1

Sudanese Traditions and

Nutrition

Staff Resource

Created by Fiona Sneyd and Nicola Dobney

Deakin University Dietetics Students

2007

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Acknowledgements

We would like to thank the following people for their contribution to the development of this

resource.

♦ Lisa McCarthy

♦ Afaf Mohammed

♦ ISIS Primary Care Refugee Health Nurses

♦ ISIS Primary Care Dietitians

♦ ISIS Primary Care Health Promotion Staff

Photo obtained from /www.careinternational.org.uk

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Contents

Background Information Page 4.

Traditional Sudanese Diet Page 5 - 7.

Adjusting to the Western Diet Page 8.

Meal Patterns Page 9.

Cooking Methods Page 9.

Portion Size Page 9.

Religious & other Special Occasions that Affect Dietary Intake Page 10.

Traditional Sudanese Foods in Brimbank Page 11.

Common Nutritional Problems Page 12.

Weight Gain and Obesity Page 12.

Iron Deficiency and Anaemia Page 13.

Vitamin D Deficiency Page 14

Useful Resources Page 15.

Appendices Page 16—27

Muslim Customs Appendix 1

Christian Customs Appendix 2

Indigenous Beliefs Appendix 3

Local Sudanese Food Stores Appendix 4

Anaemia and Iron Deficiency Appendix 5

Iron Pictorial Education Sheet Appendix 5

Vitamin D Deficiency Appendix 6

Vitamin D Pictorial Education Sheet Appendix 6

Common nutritional problems Appendix 7

Healthy Eating Guidelines Appendix 8

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Sudan is located in the northeast of Africa and is only slightly smaller than Western Australia. Sudan shares boarders with Eritrea, Ethiopia, Kenya, Uganda, the Democratic Republic of Congo,

the Central African Republic, Chad, Libya and Egypt.

Disputes between military regimes and Southern Sudanese groups over access to power and resources have been the cause of two extended periods of civil war in Sudan. The first began shortly after independence from British-Egyptian administration in 1956 until 1972, and the second

from 1983 to 2005 when a peace agreement was signed.

The return of approximately 500,000 Sudanese refugees who fled to surrounding countries has been hindered by drought, famine, war damage and limited infrastructure. Australia has assisted

in resettling a proportion of refugees from this area.

Over the past few years there has been a shift from European to African refugees entering Australia under the humanitarian program. In Victoria, Brimbank closely follows Greater Dandenong as the most common LGA settlement for African refugees. In Brimbank the largest

proportion (87%) of African refugees are Sudanese

Refugees who have arrived under the Humanitarian Program are victims of the second civil war between the North and South of Sudan. The majority of these refugees have spent time living in

refugee camps in surrounding countries such as:

Kenya Egypt Ethiopia Northern Uganda

Zimbabwe

Many refugees have spent long periods in refugee camps, in environments that are extremely unsafe with poor sanitation and where the risk of exposure to infectious diseases is high and access to a nutritious diet is low. Many refugees will be unfamiliar with our formal health system, Western style

medicine and being treated by practitioners of the opposite gender.

Lifestyle

Sudanese lifestyles vary greatly depending on which religion they follow and whether they live in villages, towns or cities. .

“There are great differences between the Dinka people who travel with their herds, subsistence farmers like the Zandes who work with ancient tools and farming methods, and the very westernized Sudanese urbanites who enjoy high-tech living.”

Source: Food Throughout the Life Cycle

Gender roles are more prominent in rural areas of Sudan where men participate in public life while

women are responsible for the home and often manage crops.

Language

Arabic is the most widely spoken language in Sudan followed by Dinka. In addition to Arabic, Dinka and English, there are over 100 different languages

and 400 dialects spoken in Sudan . Most Sudanese are bi- or multi-lingual.

Background Information

This Resource This resource was developed for use by staff who work with Sudanese clients. It includes

information concerning Sudanese foods and traditional practices relating to food, their adjustment

to the western diet and common nutritional problems experienced by Sudanese refugees.

The aim of this resource is to increase awareness of these issues to enable health service staff to provide appropriate and effective care for refugees to ensure that they enjoy the same

health status as other Australians.

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Food Description

Breads and Cereals

Asida Porridge made from millet of sorghum.

Kisra Flat bread. Used to scoop up meat and vegetable dishes.

