Determinants, Health Problems, and Food Insecurity in Urban Areas of the Largest City in Cape Verde
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design Overview
2.2. Sampling Procedures
2.3. Data Collection and Analysis
2.4. Ethical Considerations
2.5. Characteristics of Participants
3. Results
3.1. Health Problems: Hypertension and Obesity—Perceptions about the Main Causes
“The causes [of hypertension] are exaggerated consumption of salt and fatty foods (such as pork and beef)”.(FG-F1-women)
“Unemployment causes stress and ... people who are studying, when you finish college and cannot find work. This causes a lot of stress”.(FG-T7-men)
“Stress, excessive intake of salt, alcohol [are all causes of hypertension]”.(FG-I2-men)
“As my colleagues just talk, is not only the food, also the concerns ... with regard to food, we know we have to avoid many things that are bad like salt. I just eat something with lots of salt, then I feel the difference. It’s salt and fat”.(FG-I6-women)
“There are many people here in Cape Verde with this problem [of hypertension] because of stress, we are living in an insecure environment”.(FG-I5-women)
“Insecurity also causes a lot of stress at home, when we turn on the TV. (...) Cape Verde has many single parents and it also hurts a lot because only one person is working to support the house, and gets a lot of problems in the head, I think it also influences.”(FG-T7-men)
“(…) There is a lot of unemployment, crime, too much tension, the economic situation is bad and there is also very excessive consumption of salt, obesity, all this causes hypertension”.(FG-I5-women)
“Well, first I think it’s the food ... Another is the family history, for example, in my case, my mother is hypertensive, my grandmother, my aunt ... and I also have a tendency, whenever I am anxious my tension starts to rise .... eating habits because of the rush, lifestyle, and family history”.(FG-T9-women)
“There are many young people now with high blood pressure because of drug use, alcohol, stress”.(FG-I2-men)
“But from the moment we begin to eat imported foods.—Yes, precisely. When we ate natural foods, ‘product of our land,’ no one had this problem. Look at the example of my father who is 96 years old
(…)—I think they are [changing us all]".(FG-I4-men)
“I think what leads to overweight is poor diet, especially when they do not include salad, fish, fruit and also the lack of physical exercise, drink[ing] less water (...)”.(FG-I5-women)
“Because the food we now consume is not from our land as two years ago. Two years ago we were eating only products of agriculture [and] fishing and today we have almost no fish because the boats are coming out to fish the best fish and take it. We have few fish and it is expensive. And we do not have access, then the only solution we have is ... and the food as we know has many chemicals that bring diseases such as cancer and some more (...) ".(FG-T7-men)
“[Traditionally] We seek more quantity than quality”.(FG-T7-men)
“The problem is that the Cape Verdean[s] like food that fills the stomach, the salad does not satisfy enough. —Salad is a light food, does not satisfy, you can eat now and get it over with hunger. In Cape Verdean tradition, it is not so. —Yes, exactly, the Cape Verdean prefers cachupa [a traditional dish] with chicken, fish, chorizo with everything and anything”.(FG-I2-men)
“We Cape Verdeans always prefer a plate of "cachupa” (…)—“Beans with fried fish (preferably). Because the food is greasy, has too much salt and almost always includes fried foods (...)—It’s a bomb to the stomach”.(FG-I5-women)
“You can eat well in kiosks, for example, I have eaten there, and they usually have salads with carrots, beets, lettuce, and cucumber. Where I do not advise, it is “Sucupira” [local market] ... Because the food they make there is harmful to health (...) too fat”.(FG-I5-women)
