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Prevention of diabetes

Prevention of diabetes through promotion of physical activity and consumption of healthy diet

 

Background

Diabetes is increasing globally at an alarming rate, becoming one of the most costly and burdensome chronic diseases of our time (1). In Norway, diabetes constitute a major public health problem with 6 to 7 thousand Norwegians acquiring the disease annually, while similar number may remain undetected and thus unaccounted for (2;3). Nonetheless, diabetes prevalence varies among Norwegian populations with non-western immigrants being disproportionately affected   (4). This health disparity highlights the need for better prevention efforts of diabetes among immigrants. Health literacy is known to be an important predictor in the utilization of preventative health measures (5). However, little is known about the role of health literacy and utilization of preventive health measures on risks of DM in African immigrants in Norway.

 

Immigration to the west is usually accompanied by environmental and lifestyle changes that can increase immigrants risk for diabetes (6). Studies in Sweden, Denmark and Norway presented extremely higher prevalence rates of DM among immigrants than non-immigrants (4;6;7). Earlier study in Oslo revealed that large proportions of women in reproductive age, who live in Oslo, are obese, sedentary, and at greater risk of diabetes, specially non-western immigrants (4;8). A prevalence study of diabetes among psychiatric patients from 4 countries that have undergone civil war, found the highest prevalence of diabetes (32%) among Somalis (9). The same study found a prevalence of obesity of 41.1% among Somalis compared to 8.6% and 19.5% among Vietnamese and Cambodians respectively. High level of physical inactivity and higher BMI were also observed among Somalis in the UK and New Zealand (10;11).

An estimated 90,000 African immigrants, most of them from Somalia, live in Norway   (12). The majority of African immigrants came to Norway after 2002 as asylum seekers with almost half living in Oslo (13). Regarding socioeconomic indicators, the African community stands out as the worst off by any standard compared to other immigrants in Norway. For instance, the employment rate of Somali immigrants in Norway were 25.8% in 2001 compared to 45% among Pakistanis (13). Moreover, Somalis has been found to be the least integrated with mainstream Norwegian culture (12).

One of the major concerns is the fact that many Africans do not consider overweight and obesity as a disease but as a sign of success, wealth, good health and happiness (6;7). In African culture, most of chronic diseases   often go undetected until complications arise. The reason is that no disease is perceived as a problem unless it’s accompanied by symptoms that drive one to seek health care and warranting treatment such as fever, diarrhea, pain, couch etc (7). Traditional Somali diet revolves around pasta, rice, injera bread, meat and tea with lots of sugar. It is a diet that, when combined with a more sedentary lifestyle than they had in Africa, can lead straight to diabetes (14). Thus, access to proper health information and subsequent utilization of available preventive services are vital in containing diabetes epidemic among immigrants in Norway. African Health Organization is committed in promiting physical activity and healthy diet among African immigrants women in Oslo and Akershus.

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