Rice White rice (not basmati) particularly eaten by refugees who spent some

time in Kenya. Usually added to soups.

Pasta Often eaten with a mince beef type sauce particularly by refugees who

spent some time in Egypt.

Bread Western style white bread.

Traditional Sudanese diet

Along with traditional foods, many Sudanese refugees who have settled in Australia consume a variety of additional foods from their transitional countries. This contributes to vast dietary

variation in these communities.

Pulses

Lentils Usually red split, yellow or orange lentils.

Green Beans Not typically eaten in the South of Sudan but adopted by those who

spent time in Egypt.

Vegetables

Potato Eaten by those who spent some time in Egypt but

not typically eaten in the South of Sudan.

These vegetables are commonly used in stews and soups,

sometimes in addition to meat. Salads

may accompany

meals

Okra Small green vegetable. Also known as lady’s fingers.

Rich in Vitamins C, K and A.

Molokhiya Green spinach-like vegetable. Rich in beta carotene,

iron, calcium and Vitamin C

Cucumber Combined with yogurt and garlic in a traditional

summer salad.

Cabbage Eaten in Kenya by those who spent time there.

Sweet Potato

Tomato

Onion

Eggplant

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Food Description

Fruit

Mango

Some of these fruits were not always available in smaller villages especially in the South. Fruits are typically peeled and cut in small

slices for dessert.

Watermelon

Banana

Apple

Orange

Mandarin

Guava

Papaya

Cassava

Sultanas

Meat and Fish

Beef Sometimes dried. Ground beef used with onion to

make koftas (meat balls). Often used in Stews with vegetables. Those

practicing Islam require halal

meats.

Lamb Sometimes dried.

Pork Was eaten in Egypt by those not practicing Islam

Chicken Not commonly eaten in Sudan as expensive (consumed by higher class) but was more affordable

in Egypt for those who spent time there.

Fish Smoked, dried or fresh. Most commonly haddock, halibut or any white fish.

Dairy

Sour Yogurt Combined with cucumber and garlic in a traditional summer salad

Bulgarian

Cheese

Other Foods

Eggs Most commonly boiled or fried.

Peanut Butter Often added to meat dishes. Many children are given peanut butter as

infants as many Sudanese people believe that it aids growth.

Crème

Caramela Sudanese Caramel Custard made from milk, sugar, eggs, vanilla and

butter. Nuts Especially peanuts. Widely available product of Sudan.

Honey Often added to drinks as some believe it to have medicinal effects.

Corn oil Used in large amounts. Many traditional dishes that involve frying meat. Also added to soups and stews.

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Spices and Flavours Chilies Red and green. Used in stews

Salt and pepper are added to most traditional dishes. The other spices and flavours are used in different combinations

in a variety of dishes.

Garlic Fresh or garlic powder.

salt Large amounts used in cooking

Cinnamon Cinnamon sticks added to tea

Pepper

Lemon juice

Cumin

Drinks

Tea Many add up to 5 or 6 sugars to each cup and some add powdered

milk. Often flavoured with cloves, cinnamon or mint.

Coffee Very popular drink. The coffee beans are fried and then ground with

cloves and certain spices.

Milk Cow’s milk

Food Description

The food in refugee camps

The foods available usually include some wheat, rice, millet, maize or another cereal and is

cooked in oil with the addition of legumes.

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Adjusting to the Western Diet

Sudanese refugees in the Brimbank area report that they have no difficulty obtaining any

traditional foods or ingredients in Australia.

Many are familiar with most western foods but unsure of how some are usually cooked. Several cooking methods, appliances and utensils are new to these refugees and such un-familiarities can restrict their eating habits. Many have never used microwaves, ovens, vegetable peelers or graters, and combined with their post-arrival hardship and other integration stresses; anxiety

around meal preparation can cause great strain on these refugees.

A resource called The Welcome Kit has been developed aimed towards newly arrived migrants and refugees. This kit contains fact sheets covering cooking techniques, food safety habits, how to purchase vegetables and

fruit, and includes useful health messages (see page 15).

Brief practical demonstrations of how to use foreign utensils and appliances can assist in easing clients’ settlement. Simple pictorial recipes books can be useful for individuals or groups with

little English and can be ordered online (see page 15).

Nutrition and healthy eating is also often a low priority for refugees during their tumultuous re-settlement period. Many Sudanese families are quite large and therefore more expensive to

care for which can also present a barrier to healthy eating.

