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Sunday, September 30, 2018
Jigjiga Hospital Named After Meles Zenawi Changed Its Name to Suldan Sheekh Hassan
September 29, 2018 - Reflecting the changing times, a referral hospital in Jigjiga city, the capital of Somali regional state, is dropping its former name and assuming a new one. The hospital in question is Meles Zenawi Memorial Referral Hospital located in Jigjiga, Somali regional state of Ethiopia.
The corner stone for the hospital was laid by former Ethiopian Prime Minister Meles Zenawi in 2011. It was inaugurated in 2016 by former Prime Minister Hailemariam Desalegn. Since the hospital was built, it was being administered by Jigjiga University.
The hospital is believed to be equiped with modern equipment, according to the report.
The reason for the name change was not given, according to Awramba Times that broke the news.
Ethiopia is currently undergoing deep political reform led by the new Prime Minister Dr. Abiy Ahmed.
Many political groups and personlities who left the country for one reason or another, and some of whom were previously banned from the country, are returning home. Many is these groups strongly condemn the policies promoted by Meles Zenawi.
Given the new political climate in the country, such a name change is unlikely to be the last one
The Ministry of Health of Somalia has announced 34 new cases of cholera including one death for week 37 (10 to 16 September) of 2018. Since week 28, there has been a decreasing trend in the number of cholera cases reported. The cumulative total of cases is 6364, including 42 associated deaths (case-fatality rate 0.7%) since the beginning of the current outbreak in December 2017. Of 267 stool samples collected since the beginning of this year and tested in the National Public Heatlh Laboratory in Mogadishu, 80 tested positive for Vibrio cholerae, serotype O1 Ogawa.
The cholera outbreak started in December 2017 in Beletweyne along river Shabelle and has spread to Jowhar, Kismayo, Afgoye Merka and Banadir. For the past eight weeks, cholera cases have been localized in Lower Jubba and Banadir region.
In week 37, active transmission of AWD/cholera was reported in Kismayo district in Lower Jubba, as well in 10 districts of Banadir region (Darkenly, Daynile, Hawlwadag, Hodan, Madina, Waberi, Hamarjabjab, Karaan, Abdilaziz, and Yaqshid districts). Banadir accounts for 88% (30) of the newly reported cases, and also has the highest concentration of IDPs living with limited safe water and sanitation. Among them, 30% are children below 5 years old. The oral cholera vaccination campaign that was implemented in 10 high risk districts in 2017 and 2018 across Somalia has greatly contributed to the reduction in the number of new cholera cases compared to the same period in 2017.
WHO continues to provide leadership and support for activities with the Ministry of Health (MoH) to respond to this cholera outbreak, including case management, surveillance and laboratory investigations and water sanitation, hygine (WASH) and risk communication.
This week, on the job training for health care workers were conducted in cholera treatment centers in Kismayo, Farjano, Banadir and Marka. Disease surveillance data has been collected from 415 health facilities across the country through early warning alert and response network (EWARN). This surveillance system was re-established in 2017 with support of WHO, and contributes to early detection of cases as well as prompt response to outbreaks, by using an electronic platform
Increased cases of children and adults fallen ill with TB in Mogadishu
(ERGO) – Somali health officials say hospitals and health centres in Mogadishu have seen a dramatic rise in the number of people suffering from Tuberculosis (TB) over the past few months.
According to Dr Mohamed Sheikh Omar, head of the TB ward at Banadir hospital, 73 people have been treated in the hospital since May. This compares with 183 people treated there during the whole of last year.
He said most cases were treated as outpatients, whilst 15 patients, including some children, were hospitalized due to the severity of their conditions. TB treatment is provided free of charge by the hospital.
A 22-day old infant baby boy was among those hospitalised after being brought in by his mother. Dr Mohamed said the baby was the youngest TB patient he had ever seen and must have been infected by others living in the neighbourhood.
The baby is receiving drugs by intravenous drip and by adding medicine to bottled milk.
Another mother, Nasro Abshir Mohamed, brought her two-year-old son to hospital on 8 August. He had been coughing for three months, Nasro told Radio Ergo’s reporter, but initially she thought he just had a cold and would recover quickly. However, due to his loss of appetite and weight loss, she finally decided to bring the child to hospital, where he was admitted for two weeks. He will need to continue the medication at home on discharge.
Another TB centre in Mogadishu’s Hamar-jajab district has treated 200 patients in the past three months. The director, Dr Nur Mohamed Abdi, told Radio Ergo that the centre treated 100 TB patients in the whole of 2017. Among the 25 patients seen in the last two weeks, there were 12 children under the age of five.
The health centre attracts many poor people and IDPs from other areas to come there for free services. The doctors often diagnose TB after a patient’s visit for another purpose.
