Diet-nutrition-related cancer prevention knowledge and beliefs of Sudanese in Khartoum: A descriptive study

Adelia Bovell-Benjamin, Essam Elmubarak

Tuskegee University, Tuskegee, USA.

DOI: 10.4236/ojpm.2013.33043                

Abstract

Cancer appears to pose a major threat to the health of the Sudanese population. It is the third leading cause of death in the Sudan after malaria and pneumonia, accounting for 5% of all deaths. In 2005, approximately 22,000 people in the Sudan died from cancer and 17,000 of these people were less than 70 years old. This study was designed to: 1) assess nutrition knowledge and selected dietary beliefs related to cancer in Sudanese residing in Khartoum; 2) identify perceived barriers to the adoption of eating behaviors consistent with those recommended for cancer prevention; and 3) describe the food preferences and dietary practices in Sudanese residing in Khartoum. An interviewer-administered questionnaire elicited demographic information, cancer-related food and nutrition knowledge, food preferences, selected dietary beliefs, barriers to healthy eating and food practices from 182 participants between the ages of 18 and 35 years. More than 50% of females and males correctly identified the food lowest in fiber from a given list. Respondents were knowledgeable about the fat content of their traditional foods, but unaware of the different types of fat. Only 8.8% of the respondents thought that consumption of fruits and vegetables reduced cancer risk. Resondents perceived nutritionists as the most reliable source of information about nutrition and cancer, and the media as the best source of information on nutrition and healthy cooking. “Samin”, feta cheese, a variety of stews, “Zalabia”, lean meat, brown bread, sesame oil, dried okra, fried fish, and chicken were described as preferred food items by respondents. Daily salt/ sodium intake was described by 44% and 39% of the male and female respondents, respectively, as “high” (>2400 mg/day). The findings of this study have clear implications for aggressive nutrition education intervention programs with emphasis on the traditional foods of the Sudan.

Keywords

Food and Nutrition Knowledge; Cancer Prevention; Dietary Beliefs; Food Preferences; Food Practices and Purchasing Patterns

