Post-migration food habits of sub-Saharan African migrants in Victoria: a cross-sectional study.

Abstract

Objective: (i) To describe sub-Saharan African (SSA) post-migration food habits and eating patterns; and (ii) to examine how the food habits of SSA households in Victoria reflect post-migration acculturation.

Design: A cross-sectional survey using a snowball sampling technique. Data on food habits and eating patterns were obtained using semi-structured, face-to-face interviews from November 2001 to April 2002.

Subjects: A total of 139 households of demographically diverse recent migrants from across sub-Saharan Africa.

Setting: Melbourne metropolitan and Melbourne fringes.

Analysis: Data were summarised using descriptive statistics.

Results: SSA migrants and refugees indicated dietary acculturation characterised by three processes: substitution, supplementation and modification of recipes. They experienced difficulty locating their traditional foods, in particular, African vegetables (34.2%), unprocessed maize meal (29.1%), camel milk (23.1%) and maize grain (13.7%). The new foods adopted since arrival were pizza, breakfast cereals and fast foods, but also included new fruits and vegetables. Takeaway food such as Pizza Hut or McDonalds featured prominently in the SSA post-migration diet. Reasons for eating out were favourite food (48.3%), routine family outing (38.3%), special occasion (33.3%) and no time to cook (25%). A significant change in meal pattern was the inclusion of breakfast, although 21% reported skipping breakfast.

Conclusion: Many of the observed dietary changes were not consistent with good health and may predispose this population to rapid weight gain and chronic disease. Rapid modernisation and the Anglo-Australian culture interact in a complex way with traditional eating and socialisation practices of SSA migrants. Understanding these forces can allow effective health promotion and community development strategies to be developed for the future health of SSA migrants and their communities.

Key words: cooking practice, dietary acculturation, eating pattern, food habit, sub-Saharan African migrant.

INTRODUCTION

The concept of acculturation is used to describe 'culture change that results from continuous, first hand-contact between two distinct cultural groups'. (1) According to Rissel, acculturation refers to 'a process through which migrants and their children acquire the values, behavioural norms and attitudes of the host society'. (2) Such adaptation may include the adoption of the beliefs and behaviours of the host country, such as beliefs about the manner in which people interact with their social and physical environment, beliefs surrounding food habits, including how food is shared within a household, and the feeding patterns or cultural understanding of foodstuffs. (3,4)

There are little available data on the dietary habits of most culturally and linguistically diverse communities in Australia. Dietary acculturation has been described in Greek, (5) Lebanese (6) and Chinese migrants. (7) Many African communities have until relatively recently been small and emerging. For this reason there is a scarcity of studies of the dietary acculturation of these peoples in Australia. An Australian study by Saleh et al. of Ghanaian migrants reported that following migration, the consumption of chicken, rice, bread and beef increased, and the consumption of fish and fruit decreased, and tropical root crops (usually cassava flour) were replaced with potato starch. (8) In another Australian study, Burns and colleagues found Somali migrants struggle to find their traditional foods. (9) Burns has also described how female Somali migrants changed meat source, adopted breakfast cereals but rejected ready prepared and takeaway foods on settlement in Australia. (4) In addition, Renzaho has found African migrant children to be at high risk of both malnutrition and overnutrition in Australia. (10) Therefore, Africans are an important group to study, both to improve our understanding of dietary acculturation, and to gain leverage for public health interventions in these high-risk populations.

The aim of the present study was to examine the post-migration food habits of migrant children to Australia from countries across sub-Saharan Africa. For the present study we used the theoretical framework for dietary acculturation developed by Jerome et al. (11) and Goode et al. (12) Jerome et al. suggest five levels of analysis: (i) family food practices: a category dealing with dietary selection and patterning, consumption practices, values and beliefs determining/guiding the household's dietary behaviours; (ii) continuity of changes in food practices: a category dealing with dietary acculturation, notably dietary patterns and food practices maintained and/or discarded; (iii) opinion: a category exploring demands of living in a new environment; (iv) life history: a category concerned with the description of particular life events, for example festivities; and (v) family characteristics: exploring members' opportunity to be in contact with the dominant culture and members' social characteristics. (11) Goode et al. proposed that the continuity and maintenance of traditional dietary practices be assessed in terms of community-shared rules (e.g. eating events and the social contexts in which they occur, such as life cycle feasts, weekly meals, holidays, weekend meals) and levels of a food system (level of use of available food items to formulate recipes, style of food preparation, meal formats). (12) Berry (13,14) and Flannery and colleagues (15) note that this is a pluralistic process where immigrants accept a new culture from the dominant society but also retain some of their own culture. Therefore, in the present study it was hypothesised that dietary changes would be consistent with a move to a developed economy, that is, adopting an elaborate, high-calorie diet in which some traditional food items are retained. It was further hypothesised that this effect would be modified by religion and the availability of traditional foods.