Dr Nur advised people to report suspected cases of TB immediately to the health centre to contain the spread of the disease. Treatment for TB takes many weeks and involves a sustained course of drugs.
Research by the Ministry of Health of the Federal Government of Somalia and the World Health Organization last year reported more than 62,000 people living with TB. The head of the ministry’s Department of Tuberculosis, Dr Abukar Dini, said the ministry is concerned by the high number of cases and is working on creating more awareness about the disease.
Dr Dini said this communicable disease is more common in southern Somalia, especially in urban areas due to high population density where it spreads widely.
Doctors say there has been little awareness raising over the importance of the TB vaccination for children.
Welcome Center: Health clinic expands services to help Somali refugees, immigrants
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Abdikadir Abdi, originally from Somalia, works with a client with papers at the Welcome Center on Southwest Fourth Avenue in Ontario, provided by Four Rivers Health Care.
Larry Meyer | The Argus ObserverONTARIO — Four Rivers Health Care in Ontario began in 1999 as a clinic to serve the medical needs of low-income people not covered by insurance or other programs, but has now added services to help some of the area’s newest residents — immigrants and refugees.
The Welcome Center, located in the health clinic, has been open since May, center director Renee Cummings said. It helps families with myriad services, such as finding jobs, filling out applications, providing translators and following up with employers, Cummings said. It also serves to get the immigrants and refugees engaged in the community.
About 50 families, Iraqis and Somalis, have come to the area from larger cities where they first arrived in the U.S. Some of those cities include San Diego, Portland and Boise, Cummings said. The refugees are often drawn to the rural communities where housing and the overall cost of living are lower, she said. Some also prefer less crowded areas.
The health clinic obtained a grant to open the Welcome Center as an outreach to refugees coming into the area. It works with the Immigrant and Refugee Organization, which is based in Portland, and which has provided two Arabic speakers and one Somali speaker to help with translation services. Agency officials will be coming to Ontario in the next few months to see what the needs are, and to determine what direction the Welcome Center needs to go.
Cummings, who was formerly executive director of Harvest House Mission and more recently worked at Community in Action, said she was approached by officials of the health clinic to be the lead at the Welcome Center. She said she accepted with some trepidation.
I know only English,” she said, adding that she had never worked with refugees.
“It was challenging,” she said of the language barriers.
It is definitely needed for this area,” Cummings said of the center. Some simple things can be complicated when people don’t know the language or the culture and want to get employment out in the community.
As many as six to 10 families per day visit the center, which is open Monday through Friday.
Local businesses who are employing some of the refugees include WalMart, Woodgrain Millwork, Dickinson Frozen Foods, Fry Foods and CTI Foods near Wilder, Cummings said.
Many of the refugees have education degrees and skills that are not recognized in the United States, such as teachers and engineers. However, there are efforts in the U.S. and Canada to get that education of the refugees recognized so they can use their expertise.
One of the people working at the Welcome Center is Abdikadir Abdi, himself a refugee from Somalia, who lived in a refugee camp in Kenya for seven years, from age 7, before he was able to come to the U.S. in 2007, at age 14.
Now living in Boise with his family – a wife and five children – Abdi, 28, said he plans to move to Ontario. He is preparing to start classes at Treasure Valley Community College to study nursing.
In the meantime, Abdi has started the Somalia Community Association in Ontario, through which he helps Somalis coming into the area to settle in and to feel more at home.
Peacekeepers conduct free cleft lip surgery in Somalia
Doctors from the African Union Mission in Somalia (AMISOM) are conducting the operations in partnership with the international cleft lip charity, Smile Train, and Washington-based Company, Bancroft Global Development.
It is hoped that the camp will benefit over 100 patients in the region.
Team leader, Dr. Col. James Kiyengo, said the medical camp will benefit both children and adults.
We are also going to do cleft palate surgery and also we are training doctors of Kismayo General Hospital on how to conduct cleft lip surgery,” said Kiyengo
Cleft lip and palate is a condition that occurs when a baby’s lip or mouth does not form fully during pregnancy. It can either be a small or large opening that goes through the lip to the nose, making feeding and speaking difficult.
Somalia is slowly reconstructing after decades of conflict, little has been spent though on improving public health, education or infrastructure so far.
The high cost of treatment and lack of specialists in the country means many patients are not able to access the healthcare services they need.
Treatment often entails two or three operations and involves various specialists, including therapists, psychologists, dentists and odontologists working together to ensure the surgery is successful.
Dr. Kiyengo says the exercise is expected to help address some of the challenges faced by residents with cleft lip problems.
Many children with the condition often grow up ostracized by society.