“Cachupa, bean stew with meat, fish, all mixed up, I do not think that is healthy ..." (street food).(FG-I2-men)
“We [take our] morning coffee (...) our routine does not allow us to eat on time. (...)—I agree ... our routine does not have a power on time. (…)—In addition to not eat healthy foods Cape Verdeans have a bad habit of not eating on time”.(FG-F1-women)
“In [the] poor area is breakfast, lunch and dinner in the VIP area they have lunch in the middle and we do not snack in between. That’s why we, the poor, we care to take a good coffee, sometimes with good bread with butter and a glass of milk. At lunch increases our concern to eat much for the belly is full. We [eat] rice, beans, or cachupa and that’s it. (…)—It’s the same thing. Once we lunched [on] rice or xerém and dinner was cachupa. Now things have changed, if you eat rice or cachupa at lunch, at dinner you can make a soup. And not all people do it because it depends on the economic possibilities of each one”.(FG-T10-women)
“There are people who do not have time to cook because of the work routine, but some eat because they like, you know everything that is fried tastes different (…)—It is not only the food which increases weight, contraceptive method also contributes to it ... This is my case”.(FG-I5-women)
“Yes ... (I think people do not eat well). (…)—I do not say good or bad, depends on the conditions of each one, sometimes for lack of economic conditions you cannot make a healthy diet. (…) —If you can only afford to eat in these places (restaurants/kiosks) you cannot do anything, so I think [having] a healthy diet depends on the economic conditions of each one ... For example, if I have $70 (Cape Verde escudos ($); $100 = 0.90€ (euros)—currency in October 2016) and find a meal in these places (cachupa, beans ...), even aware that it is not appropriated, and it is not good for our health, I will eat”.(FG-I3-men)
“I also think that the lack of physical exercise can lead to those problems too [obesity and hypertension]... ”.(FG-I3-men)
“People who work sitting (...).—Vendors [Rabidantes] (...).—The people working in the market”.(FG-I2-men)
“People who work sitting [are] more likely to get fat ... For example, people working in offices”.(FG-I3-men)
“Students, workers, taxi drivers, those working in the bus sector (…)—They eat a lot of food “on the street" (…).—Because they always work in the same place and do not have time to prepare the food”.(FG-T7-men)
(Market vendors)—Yes, they also tend to put on weight, they are still and always eating fatty foods”.(FG-I3-men)
(Market vendors)—They have poor eating habits, such as fried food, street food”.(FG-T8-women)
“There are people who work on the street and do not have time to go home.—They have to eat at the kiosks.—Certainly [it’s] not the cheapest food, but it’s a matter of time”.(FG-I6-women)
3.2. Health Issues: Alcohol, Quality, and Quantity—A Double Problem?
3.2.1. Quality of Alcoholic Beverages
“—There is no control of production quality”.(FG-F1-women)
“(...) the quality of ‘grog’ is very bad and damages health”.(FG-I5-women)
“It’s easy to produce the grog”.(FG-I6-women)
“—Also the quality of alcohol (…)—People put water and make “grog” in the frying pan…”(FG-T7-men)
3.2.2. Quantity of Alcohol Consumption
“[collective answer] A lot of [alcohol] consumption!”(FG-T7-men)
“Question—What do you think about the consumption of alcohol in the city? —It´s serious! [all the others agreed]”(FG-I6-women)
“It’s more or less the same (…) is equal consumption on weekdays and at the weekend...”(FG-I2-men)
“But now for young people [it] is not like that ... they drink every day”.(FG-I4-men)
“In my area is every day (...). Serious! [Alcohol intake]”(FG-I6-women)
“Both ... Family parties and street events”.(FG-I5-women)
“Drink in all areas”.(FG-T7-men)
“Most young people now;—Young people drink more;—More the younger than the older ones.
