ABERDEEN GUYANA RESEARCH 2015
One of the greatest hopes for this project is that is participants will be able to learn from the experiences of the other country and learn from them. Where Guyana has not yet seen a true epidemic in obesity and lifestyle related disease Scotland has, where Scotland has become seperate from very traditional lifestyles Guyana has not.
Research Background
Global explosion in non-communicable diseases like obesity and diabetes type II
Indigenous peoples at higher risk?
Economic growth and spread of western diet and lifestyle
Why Guyana and why now?
According to World Bank Guyana is “rapidly emerging as one of the countries with the highest economic growth rates in Latin America” (World Bank, 2015). There has thus been a drop in childhood malnutrition, but a rise in nutrition related chronic non-communicable disease (WHO, 2015,FOA, 2003). Even the rising of popularity fast food chains within Georgetown are poignant markers of how the food landscape of the nation is changing. However robust evidence to the precise nature of the problem is sorely lacking. International research within Guyana over the last decade has been utterly dominated by ecological projects while vanishingly few medical studies have been executed. This is despite the great opportunities for research within Guyana which has a diverse and English speaking population.
A demonstration of the severity of knowledge deficit is seen through a Medline search using the MESH term Guyana. This yields only 480 results between 1946 and the present day. Narrow the search to include term Amerindian and there are only 20 results, of these only 1 article includes information pertaining to non-communicable disease.
General background
If you want more information about the countries in general; the culture, lifestyle, heritage and politics either check out our blog or go to our Guide 2 Guyana page, linked below.
This research matters, even if we are unable to raise the funds to allow it to take place this year, we will push for another group to carry out this project.
There are of course estimates of the burden of non-communicable disease (NCDs) available, as datasets have been published by the WHO, UN and in the Ministry of Health’s statistical bulletin. They have estimated that 37% of premature mortality within Guyana are attributable to non-communicable disease, and that levels of obesity have risen to 17% in the general population (International Food Policy Research Institute, 2014). However even within Guyana’s strategic plan a large body of data comes from combined Carribbean survey results rather than Guyana-specific studies (Ministry of Health Guyana, 2013). While these estimates provide meaningful estimation of the scale of the issue they are formulated using models and limited surveillance data (WHO, 2012). Furthermore there is currently no populational comparison of the differential risk to the Amerindian populations, in studies carried out worldwide multiple Indigenous populations including; American Indians, Native Hawaiians and Other Pacific Islanders, have been shown to have a higher risk of developing non-communicable diseases after having been exposed to a westernised diet and lifestyle than the general populace, whether this is due to underlying genetic risk factors or social behaviours is unknown (Hutchinson & Shin, 2014; Mau et al., 2009).
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Fish is a large part of a traditional diet in Guyana
There is a great need for more information about non-communicable disease in order to aid government, healthcare providers and the community
Table taken for WHO country report on non-communicable disease, please go to
http://www.who.int/nmh/countries/guy_en.pdf
Non-communicable disease, an ever growing problem in Guyana and worldwide
According to the WHO NCD's already account for 67% of deaths in Guyana.
!&17.2% of adults are already obese and
29.4% of people have hypertension.
By comparison in the UK 89% of total deaths are related to NCD's. 26.9% of adults are obese and 27.7% of adults have hypertension.
Neither is there data that focuses in particular on current levels of understanding or perceptions to nutrition and health. It is established that the current burden of obesity and lifestyle related disease worldwide is strongly influenced by social and cultural shifts (Lobstein, Baur and Uauy, 2004) The patterns of economic growth, social changes and rise in obesity has been repeated societies worldwide, particularly in South America (Popkin, Adair and Nang, 2012). As There is a large population of Amerindians in the cities that lie along the coast in Guyana, as well as increase in ‘eco-tourism’, logging and mining, increasing the exposure of Amerindian people to Western diets and lifestyles in the Interior (Clegg, 2014). However the choices made by this population to consume these foods are influenced by local perception of food and concurrent to this is the issue of body image. Moreover as modern media exposes women to western body ideals via the media, women have an ongoing preoccupation with body size despite increasing waistlines (Muennig et al., 2008). Whether this preoccupation is mirrored in Guyana is an interesting enquiry and might provide insight into the relationship between food and body image at a societal level and provide another dimension to our understanding of how to approach to lifestyle advice and interventions.These questions represent a major gaps in our understanding and ability to predict the future of NCD epidemics in Guyana.
The readiness of the Amerindian communities to cope with this potential increased burden of disease represents yet another unknown. To address barriers to improving healthcare in poor Amerindian communities it is essential to assess the willingness and ability of communities to access healthcare in isolated areas and in urban settings. The combination of information gathered will build a bigger picture of the preparedness of Amerindians for the potential health risks that economic and social development in Guyana may bring.The Guyanese government was praised by the WHO for their commitment to tackling public health issues (WHO, 2013). It is hoped that the information gathered in this study will aid in the progress of Guyana’s Strategic Plan 2013-2020, which aims for Integrated Prevention and Control of Non-Communicable Diseases (NCDs) in Guyana. While there the contribution of real data to the national system may not match the impact of existing WHO and governmental estimates, it will give insight into the issues facing the vulnerable populations within Guyana. Equally important in order to tackle NCD’s cross-sector partnerships are essential, especially with the present decentralised and fragmented nature of Guyanese healthcare. This study is the first steps towards publicising recommendations and opening up discussions with local stakeholders and medical students can only promote the development of a more cohesive effort against the rise in NCD’s.
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This study is designed as a pilot project. We have focused on a very specific region and tribe of people in the hope that results will lead to larger scale projects in future. Furthermore, we hope these projects will be instigated and led by the University of Guyana and supported by the University of Aberdeen rather than externally driven, thus the legacy of the project and the establishment of strong working partnerships has always been a priority for the team.
Food market in Guyana
The relevance of the chosen outcome measures is based on a vast body of research demonstrating their relevance to human health. Hypertension is a major risk factor for cardiovascular disease and is associated with coronary heart disease (Roccella and Bowler, 1990), myocardial infarction (Yusuf et al., 2004) and increased mortality (Kannel, 1974). Both body mass index (BMI) and waist to hip ratio are measurements of relative weight and body fat distribution respectively and can be used together to predict disease risk (WHO, 2008). An increased waist to hip ratio is associated with cardiovascular events (de Koning et al., 2007) and has been found in multiple studies to be a superior predictor for cardiovascular disease than BMI (Czernichow et al., 2011 ).
As well as determining of underweight, overweight and obese individuals, BMI is also associated with an increased risk of stroke (Hu et al.,2007). Obesity itself is associated with hypertension, hypercholesterolemia (both cardiovascular risk factors), certain cancer types and type II diabetes (NIH, 1985).
Both BMI and Hip-to-waist-ratio are associated with hypertension, type II diabetes and overall mortality (WHO, 2008).
Peak expiratory flow (PEF) is a measurement of maximum expiratory airflow which can be used epidemiologically for identifying airflow limitation and its severity (Quanjer et al., 1997). There have been studies which have found an inverse relationship between height adjusted peak flow readings and mortality from cardiovascular and respiratory disease in men over the age of 40 (Smith et al., 2013) as well as a relationship between low height adjusted peak flow and disability and death in the elderly (Fragoso et al., 2008). It has also been found to be an independent predictor of hospitalisation and decreased expected survival times in the elderly (Roberts and Mapel, 2012).
REFERENCES
References
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Clegg, P. (2014). Guyana, its Foreign Policy, and the Path to Development. The Round Table, 103(4), pp.399-410.
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