These cleft lips are a problem because the child cannot play with other children, he cannot go to school, he is not comfortable with neighbours and when he grows up he can’t marry or get married and after that he cannot even work because some people cannot employ him, so when we do one cleft lip we solve the problem for the family of the child; he can get employment so his family is going to exist and get supported,” he said.
“I brought him [child] from Bula Haji town which is about 90 kilometres from Kismayo, and thank God, his operation was successful and I hope he will get even better treatment. There is noticeable change, because initially the lip was open but it has been corrected. I expect a lot more improvement but for now, he is healthy and will get better,” said Mohamud Kuresh Ibrahim, a parent.
AMISOM deployed to Somalia in 2007 to help restore order and defeat the Islamist militant group al Shabaab. It is credited with pushing al Shabaab out of many towns in south-central Somalia, strengthening the hold of the Somali federal government. Source
Unite to Light Donates 250 Solar Chargers to Local, International Nonprofits
Unite to Light, a Santa Barbara based nonprofit, donated 250 of its new solar charger amd battery banks to three nonprofits, Direct Relief, Africa Schools of Kenya and Edna Adan Hospital Foundation in Somaliland.
The donations were enabled through Unite to Light’s Buy One, Give One business model that dedicates a charger for every one purchased. Chargers were sold as part of a re-sale”event in June to launch this new product.
Unite to Light was founded in 2010 when Dr. John Bowers met a visiting professor from Ghana and learned of students unable to study at night due to the lack of electricity. They developed a low cost, highly efficient, durable solar lamp.
The new solar charger is the result of feedback from clients to meet a growing demand for power for phones, tablets and small medical devices.
To date, Unite to Light has distributed some 105,000 solar lamps and solar chargers to help children learn to read, enable midwives and community health clinics, and assist in times of disaster.
“Direct Relief is actively responding to multiple complex emergencies and civil conflicts around the world,” he said.Andrew MacCalla, director, International Programs & Emergency Preparedness and Response at Direct Relief told how they would prioritize the donation:
“The solar chargers will be distributed by our local partners in places like Yemen, Bangladesh, Democratic Republic of Congo and Uganda primarily benefiting people living in under-resourced refugee camps,” he said.
“The Unite to Light solar chargers will greatly benefit the Maasai students of Esiteti Primary School,” said Teri Gabrielsen, executive director of Africa Schools of Kenya.
“A recent Digital Literacy Training Program was introduced by our Kenyan partner, Land and Life Foundation. Keeping tablets and other electrical school supplies consistently up and running is essential to our students’ learning experience and focus,” Gabrielsen said.
Third recipient, the Edna Adan Hospital Foundation in Somaliland, will give the Chargers to the midwives they train.
“By bringing solar chargers to midwives in rural, nomadic, drought-affected communities, we expect morbidity and mortality of infants, children and their mothers to decrease,” said founder Edna Adan.
“We are honored to work with these amazing partners and provide them with the tools they need to do their important work,” said Megan Birney, president of Unite to Light.
“Our Buy One, Give One model allows us to provide chargers for camping or emergency kits to our customers here, while supporting the missions of some of our favorite nonprofits around the world,” she said.
Two Sisters Bled to Death in Somalia After a Female Genital Mutilation Procedure
Two sisters have died in Somalia from complications that arose after undergoing female genital mutilation, according to Hawa Aden Mohamed, who campaigns against the procedure.
Ten-year-old Aasiyo Abdi Warsame and her sister, Khadijo, 11, died a day after they were subjected to the procedure in the remote village of Arawda in Puntland State on September 11, said Aden Mohamed, director of the Somalia's women's rights group Galkayo Education Center for Peace and Development.
According to Aden Mohammed, the sisters were cut the same day by a local circumciser.
They continued bleeding 24 hours after the procedure, and died while their mother was taking them to a health center, Aden Mohamed said.
"Unfortunately, they never made it to the hospital as they all died on the way," said Aden Mohamed, who has been calling for legislation banning the practice commonly done on young girls in Somalia.
The sisters' death comes two months after Somalia's government vowed to pursue a landmark prosecutionin the case of a 10-year-old girl who died after female genital mutilation, a practice that is legal in the country.
Deeqa Dahir Nuur died two days after she was subjected to one of the most extreme forms of female genital mutilation, according to doctors who tried to save her after she suffered complications from the procedure performed by a local cutter in another village in Somalia on July 17.
Aden Mohamed, a survivor of the procedure, said young girls continue to bear the consequences of the practice because of the government's reluctance to pass anti-female genital mutilation laws.
It is another sad story coming even before the dust settles and action is taken in the Deeqa case. Yet there seems to be reluctance in discussing and passing the anti-FGM law," she said.
We hope that this will serve as a wake-up call for those responsible to see the need to have the law in place to protect girls from this heinous practice," Aden Mohamed added.