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Hamad, H.M. (2006) Cancer initiatives in Sudan. Annals of Oncology, 17, 32-36. doi:10.1093/annonc/mdl985
[2]	Awadelkarim, K.D, Aceto G., Veschi, S., Elhaj, A., Morgano, A., Mohamedani, A.A., Eltayeb, E.A., Abuidris, D., Di Gioacchino, M., Battista, P., Verginelli, F., Cama, A., Elwali, N.E. and Mariani-Costantini, R. (2007) BRAC1 and BRAC2 status in a Central Sudanese series of breast cancer patients: Interactions with genetic, ethnic and reproductive factors. Breast Cancer Research Treatment, 102, 189-199. doi:10.1007/s10549-006-9303-z
[3]	Awadelkarim, K.D., Arizzi, C., Elamin, E., DeBlasio, P., Hamad, H.M.A., Mekki, S.O., Osman, I., Biunno, I., Elwali, N.E., Mariani-Costantini, R. and Barberis, M.C. (2008) Pathological, clinical and prognostic characteristics of breast cancer in Central Sudan versus Northern Italy; implications for breast cancer in Africa. Histopathology, 52, 445-456. doi:10.1111/j.1365-2559.2008.02966.x
[4]	El Hassan, A., El Hassan, L., Mudawi, H., Gasim, B., Own, A., Elamin, E., Ouf, M.I., El Mekki, M. and Fedail, S. (2008) Malignant gastric tumors in Sudan: A report from a single pathology center. Hematology Oncology and Stem Cell Therapy, 1, 130-132.
[5]	Ahmed, H.G., Ali, A.S. and Almobarak, A.O. (2010) Frequency of breast cancer among Sudanese patients with breast palpable lumps. Indian Journal of Cancer, 47, 2326. doi:10.4103/0019-509X.58854
[6]	Elgaili, E.M., Abuidris, D.O., Rahman, M., Michalek, A.M. and Mohammed, S.I. (2010) Breast cancer burden in central Sudan. International Journal Women’s Health, 2, 77-82.
[7]	WHO Global Infobase: Data for Saving Lives. https://apps.who.int/infobase
[8]	Willet, M.C. (1995) Diet, nutrition and avoidable cancer. Environmental Health Perspectives, 103, S165-S170.
[9]	Bovell-Benjamin, A, Dawkins, N., Pace, R. and Shikany, J.M. (2010) Dietary consumption practices and cancer risk in African Americans in the rural South. Journal of Health Care for the Poor and Underserved, 21, 57-75. doi:10.1353/hpu.0.0361
[10]	Elmubarak, E., Bromfield, E. and Bovell-Benjamin, A.C. (2005) Focused interviews with Sudanese Americans: Perceptions about diet, nutrition, and cancer. Preventive Medicine, 40, 502-509. doi:10.1016/j.ypmed.2004.09.021
[11]	Bronner, Y.L., Ebede, T.L., Hossain, M.B., Nowverl, A. and Harris, E. (2001) Historical assessment of nutrition studies using only African American study subjects: Gender, socioeconomic status, and geographic location. Ethnicity & Disease, 11, 134-143.
[12]	Laverentz, M.L., Cox, C.C. and Jordan, M. (1999) The Nuer nutrition education program; breaking down cultural barriers. Health Care for Women International, 20, 593601.
[13]	Novak, J.D. and Gowin, D.B. (1984) Learning how to learn. Cambridge University Press, Cambridge. doi:10.1017/CBO9781139173469
[14]	Smith, P.G. and Morrow, R.H., Eds. (1993) Methods for field trials of interventions against tropical diseases: A tool box. Oxford University Press, Inc., New York, 176196.
[15]	Green, L. and Kreuter, M. (1991) Health promotion planning. Mayfield Publishing Co., Mountain View, 2-20.
[16]	Wardle, J. (1993) Food choices and health evaluation. Psychology and Health, 8, 65-75. doi:10.1080/08870449308403167
[17]	Margetts, B.M. (1991) Basic issues in designing and interpreting epidemiological research. In: Margetts, M. and Nelson, M., Eds., Design Concepts in Nutritional Epidemiology. Oxford University Press, New York, 22-51.
[18]	Perkin, J. (1992) Design and use of questionnaires in research. In: Monsen, E.R., Ed., Research: Successful Approaches. American Dietetic Association, Chicago.
[19]	Fowler, F.J. and Mangione, T.W. (1990) Standardized survey interviewing. Sage Publications Inc., Applied Social Research Method Series, Newbury Park.
[20]	Schinke, S.P., Singer, B., Cole, K. and Contento, I.R. (1996) Reducing cancer risk among Native American adolescents. Preventive Medicine, 25, 146-155. doi:10.1006/pmed.1996.0040
[21]	Burkitt, D.P. and Trowell, H.C. (1975) Refined carbohydrate and disease. Academic Press, New York.
[22]	Musaiger, A.O. (2002) Diet and prevention of coronary heart disease in the Arab Middle East countries. Medical Principles and Practice, 11, 9-16. doi:10.1159/000066415
[23]	Kendall, C.W.C., Esfahani, A. and Jenkins, D.J.A. (2010) The link between dietary fibre and human health. Food Hydrocolloids, 24, 42-48. doi:10.1016/j.foodhyd.2009.08.002
[24]	WCRF/AICR (World Cancer Research Fund/American Institute for Cancer Research) (2007) Food, nutrition, physical activity, and the prevention of cancer: A global perspective. AICR, Washington DC.