Most Sudanese refugees’ diets in Australia are very similar to their pre-arrival diet. The main

changes include increased intake of high fat, sugar and salty foods including;

♦ Soft drinks

♦ Ice cream

♦ Take away and fast foods

♦ Chicken

♦ Cordial

These changes are the result of greater access to these foods, the consumption of which was

once seen as an indicator of higher status.

Some refugees report that they are concerned about the chemicals used in the farming of fruit

and vegetables in Australia and this may inhibit their consumption of these foods.

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Meal Patterns

Comparison of Sudanese refugees’ meal patterns in Sudan and in Australia

Cooking Methods

Traditionally women are responsible for the food shopping and cooking. Some Sudanese people will only cook once per day and eat the same meal for lunch and dinner. Often meals

are prepared all in one pot.

In Sudan the main cooking methods are

♦ Stewing

♦ Boiling

♦ Frying

In Australia many refugees only use the stove top to cook and are unfamiliar with many

appliances such as:

♦ Griller

♦ Microwaves — may be afraid to use due to misconceptions about the radiation they emit

♦ Toasters

♦ Electric and gas ovens

Sudanese people often use large amounts of oil while cooking and also add a lot of spices,

salt and sugar to foods and drinks.

Portion Size

In Sudan, meals were often very large due to infrequent consumption (once or twice per day),

and large appetites due to the high levels of physical activity involved in traditional daily life.

In Sudan In Australia ♦ In the villages – eat once or

twice per day (No Breakfast)

♦ In the cities – 3 meals per day

(Breakfast, Lunch and Dinner)

♦ Meals are often communal and the kisra is used to scoop from

or dip into shared bowls.

♦ Typically eat twice per day (No

Breakfast)

♦ Not used to packing food to eat away from home. (e.g. school

lunches)

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Religion & Practices that Affect Dietary Intake

Many Sudanese (65%) follow the religion of Islam (Sunni Muslims), 25% follow indigenous beliefs and Christians make up the remainder. Muslims predominate in the North and

Christians in the South. Islam

♦ Halal foods – describes foods that aren’t a forbidden substance, and meat that has been

slaughtered according to traditional guidelines.

♦ Forbidden Substances

♦ Pork, or any pig-based products (e.g. gelatin)

♦ Blood

♦ Animals slaughtered in the name of anyone but God

♦ Carnivorous animals, with the exception of most fish and sea animals

♦ All intoxicants (especially alcohol).

♦ Ramadan – takes place during the ninth month of the Islamic calendar and is observed for 30 days straight. During Ramadan, Muslims are required to fast between sun rise and sunset (fasting includes water). Children, the elderly and pregnant women are

excused from this practice.

Christianity

♦ Lent – 40 days of fasting between Ash Wednesday and Holy Saturday. This period is marked by fasting which can range from abstinence from a favourite food or drink to

abstinence from meat, eggs and dairy.

Indigenous beliefs

No practices that affect dietary intake

For more information on religious occasions please refer to Appendix 1– 3.

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Traditional Sudanese Foods in Brimbank

Newly arrived refugees usually obtain information regarding where traditional foods can be

bought, from others living in the area.

There are stores that specialize in traditional African foods in:

♦ St Albans

♦ Sunshine

♦ Footscray

(See Appendix 4 for a list of store locations)

Many refugees prefer to shop in Footscray as there are a greater number of African food stores (including Footscray Market stalls) and restaurants in this area and for the social

aspect.

Getting to the shops

♦ Car (if they own one)

♦ Walking

♦ Public transport (Some are not confident with using public transport and find travel

tickets, stops and routes confusing).

Purchasing groceries

Numerous foods advertised on television and available in supermarkets are foreign to

African refugees. A common misconception buy this group is confusion of orange cordial

for orange juice. As many refugees with iron deficiency are recommended orange juice, It

is important to clarify this and any other product misunderstandings with your clients.

Many refugees prefer to shop for meat at Halal butchers rather than Supermarkets. For

some this is for religious reasons whilst others fancy being able to request a certain cut and

weight of meat. Purchasing meat in Supermarkets can be difficult for some refugees as

they may not be able to recognise which animal the pre packaged meat has come from.

