African Migrant Populations Research Articles

Investigating the relevance of the advanced activities of daily living tool for the screening and diagnosis of mild cognitive impairment and dementia to the Sub-Saharan African migrant population in Belgium: A qualitative focus group study

Introduction: Early diagnosis of dementia is partly based on the evaluation of the basic (b-), instrumental (i-) and advanced (a-) activities of daily living (ADL). Adapting the item content of assessment tools to maintain relevance, understanding, and equivalence of the items and scales across other groups is pertinent. However, there are limited assessment tools developed on or adapted for use on the growing older Sub-Saharan African (SSA) migrant population in Europe. Focusing on the item content, we evaluated the relevance of the advanced activities of daily living (a-ADL) tool to the older SSA migrant population in Belgium. Method: Two focus group discussions were organized with participants from the SSA community in Gent, Belgium. Relevant, irrelevant, unclear, and new items were identified. The data was analyzed through the inductive method while consensus agreements were used to arrive at refined themes. Results: Out of the 49 items on the tool, both groups unanimously agreed that 15 items were relevant and 23 irrelevant. Thirteen new items were identified, whereas 15 items were considered unclear. Conclusion: Participants agreed the tool was relevant but should be adapted. Verification and validation of these results in a larger SSA older migrant population in Belgium is strongly recommended.

Transitioning food environments and diets of African migrants: implications for non-communicable diseases.

Non-communicable diseases disproportionately affect African migrants from sub-Saharan Africa living in high-income countries (HICs). Evidence suggests this is largely driven by forces that include migration, globalisation of unhealthy lifestyles (poor diet, physical inactivity and smoking), unhealthy food environments, socio-economic status and population ageing. Changes in lifestyle behaviours that accompany migration are exemplified primarily by shifts in dietary behaviours from more traditional diets to a diet that incorporates that of the host culture, which promotes the development of obesity, diabetes, hypertension and CVD. The current paper presents a critical analysis of dietary change and how this is influenced by the food environment and the socio-economic context following migration. We used a food systems framework to structure the discussion of the interaction of factors across the food system that shape food environments and subsequent dietary changes among African migrant populations living in HICs.

Post-Migration Stressors and Mental Health for African Migrants in South Australia: A Qualitative Study.

We conducted a qualitative study involving African migrants (n = 20) and service providers (n = 10) in South Australia to explore mental health stressors, access to mental health services and how to improve mental health services for African migrant populations. This paper presents the views and experiences of African migrants about the post-migration stressors they faced in resettlement that pose mental health challenges. The participants were recruited using the snowball sampling technique. To align with the COVID-19 pandemic protocol, the data collection was conducted using one-on-one online interviews through Zoom or WhatsApp video calls. Data analysis was guided by the framework analysis. The post-migration stressors, including separation from family members and significant others, especially spouses, imposed significant difficulties on care provision and in managing children’s attitudes and behavior-related troubles at school. African cultural practices involving the community, especially elders in care provision and disciplining children, were not consistent with Australian norms, compounding the mental health stressors for all involved. The African cultural norms, that do not allow young unmarried people to live together, also contributed to child–parent conflicts, enhancing parental mental stressors. Additionally, poor economic conditions and employment-related difficulties were post-migration stressors that the participants faced. The findings indicate the need for policy and intervention programs that address the above challenges. The provision of interventions, including social support such as subsidized or free childcare services, could help leverage their time and scheduled paid employment, creating time for effective parenting and improving their mental health and wellbeing. Future studies exploring what needs to be achieved by government and non-governmental institutions to support enhanced access to social and employment opportunities for the African migrant population are also recommended.

The Changing Material Conditions of Cameroonian Migrants in South Africa: What does this say about an “Afrophobic” post-apartheid State?