Even young people, even children;—10 to 12 years (...)”.(FG-I2-men)
“In my neighborhood are mostly young people who consume alcohol (...)”.(FG-I3-men)
“Usually start from 11 to 16 years (…)—When I was in high school we took juice for lunch, but now is the ’bottle’ (grog) $100 ($100 = €0.90—currency in October 2016)”.(FG-T8-women)
3.2.3. The Availability of Alcoholic Beverages
“There are also those kiosks selling drinks to anyone, even to minors because there is no supervision. (…) There are many people who sell alcohol and disguise that as they are selling candy”.(FG-F1-women)
“It is normal to see a kid with a bottle of alcohol, sometimes even out of curiosity (...).—It’s not limited (access of alcohol to children), although there is a law that prohibits the selling of alcoholic beverages, there are places that sell to children simply because they say were sent by the parents (...)”.(FG-I2-men)
“I think the liquor is cheaper than food”.(FG-I2-men)
“Of course (the drink is cheaper than food). 1 L of spirits costs 200 escudos ($200 = €1.80—currency in October 2016). (…) It’s not cheap. It’s almost free!”(FG-I4-men)
“Now you can buy a bottle of brandy for $100 ($100 = €0.90—currency in October 2016). [Another woman agreed]—$90(FG-F1-women)
“Let me just say one thing, it’s easier to raise a seller from bed in the middle of the night to sell a bottle of alcoholic beverage than 1 kg of rice”.(FG-I2-men)
“Now I can send my son to buy beer and he can buy”.(FG-I6-women)
“This is because children tend to follow the examples of those closest and nowadays all kids from 10 to 20 years consume alcohol, I know cases of children from 11 to 15 years…who consume alcoholic beverages, smoke and there’s nobody to guide them (...)”.(FG-I3-men)
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
- FAO. Trade Reforms and Food Security; FAO: Rome, Italy, 2003; Available online: http://www.fao.org/3/a-y4671e.pdf (accessed on 15 July 2016).
- Boon, E.K. Food Security in Africa: Challenges and Prospects. ”Regional Sustainable Development Review: Africa, Encyclopedia of Life Support Systems (EOLSS); Eolss Publishers: Oxford, UK, 2004. [Google Scholar]
- Coleman-Jensen, A.; Gregory, C.; Singh, A. Household Food Security in the United States in 2013; U.S. Department of Agriculture, Economic Research Service: Washington, DC, USA, 2014.
- Kirkpatrick, S.I.; Dodd, K.W.; Parsons, R.; Ng, C.; Garriguet, D.; Tarasuk, V. Household food insecurity is a stronger marker of adequacy of nutrient intakes among Canadian compared to American youth and adults. J. Nutr. 2015, 145, 1596–1603. [Google Scholar] [CrossRef] [PubMed]
- Tacoli, C.; Bukhari, B.; Fisher, S.; International Institute for Environment and Development, Human Settlements Programme. Urban Poverty, Food Security and Climate Change; Human Settlements Group, International Institute for Environment and Development (IIED): London, UK, 2013. [Google Scholar]
- UNFPA Urbanization. Available online: http://www.unfpa.org/urbanization (accessed on 1 September 2016).
- Instituto Nacional de Estatística de Cabo Verde Estatísticas por Tema: Evolução da População Urbana 1990–2010. Available online: http://www.ine.cv/dadostats/dados.aspx?d=1 (accessed on 31 August 2016).
- Vieira, A. Qualidade e Segurança de Alimentos Tradicionais Em CABO Verde; Tese Grau de Doutor, Universidade de Lisboa: Lisboa, Portugal, 2015. [Google Scholar]
- Ziraba, A.K.; Fotso, J.C.; Ochako, R. Overweight and obesity in urban Africa: A problem of the rich or the poor? BMC Public Health 2009, 9, 465. [Google Scholar] [CrossRef] [PubMed]
- Abrahams, Z.; Mchiza, Z.; Steyn, N.P. Diet and mortality rates in Sub-Saharan Africa: Stages in the nutrition transition. BMC Public Health 2011, 11, 801. [Google Scholar] [CrossRef] [PubMed]
- Dop, M.C.; Pereira, C.; Mistura, L.; Martinez, C.; Cardoso, E. Using household consumption and expenditures survey (HCES) data to assess dietary intake in relation to the nutrition transition: A case study from Cape Verde. Food Nutr. Bull. 2012, 33, S221–S227. [Google Scholar] [CrossRef] [PubMed]
