is high. There is a high gender risk of COPD as mostly women cook traditional meals using fuel wood as seen in the picture below

A health literacy package that brings about individual cultural change must propose options otherwise behavioral or culture modification will not last long

Culture amongst the Tikaris in Cameroon , Chad and Northern Nigeria

Local customs presents risk to NCDs: Bride price in a tribe in Cameroon : The outcome of the continuous usage may pose a

risk to NCDs

Poor Indoor air quality a risk factor for Respiratory Disorders (COPD) ; some of the woods may contain pesticide residues

A health literacy package that bring about cultural change in individuals must propose options

Cancer Burden is in Africa is growing DISTRIBUTION OF FEMALE CANCERS IN LUTH(2007)

Cancer Reg & Epid wkshop April '09 25 8/8/2017

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Afro specific cultural risk factors are drivers of the epidemiological transition of cancer incidence in Sub Saharan Africa as highlighted

in summary below: • African population is ageing • Major socio-economic changes (especially urbanisation) • changes in risk factors such as diet, physical activity, smoking etc.

Local customs with smoking, use of fuel woods, Breast ironing, female genital mutilation,

circumcision, scarifications, use of traditional tree exudates applied to the breast and genitals etc

• Smoking pipe by a number of elderly in some rural areas- a tradition to show supremacy and wisdom

• Although there is reduced cigarette compared to many western societies, consumption amongst youth and some adult is a sign of bravery.

• There is increased health promotion on cigarettes across Africa, also certain cultures are intolerant to smokers, nonetheless!

Some non-communicable diseases in Africa have infectious origin, eg Helicobacter pylori and colon cancer; Kaposi sarcoma and other Immune deficiency malignancies

Perceptions with use of aluminum utensils • A number of Africans believe that , Cooking cereal based meals with Aluminum

pots is predisposing to cancer because aluminum extracts into the food!

. Hot Food wraps in plastic papers/polyethylene also presents a risk of extracting metals into the food.

..Water storage /preservation with Alum and hypochlorite is also a risk to NCDs

Traditional Breast ironings and female genital mutilations also a risk to NCDs

• Young girls Spraying perfumes on their breasts: alcohols which are precursors of cancers (ethybromide) ?? Breast cancers

• Certain lotions and rubs – expensive but possess carcinogens (alcohols and carboxylic acids etc , avoid eyes (health Literacy has to adequately address these)

The general perception is that Traditional Calabash for water storage is devoid of heavy metal and presents less risk to NCDs, and has been in use in many rural Africa communities since antiquity ,but now being abandoned in lieu of more attractive Aluminum containers . Health literacy package targeting this for individuals would have to be built on this existing perceptions.

Traditional eco –cutlery made of fiber abandoned in lieu of aluminum pots

SEX DISEASE PREVALENCE of NCDs IN CAMEROON (2010-2016)

For men: Diabetes (5.3%), Hypertension (26.4%), Stroke (15%) Rheumatism (4.8%), Prostate Cancer (19.2 /10000, Asthma (1.5%), Epilepsy and Sickle cell also identified prominent in a number of rural areas

• SEX DISEASE PREVALENCE of NCDs IN CAMEROON (2010-2016 • For Women: Diabetes (5.3%), Hypertension (29.6%),

Rheumatism (4.8%), Asthma (1.5%) Breast Cancer (27.9 /10000 ) Cervical Cancer( 24.0/10000)

• There is a need to engage a strong Health Literacy Intervention!

• Health Literacy measurement tools and health literacy package targeted at : Who, How, What, Where, When, Whom?? Is very critical!

We recommend an Appropriate Afro -centric Health Literacy intervention for prevention, management and control of NCDs

from generation to generation 1. Health literacy strengthening strategies for individual Religious

leaders – Priests and pastors are overwhelmingly engaged in healing and counseling of patients with chronic diseases (for two years now we are engaged in this, and needs to intensify)

2. Health Literacy strengthening for Local kings and chiefs and heads of clans. ( Africans trust their traditional leaders and follow them) we are building on this.

3. Health Literacy packages and strengthening for individual Traditional doctors, diviners, etc more than 70 % of patients with chronic diseases attend a traditional doctors clinic (cancer, Diabetes and Hypertension). Poor knowledge of NCDs is generally noted. ( I supervised three M.sc dissertation on this)

4. Health Literacy intervention must deal with demystifying traditional belief systems which are widespread with chronic diseases (eg. Spells associated with Cancers and other cardiovascular diseases.

Evolutionary Learning Health Literacy systems Laboratory (ELHLSlab) for Local control of NCDs (one of outcomes)

• The laboratory is a virtual mental space not a

real space per se. It brings to the table all these people in equal rights. The approach is not just participatory but more inclusive in that everybody interacts,

. we interact to generate new knowledge and co-evolve with the knowledge and evolve ways of passing it on to the next generation, so we co- create and ensure that our next generation is growing the knowledge. This is why different age groups and children are part of our lab and are key players.

illustrates the conceptual framework of systems approach to dealing with contemporary health

problems rather than a one traffic approach

Testing our lab- Our capacity building on Evolutional Learning Systems Health Literacy Lab (ELSHLlab) for sustainable control of

NCDs in Cameroon

Made up of priests, chiefs, Community leaders, all walks of life, We evaluate the health knowledge, and jointly build and grow on the health knowledge Positive behavior changes noticed after 12 months .

We provided training on health promotion tips etc. We have 78 groups at community level with a population of 500 with 65% made of women with 38% made of women of child bearing age

So our health promotion and literacy for children and adults are spiced with practical intervention programs built or designed from the culture of the people in question- building a sustainability for the future with confidence

Lessons from a Holistic approach to health through a “Health literacy campus projects in Cameroon We have carried out evidence based

projects to build our Health Literacy Packages and advise on healthy options in lieu of the exotics

Conclusion WORKING WITH LOCAL PEOPLE

Local people have their own beliefs, concepts, and cultural models for illness. They use specific protocols to control it and are often willing to help with control efforts. These practices can contribute to control the NCDs across Africa

Some of the local beliefs and practices are neither health-lowering nor health-enhancing. Health Promotion strategies must be contextualized.

These include use of prevention models, also considering a health literacy system that can dissuade people from their belief on ritual activities to deter spirits. Some beliefs and practices such as traditional funeral/marriages etc practices can amplify the incidence of NCDs

Conclusion cont’d The local people need to be part of the health literacy measurements

mechanisms and health literacy intervention delivery chain. • Health Literacy literature is growing fast and huge but largely does not

connect at grassroots in Africa.

• In Africa “Health literacy means more than being able to read pamphlets and make appointments. We must connect with people as agents of change

• Eevidence based health Literacy research, a reality check on the scientific basis of the local customs , perceptions on health issues before we can construct a health literacy program is KEY (Yongabi, 2016).

• We need to sometimes question the authenticity of scientific knowledge on some health issues as well as question the safety of local customs

Masquerades like this in Africa is part of African customs, and must be made health Literate on NCDs.

Thank you very much