Violent attacks on African migrants have produced a richer body of knowledge on African transnational migration, xenophobia/Afrophobia, and their intersections with questions of citizenship and autochthony, especially in a country that historically has always been a home for African migrants. Constellations of narratives now vilify South Africa as a demonic state whose hatred of Africans and fixation on exorcising them have short-circuited the process of nation-building. The vilification of South Africa also tells us that many researchers, scholars, and even migrants are unaware of the ways that the country has transformed the lives of its increasing African migrant population. This article reflects on the changing material conditions of Cameroonians in South Africa to understand why this “Afrophobic†state is still a key migration destination for Cameroonians. Drawing on personal exilic experiences, observations, and relevant literature, we argue that despite the victimization of Africans, including Cameroonians, this constitutional democracy has opened up political, economic and sociocultural opportunities for many Cameroonians residing permanently in the country. In forging this argument, the article interrogates the political landscape in Cameroon and examines key economic and sociocultural moments/activities in South Africa as well as accomplishments in this migrant community, to elicit how access to different opportunities in South Africa has significantly transformed the lives of Cameroonians.

The translingual subjects: Shaping identities and deconstructing rainbowism in One Foreigner’s Ordeal

The end of the apartheid era in South Africa inaugurated an increased mobility and accessibility to previously prohibited spaces. Although African migrant populations are still highly regulated in South Africa, their presence has also profoundly transformed the country’s present-day sociolinguistic and cultural landscape. The textual construction of the literary text in this study draws attention to the post-structuralist perspective which argues that languages are not closed entities but rather open systems utilised for expressive purposes in specific social contexts. Most significantly, recent sociolinguistic studies show that languages are no longer regarded as discrete systems in communication because they form expansive linguistic repertoires in contact spaces. Such an understanding of multilingual use facilitates communication across cultural, linguistic and national borders, thereby subverting exclusionary normative practices. The present article draws from translingual perspectives to examine communicative practices in literary discourse. A close textual analysis is adopted to identify how translingual practices make languaging a contested terrain meant to project multi-voiced and multi-perspectival discourses with transformative capacities in the context of the ‘rainbow nation’ metanarrative.

Acculturation and Perceived Ethnic Discrimination Predict Elevated Blood Glucose Level in Sub-Saharan African Immigrants in Australia.

Sub-Saharan African migrants experience significant sociocultural challenges, including those related to acculturation and perceived ethnic discrimination (PED), in addition to increased risk of non-communicable diseases, such as type 2 diabetes mellitus (T2DM). Although acculturation and PED are each established risk factors for elevated blood glucose level (EGBL) and T2DM, they have not been studied in relation to EBGL risk in a single model. This study aimed to investigate associations between acculturation, PED and EBGL in a sub-Saharan African migrant population in Australia. Face to face survey using a purposive sampling method was used to collect data from 170 adults, aged 18-72years. A large proportion (41.8%) of the study group was in the integration mode of acculturation, which strongly correlated positively with EBGL/T2DM, although traditional mode correlated inversely with EBGL/T2DM. PED correlated positively with EBG/LT2DM. Immigrants manifesting the integration mode were 4.2 times more likely to have EBGL/T2DM than other acculturation modes. Multiple linear regression showed that the association between integration mode and EBGL/T2DM was mediated by PED. The apparent interaction between PED and acculturation in relation to EBGL/T2DM risk suggests that interventions to lower T2DM risk in this population may benefit from incorporating strategies to address these two important health determinants.

Abstract P078: Racial Differences in the Association Between Diabetes and Length of Residence Among African Migrants to the US

Background: In the US, length of residence has been shown to increase diabetes risk in migrants. Unfortunately, there is a dearth of research on the topic for African migrants especially as it relates racial differences. However, the prevalence of diabetes is higher in North Africa compared to sub-Saharan Africa. Thus, the goal of our study was to assess the effects of race on the association between the length of residence and diabetes among African migrants. Hypothesis: There is a positive association between length of residence and diabetes among non-Black African migrants compared to Black African migrants. Methods: Data from the 2010-2017 NHIS (National Health Interview Survey) were analyzed. The initial sample selected 1911 individuals, 18 years or older, whose birthplace was Africa and who answered questions about diabetes diagnosis. After selecting on non-missing values, the final sample included 1899 African migrants. Chi-square tests and logistic models were used to assess the association between race, length of residence divided into less than 10 years vs 10 years or more and, diabetes. Results were weighted to account for the complex sampling design. Results: The prevalence of diabetes in the selected population was 5.9 % (95% CI: 4.8%-7.1%). The prevalence was significantly higher (p=0.027) for non-Black migrants (8.2%, 95% CI: 5.7-11.6%) compared to non-Black migrants (5.1%, 95% CI: 4.1- 6.3%). Additionally, a larger proportion of non-Black migrants (74.5%, 95% CI: 69.9-78.5%) had resided in the US for 10 years or more compared to Black migrants (58.6%, 95% CI: 55.6-61.6%; p<0.001). The age-and gender-adjusted regression analysis revealed there was no significant association between diabetes and length of residence (OR= 1.41, 95% CI: 0.78-2.55) in the general African migrant population. While the association remained non-significant among non-Black African migrants (OR=0.54, 95% CI: 0.15-1.92), the age-and gender-adjusted model revealed that Black Africans who had lived in the US for 10 years or more were twice more likely to be diabetic compared to those who had lived in the country for less than 10 years (OR=2.02, 95% CI: 1.09-3.77). Conclusions: In conclusion, in the US, the association between length of residence and diabetes was significant for Black Africans and non-significant for non-Black Africans. These results suggest the need for diabetes prevention programs that acknowledge the racial and cultural diversity of African migrants.