Image obtained from www.justfocus.org.nz/ Image obtained from www.fsl.orst.edu

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Common Nutritional Problems

African refugees arrive in Australia with high rates of certain diseases and nutritional deficiencies many of which will be asymptomatic on arrival. These health problems are mostly the result of the poor living conditions endured in refugee situations combined with

previously limited access to health services.

The following have been identified as the most common post-arrival health issues for

African refugees that affect nutritional status:

♦ Vitamin D deficiency

♦ Iron Deficiency and Anaemia

♦ Parasitic infection

♦ Malaria

♦ Tuberculosis

♦ Obesity

Poor appetite upon arrival is common due to cultural transition, post traumatic stress, depression, intestinal parasites, anemia, poor oral health and reduced physical activity. These impact on their nutritional intake and overall health. Please refer to Appendix 7 for

more information on Malaria, Tuberculosis and Parasitic infections.

The most common nutritional deficiencies in Sudanese refugees are Vitamin D and iron and many have a limited understanding of vitamin and minerals. Refer to Appendix 5 and

6 for Vitamin pictorial education sheets.

Weight Gain and Obesity

Many refugees are from a poor and malnourished backgrounds and tend to gain weight

following settlement in Australia. This can result in overweight, obesity and diabetes.

The main cause of weight gain in these groups are:

♦ lack of understanding of healthy eating

♦ increased access to certain foods (mostly fast foods and soft drinks), the

consumption of which was once seen as an indicator of higher status.

♦ continuing to consume large portions as they did in

Africa but exercising much less.

For more information regarding healthy eating refer to

Appendix 8.

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Iron Deficiency and Anemia

Iron deficiency and iron deficiency anemia are common nutritional issues experienced by Sudanese refugees. These conditions can result in serious consequences such as reduced

cognitive and psychomotor development in children.

Symptoms

♦ Tiredness

♦ Lethargy

♦ Dizziness

♦ Loss of appetite

♦ Poor immune function – resulting in recurrent infections and delayed wound healing.

Foods that contain Iron

Haem sources are readily absorbed and include:

♦ Lean Red meat*

♦ Lean Chicken* and pork

♦ Fish* and shellfish

Non Heam sources require addition of vitamin C or meat to improve absorption and include:

♦ Beans* (including baked beans) or lentils*

♦ Eggs

♦ Spinach*

♦ Molokhiya*

♦ Broccoli

♦ Dried fruit* - Sudanese people ate sultanas to prevent or treat anaemia whilst living in

Sudan or transitional countries.

♦ Milo & ovaltine

♦ Fortified breakfast cereals

♦ Wholemeal bread

♦ Wholegrain cereals

♦ Peanut butter* only after 9mths of age and whole nuts*

♦ Tahini*

♦ Asida*

*indicates foods commonly consumed in the Sudanese diet.

Milk and tea inhibit the absorption of iron if consumed with a iron containing food.

If you feel one of your clients is deficient, contact their Doctor or nurse for a full blood count

and serum ferritin tests before any treatment is considered.

For more information on iron deficiency during different life stages, foods that inhibit and

enhance iron absorption, and treatment options please see Appendix 5.

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Vitamin D deficiency

Vitamin D is a fat soluble vitamin that is found in minimal amounts in food, however our main source is made by the body after exposure to ultraviolet (UV) rays from the sun. Sunscreen

greater than SPF factor 8 will stop the skin synthesizing Vitamin D.

Who’s at risk:

♦ People with dark skin

♦ People who keep the majority of their skin covered such as women who follow the

Islamic faith

♦ Children of women who were Vitamin D deficient during pregnancy

♦ Babies who experienced prolonged exclusive breastfeeding

Recommended sunlight exposure to assist in the prevention of Vitamin D deficiency

Source: Risks and Benefits of Sun Exposure Position Statement – Approved by Osteoporosis Australia, and the Cancer Council of

Australia, 2005, and is restricted to the state of Victoria.

A deficiency can be diagnosed by measuring the concentration of a specific form of vitamin D in blood. If you feel your client may be Vitamin D deficient, refer them to their doctor before any

treatment is considered.

For further information regarding symptoms, causes, treatment and food sources refer to

Appendix.6.

September - April May – August

Length of exposure

People with dark skin need three times the length of

exposure indicated

5 to 15 mins twice a day

Therefore people with dark skin require 15 to 45 mins

twice a day

2-3 hrs total over the week

Therefore people with dark

skin require 6-9 hrs a week.