The report said around 200 million girls and women in the world are affected by the practice.
Female genital mutilation involves the altering or removing of the female genitals, such as the clitoris or labia. The procedure can cause severe bleeding and health issues including infections and infertility, as well as complications in childbirth.
The practice is recognized internationally as a violation of the human rights of girls and women, but remains widespread in Somalia, where more than half the female population believe it should not be abolished.
East African countries set to launch joint polio vaccination drive
Kenya, Ethiopia, and Somalia Health ministers are expected to launch a point polio vaccination campaign for the Horn of Africa in Garissa town on Friday.
They will be hosted by Kenya’s Health CS Sicily Kariuki and the county government of Garissa.
A clinical officer administering a polio vaccine to a young child on July 12, 2018. /EZEKIEL AMING'A
In a press statement on Thursday, the CS said the Global Polio Eradication Initiative recommended two rounds of synchronised polio vaccination campaigns to be conducted in Somalia, Kenya, and Ethiopia.
She said this was due to the recent isolation of more circulating vaccine-derived polio viruses in Somalia, and particularly in areas close to Kenya-Somalia-Ethiopia border.
"The first round of the campaigns in Kenya will be conducted from September 15 to 19 and subsequent round in October."
Kariuki said the campaign targets 827,089 children below five years of age.
The two planned rounds in Kenya will target 12 high-risk counties that participated in the July and August immunisation drive.
They include Nairobi, Wajir, Garissa, Mandera, Lamu, Tana River, Meru, Kitui, Machakos, Isiolo, Kiambu, and Kajiado counties.
Somalia and Ethiopia will also be conducting their campaigns within the same period.
The Ministry would like to assure the public that the polio vaccines are the usual vaccines used for routine vaccination in our health facilities," the CS said.
Kairuki added that the vaccines have undergone rigorous safety procedures during the manufacturing processes.
In addition, the Ministry, together with the Kenya Conference of Catholic Bishop's medical personnel and Vaccine testing expert committee, have undertaken further testing of the vaccines at National Quality Control Laboratory in Nairobi and the test confirmed the safety of the vaccines," the CS added.
She said the Health ministry is committed to implementing preventive health interventions and response measures as guided by national policies and in line with international requirements as provided for in International Health Regulations (IHR) 2005.
The Cabinet Secretary appealed to all Kenyans in the respective target counties to make their children available for the polio vaccine to help kick polio out of Kenya by the year 2020.
"If we achieve this, then our goal of universal health coverage will be a reality," she concluded.
Measles kill an infant and elderly mother as many others got infected in Mandera County
An elderly mother and a child are the latest victims of measles outbreak in Mandera County. The mother of eight hails from Goffa in Guticha ward in Mandera North Sub County whereas the child is from Mandera east. The late is Sarura Mohamed who is a mother of eight.The first cases of measles were reported in Mandera east in June/July this year.
Dr Edan examining a patient at Mandera County referrals hospital
This outbreak comes at a time when Mandera County is at 32% of immunization against measles outbreaks, half below the national percentage of 75 to 80%; depending on each case for specific county.
NepPlus spoke to Health County Executive Committee member, Dr Mohamed Adan who confirmed the outbreak. The total people reported with cases in health facilities are 275 in the entire County.
We are planning to combine the polio phase three and the measles immunisation next week” Said Dr Eda
I am planning to increase all primary immunisation percentage to national level which is between 75 and 80 %.” Said the newly appointed County executive committee member for health, Mandera County.
Dr Eda has worked in Coast general hospital where he played a key role in transforming the critical care unit and upgraded the ICU to state of art. Al-Furqan hospital where life saving surgeries was conducted was lead by Dr Eda. He left the government to venture into private medical practice in Mombasa.
” The response to measles outbreak has been very poor and took longer for the emergency response by the county Government” said Hussein, a resident of Rhamu, mandera North sub county.
Red cross Kenya has availed nine million shillings to mandera County for social mobilisation. Other stakeholders working with Mandera County are World health organisation, Ministry of health, Kenya and UNICEF among others.
Measles outbreak was reported in Wajir and Mandera counties in February 2018 with a total of 39 and 103 cases recorded respectively. The outbreak has since been contained through active researches, case management and enhanced outreach vaccination services.