Medication non-adherence and blood pressure control among hypertensive migrant and non-migrant populations of sub-Saharan African origin: the RODAM study.

Large differences in blood pressure (BP) control rates have been observed between sub-Saharan African migrant populations in Europe compared to their counterparts living in Africa. Our main objective was to investigate whether inter-geographical differences in BP control rates can be explained by differences in medication non-adherence. Additionally, we studied the prevalence of medication non-adherence and associations between medication non-adherence, socio-demographic-related, clinical/treatment-related, lifestyle factors, and experienced stress on the one hand and BP control on the other hand. We used data from the multi-center RODAM (Research on Obesity and Diabetes Among African Migrants) study, from Ghanaians receiving antihypertensive therapy and residing in three European countries versus non-migrants residing in rural and urban Ghana (n = 1303). Bivariate and multivariate logistic regression analyses stratified by sex were applied. We found inter-geographical differences in BP control rates among Ghanaian males but not among females. Ghanaian males residing in Amsterdam and Berlin had not only the lowest BP control rates but also the lowest rates of medication non-adherence. Inter-geographical differences in BP control rates among males became therefore more pronounced after adjustment for medication adherence. Medication non-adherence was significantly and independently associated with suboptimal BP control in males and females. Other factors associated with suboptimal BP control in females were a higher number of prescribed antihypertensives, higher fasting glucose levels, and pregnancy-induced diabetes. When adjusted for medication non-adherence and socio-demographic-, clinical/treatment-, lifestyle-, and stress-related factors, inter-geographical differences in BP control in males disappeared, except for Berlin. In conclusion, the observed inter-geographical differences in BP control rates in Ghanaian males cannot be explained by differences in medication non-adherence.

Ramadan in the Republic: Imperial necessity and local religious assistance to Muslim migrants

In May 1953, a group of Lyon’s political and social leaders hosted a series of Ramadan celebrations in honour of the region’s growing Muslim North African migrant population. While it seems strange that civil authorities in the secular French Republic would publically observe a Muslim holiday, the French Empire had, for decades, engaged in activities to promote Muslim attachment to France and demonstrate its support for Muslim cultural and religious practices. From declarations that France was a ‘Muslim power’ through the campaigns of the Algerian War, the French consistently waived the ideals of strict laïcité in order to strengthen the imperial system. This pragmatic willingness to relax secular positions when greater state interests were at stake contrasts with contemporary claims that the Republic can make no accommodations to Islam or its observance. More importantly, this history proves that there are strong French precedents for allowing the Republic to make space for its Muslim citizens.

Health Care Experiences and Perceived Barriers to Health Care Access: A Qualitative Study Among African Migrants in Guangzhou, Guangdong Province, China.

Guangzhou, one of China's largest cities and a main trading port in South China, has attracted many African businessmen and traders migrating to the city for financial gains. Previous research has explored the cultural and economic roles of this newly emerging population; however, little is known about their health care experiences while in China. Semi-structured interviews and focus groups were used to assess health care experiences and perceived barriers to health care access among African migrants in Guangzhou, China. Overall, African migrants experienced various barriers to accessing health care and were dissatisfied with local health services. The principal barriers to care reported included affordability, legal issues, language barriers, and cultural differences. Facing multiple barriers, African migrants have limited access to care in Guangzhou. Local health settings are not accustomed to the African migrant population, suggesting that providing linguistically and culturally appropriate services may improve access to care for the migrants.