Time of Day Before 10am or after 3pm During sunny periods

Areas Exposed Face, arms & hands or

similar surface areas Face, arms & hands or

similar surface areas

Sunscreen Must wear between 10am &

3pm & re-apply hourly Sun protection not

necessary during winter months

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Useful resources: Countries and their Cultures

http:www.everyculture.com/index.html

Good food for New Arrivals

http://www.asetts.org.au/nutrition.htm

Easy Cook Book

http://www.easycookbook.org

Welcome Kit

http://www.brimbank.vic.gov.au/Files/Welcome_Kit_Order_Form.pdf

NSW Health Website

www.mhcs.health.nsw.gov

Easing the Transition

www.survivors.vic.org.au

Image obtained from www.beds.ac.uk/photos

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Appendix 1 Muslim Customs

Halal

The Qur’an, the holy book of Islam specifies which foods are halal, meaning lawful. The proper Islamic method of slaughtering an animal is called Dhabiha, where a land animal

must be slaughtered by a Muslim who pronounces the Name of Allah before cutting its throat.

The carcass should be hung upside down for long enough to be blood free.

Ramadan

Ramadan is an Islamic religious observance that takes place during the ninth month of the Islamic calendar, when the Qur’an was reveled. It is considered the most venerated and blessed month of the Islamic year. Prayers, fasting, charity, and self accountability are

especially stressed at this time.

Ramadan is divided into three ten-day parts, or ashra (Arabic for ten). They are named Rahmah (mercy of God), Maghfirah (forgiveness of God), and Najah (salvation), respectively. Lavlat al-Qadr, which falls during the last third, commemorates the revelation of

the first verses of the Qur'an and is considered the most holy night of the year. Ramadan ends with the holiday Eid ul-Fitr, on which feasts are held. During the month following

Ramadan, called Shawaal, Muslims are encouraged to fast for a further six days.

The Islamic calendar is a lunar calendar, and months begin when the first crescent of a new moon is sighted. Since the Islamic lunar calendar year is 11 to 12 days shorter than

the solar year, Ramadan migrates through the seasons.

The ill and travelers' may substitute other days to perform their Ramadan obligations. Children, the elderly and pregnant women are viewed as excused. Women menstruating also

make up the days missed, usually in Shawwal.

The most prominent event of this month is the daytime fasting (sawm) practiced by

most observant Muslims. Every day during the month of Ramadan, Muslims around the world get up before dawn to eat and perform their Fair prayer. They break their fast when the fourth prayer of the day, Maghrib (sunset), is due. The fast is intended to be an exacting act of deep

personal worship in which Muslims seek a raised level of closeness to God. The act of fasting is said to redirect the heart away from worldly activities, its purpose being to cleanse the inner soul and free it from harm. Properly observing the fast is supposed to induce a comfortable feeling of peace and calm. It also allows Muslims to practice self-discipline, sacrifice, as well as sympathy for those who are less fortunate, intending to make Muslims more generous and

charitable.

The Islamic holiday of Eid ul-Fitr marks the end of the fasting period of Ramadan and the first day of the following month, after another new moon has been sighted. Eid ul-Fitr

means the Festival of Breaking the Fast, a special celebration is made. Food is donated to the poor (‘Zakat al-Fitr’), everyone put on their best, preferably new, clothes, and communal

prayers are held in the early morning, followed by feasting and visiting relatives and friends.

Muslims are encouraged to fast six days in Shawwal, the month following Ramadan that begins after Eid ul-Fitr; these days need not be consecutive. According to hadith, one who fasts the month of Ramadan and six days during Shawaal will be rewarded as though he

fasted the entire year.

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Appendix 2. Christian Customs

Lent

In most Christian denominations, Lent is the forty-day period (or season) lasting from Ash Wednesday to Holy Saturday. The forty days represents the time Jesus spent in the desert, enduring the temptation of Satan. Sundays in Lent are not counted in the forty days because each Sunday represents a "mini-Easter" celebration of Jesus' victory over sin and death. Lent is a time of preparation for Holy Week, which recalls the events linked to the

Passion of Christ and culminates in Easter, the celebration of the Resurrection of Jesus Christ.

Fasting during Lent was more severe in ancient times than today. In some places, all animal products were strictly forbidden, while others would permit fish and fowl and others prohibited fruit and eggs. In some places, believers abstained from food for an entire day; others took only one meal each day, while others abstained from all food until 3 o'clock. In most places, however, the practice was to abstain from eating until the evening, when a small

meal without meat or alcohol was eaten.