Measles outbreak has been reported in the entire mandera except Kutulo and Banisa towns. The youngest victim is a two year old from Balawle in Takaba sub County
Measles outbreak in Kenya was reported in April 2017 in Dadaab refugee camp in Carissa. Children under 5 were affected; no one died then. By Abdullahi Alas
Prevalence and Predictors of Overweight and Obesity among Somalis in Norway and Somaliland: A Comparative Study
Abstract
Background and Aim. The knowledge about the health status of Somalis in Norway and Somaliland is limited. This paper reports the results of a comparative study on the prevalence and predictors of overweight/obesity among Somalis in Norway and Somaliland. Method. We conducted two cross-sectional studies using the same tools and procedures, between 2015 and 2016. The study population was adults aged 20–69 years ((Somaliland) and (Norway)). Results. The prevalence of obesity (body mass index (BMI) ≥30 kg/m2) was 44% and 31% in women in Norway and Somaliland, respectively. In contrast, the prevalence of obesity was low in men (9% in Norway; 6% in Somaliland). Although the prevalence of high BMI was higher in Somali women in Norway than women in Somaliland, both groups had the same prevalence of central obesity (waist circumference (WC) ≥ 88 cm). In men, the prevalence of central obesity (WC ≥ 102 cm) was lower in Somaliland than in Norway. For women in Somaliland, high BMI was associated with lower educational level and being married. Conclusion. The prevalence of overweight and obesity is high among Somali immigrants in Norway, but also among women in Somaliland. The high prevalence of overweight and obesity, particularly among women, calls for long-term prevention strategies.
Overweight and obesity are regarded as serious threats to public health which significantly increase the risk of noncommunicable diseases (NCDs) such as cardiovascular disease (CVD), type-2 diabetes (T2D), hypertension, and certain cancers [1]. The World Health Organization (WHO) estimates that overweight and obesity are the fifth leading cause of death globally. Today, nearly two billion adults worldwide are overweight or obese [2]. Along with increased body mass index, waist circumference (WC) and waist-hip ratio (WHR) are accepted as alternative predictive measurements of NCD [3].
Overweight and obesity are not only a problem in developed countries but are also dramatically on the rise in low- and middle-income countries, particularly in urban settings [4]. A high prevalence of overweight and obesity has been identified in sub-Saharan Africa (SSA), especially among women and urban dwellers [5]. Currently, there are no official data about the prevalence of overweight and obesity among the Somali population in the Horn of Africa. However, according to WHO estimates, the prevalence is not high [6].
In Norway, studies have demonstrated that non-Western immigrants tend to adopt the negative aspects of a Western lifestyle, including poor eating habits and a sedentary lifestyle, and thus become at high risk of overweight and obesity [7–9]. In women, the prevalence of overweight and obesity among immigrants is high compared to ethnic Norwegians; however, there are large differences between immigrant groups [10]. Somalis are one of the largest non-Western immigrant groups in Norway, with most of them migrating due to their country’s civil war, which started in the late 1980s [11]. Therefore, they are a relatively new immigrant group, and the knowledge about their health status in both the host country and their country of origin is limited. Results from a few studies have shown that many Somali immigrants are overweight and obese due to nutritional transition, lack of physical activity, and other factors [12, 13].
To our knowledge, no studies have yet compared the prevalence of overweight and obesity among Somali immigrants with their counterparts in the country of origin. The aim of this article was to compare the prevalence and predictors of overweight and obesity among Somalis in Oslo, Norway, and Somalis in Hargeisa, Somaliland.
2. Methods
This is a comparative cross-sectional study conducted between December 2015 and October 2016 in Norway and between March and September 2016 in Somaliland. In both studies, participants were excluded if they confirmed to be pregnant or were suffering from kidney or liver failure, cancer, and other serious diseases.
2.1. Study Population and Recruitment
2.1.1. Study 1, Oslo, Norway
The majority of Somali immigrants live mainly in eastern and central districts of Oslo. Experience from other studies on immigrant populations has shown that drawing a random sample from the Statistics Norway (SSB) and contacting possible participants through written information does not work well in many immigrant groups. Therefore, for organizational purposes, this study was limited to Sagene district, which has one of the highest populations of Somali origin in the city. Cooperation with Somali organizations, a healthy life centre, a volunteer centre, the district medical officer, and the community development centre in Sagene area was established. These user partners contributed to the recruitment of participants in this study. Information of the study was shared through local Somali radio, community centres in the district, and other locations. We could not get the exact numbers of Somalis in the district because people move frequently without reporting their new address, and the statistics data at the district level are not updated often. However, in 2015, there were 1200 persons with Somali background in all ages registered in the district. An attempt to contact every adult person of Somali background living in the district was made, and those available were invited to participate in the study. We ended up including 221 persons, and 50 persons either did not want to participate or did not come for the appointment. The participants were healthy adult men and women of Somali origin, aged 20–69 years. The response rate of the participants was 82% (221/271).