Female genital mutilation/cutting - towards abandonment of a harmful cultural practice

Globally, the prevalence of, and support for, female genital mutilation/cutting (FGM/C) is declining. However, the entrenched sense of social obligation that propagates the continuation of this practice and the lack of open communication between men and women on this sensitive issue are two important barriers to abandonment. There is limited evidence on the role of men and their experiences in FGM/C. Marriageability of girls is considered to be one of the main driving forces for the continuation of this practice. In some countries, more men than women are advocating to end FGM/C. Moreover, men, as partners to women with FGM/C, also report physical and psychosexual problems. The abandonment process involves expanding a range of successful programs, addressing the human rights priorities of communities and providing power over their own development processes. Anecdotal evidence exists that FGM/C is practised amongst African migrant populations in Australia. The Australian Government supports a taskforce to improve community awareness and education, workforce training and evidence building. Internationally, an African Coordinating Centre for abandonment of FGM/C has been established in Kenya with a major global support group to share research, promote solidarity, advocacy and implement a coordinated and integrated response to abandon FGM/C.

End-of-life experiences and expectations of Africans in Australia

The ageing and frail migrants who are at the end of life are an increasing share of migrants living in Australia. However, within such populations, information about end-of-life experiences is limited, particularly among Africans. This article provides some insights into the sociocultural end-of-life experiences of Africans in Australia and their interaction with the health services in general and end-of-life care in particular. It provides points for discussion to consider an ethical framework that include Afro-communitarian ethical principles to enhance the capacity of current health services to provide culturally appropriate and ethical care. This article contributes to our knowledge regarding the provision of culturally appropriate and ethical care to African patients and their families by enabling the learning of health service providers to improve the competence of palliative care systems and professionals in Australia. Additionally, it initiates the discussion to highlight the importance of paying sufficient attention to a diverse range of factors including the migration history when providing palliative and hospice care for patients from African migrant populations.

‘Experts’, ‘partners’ and ‘fools’: Exploring agency in HIV treatment seeking among African migrants in London

In an attempt to promote patient agency and foster more egalitarian relationships between patients and doctors, discourse concerning health and wellbeing in the UK has increasingly centred around the notion of informed and 'expert' patients who are able to effectively input into the direction and management of their own health care and treatment. While the relationship between a patient and their doctor can play a vital role in influencing the treatment decisions and health-related outcomes of people living with long term illness, little is known about the ways in which people living with HIV actually perceive their relationship with their doctors, nor the implications this may have for the types of treatment they may seek to use and the related information that they share. Drawing on 11 focus group discussions and 20 repeat interviews undertaken in 2008-2009 with HIV-positive adult migrants from Zambia, Zimbabwe and South Africa living in the UK, this paper argues that patient-doctor relationships can be heavily influenced by the perceived legitimacy of different forms of medical knowledge and treatments and by culturally influenced ideas regarding health, wellbeing and agency. Despite a desire amongst some migrants to use 'traditional' medicines from southern Africa as well as other non-biomedical treatments and therapies, the research found that the perceived lack of legitimacy associated with these treatments in the UK rendered their use a largely clandestine activity. At the same time, many patients made clear distinctions concerning issues affecting their immediate health and factors influencing their more general wellbeing, which in turn, impacted upon the information that they chose to share with, or conceal from, their doctors. Such findings challenge assumptions underpinning policy promoting patient agency and have significant and, in cases, potentially adverse implications for the safety and effective administration and management of HIV treatments in African migrant populations and possibly more generally.