[25]	Abdelgadir, W.S., Ahmed, T.K. and Dirar, H.A. (1998) The traditional fermented milk products of the Sudan. International Journal of Food Microbiology, 44, 1-13.
[26]	Harnack, L., Block, G., Subar, A., Lane, S. and Brand, R. (1997) Association of cancer prevention-related nutrition knowledge, beliefs, and attitudes to cancer prevention dietary behavior. Journal of the Academy of Nutrition and Dietetics, 97, 957-965.
[27]	Charlton, K.E., Brewitt, P. and Bourne, L.T. (2004) Sources and credibility of nutrition information among black urban South African women, with a focus on messages related to obesity. Public Health Nutrition, 761, 801-811.
[28]	Stott-Miller, M., Neuhouser, M.L. and Stanford, J.L. (2013) Consumption of deep-fried foods and risk of prostate cancer. The Prostate, 73, 960-969. doi:10.1002/pros.22643
[29]	FAO-SIFSIA (2010) Soaring food prices and its policy implications in north Sudan: A policy brief Sudan institutional capacity programme: Food security information for action (sifsia) brief soaring food prices. http://www.fao.org/fileadmin/user_upload/sifsia/docs/Policy
[30]	Laessing, U. (2013) Sudanese boycott meat to fight food inflation. AL ARABIYA. www.alarabiya.net
[31]	Ibnouf, F.O. (2012) The value of women’s indigenous knowledge in food processing and preservation for achieving household food security in rural Sudan. Journal of Food Research, 1, 238-253. doi:10.5539/jfr.v1n1p238
[32]	Sukkar, M.Y., Boutros, J.Z. and Yousif, M.K. (1975) The composition of common Sudanese foods. Sudan Medical Journal, 13, 51.
[33]	Ibnouf, F.O. (2009) The role of women in providing and improving household food security in Sudan: Implications for reducing hunger and malnutrition. Journal of International Women’s Studies, 10, 144-167.
[34]	Sulieman, A.E., Ali, A.O. and Elkhalifa, E.A. (2003) Some characteristics of the Sudanese bread (Kissra) supplemented with fenugreek (Trigonellafoenum-graecum L.). Gezira Journal of Agricultural Science, 1, 15-25.
[35]	Abdualrahman, M.A.Y. and Ali, A.O. (2012) Supplementation of Sudanese sorghum bread (Kissra) with Bambara groundnut flour (Vignasubterranea (L.) Verdc.). International Journal of Agricultural Research, 7, 215-222.
[36]	Dirar, H.A. (1993) The indigenous fermented foods of the Sudan. C.A.B. International, Wallingford.
[37]	Hamad, H.M. (2006) Cancer initiatives in Sudan. Annals of Oncology, 17, 32-36. doi:10.1093/annonc/mdl985
[38]	Awadelkarim, K.D, Aceto G., Veschi, S., Elhaj, A., Morgano, A., Mohamedani, A.A., Eltayeb, E.A., Abuidris, D., Di Gioacchino, M., Battista, P., Verginelli, F., Cama, A., Elwali, N.E. and Mariani-Costantini, R. (2007) BRAC1 and BRAC2 status in a Central Sudanese series of breast cancer patients: Interactions with genetic, ethnic and reproductive factors. Breast Cancer Research Treatment, 102, 189-199. doi:10.1007/s10549-006-9303-z
[39]	Awadelkarim, K.D., Arizzi, C., Elamin, E., DeBlasio, P., Hamad, H.M.A., Mekki, S.O., Osman, I., Biunno, I., Elwali, N.E., Mariani-Costantini, R. and Barberis, M.C. (2008) Pathological, clinical and prognostic characteristics of breast cancer in Central Sudan versus Northern Italy; implications for breast cancer in Africa. Histopathology, 52, 445-456. doi:10.1111/j.1365-2559.2008.02966.x
[40]	El Hassan, A., El Hassan, L., Mudawi, H., Gasim, B., Own, A., Elamin, E., Ouf, M.I., El Mekki, M. and Fedail, S. (2008) Malignant gastric tumors in Sudan: A report from a single pathology center. Hematology Oncology and Stem Cell Therapy, 1, 130-132.
[41]	Ahmed, H.G., Ali, A.S. and Almobarak, A.O. (2010) Frequency of breast cancer among Sudanese patients with breast palpable lumps. Indian Journal of Cancer, 47, 2326. doi:10.4103/0019-509X.58854
[42]	Elgaili, E.M., Abuidris, D.O., Rahman, M., Michalek, A.M. and Mohammed, S.I. (2010) Breast cancer burden in central Sudan. International Journal Women’s Health, 2, 77-82.
[43]	WHO Global Infobase: Data for Saving Lives. https://apps.who.int/infobase
[44]	Willet, M.C. (1995) Diet, nutrition and avoidable cancer. Environmental Health Perspectives, 103, S165-S170.
[45]	Bovell-Benjamin, A, Dawkins, N., Pace, R. and Shikany, J.M. (2010) Dietary consumption practices and cancer risk in African Americans in the rural South. Journal of Health Care for the Poor and Underserved, 21, 57-75. doi:10.1353/hpu.0.0361
[46]	Elmubarak, E., Bromfield, E. and Bovell-Benjamin, A.C. (2005) Focused interviews with Sudanese Americans: Perceptions about diet, nutrition, and cancer. Preventive Medicine, 40, 502-509. doi:10.1016/j.ypmed.2004.09.021