2.1.2. Study 2, Hargeisa, Somaliland
There is no population registry in Somaliland, and the only available registry is the number of households. Each household has a unique number, and the number of people residing in the household is registered at the district level. Hargeisa city composes of five major districts, of which each district is further subdivided into four main subdistricts. These subdistricts are the primary sampling unit (PSU). Due to the lack of data on the prevalence of the risk factors on the population under study, the sample size was calculated using the diabetes prevalence of 4%. The sample design for the survey was two-stage cluster sampling. The first stage units were subdistricts designated as the PSUs, and the second stage units were households. The number of PSUs targeted was twenty subdistricts, and the number of all households in the targeted PSUs was 66635 (households in all subdistricts). Out of the twenty PSUs, ten were randomly selected. A total of 1100 households were randomly selected from the ten subdistricts based on the probability proportionate to size (PPS) in each subdistrict [14]. In each household selected, all the eligible persons (20–69 years) living in the house were listed in a Kish household coversheet. The Kish method addresses the selection of gender and different age-groups in the sample. Men and women were listed in order of decreasing age (oldest to youngest) and given a rank number. Then, the Kish selection table was applied to select the eligible participant whose rank number matched with the last digit of the household. If the selected person rejected participation, another person was selected from the Kish list and continued until one person from each household was included in the study. If there was nobody at home on the day of the study, a notification card was left at the door, and we returned the next day until we had a participant from each house. Data collection continued until there were 1100 participants, resulting in a final sample of 955 women and 145 men.
2.2. Data Collection
The two studies followed similar data collection methods and used the same tools. The Hargeisa study followed the WHO STEPwise approach to chronic disease risk factor surveillance [14]. Data collection was conducted by researchers and trained fieldworkers. Participants from Oslo and Hargeisa were interviewed using a structured questionnaire. Age, education, occupation, and marital status were reported.
In both studies, body weight was measured to the nearest 0.1 kg by an electronic Omron medical scale, height was measured to the nearest 0.5 cm with participants standing without shoes using a portable stadiometer seca 213, and body mass index (BMI) was calculated as weight in kilograms divided by the square of the height in meters (kg/m2).
WC was measured at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest, using a stretch to the nearest 0.1 cm with the subject standing and breathing normally. Hip circumference (HC) was measured around the widest portion of the buttocks with the tape parallel to the floor. WHR was calculated by dividing WC by HC.
BMI was categorized according to World Health Organization classification: underweight (<18.5 kg/m2), normal (BMI 18.5–24.9 kg/m2), overweight (BMI 25–29.9 kg/m2), and obese (BMI ≥ 30 kg/m2) [15]. Central obesity was defined as WC ≥ 88 cm for women and ≥102 cm for men as well as WHR ≥ 0.85 for women and ≥1.00 for men [16].
2.3. Ethics Statement
Both studies were approved by the Regional Committee for Medical and Health Research Ethics, Norway. In addition, the Somaliland study was approved by the Ministry of Health in Somaliland. Permission to conduct the study was obtained from the local government of the municipality and household level. In both studies, written informed consent was obtained from all participants.
2.4. Statistical Analysis
Combined data were analysed by IBM SPSS statistical software-24 (SPSS Inc., Chicago, Illinois, USA). Descriptive statistics are presented as mean (SD) and percentage. We compared categorical variables using χ2test and independent t-test for continuous variables. We compared age-adjusted means for anthropometric measurements using analysis of covariance (ANCOVA). The relationship between BMI and associated variables (location, gender, age, education, marital status, and occupation) were tested using linear regression model. In addition, age-adjusted prevalence ratio was calculated in STATA version 14 by generalized linear model (log-binomial regression) logarithmic link function. A value of <0.05 was considered statistically significant.
3. Results
3.1. Background Characteristics
A total of 1320 respondents were included in the analysis, with 1100 from Hargeisa and 220 from Oslo.
In Table 1, sociodemographic characteristics of the study population are shown. In Hargeisa, more women than men were included, whereas the proportion of men and women included in Oslo was equal. The mean age (years) in men and women was similar among the groups. The educational level was relatively low among participants from Hargeisa, particularly among women where two-thirds had no formal education. Moreover, unemployment was high among women from Hargeisa (88.5%), as most of the participants were housewives. Around one-third of the men in Hargeisa and one-fifth of the men in Oslo were unemployed.
Table 1: Sociodemographic characteristics of the study population in Oslo and Hargeisa.
