The Research Proposal | Aberdeen Guyana Research

The effects of westernisation in Guyana

The Proposal

The essence of this project is to provide an initial data on the degree of risk of non-communicable disease amongst Guyanese Amerindians. In order to achieve this we will carry out three interlinked studies. The first of these (and the main focus of the study) will collect data on basic health parameters such as BMI in Amerindian populations. The second will investigate attitudes to social determinants of health, in particular perceptions of diet and eating behaviours. The third will aim to gauge access and availability of healthcare for Amerindian communities.

Research will be carried out within Guyana. In urban townships outside of Georgetown looking at westernised Amerindians and non-Amerindian Guyanese, and along the North Rupununi region of the Interior, a highly remote jungle region, looking at non-westernised Amerindians. The data will be collected over the course of 2 months.

We hope to not only gather quantitative data which will provide key evidence as to the scale of the issue amongst Amerindian participants but also to try and find out the how Amerindian communities feel about the changes in Guyana...

Assess whether Amerindians who are exposed to Western diet and lifestyle are at increased health risk.

Assess cultural, social and spatial factors that influence attitudes and use of healthcare.

Qualify perceptions of health care provision in its current form.

Analysing perception of body image and diet amongst Guyanese Amerindian Women.

Develop research techniques in working with indigenous communities.

Develop skills in working with an international team and build strong relationships with the partner team at the University of Guyana.

Improve personal skills and abilities in field research.

Lay the foundations for future research in this unique environment and attempt to enable University of Guyana students to conduct research themselves in the future.

The Participants

In order to assess the differential risk to Amerindians in comparison to the more general population within Guyana the study will divide participants, defined as males and females aged 18-70 who are capable of giving informed consent, into three groups:

1.Non-Amerindian urban Guyanese presumed to be exposed to western lifestyle but without genetic risk factors. (100 male, 100 female).

2. The Amerindian populations living in urban areas (assumed to have heightened exposure to western cultural influences) (100 male, 100 female).

3. Mukushi Amerindian populations living along the Rupuni and Rewa rivers assumed to have minimal exposure to western culture (maximum number dependant on recruitment success)

Recruitment of participants will be through community health groups identified by the University of Guyana in suburban Georgetown and surrounding areas. The ministry of Amerindian affairs will aid in liasing with Amerindian Guyanese living within the Interior and through them we will be arranging specific requests for access from village leaders from the Mukushi tribes. Arrangements have been made with the University of Guyana to commence data collection over a series of months before the Aberdeen team arrives. This partner team will conduct the city based research and a week of data collection in Georgetown, the Aberdeen team (with three Guyana team members) will travel up the Rupununi and Rewa rivers, visiting several tribes that live along its banks who will have been contacted and agreed in advance to our visitation. The Rupununi region was chosen for this pilot project after discussions with local partners, while not the most isolated of the Amerindian communities the Mukushi tribes to be visited along this river. The remoteness of further tribes and the anticipated difficulty in obtaining permission for visitation precludes visitation of tribes such as the Wei Wei at present. However it is hoped that relationships and understanding built up in this initial visit will facilitate more comprehensive data collection in the future.

Due to the remoteness of the Interior phase of the study and lack of information on precise village size and location, it is difficult to establish a definitive number of participants for the jungle phase. As a result we will recruit as many participants as are willing and who meet our agreed parameters (18-70 years of age, spent whole life residing in the Interior, infrequent western contact (not tour guides)). The common language used in the area is English, but as Mukushi as also spoken we have employed guides who are willing to act as translators, and have ensured that participant information and consent can be delivered through the Mukushi language.

Assessing whether Amerindians who are exposed to Western diet and lifestyle are at increased cardiovascular and respiratory health risk.

1.

Multiple Indigenous populations such as American Indian, Alaska Natives, Native Hawaiians and Other Pacific Islanders, have been shown to have a higher risk of developing Non-Communicable Diseases (NCD’s) after having been exposed to a westernised diet and lifestyle, (Hutchinson and Shin, 2014; Mau et al., 2009). These NCD’s include diabetes, metabolic syndrome, hypertension, cardiovascular disease, and respiratory disorders. In the current proposal, hypertension, peak flow, BMI and hip-waist ratio will be investigated. Relatively simple procedural techniques are being used due to the difficulty posed by reproducibility in a jungle based setting, as well as being consciously aware that more invasive investigations could result in psychological and social damage in primitive communities. 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, with large numbers of non-Amerindian people traveling into the Interior, thus increasing the exposure of Amerindian people to Western diets and lifestyles. Assessing the population risk would allow policy makers to act in the best interest of the Amerindian community.

The aim is to determine if there is an increased health risk posed by western lifestyles to Amerindian Guyanese compared to non-Amerindian Guyanese. This will be assessed through risk factor comparison between those Amerindians with a traditional lifestyle and those Amerindians in urban areas.

Research Objectives

Diet and Obesity - looking at the Body Mass Index (BMI) and hip to waist ratio of city based compared to Interior based Amerindian people.

Peak flow (a non-invasive assessment of lung function) in city vs interior based Amerindian people, as well as smoking prevalence.

Blood pressure (hypertension prevalence) in city vs interior based Amerindian people.