- Organisation Mondiale de la Santé. Global Status Report on Noncommunicable Diseases 2014: Attaining the Nine Global Noncommunicable Diseases Targets; A Shared Responsibility; World Health Organization: Geneva, Switzerland, 2014. [Google Scholar]
- Terrell, A. Is food insecurity associated with chronic disease and chronic disease control? Etnicity Dis. 2009, 9, 3–6. [Google Scholar]
- Seligman, H.K.; Laraia, B.A.; Kushel, M.B. Food insecurity is associated with chronic disease among low-income NHANES participants. J. Nutr. 2010, 140, 304–310. [Google Scholar] [CrossRef] [PubMed]
- Irving, S.M.; Njai, R.S.; Siegel, P.Z. Food insecurity and self-reported hypertension among Hispanic, Black, and White adults in 12 states, behavioral risk factor surveillance system, 2009. Prev. Chronic Dis. 2014, 11, 140190. [Google Scholar] [CrossRef] [PubMed]
- Oliveira, M.M.; de Malta, D.C.; Santos, M.A.S.; Oliveira, T.P.; Nilson, E.A.F.; Claro, R.M. Consumo elevado de sal autorreferido em adultos: Dados da Pesquisa Nacional de Saúde, 2013. Epidemiol. E Ser. Saúde 2015, 24, 249–256. [Google Scholar] [CrossRef]
- Franklin, B.; Jones, A.; Love, D.; Puckett, S.; Macklin, J.; White-Means, S. Exploring mediators of food insecurity and obesity: A review of recent literature. J. Community Health 2012, 37, 253–264. [Google Scholar] [CrossRef] [PubMed]
- Dinour, L.M.; Bergen, D.; Yeh, M.-C. The food insecurity–obesity paradox: A review of the literature and the role food stamps may play. J. Am. Diet. Assoc. 2007, 107, 1952–1961. [Google Scholar] [CrossRef] [PubMed]
- FRAC. Understanding the Connections: Food Insecurity and Obesity; FRAC: Washington, DC, USA, 2015. [Google Scholar]
- Wilde, P.E.; Peterman, J.N. Individual weight change is associated with household food security status. J. Nutr. 2006, 136, 1395–1400. [Google Scholar] [PubMed]
- Adams, E.J.; Grummer-Strawn, L.; Chavez, G. Food insecurity is associated with increased risk of obesity in California women. J. Nutr. 2003, 133, 1070–1074. [Google Scholar] [PubMed]
- Jones, A.D.; Ngure, F.M.; Pelto, G.; Young, S.L. What are we assessing when we measure food security? A compendium and review of current metrics. Adv. Nutr. Int. Rev. J. 2013, 4, 481–505. [Google Scholar] [CrossRef] [PubMed]
- Whitaker, R.C.; Sarin, A. Change in food security status and change in weight are not associated in urban women with preschool children. J. Nutr. 2007, 137, 2134–2139. [Google Scholar] [PubMed]
- Dammann, K.W.; Smith, C. Food-related environmental, behavioral, and personal factors associated with body mass index among urban, low-income African-American, American Indian, and Caucasian women. Am. J. Health Promot. 2011, 25, e1–e10. [Google Scholar] [CrossRef] [PubMed]
- Rehm, J.; Baliunas, D.; Borges, G.L.G.; Graham, K.; Irving, H.; Kehoe, T.; Parry, C.D.; Patra, J.; Popova, S.; Poznyak, V.; et al. The relation between different dimensions of alcohol consumption and burden of disease: An overview. Addiction 2010, 105, 817–843. [Google Scholar] [CrossRef] [PubMed]
- Husain, K.; Ansari, R.A.; Ferder, L. Alcohol-induced hypertension: Mechanism and prevention. World J. Cardiol. 2014, 6, 245–252. [Google Scholar] [PubMed]
- Briasoulis, A.; Agarwal, V.; Messerli, F.H. Alcohol consumption and the risk of hypertension in men and women: A systematic review and meta-analysis: Alcohol and hypertension. J. Clin. Hypertens. 2012, 14, 792–798. [Google Scholar] [CrossRef] [PubMed]
- WHO. Global Status Report on Alcohol and Health 2014; WHO: Geneva, Switzerland, 2014. [Google Scholar]
- Gonçalves, L.; Santos, Z.; Amado, M.; Alves, D.; Simões, R.; Delgado, A.P.; Correia, A.; Cabral, J.; Lapão, L.V.; Craveiro, I. Urban planning and health inequities: Looking in a small-scale in a city of Cape Verde. PLoS ONE 2015, 10, e0142955. [Google Scholar] [CrossRef] [PubMed]
- Lohman, T.G. Advances in Body Composition Assessment; Current Issues in Exercise Science; Human Kinetics Publishers: Champaign, IL, USA, 1992. [Google Scholar]
- Direcção-Geral da Saúde. Available online: http://www.dgs.pt/promocao-da-saude/educacao-para-a-saude/areas-de-intervencao/alimentacao.aspx (accessed on 10 Octerber 2016).