3.2. Anthropometric Characteristics and Prevalence of Obesity
Somali men in Oslo were taller and had higher mean weight, BMI, WC, HC, and WHR compared to their counterparts in Hargeisa (Table 2). While the prevalence of obesity among men was higher in Oslo compared to Hargeisa (9.2% versus 5.5%), the prevalence of underweight was substantially higher among men in Hargeisa than in Oslo (26.2% versus 1.8%) (Figure 1). Mean BMI was considerably higher in women compared to men in both locations. Women in Oslo had higher weight, BMI, and HC than women in Hargeisa, but women had similar height and WC in both locations. WHR was higher in women from Hargeisa than in women from Oslo, whereas 44.1% of women in Oslo were obese, and the corresponding prevalence in Hargeisa was 31.3%. Central obesity measured by WC and WHR was higher among men in Oslo (31.8% and 12.7%) compared to men in Hargeisa (6.2% and 6.9%). Central obesity measured as WC was similar among women in Oslo and Hargeisa (50.9% and 49.5%). However, central obesity measured as WHR was higher among women in Hargeisa (44.2%) compared to women in Oslo (28.6%) (Table 2). Additional analyses adjusting for age gave similar results as those presented in Table 2 and Figure 1 (data not shown).
Table 2: Crude anthropometric characteristics, obesity prevalence (%), and central obesity prevalence (%) for Oslo and Hargeisa.
Figure 1: Crude prevalence of weight categories among Oslo and Hargeisa participants.
3.3. Predictors of BMI
In both genders, higher BMI was associated with living in Oslo and increasing age (Table 3). In women, higher BMI was also associated with being married, whereas lower BMI was associated with being a student. Examining BMI in different educational groups according to location and gender showed that among women in Hargeisa, mean BMI was higher among those with lower education (1.77 (0.24, 3.32)) and slightly higher among those with medium education (1.93 (−0.01, 3.88)) compared to women with high education (university) (Table 4). No associations with education were found in the other groups. Additional analysis showed that, BMI was higher among married women and housewives in Hargeisa when compared to women in Oslo and men in both groups (data not shown).
Table 3: Associations between body mass index (BMI) and sociodemographic factors from linear regressions.
Table 4: Age-adjusted mean BMI (95% CI) and prevalence ratio (PR) (95% CI) with education.
4. Discussion
Our study demonstrated a high prevalence of overweight and obesity among women in both populations, especially in Oslo where nearly one in two women were obese. The prevalence of obesity was considerably lower in men than women, especially among men in Hargeisa where one in four men was underweight. In addition, men in Hargeisa had a low prevalence of central obesity. However, this must be interpreted with caution, as the number of male participants in Hargeisa was low. Despite a higher BMI among women in Oslo than that in Hargeisa, the prevalence of central obesity measured by WC was the same between the two groups, and WHR was higher among women in Hargeisa than those in Oslo.
To our knowledge, this is the first study comparing the prevalence of overweight, obesity, and associated factors among Somali immigrants in Oslo and their counterparts in Hargeisa. Generally, the knowledge of the health status of Somalis in both the diaspora and the Horn of Africa is limited. The high prevalence of overweight and obesity among Somali immigrants in this study, especially among women, is in line with the few studies conducted among Somali immigrants in other Western countries [13, 17]. Although the prevalence of overweight and obesity was lower in Hargeisa compared to Oslo, the prevalence of overweight and obesity among women in Hargeisa was much higher than the estimates in Global Burden of Disease (GBD) data, which were obtained from the Somali Multiple Cluster Survey [18].
The higher prevalence of overweight and obesity among women was also reported in others studies in sub-Saharan Africa (SSA) [19, 20]. Also in other ethnic immigrant groups from developing countries living in Norway, a higher prevalence of obesity has been reported among women than among men [10]. In contrast, the prevalence of obesity among ethnic Norwegians is slightly higher in men than in women [21]. The prevalence of obesity in ethnic Norwegian men was somewhat higher than in Somali men in Oslo, whereas the prevalence of obesity was much higher among Somali women in Oslo than among ethnic Norwegian women [22]. Furthermore, Somali men in Oslo had higher prevalence of overweight (51.4%) compared to men in Hargeisa (17.9%), which may be indicative of an increase in obesity in the future if no prevention measurements are taken.
It has been reported that immigrants from SSA are at increased risk of overweight and obesity-related diseases after immigration to industrialised countries [23, 24]. In Norway, studies have demonstrated that non-Western immigrants tend to adopt the negative aspects of a Western lifestyle, including poorer eating habits and an increased sedentary lifestyle [7–9]. The underlying causes of the high prevalence of obesity among Somali women in Oslo can be multifactorial, including an adoption of a sedentary lifestyle and the rapid “acculturation” of poor dietary habits, characterized by foods of low nutritional quality, high caloric density, and high saturated fat. Nevertheless, little is known about Somali diet and cultural behaviours both in Norway and Somaliland. Traditionally, Somali food consists of pasta, rice, and red meat. Additionally, tea with large quantity of sugar is an essential drink in their daily life [25]. The high prevalence of obesity among women in Hargeisa can also be due to urbanization and a rapid nutrition transition.