Today many modern Christians consider the observation of Lent to be a choice, rather

than an obligation. They may decide to give up a favourite food or drink (e.g. chocolate,

alcohol) or activity (e.g. going to the movies, playing video games) for Lent, or they may

instead decide to take on a Lenten discipline such as devotions, volunteering for charity work,

and so forth.

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Appendix 3. Indigenous Beliefs Each indigenous religion is unique to a specific ethnic group or part of a group, although several groups may share elements of belief and ritual because of common ancestry or mutual influence. The group serves as the congregation, and an individual usually belongs to that faith by virtue of membership in the group. Believing and acting in a religious mode is part of daily life and is linked to the social, political, and economic actions and relationships of the group. The beliefs and practices of indigenous religions in Sudan are not systematized, in that the people do not generally attempt to put together in coherent

fashion the doctrines they hold and the rituals they practice.

The concept of a high spirit or divinity, usually seen as a creator and sometimes as ultimately responsible for the actions of lesser spirits, is common to most Sudanese groups. Often the higher divinity is remote, and believers treat the other spirits as autonomous, orienting their rituals to these spirits rather than to the high god. Such spirits may be perceived as forces of nature or as manifestations of ancestors. Spirits may intervene in people's lives, either because individuals or groups have transgressed the norms of the society or because they have failed to pay adequate attention to the ritual that should be

addressed to the spirits.

Image obtained from www.pilotguides.com/images

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Appendix 4. Local Sudanese Food Stores

This table lists some of the local food stores that sell traditional Sudanese foods.

Name of store Type of store Address

Thuan Khiem Green grocer 12 Alfrieda St, St Albans

Kim Minh Asian grocery 1/32 Alfrieda St, St Albans

Continental Discount mini-market Mini market 27 McIvor Rd, St Albans

FoodWorks Supermarket 35-41 Conrad St, St Albans

Australian Pacific supermarkets Supermarket 14-18 East Esplanade, St Albans

African variety shop Mini Mart 7 East Esplanade, St Albans

Indo Pak Spices Spice shop 340-342 Main Rd West, St Albans

Spice World Spice shop 7s/323s Main Rd East, St Albans

Footscray Market Market Irving St, Footscray (opposite

Footscray train station)

Image obtained from www.londonphotos.org

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Appendix 5. Anaemia and Iron Deficiency

Causes for deficiency or anaemia;

♦ Previous and prolonged periods of food deprivation

♦ Poor access to iron rich foods

♦ Blood diseases such as Thalassaemia

♦ Previous bouts of Tuberculosis (TB)

♦ Previous bouts of Malaria

♦ Worms

♦ Multiple pregnancies.

Vitamin C

Vitamin C helps the body to absorb more iron. Foods that are high in vitamin C include some fruits (rockmelon, strawberries, pineapple, citrus fruits, kiwi fruit and tomato) and some vegetables (broccoli, capsicum, cauliflower, and brussel sprouts) including Okra and

Molokhiya which are commonly used in traditional Sudanese dishes.

Including a serve of vitamin C rich fruit and vegetables with meals helps the body to absorb

more iron. For example:

♦ Fruit on breakfast cereal.

♦ Vegetables or a salad with meals.

♦ Fruit for dessert.

♦ A small glass of fruit juice (not cordial) with meals.

Tea Consumption of tea with meals is very common in Sudan however the tannin found in tea reduces the absorption of iron. Tea should be avoided at meal times for both children and adults. Limit consumption to 3 weak cups per day (the amount of sugar added in each cup

should also be limited).

Milk The absorption of iron is also decreased by milk and should therefore be limited to 3 glasses

(600mls) each day.

Treatment Iron supplements are available as a liquid, tablet or powder (can be sprinkled on foods). These can take weeks to months to work and it is extremely important to adhere to dosage recommendations (high doses can be toxic, therefore should be stored out of reach of children). Side effects can include, nausea, constipation and black stools. Clients on iron supplements should be encouraged to choose wholemeal bread and cereals, eat plenty of fruit

and vegetables, drink plenty of water and do some form of physical activity everyday.

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Appendix 5. Anaemia and Iron Deficiency

Iron Deficiency and Anaemia throughout the life cycle

Infants 0-6mths

Iron stores are heavily influenced by what has occurred in pregnancy.

