Diet, activity, and medicine usage in South Asians at risk for cardiovascular disease in Aotearoa New Zealand
Investigators and affiliations:
- Dr Sherly Parackal, Centre for International Heath, Division of Health Sciences, University of Otago
- Associate Professor Kirsten Coppell, Research Associate Professor, Department of Medicine University of Otago, Wellington
- Dr Mudassir Anwar, School of Pharmacy, University of Otago
- Dr Sumera Akhtar, Centre for International Heath, Division of Health Sciences, University of Otago
Funding: Otago Medical Research Foundation Laurenson Bequest Award
Abstract
Cardiovascular disease (CVD) is the most potent killer in New Zealand (NZ) with NZ South Asians (SA) being one of the three high risk groups. Nevertheless, targeted prevention measures for NZ SAs are glaringly negligible. Poor dietary habits and sedentary lifestyles are strongly associated with CVD as is poor medicine usage among SAs with diabetes, a risk factor for CVD. International research demonstrates the importance of first gaining an understanding of health beliefs, knowledge, and behaviours related to diet, physical activity, and medicine usage before designing ethnic-specific interventions to reduce CVD burden. We aim to gain this understanding for SAs in NZ, which is not known.
Diet and physical activity related health beliefs, knowledge and behaviour of South Asians with pharmacologically untreated hypercholesterolemia in Aotearoa New Zealand
Investigators and affiliations:
- Dr Sherly Parackal, Centre for International Heath, Division of Health Sciences, University of Otago
- Associate Professor Kirsten Coppell, Research Associate Professor, Department of Medicine University of Otago, Wellington
- Dr Sumera Akhtar, Centre for International Heath, Division of Health Sciences, University of Otago
Funding: Otago Medical Research Foundation Laurenson Bequest Award
Abstract
South Asians ( SAs ) have particularly high rates of Atherosclerotic Cardiovascular Diseases ( ASCVD ), such as coronary heart disease ( CHD ), stroke and peripheral arterial disease. NZSAs are one of the three high risk groups for high blood cholesterol, a key risk factor of ASCVD , nevertheless targeted prevention measures are absent. Epidemiological investigations have identified a positive association between dietary saturated fats and the increased risk of ASCVD. Our recently completed study indicates that most participants treated for high blood cholesterol were diagnosed at a young age and were disheartened for not being able to manage the disease via lifestyle changes. What is unknown is whether SAs with medically untreated high blood cholesterol have the knowledge to make lifestyle changes and if they have received culturally appropriate professional advice to enable this. The current study aims to address this gap in our knowledge to inform clinical practice and develop an ethnic-specific intervention.
A pilot trial of a co-designed, digitised health promoting intervention for New Zealand South Asians
Investigators: Dr Sherly Parackal1, Clare Wall2, Tony Savarimuthu3, Andrew Gray4
- Centre for International Health;
- Discipline of Nutrition, University of Auckland
- Department of Information Science,
- Biostatistics Centre, University of Otago
Funder: Lottery Health Research Grants 2021-22
Status: Current
Abstract
In comparison to New Zealand ( NZ ) Europeans, people from the Indian sub-continent collectively referred to as South Asians ( SAs ) have an increased risk of diet related chronic diseases such as diabetes and cardiovascular ( CVD ) diseases. This is a serious concern, as SA migrants are healthier than the majority population on arrival due to the stringent health selection criteria applied by NZ. A suite of studies to address this disparity has resulted in developing a culturally appropriate digitised intervention using a co-design approach to promote healthy diet and activity. This project aims to pilot the developed intervention prior to a full trial aiming to test the effectiveness of the intervention.
Co-creating educational comics and video clips for a health promoting dietary and activity programme targeting early South Asian migrants
Investigators and affiliations: Dr Sherly Parackal1, Rachel Brown2, Prasath Jayakaran3, Tony Savarimuthu4
- Preventive and Social Medicine,
- Department of Human Nutrition,
- School of Physiotherapy,
- Department of Information Science, University of Otago.
Funding: Department of Preventive and Social Medicine Strategic Grants, 2018
Status: Completed
Abstract
In comparison to New Zealand (NZ) Europeans, South Asians (SAs), i.e., people from the Indian sub-continent, have a five to six-fold increased prevalence of being on treatment for diabetes, a rate similar to our Pacific peoples but higher than Māori (three-fold) and other Asians (two-fold). SAs also have a higher prevalence and incidence of cardiovascular disease compared to non-Māori. This is a serious concern, as SA migrants are healthier than the majority population on arrival and hence, an early loss of their healthy migrant status can be counter-productive and pose a huge disease burden and impact on health costs.