In the present study, Somali women in Oslo had a lower WHR compared to women in Hargeisa. However, WC was similar, and the difference in WHR was driven by a higher HC among women in Oslo. In other words, despite a higher BMI, women in Oslo had more mass accumulated on the hips than on the waist compared to women in Hargeisa. Their risk of future diseases like diabetes and cardiovascular disease might therefore be lower than anticipated from BMI alone. Some studies have recommended that proper cutoff points for BMI and anthropometric measures may need to be established for SSA populations [26, 27].
The relationship between BMI and education is nonlinear [28]. In Hargeisa, women with lower and middle education had higher mean BMI compared to those with higher education. However, both for men in Oslo and Hargeisa and for women in Oslo, results did not differ significantly. These results are contrary to the findings in other SSA countries, where BMI has been associated with higher educational level [29, 30], while other study found that women with no education and higher education had lower BMI when compared to those with some schooling [31]. One explanation for our findings is that less educated women were married housewives and might eat more calorie-dense food or have inactive lifestyle than more highly educated women. However, there was no association between mean BMI and other socioeconomic status (SES) among other participants. Further studies are needed to investigate the relationship between BMI and SES in this population.
4.1. Strengths and Weaknesses
Our study has several strengths. Similar design and standardised tools were used in the two studies, facilitating the comparisons of groups in different settings. The same project leaders in Oslo and Hargeisa conducted and supervised the teams during data collection. The weight scales were checked every morning. The Hargeisa study is the first population-based study that has been carried out in Somaliland that used the WHO STEPwise approach to noncommunicable disease risk factor surveillance (STEPS) [14].
A limitation of our study was the underrepresentation of men in Hargeisa. They constituted only 15% of the sample. Most of the men were away from home at the time of the study. If the selected men were not home, we left a notification letter that the team would come back the next day. But if they were not present the next day, we selected the next eligible person from the Kish list. Moreover, 50 eligible men refused to be included in the study. According to Somali culture, women are in the houses during the daytime and men are away working or socializing with other men. The men included might therefore have been men who were home for a special reason, such as poor health, and therefore, a selection bias may be present.
The Hargeisa study was only carried out in an urban setting. The sample was drawn from a big city with inhabitants from all Somali regions. Thus, we believe that our results may possibly be representative for cities all over Somaliland. Formerly, before separation between Somaliland and Somalia, Hargeisa was the second biggest city in Somalia. Regardless of political differences, the findings could also possibly be applied for regions in today’s Somalia as Somalis are homogeneous groups, sharing social behaviour associated with overweight and obesity such as culture, tradition, language, religion, food habits, and other attitudes.
In the Oslo study, an attempt to contact every adult person with Somali background living in the district was made. Although the Norwegian Population Registry is of high quality in many aspects, the living address is often not up to date as immigrants frequently move within the city or within the country. On the other hand, comparison of the education levels and age distribution of included participants to data from Statistics Norway suggest that the participants included in the present study seem to be representative of adults with Somali background living in Norway.
5. Conclusion
The prevalence of overweight and obesity was high among Somali immigrants in Oslo but also among women in Hargeisa. The high prevalence of overweight and obesity, particularly among women, calls for long-term prevention strategies. Achieving reductions in overweight and obesity rates for Somali people who are in the midst of a nutrition transition and who are immigrants is of critical importance in lowering high obesity-related social and healthcare costs, as well as morbidity and mortality. The sociodemographic factors associated with overweight and obesity in Somali population requires further investigation.
Abbreviations
BMI:
Body mass index
CVD:
Cardiovascular diseases
NCD:
Noncommunicable diseases
PSUs:
Primary sample units
PPS:
Probability proportionate to size
T2D:
Type-2 diabetes
WC:
Waist circumference
WHO:
World Health Organization
WHR:
Waist-hip ratio.
Conflicts of Interest
The authors declare that they have no conflicts of interest.
Authors’ Contributions
Ahmed A. Madar, Haakon E. Meyer, and Marte K. Kjøllesdal planned the study. Soheir H. Ahmed and Ahmed A. Madar carried out the data collection in Hargeisa and Oslo, respectively. Soheir H. Ahmed performed data analysis and prepared the manuscript. Haakon E. Meyer and Marte K. Kjøllesdal commented on the draft, contributed to the interpretation of the findings, and approved the final version of the manuscript.
Acknowledgments
The study was supported by the Norwegian Directorate of Health and University of Oslo (UiO). The authors thank the participants, the Somali organization, Sagene Life Health Centre, the youth volunteers, and the Sagene Medical Officer for public health for their help with this study. The authors also thank Dr. Derie Ismail Ereg, Dean of the Faculty of Medicine (University of Hargeisa), for facilitating the study in Hargeisa.
1Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway 2College of Medicine & Health Science, University of Hargeisa, Hargeisa, Somaliland 3Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
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