Infants 6-12mths

Particularly vulnerable stage due to poor feeding practices including the late introduction of solids. Iron deficiency at this age is of particular concern as there is rapid psychomotor

development and a deficiency in iron can lead to cognitive and psychomotor delay.

Women from Sudan usually exclusively breastfeed their children until 2 years of age as the introduction of food before this time was thought to cause diarrhoea and illness. Sudanese

women should be encouraged to:

♦ Begin to introduce solids from 6 months of age including iron fortified baby cereal and

naturally iron rich lentils.

♦ Introduce Red and white meat finely chopped at 7-9 months of age.

♦ Cows milk as a drink must NOT be introduced until >12months. Children over 12 months

of age can drink up to 600mls of full cream cows milk each day from a cup.

Toddlers

Iron deficiency at this life stage is quite frequent. There is a need to broaden the range of foods and to establish healthy eating habits as energy and iron demands for growth continue

to be high. A large number of children display no symptoms at all.

Adolescents

Particularly high risk group as they have extra iron requirements due to the growth spurt, poor

eating habits and the onset of menstruation in girls.

Pregnancy

Pregnant and breastfeeding women are at a high risk of anemia especially if they have had multiple pregnancies, concurrent breastfeeding with pregnancy and extended breastfeeding all of which are common in the Sudanese culture. Many women from Sudan are pregnant at a

relatively young age which places them at an increased risk of iron deficiency.

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This resource can be accessed through the following pathway: J:\CommHealth\Dietetics\CALD resources\Iron Pictorial Resource

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Appendix 6. Vitamin D Deficiency

Causes for Deficiency;

♦ Usual intake is below recommended levels,

♦ Limited exposure to sunlight,

♦ The kidney cannot convert vitamin D to its active hormone form,

♦ Vitamin D cannot be adequately absorbed from the digestive tract.

Symptoms

♦ In children, vitamin D deficiency causes rickets. Rickets is a bone disease that results in soft bones and skeletal

deformities.

♦ In adults, vitamin D deficiency can lead to osteomalacia, which results in muscular weakness in addition to weak bones. Symptoms of bone pain and muscle weakness may indicate vitamin D deficiency, however symptoms may be subtle and go undetected in the initial

stages.

Treatment

Supplements are available for the treatment of Vitamin D deficiency however they rely on

being taken daily therefore compliance may be poor.

A deficiency can be diagnosed by measuring the concentration of a specific form of vitamin D

in blood. If you feel your client may be Vitamin D deficient, refer them to their doctor before

any treatment is considered

Vitamin D food sources include:

♦ fatty fish - including salmon, mackerel, tuna and sardines)

♦ eggs

♦ fortified foods – margarine, some breakfast cereals and milks such as Anlene and Physical (however dairy products are generally not fortified with vitamin D and

contain only small amounts).

1 cup of fortified milk provides approx ¼ of the estimated need for adults.

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This resource can be accessed through the following pathway: J:\CommHealth\Dietetics\CALD resources\Vitamin D Pictorial Resource

September—April

5—15 mins twice a day

May—August

2-3 hrs total over the week

People with dark skin require 3

times the amount of sun exposure

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Appendix 7. Common Nutritional Problems

Diseases commonly experienced by African refugees include malaria, tuberculosis and

parasitic infections. These diseases present with symptoms of:

♦ abdominal pain

♦ bloating

♦ vomiting

♦ diarrhoea

♦ gut inflammation

♦ Infection.

Such symptoms can cause a loss of appetite and reduced nutrient absorption, potentially

resulting in weight loss and malnutrition.

Dietary interventions during and immediately after infectious disease can affect the course and effects of the disease, and reduce the extent to which nutritional status suffers.

Therefore adequate nutrition is important in disease management to improve immune

function and protect against disease.

If you feel that one of your clients may be suffering from these diseases please refer them

to their doctor for testing.

If one of your clients does have one of these conditions please refer to a Dietitian for the prescription of a high energy diet.

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Appendix 8. Healthy Eating

Daily recommended number of serves from each food group.