METHODS

Recruitment of participants and sampling methods

The data reported here were part of a large study of nutritional status, lifestyle behaviours and acculturation in African migrant children. Households to be surveyed were selected using a snowball sampling strategy. (16) This sampling technique is considered best for difficult-to-access populations but may not yield a representative sample. However, in attempt to limit this effect to the sampling, the current study was stratified by region of origin using the United Nations' classification of African regions and subregions to ensure inclusiveness and adequate coverage of the target population. (17,18) A matrix of four regions of origin was constructed. In each region, an initial family was identified through community health workers, community health centres and migrant resource centres, Kindergarten Parents Victoria or African community organisations' networks. Then, the identified family was asked to identify or recommend other families from their region of origin. The next identified family was only visited after the preceding procedure was implemented across regional strata. The process continued until the stratum was exhausted or saturated, that is, no more families could be identified. This process identified a total of 143 households and 139 households were surveyed.

However, although cell sizes were proportional to the sub-Saharan African (SSA) population in Australia for eastern, central and western Africa, migrants of southern African origin were difficult to locate as the majority of them are white South Africans and Zimbabweans. White Africans were excluded from the present study as their food habits are significantly different from black Africans. Hence, only three households from this region were identified and were eligible for the present study. Consequently, our coding of African regions merged southern with eastern Africa. The subsequent analysis was based on three regions: Central Africa, Eastern/Southern Africa and Western Africa.

All participants were required to sign a consent form. Those who could not write provided verbal consent. For these participants, bilingual workers read the consent form to them in their preferred language. Deakin University's research ethics committee cleared the project.

Data collection protocol

Four bilingual African interviewers were recruited from each of the major sub-Saharan regions to carry out the data collection. Data collection was carried out using a semi-structured interview with parents. The interview protocol was trialled before use. The interview took, on average, two hours and was conducted in the respondents' homes. Respondents were given a $20 gift voucher in compensation for their time and effort.

Data were collected by interview with a parent, using closed questions, included demographic data, family food habits and practices including eating out and consumption of takeaways, consumption of breakfast, meals taken as a family, influences on food habits, types of oil used in cooking, cooking and seasoning methods. The interview also used open-ended questions relating to foods from country of birth (COB) that were not available and substituted for in Australia, traditional dishes that the respondents continued to prepare, and the new foods that they had adopted. In order to assess the level of pre- and post-migration food insecurity, the following questions were asked: (i) 'Has your family ever run out of food in Australia?' and (ii) 'Has your family ever run out of food when you lived in your country of birth (COB)?' (19) The interviewer recorded responses on paper. All responses were single words or simple phases that could be easily coded. No thematic analysis was necessary.

Data analysis

Data from both open and closed questions were coded manually then entered in SPSS (SPSS, Chicago, IL, USA, 2000, SPSS version 10) for analysis. Data were summarised using descriptive statistics; frequency tables.

RESULTS

Response rate and characteristics of participants

The demographic characteristics of the study sample are summarised in Table 1. In total, 143 households were located and contacted between November 2001 and April 2002 and were invited to take part in the present study. Four households (2.8%) declined to participate, giving a response rate of 97.2%. Of the 139 households surveyed, 18.7%, 69.1%, 10.4% and 2.1% were from central, eastern, western and southern Africa, respectively. Australia accepts overseas migrants under the skilled worker steam, the family reunition stream, humanitarian programme or as non-programme migrants (mostly New Zealanders). (20) The Australian Humanitarian Program offers resettlement to refugees and others overseas who are in need of humanitarian resettlement. Of the sample 54% had arrived in Australia as refugees under the Humanitarian Immigration Programme. The remainder were entered under other migrant streams.

The members of the surveyed households had been in Australia for an average of 6.2 [+ or -] 4.4 years (mean [+ or -] SD), with an average of 3.7 [+ or -] 2.0 children per household. Of the 139 parents who were interviewed, 20.1% were men and 79.9% women. The average age of the parent interviewed was 36.2 [+ or -] 6.3 years. From Table 1 it is evident that the majority of the sample came from non-English-speaking countries (72.7%). Of the surveyed households, 19.7% lived in refugee camps prior to migration. In terms of religion, 51.1% were Christian and the remaining 48.9% Muslims. The majority (83.3%) of respondents were married. However, 21% of married couples were not currently cohabiting with their partners at the time of the survey. Approximately 37% of the sample had reached technical or tertiary level education prior to migration. More than 50% were either unemployed or not in the labour force. Almost half (41.2%) of respondents nominated home duties as their occupation. The level of income was diverse, but almost three quarters (71.8%) of the sample earned $37 000 or less per year.