To address this, a culturally appropriate health promoting intervention has already been designed using a co-design approach and has resulted in six intervention modules. The proposed study is a follow-on study aiming to co-create educational comics and motivational, informational and demonstration video clips for the developed modules.
Co-designing a culturally appropriate intervention to prolong the Healthy Migrant Status of South Asians
Investigators: Dr Sherly Parackal1 Rachel Brown2
- Preventive and Social Medicine
- Department of Human Nutrition
Funding: Department of Preventive and Social Medicine Strategic Grants, 2018
Status: Completed
Abstract
Because of health screening on application, on arrival in New Zealand (NZ), South Asian (SA) migrants are healthier than the majority of the NZ population, but subsequently develop a four-to-five-fold higher risk for diabetes and cardiovascular diseases, including compared to other migrant groups. One of the most important independent risk factors for many chronic diseases among both first and subsequent generations of migrant SAs is food intake and, in particular, dietary patterns.
A review of dietary changes and its impact on the trajectory of health among SA migrants in western countries has highlighted that the first five years post migration is a window of opportunity to promote healthier dietary habits to address diet related chronic disease in the SA diaspora. The aim of the proposed project is to use a co-design approach and qualitative methods to develop the components of a culturally appropriate health promoting dietary intervention targeting new SA migrants. The expected long-term benefit of this research is to prolong the healthy migrant status of SA migrants by promoting healthy dietary habits.
Development and piloting of a South Asian specific Food Frequency Questionnaire (SANZ FFQ) to investigate associations between their dietary patterns and health outcomes in New Zealand
Investigators: Dr Sherly Parackal1, Paula Andrews1, Clare Wall2, Andrew Gray1
- University of Otago
- University of Auckland
Funding: Lottery Health Grants
Status: Completed
Abstract
Because of health screening on application, on arrival in New Zealand (NZ), South Asian (SA) migrants are healthier than the majority of the NZ population, but subsequently develop a four-to-five-fold higher risk for diabetes and cardiovascular diseases, including compared to other migrant groups. One of the most important independent risk factors for many chronic diseases among both first and subsequent generations of migrant SAs is food intake and, in particular, dietary patterns.
In order to assess food intake accurately in epidemiological studies, information is most frequently collected using food frequency questionnaires (FFQs) as they are a pragmatic way to provide an estimate of usual dietary intake with lower participant burden and cost compared to either weighed records or 24 hour recalls with repeated administration. However, any FFQ needs to be suited to the population it is to be used in, in terms of foods included and comprehensibility. Surprisingly, there are no ethnic specific FFQs for SAs in NZ.
The proposed research aims to develop and pilot an ethnic specific FFQ for SAs in NZ (SANZ FFQ). This is crucial to gain an understanding of the nutritional etiological pathway for health disparities observed among SAs in NZ.
Development of rifampicin as a dry powder inhaler for tuberculosis
Co-investigator: Professor Philip Hill
Funder: Health Research Council (NZ). $1,086,230 over 3 years
Status: Current (Commenced 2022)
Following on from the study in rats, HRC NZ have now funded a safety and pharmacokinetics study in humans, led by Dr Jack Dummer in Otago's department of Medicine and Professor Shyamal Das from Otago's School of Pharmacy. We will also do an acceptability study of an inhaler in TB patients in Indonesia.
Dodging bullets: how the Beijing TB strain evades and subverts BCG-mediated trained innate immunity
Co-investigator: Professor Philip Hill
Funder: Marsden Fund, Royal Society of New Zealand. $960,000 over 3 years.
Status: Current (commenced 2021)
This is the first Marsden project linked to our Indonesia collaborations. Led by Associate Professor Jo Kirman in Otago's Microbiology and Immunology department, It is exploring, in mice, the mechanism for evasion of BCG-mediated immunity by Beijing strains of Mycobacterium tuberculosis, using a mouse infection model.
Easy As! Or Is It? Asian Migrants Navigating the New Zealand Health System
Investigators: Dr Sherly Parackal1 , Dr Gagan Gurung2, Professor Rathan Subramaniam3
- Centre for International Health
- Department of General Practice
- Department of Medicine, University of Otago
Funding: Otago Medical School
Abstract
Understanding the health system or health literacy is important for positive health outcomes of any population. If health literacy is poor, navigation of health systems in migrant receiving countries such as New Zealand can be a challenge to migrants from low- and middle-income countries. Asians who currently make up 15% of the New Zealand population are the fastest growing ethnic population.