General health questionnaire - Assessing a variety of variables and conditions including : ethnicity, age, diet, exercise, smoking, diabetes prevalence and mental health status.

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).

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2. Analysing perception of body image and diet amongst Guyanese Amerindian Women.

The current burden of obesity and lifestyle related disease worldwide is undoubtedly multifactorial (Popkin and Doak 1998). The increase in portion sizes and change in the constituents of the diet have been in part driven by increase in wealth and availability of food, but also 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 Ng, 2012). In short their needs to be research into the determinants of healthy eating. As Guyana teeters on the brink of major socioeconomic development the Amerindian population has increasing access to processed foods high in sugars, saturated fats, salts (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. Evidence suggests that patterns of disordered eating that play a major role in the obesity crisis are greatly by social and cultural behavioural pattern. As a westernised lifestyle exposes women to 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.

Aim

To compare understanding and attitudes of factors known to influence obesity in women between 18-50 years in three separate groups: Amerindian women and Guyanese women in and around Georgetown and Amerindian women residing in the interior of Guyana, as well as views of women of the same age in Great Britain

Research objectives

To obtain information of the following key areas:

Access the availability of food, content of diet and portion size.
Perception of diet
Food and development
Emotional responses and eating
Perception of body image and beauty

Methodology

The study will comprise of a series of semi structured recorded interviews with those living in the city and those living in the interior. Consent for interviews to be recorded will be obtained and an explanation of the purpose of the questions will be given. Discussion with Guyanese guides and students will be carried out upon arrival in Guyana with regard to specific phrasing or to inform the interviewers of cultural sensitivities that may require us to adapt the questions. We would aim to interview 10-20 women between 16-50. Women of childbearing age have been chosen as the target group for the enquiry as they are pivotal figures in determining the way society consumes food, they are the principal providers of food in most cultures and the variation in cultural perception of ideal body image is most pronounced in females. The questions below are just guiding questions, the context of the interviews may alter the questions and challenges like language barriers and cultural sensitivity may lead researchers to adapt the questions. Supporting evidence provided by the team’s general observations with, pictures of local food sources and Amerindian cuisine.

Key Questions:

1. ACCESS TO FOODs

a)Where do you get your food?

b) How much does food cost? (Proportion of income)

2. DIET CONSTIUENT and PORTION SIZES

a. What/when do you eat in a normal day?

i. Morning

ii. Evening

iii. Night

b. Are there foods you do not eat? Why?

c. Who prepares the food?

d. What do you drink?

3. PERCEPTION of DIET

a. What foods do you dislike?

b. What foods do you like?

c. What does unhealthy food mean to you?

d. What is it important to eat?

e. Can food make you ill? Why?

f. What do you think of American food?

4. FOOD and DEVELOPMENT

a. What do children eat?

b. When are children weaned?

5. DIET and EMOTIONAL FACTORS

a. Do you eat differently when you are upset/happy/sick?

b. Do you think food is used as a reward?

6. BODY IMAGE

Ask participants to choose a flashcard

a. Do you like the way you look?

b. Which one do you think is the most beautiful?

c. What is a healthy body?

3. Assessing the availibility to, and perceptions of healthcare in Amerindian communities

The ‘hinterland’ is the regional classification given to ‘remote and rural’ Guyana, the topography in such areas predominantly consists of mountain ranges and dense rain forests accounting for population densities as low as <1 person per square kilometer. The population and spatial dynamics of Guyana’s hinterland create inherent difficulties in implementing health care policy, additionally variations in cultural factors influence the accepted standard of government provide health care in remote and rural regions. The proximity and accessibility of built up populated areas &/or ‘Western influences’ on Amerindian populations must be taken into consideration, currently there are very few if any villages in Rewa and surrounding areas that have not been impacted by Western culture.

Aim

The primary objective of the study is to establish the extent of accessibility to health care of Amerindian populations residing in Guyana’s ‘hinterland.’ Currently this varies greatly from accessibility to health care experienced by populations in Guyana’s urban regions, specifically the capital Georgetown. The following research objectives shall be conducted by a means of quantitative and qualitative methods to establish the factors, which contribute to the accessibility and format of healthcare experienced by hinterland populations. Additionally some objectives aim to establish differences in the perceived acceptable standard of healthcare, incorporating socio-economic, mobility, accessibility and spatial factors, with an overarching aim to establish why variations in accessibility to healthcare exists, and the what this means to those implementing health care in Guyana, and to those that it effects.

Research objectives

Establish the spatial factors which influence accessibility and the extent to which they do so.

Establish social/cultural factors which influence accessibility and the extent to which they do so.

Establish the perceived spatial factors which influence accessibility and the extent to which they do so.

Establish the perceived socio-economic factors which influence accessibility and the extent to which they do so.

Establish the differences in perception, if any exist, of the format and availability of the health care the currently exists for rural/remote populations and the potential health care that WHO and PAHO aim to provide.

Methodology

Data collection shall be based primarily on a questionnaire which shall be conducted in each of the villages visited in a five week time frame.

In addition to this a series of informal recorded interviews shall be conducted with a variety of willing participants with the aim to interview residents of the village that vary in age, gender, health, education and perceptions of what healthcare is and how it is and should be administered.