Sexually transmitted infections in an African migrant population in Portugal: a base-line study

For geographical and recent historic reasons, Portugal is a gateway and home for immigration from sub-Saharan countries. Misconceptions related to these populations often lead to consider them as high-frequency clusters for dissemination of sexually transmitted infections (STIs). Epidemiological evidence-based data is needed to elucidate these issues and baseline prevalence studies are the starting point for this. A prospective study was conducted in 220 African migrants (171 men and 49 women), recently arrived in Portugal, at the time of their first consultation. The presence of STIs was evaluated using a clinical syndromic approach and biological confirmation for gonorrhoea, Chlamydia trachomatis genital infection, syphilis, Hepatitis B and Human Immunodeficiency Virus (HIV) infection. Global prevalence of the targeted infections were 1.8% for gonorrhoea, 0 % for Chlamydia infection, 4.1% for Syphilis, 5.9% for HBsAg presence and 7.3% for HIV infection. Globally, 16.4% of the studied persons had at least one sexually transmitted infection. We concluded that prevalence rates encountered in this population is similar to that of non-migrant Portuguese populations with a high risk for sexually transmitted diseases. Therefore migration from sub-Saharan Africa doesn't seem to constitute a particularly critical isolated factor for public health risk of STIs in the community.

An agenda for future research on HIV and sexual behaviour among African migrant communities in the UK

The epidemiology of the recent rise in HIV cases in Britain highlights the need for more research among the heterosexual African migrant population. New research should not, however, only extend the limited number of studies that describe observable patterns in sexual health but should also seek to determine their underlying social causation. To achieve this, both methodological and ontological shifts are necessary in the existing research paradigm; we advocate that a broad range of qualitative techniques be deployed both to uncover the empirical details of specifically African sexual behaviours and to highlight and explore the ‘relational’ nature of sexual decision-making. Rather than fixing on individuals, analysis must situate them within the broader discursive and material frames that structure the boundaries of decision-making. In addition, researchers need to utilise the parallel literature on the social embeddedness of HIV in Africa to inform analysis of the British context. It would then be possible to address the crucial question of whether the social conditions known to cause high-risk behaviours and facilitate transmission in Africa persist, or are transformed, after migration to the UK. A key, and neglected, dimension of this is the role of spatial context in relational sexual decision-making and the constitution of social relationships in particular arenas. This needs further thought, particularly in relation to domestic space and gender identities. We believe that the research agenda proposed herein has much to contribute to interventions and service provision. Nevertheless, we are mindful of the need for self-reflexivity about our role in the production of powerful knowledges about sex. Our final proposal is that researchers seek ways to work with, not on, African communities in order to facilitate their own informed management of sexual health.

Travel and HIV/AIDS

Although travel has been recognized as contributing to the spread of HIV infection little empirical data have been collected on the specific risks of travel or why there are risks. The discussion is concerned with reviewing studies of migrants truck drivers and commercial sex workers and their relationships with travelers and HIV infection. Migration studies include work by Yelibi on Ivory Coast migrants. Gousard and Sahraoui on North African populations in France Painter on West African migrant populations Haour-Knipe on migrants in 12 European countries Van Duifhuizen on prevention with European travelers and Bronfan on Mexican migrants in the US. The spread of AIDS through truck drivers from urban to rural areas was examined by Wawer et al. on Uganda populations Gashau on Nigerian truckers the Kenya Medical Research Institute Kumaresan on truckers in Madras India and Oliveria in Brazil. Tourists as a source of transmission were examined by Hawkes in London Ankrah in Uganda and Choi in South Korea. Studies of commercial sex workers were conducted by Wirawan in Australia Wilke in Thailand and Vorakitphokatorn on Japanese tourists in Bangkok. some of the findings for instance of Yelibi were that foreigners were less educated and not as knowledgeable about AIDS. Women participated less in community and religious groups. Education must reflect these conditions. Educational messages in France should be in Arabic for less literate North African populations. The radio was a frequently cited source of information in the Ivory coast; low levels of literacy means written campaigns would be irrelevant. In the 12 European country study of AIDS prevention programs there was little evaluation conducted and a variety of programs which were linguistically and culturally sensitive. The Van Duifhuizen project aims to coordinate efforts among AIDS prevention workers across Europe; and annual publication a data base and pilot projects will be established. Findings from a truck driver study showed that transmission of HIV infection followed lines of communication along major and secondary roads in rural Uganda; distance from the main road meant fewer cases of infection. HIV prevalence was found to be 4.9% among Nigerian truckers and 27% among Kenyan drivers; only 6% used condoms.