[47]	Bronner, Y.L., Ebede, T.L., Hossain, M.B., Nowverl, A. and Harris, E. (2001) Historical assessment of nutrition studies using only African American study subjects: Gender, socioeconomic status, and geographic location. Ethnicity & Disease, 11, 134-143.
[48]	Laverentz, M.L., Cox, C.C. and Jordan, M. (1999) The Nuer nutrition education program; breaking down cultural barriers. Health Care for Women International, 20, 593601.
[49]	Novak, J.D. and Gowin, D.B. (1984) Learning how to learn. Cambridge University Press, Cambridge. doi:10.1017/CBO9781139173469
[50]	Smith, P.G. and Morrow, R.H., Eds. (1993) Methods for field trials of interventions against tropical diseases: A tool box. Oxford University Press, Inc., New York, 176196.
[51]	Green, L. and Kreuter, M. (1991) Health promotion planning. Mayfield Publishing Co., Mountain View, 2-20.
[52]	Wardle, J. (1993) Food choices and health evaluation. Psychology and Health, 8, 65-75. doi:10.1080/08870449308403167
[53]	Margetts, B.M. (1991) Basic issues in designing and interpreting epidemiological research. In: Margetts, M. and Nelson, M., Eds., Design Concepts in Nutritional Epidemiology. Oxford University Press, New York, 22-51.
[54]	Perkin, J. (1992) Design and use of questionnaires in research. In: Monsen, E.R., Ed., Research: Successful Approaches. American Dietetic Association, Chicago.
[55]	Fowler, F.J. and Mangione, T.W. (1990) Standardized survey interviewing. Sage Publications Inc., Applied Social Research Method Series, Newbury Park.
[56]	Schinke, S.P., Singer, B., Cole, K. and Contento, I.R. (1996) Reducing cancer risk among Native American adolescents. Preventive Medicine, 25, 146-155. doi:10.1006/pmed.1996.0040
[57]	Burkitt, D.P. and Trowell, H.C. (1975) Refined carbohydrate and disease. Academic Press, New York.
[58]	Musaiger, A.O. (2002) Diet and prevention of coronary heart disease in the Arab Middle East countries. Medical Principles and Practice, 11, 9-16. doi:10.1159/000066415
[59]	Kendall, C.W.C., Esfahani, A. and Jenkins, D.J.A. (2010) The link between dietary fibre and human health. Food Hydrocolloids, 24, 42-48. doi:10.1016/j.foodhyd.2009.08.002
[60]	WCRF/AICR (World Cancer Research Fund/American Institute for Cancer Research) (2007) Food, nutrition, physical activity, and the prevention of cancer: A global perspective. AICR, Washington DC.
[61]	Abdelgadir, W.S., Ahmed, T.K. and Dirar, H.A. (1998) The traditional fermented milk products of the Sudan. International Journal of Food Microbiology, 44, 1-13.
[62]	Harnack, L., Block, G., Subar, A., Lane, S. and Brand, R. (1997) Association of cancer prevention-related nutrition knowledge, beliefs, and attitudes to cancer prevention dietary behavior. Journal of the Academy of Nutrition and Dietetics, 97, 957-965.
[63]	Charlton, K.E., Brewitt, P. and Bourne, L.T. (2004) Sources and credibility of nutrition information among black urban South African women, with a focus on messages related to obesity. Public Health Nutrition, 761, 801-811.
[64]	Stott-Miller, M., Neuhouser, M.L. and Stanford, J.L. (2013) Consumption of deep-fried foods and risk of prostate cancer. The Prostate, 73, 960-969. doi:10.1002/pros.22643
[65]	FAO-SIFSIA (2010) Soaring food prices and its policy implications in north Sudan: A policy brief Sudan institutional capacity programme: Food security information for action (sifsia) brief soaring food prices. http://www.fao.org/fileadmin/user_upload/sifsia/docs/Policy
[66]	Laessing, U. (2013) Sudanese boycott meat to fight food inflation. AL ARABIYA. www.alarabiya.net
[67]	Ibnouf, F.O. (2012) The value of women’s indigenous knowledge in food processing and preservation for achieving household food security in rural Sudan. Journal of Food Research, 1, 238-253. doi:10.5539/jfr.v1n1p238
[68]	Sukkar, M.Y., Boutros, J.Z. and Yousif, M.K. (1975) The composition of common Sudanese foods. Sudan Medical Journal, 13, 51.
[69]	Ibnouf, F.O. (2009) The role of women in providing and improving household food security in Sudan: Implications for reducing hunger and malnutrition. Journal of International Women’s Studies, 10, 144-167.
[70]	Sulieman, A.E., Ali, A.O. and Elkhalifa, E.A. (2003) Some characteristics of the Sudanese bread (Kissra) supplemented with fenugreek (Trigonellafoenum-graecum L.). Gezira Journal of Agricultural Science, 1, 15-25.
[71]	Abdualrahman, M.A.Y. and Ali, A.O. (2012) Supplementation of Sudanese sorghum bread (Kissra) with Bambara groundnut flour (Vignasubterranea (L.) Verdc.). International Journal of Agricultural Research, 7, 215-222.
[72]	Dirar, H.A. (1993) The indigenous fermented foods of the Sudan. C.A.B. International, Wallingford.