Nevertheless, the responsiveness of the NZ health system to Asian migrants in facilitating high health literacy and addressing the challenges they face in navigating the health system has not been well documented. Information on health literacy in the New Zealand context of Asian migrants is also lacking.
The study objectives were to 1) document Asian specific navigational tools and resources on the websites of New Zealand hospitals and medical centres and 2) investigate health literacy of recent Asian migrants (duration of residence ≤ 5 years).
Student: Valerie Xiang (Dean's Scholarship Medical student)3
Status: Current
Evaluation of safety and pharmacokinetics of inhaled rifampicin in rats
Co-investigator: Professor Philip Hill
Funder: Otago Medical Research Foundation
Status: Completed (commenced 2018)
This study, led by Professor Shyamal Das in Otago's School of Pharmacy, proved the safety and pharmacokinetic advantages of inhalation of rifampicin, a key tuberculosis drug, in rats.
Postgraduate student: Prakash Khadka (PhD)
Feasibility study for a nationally representative survey of latent tuberculosis infection in New Zealand Māori
Co-Investigator: Professor Philip Hill
Funder: New Zealand Health Research Council. $250,000 over 18 months
Status: Completed (commenced 2018)
This study, in collaboration with Dr Nina Scott's group at the Waikato District Health Board explored different options to recruit a population-based sample of Māori in Waikato. Its findings also suggested that, rather than a large reservoir of latent tuberculosis in older Māori, ongoing rates of TB in Māori are probably coming from relatively un-engaged complex pockets of transmission.
Prevalence of latent tuberculosis infection in Māori people in the Waikato region
Investigators and affiliations: Professor Philip Hill1, Nina Scott2, Joanne Baxter3, Bob Hancox4
Other collaborators: Siobhan Uruamo4, Sue McAllister1, Ron Hayudini4
- Centre for International Health, University of Otago, Dunedin, New Zealand
- Te Puna Oranga, Waikato District Health Board, Hamilton, New Zealand
- Kōhatu Centre for Hauora Māori, Division of Health Sciences, University of Otago, New Zealand
- Respiratory Department, Waikato District Health Board, Hamilton, New Zealand
Funder: HRC Feasibility Grant
Status: Completed. This feasibility study was part of an ongoing goal to elimination of TB in Māori in Aotearoa New Zealand
Abstract
Objective
This study aimed to assess the feasibility of conducting a representative tuberculin skin test (TST) survey for Māori in Aotearoa New Zealand and to estimate the prevalence of latent tuberculosis (TB) infection.
Methods
Participants were Māori in the Waikato region, recruited by a Māori nurse, through: 1) random household selection from the Electoral Roll; 2) randomly selected prison inmates; and 3) community and health settings. A TB history and symptoms questionnaire was completed, TST performed, and investigation of those with TST induration >10mm.
Results
Random household selection was resource intensive and only contributed 14 participants. Repeated random selection of prison lists were required to recruit 207 participants and there were no positive TST cases. Community and health settings yielded the highest participation (n=370) and the three people (0.5%) with TST >10mm. Age >45 years and history of contact with a TB case were associated with TST induration >5mm (n=39; 6.6%).
Conclusions
The community and health settings were the only feasible options for recruitment. The overall prevalence of a positive TST in the study population was low. A 5mm cut-off may be best to maximise sensitivity for future studies.
Implications for Public Health
A mixture of sample selection processes that are more targeted are needed to identify Māori with latent TB infection.
Unravelling the health journey of ethnic voluntary migrants in Aotearoa, New Zealand: Ethnic MIGRant heAlth TrajEctory (EMIGRATE) project
Investigators:Dr Sherly Parackal1, Robin Turner2, Kirsten Coppell3, Rathan Subramaniam3, Trudy Sullivan4, Brandon De Graaf4
- Centre for International Health
- Biostatistics Centre, University of Otago
- Department of Medicine, University of Otago
- Department of Preventive and Social Medicine, University of Otago
Funding: Yet to be funded
Status: Scoping
This project uses the lens of those who emigrated to Aotearoa, New Zealand (NZ) for employment in response to human resource shortages in NZ, for example in our health system, hospitality, and education sectors to name a few.
Currently, one million (20%) of our population of 5 million are peoples from Asia and Middle East, Latin America and Africa (MELAA). Nevertheless, very little is known about the health trajectory of migrants in NZ. Employing a vertical equity lens, i.e., unequal treatment of unequal needs and in this context, different population groups have different health needs, the current project aims to map the health journey of Asian, Middle eastern, Latin American and African migrants in New Zealand.