- Poulter, N.R.; Khaw, K.T.; Hopwood, B.E.; Mugambi, M.; Peart, W.S.; Rose, G.; Sever, P.S. The Kenyan Luo migration study: Observations on the initiation of a rise in blood pressure. BMJ 1990, 300, 967–972. [Google Scholar] [CrossRef] [PubMed]
- Steptoe, A.; Kivimäki, M. Stress and cardiovascular disease: An update on current knowledge. Annu. Rev. Public Health 2013, 34, 337–354. [Google Scholar] [CrossRef] [PubMed]
- Rosenthal, T.; Alter, A. Occupational stress and hypertension. J. Am. Soc. Hypertens. JASH 2012, 6, 2–22. [Google Scholar] [CrossRef] [PubMed]
- Noubiap, J.J.N.; Bigna, J.J.R.; Nansseu, J.R.N. Low sodium and high potassium intake for cardiovascular prevention: Evidence revisited with emphasis on challenges in Sub-Saharan Africa. J. Clin. Hypertens. 2015, 17, 81–83. [Google Scholar] [CrossRef] [PubMed]
- Ng, M.; Fleming, T.; Robinson, M.; Thomson, B.; Graetz, N.; Margono, C.; Mullany, E.C.; Biryukov, S.; Abbafati, C.; Abera, S.F.; et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014, 384, 766–781. [Google Scholar] [CrossRef]
- Food Insecurity in the World. Meeting the 2015 International Hunger Targets: Taking Stock of Uneven Progress; FAO, Ed.; FAO: Rome, Italy, 2015; Available online: http://www.fao.org/3/a-i4646e.pdf (accessed on 25 July 2016).
- Osmani, S.R. Evolving Views on Poverty: Concept, Assessment, and Strategy; Asian Development Bank, Regional and Sustainable Development Department: Manila, Philippines, 2003. [Google Scholar]
- Escoto, K.H.; Laska, M.N.; Larson, N.; Neumark-Sztainer, D.; Hannan, P.J. Work hours and perceived time barriers to healthful eating among young adults. Am. J. Health Behav. 2012, 36, 786–796. [Google Scholar] [CrossRef] [PubMed]
- Larson, N.I.; Perry, C.L.; Story, M.; Neumark-Sztainer, D. Food preparation by young adults is associated with better diet quality. J. Am. Diet. Assoc. 2006, 106, 2001–2007. [Google Scholar] [CrossRef] [PubMed]
- Popkin, B.M. Global nutrition dynamics: The world is shifting rapidly toward a diet linked with noncommunicable diseases. Am. J. Clin. Nutr. 2006, 84, 289–298. [Google Scholar] [PubMed]
- Bonauto, D.K.; Lu, D.; Fan, Z.J. Obesity prevalence by occupation in Washington State, behavioral risk factor surveillance system. Prev. Chronic Dis. 2014, 11, 130219. [Google Scholar] [CrossRef] [PubMed]
- CESO CI Portugal. Estudo de Mercado Cabo Verde. 2011. Available online: http://www.ceso.pt/upload/pdf/content_intelligence/9UriZ4OM/EstudoRCV_VersaoFinal.pdf (accessed on 31 August 2016).