Cereals (including breads, rice, pasta, noo-

dles)

Vegetables,

legumes

Fruit

Milk, yogurt,

cheese

Lean meat, fish, poultry, nuts &

legumes

Extra foods (have no

more than)

Children & teenagers

4-7 years 5-7 2 1 2 1/2 1-2

8-11 years 6-9 3 1 2 1 1-2

12-18 years 5-11 4 3 3 1 1-3

Women

19-60 years 4-9 5 2 2 1 0-2 1/2

60+ years 4-7 5 2 2 1 0-2

Pregnant 4-6 5-6 4 2 1 1/2 0-2 1/2

Breastfeeding 5-7 7 5 2 2 0-2 1/2

Men

19-60 years 6-12 5 2 2 1 0-3

60+ years 4-9 5 2 2 1 0-2 1/2

27

Appendix 8. Healthy Eating

What is a Serve?

Breads and Cereals

1 slice of bread 1 medium bread roll 1/2 cup cooked rice, pasta, noodles

1 cup porridge 1 cup breakfast cereal flakes 1/2 cup muesli

Vegetables and legumes

Starchy vegetables

1 medium potato or yam 1/2 medium sweet potato 1 medium parsnip

Dark green leafy vegetables

1/2 cup cabbage, spinach, silver beet, broccoli, cauliflower or brussel sprouts

Legumes and other vegetables

1 cup lettuce or salad

vegetables 1/2 cup broad beans, lentils, peas, green beans, zucchini, mush-rooms, tomatoes, capsicum, cucumber, sweet corn, turnips, swede,

sprouts, celery, eggplant, etc

Fruit

1 piece medium sized fruit e.g. apple, orange, mango, mandarin, banana, pear etc

2 pieces of smaller fruit e.g. apricots, kiwi fruit, plums, figs About 8 strawberries

1 cup diced pieces or canned

fruit 1 handful of dried fruit About 20 grapes or cherries

Milks, yogurt, cheese & alternatives

250 ml glass or one cup of milk (can be fresh, long life or reconstituted milk)

1/2 cup evaporated milk 2 slices of cheese 250ml (1 cup custard)

200g (1 small carton) of yogurt, plain or fruit, or, as an alternative try:

1 cup of calcium-fortified soy

milk 1 cup almonds 1/2 cup pink salmon with bones

Meat, fish, poultry & alternatives

65-100gm cooked meat or chicken (e.g. 1/2 cup mince, 2 small chops or 2 slices roast meat)

80-120g cooked fish fillet 1/3 cup peanuts or almonds

2 small eggs 1/3 cup cooked (dried) beans, lentils, chick peas, split peas or canned beans

Extras Foods – Include occasionally. They are generally higher in fat and/or sugar,

kilojoules, salt etc

1 medium piece of plain cake or 1 bun 3-4 sweet

biscuits 1/2 chocolate bar

1 tablespoon (20g) butter, margarine, oil 30g potato

crisps ½ Slice of pizza

1 can soft drink or 2 glasses cordial 2 scoops ice

cream 2 standard glasses of alcohol (for adults only)

28

References

♦ Borland, H. & Mphande, C. 2006, The Numbers of Speakers of African Languages

Emerging in Victoria, Victoria University, Ballarat.

♦ Burns, C., Webster, K., Crotty, P., Ballinger, M., Vincenso, R. & Rozman, M. 2000, Easing the transition: food and nutrition issues of new arrivals. Health Promotion Jour-

nal of Australia, vol. 10 (3), pp.230-236.

♦ Finding Familiar Foods—Good Food for New Arrivals, June 2004.

www.assets.org.au

♦ Government of Western Australia, ‘Nutritional issues for Refugees in Australia’. Pub-lished 1 October 2003. www.rph.wa.gov.au/hpnetwork/GFNA/NutInfoRef.pdf. date ac-

cessed 6 September 2007.

♦ ISIS Primary Care Statistical Data: Number of clients by Culture.

♦ Johnson, D. 2007, Rates of infectious diseases and nutritional deficiencies in newly

arrived African Refugees. Government of South Australia, Adelaide.

♦ Sinaiko Webb, Lois. Multicultural Cookbook of Life-Cycle Celebrations. Oryx Press

2000.

♦ Sudanese Community Profile—Department of Immigration and Multicultural Affairs,

August 2006. www.immi.gov.au

♦ Tiong, A. 2006, Health Needs of Newly Arrived African Refugees from a Primary

Health Care Perspective, Department of Human Services, Victoria.

Image obtained from www.soschildrensvillages.org.uk