- Cape Verde: Non-Communicable Diseases and Conditions—AHO. Available online: http://www.aho.afro.who.int/profiles_information/index.php/Cape_Verde:Non-communicable_diseases_and_conditions (accessed on 1 September 2016).
- Kumpfer, K.L. Outcome measures of interventions in the study of children of substance-abusing parents. Pediatrics 1999, 103, 1128–1144. [Google Scholar] [PubMed]
- Dagnan, N.S.; Zengbé-Acray, P.; Ekou, F.K.; Kouassi, D.P.; Sablé, P.S.; Oussou, K.R.; Cissé, S.; Soumahoro, S.I. Urban alcohol consumption among secondary school students in Côte d’Ivoire. Santé Publique Vandoeuvre-Lès-Nancy Fr. 2014, 26, 107–114. [Google Scholar]
Stage 1 (Questionnaire UPHI-STAT) | ||||
Participants and Focus Groups by Area | Formal Area (n) | Transition Area (n) | Informal Area (n) | Total (n) |
Participants (total) | 145 | 1444 | 623 | 1912 |
Participants who gave the contact for qualitative study | 31 | 253 | 129 | 413 |
Stage 2 (Nutritional Status Assessment) | ||||
Participants (total) | 22 | 283 | 294 | 599 |
Participants contacted | 6 | 78 | 60 | 144 |
Qualitative Study | ||||
Number of focus groups | 1 | 4 | 5 | 10 |
Focus group identification | FG-F1-women | FG_T7-men FG_T8-women FG_T9-women FG_T10-women | FG_I2-men FG_I3-men FG_I4-men FG_I5-women FG_I6-women | |
Participants | 3 | 24 | 21 | 48 |
Subjects | Question |
---|---|
Health issues | Hypertension: What are the causes of hypertension? |
Overweight and obesity: What are the factors that lead people to be overweight or obese? When referring eating habits and physical activity: According to your experience, why some people do not eat healthy foods or do exercise as often as they should? | |
Alcohol: What is your perception about alcohol consumption in Praia? |
Participants | Statistics |
---|---|
Gender, n (%) | |
Men | 16 (33.3) |
Women | 32 (66.7) |
Age (years), mean (SD *) | 39.75 (15.90) |
Academic qualifications, n (%) | |
None and preschool | 8 (16.7) |
Primary | 12 (25.0) |
Secondary | 20 (41.7) |
High school | 8 (16.7) |
Marital Status, n (%) | |
Without partner | 35 (74.5) |
With partner | 13 (25.5) |
Children, n (%) | 37 (77.1) |
Body fat classification, n (%) | |
Underfat or healthy | 14 (29.2) |
Overfat or obese | 34 (70.8) |
© 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Craveiro, I.; Alves, D.; Amado, M.; Santos, Z.; Fortes, A.T.; Delgado, A.P.; Correia, A.; Gonçalves, L. Determinants, Health Problems, and Food Insecurity in Urban Areas of the Largest City in Cape Verde. Int. J. Environ. Res. Public Health 2016, 13, 1155. https://doi.org/10.3390/ijerph13111155
Craveiro I, Alves D, Amado M, Santos Z, Fortes AT, Delgado AP, Correia A, Gonçalves L. Determinants, Health Problems, and Food Insecurity in Urban Areas of the Largest City in Cape Verde. International Journal of Environmental Research and Public Health. 2016; 13(11):1155. https://doi.org/10.3390/ijerph13111155
Chicago/Turabian StyleCraveiro, Isabel, Daniela Alves, Miguel Amado, Zélia Santos, Argentina Tomar Fortes, António Pedro Delgado, Artur Correia, and Luzia Gonçalves. 2016. "Determinants, Health Problems, and Food Insecurity in Urban Areas of the Largest City in Cape Verde" International Journal of Environmental Research and Public Health 13, no. 11: 1155. https://doi.org/10.3390/ijerph13111155