Level of food insecurity

None of the subjects nominated that they had run out of food since migrating to Australia, but 13.2% indicated that they had run out of food in their COB. The chief reasons for running out of food prior to migration were the planting-harvest cycle, war, flooding and drought, living in refugee camps, family problems and financial mismanagement, poverty and unemployment. The majority of families (83.2%) had run out of food in their COB for a period of as long as five days. The frequency varied according to circumstances. For those who lived in refugee camps, running out of food had happened two to three times a week in 72.6% of cases. Running out of food due to planting-harvesting cycles had happened three times a month in 63.8% of cases. The frequency of running out of food was most pronounced in cases of war, flooding and drought and this happened almost every second day in 94.5% of these cases before international food relief programmes reached the affected population. After food relief programmes were implemented following a disaster, the frequency of running out of food dropped to once a week in 82.2% of these cases.

Level of continuity and maintenance of traditional dietary practices and coping with new foods

Difficulties locating familiar traditional foods were indicated by 130 of 139 households (93.5%). Preferred food items consumed in the COB prior to migration, which were difficult to locate in Australia were: African vegetables (including sweet potato leaves, cassava leaves, pumpkin leaves, bean leaves, tarot leaves, amaranth), black eye beans, maize flour and grain, camel milk and meat, cocoyam and yam products, sorghum and sorghum products, fresh water fish, cassava, plantain banana, smoked meat and fish, African doughnuts, basso (toasted burley flour), goat meat as well as palm nut, snail and traditional yoghurt. These foods are either not available in Australia or are available in inadequate supply. Although available in Australia, cassava roots, cocoyam, millet flour, sugar cane, passion fruit, white bait and amaranth were not consumed by SSA migrants because these food items were found to taste different from the same foods in COB (Table 2). In addition, fresh foods such as figs, artichokes, swamp cabbage, snow peas, asparagus and chayote were nominated as new foods, tried but rejected because of taste. In the absence of ingredients to make up familiar African recipes, SSA migrants in Australia have adopted a coping mechanism based on simulating recipes by substituting absent or inaccessible ingredients with readily available ingredients (Table 3). For example lamb was substituted for camel meat. Despite the struggle related to locating traditional foods, a number of traditional dishes from their COBs were still being consumed in Australia prepared with traditional and substituted ingredients. These are summarised in Table 4.

Foods adopted in Australia

The 10 most widely adopted Australian foods, in order of importance, were: pizza (44.5% of household); breakfast cereals (23.6% of households); McDonalds/KFC (22.7% of households); pasta/spaghetti (19.1% of households); a variety of vegetables including broccoli, silver beet, sprouts, salad (eaten with mayonnaise) and cauliflower (13.6% of households); a variety of fruit including mangoes, apple, pears, nectarines, kiwi, peach and melon (12.7% of households); sandwiches (11.8% of households); fish and chips (9.1% of households); hamburgers (7.3% of households) and sweet cakes/doughnuts (6.4% of households). Other foods nominated as new adoptions from Australia were: lasagne, doughnuts, the institution of the barbecue, cordial, chicken and chips, ham and salami, Asian food, Vegemite, meat pie, sausage, seafood, tinned food, frozen food and chocolate.

Household eating and dining-out patterns

For 50% of the participants in the present study, lunch constituted the 'heaviest' meal. This was followed by dinner (46%) where the word 'heaviest' was used at interview to denote the largest and most formal household meal. For a further 4%, breakfast constituted the main meal. We found that the 'heaviest' meal was eaten together as a family in 86% of households. Of respondents 79% indicated having breakfast on a regular basis since migration. Of the remaining 21% of households who did not have breakfast regularly, the chief reasons stated for not having breakfast were: time and work demands (41.9%), society-induced pressure to lose weight (22.6%), not being accustomed to eating breakfast (19.4%), poverty (12.9%) and religious requirements, such as fasting (3.2%).

Of respondents 33% dined out at takeaway fast food shops at least once a week (Fig. 1). Of the 138 who answered the question on eating-out pattern, 33% indicated eating out at a takeaway fast food shop at least once a week. The main reasons given for eating out at a takeaway fast food shop were: to eat favourite foods (48.3%), routine family outing (38.3%), special occasion (33.3%), no time to cook (25%), do not know how to cook (0.8%). Other reasons (9.2%) included lack of cooking facilities, convenience, dietary variation and trying to avoid cooking in summer due to lack of airconditioning (cooking heats up the house).

Cooking and seasoning patterns

The two most common cooking methods were frying (60.3%) and boiling (30.2%). Olive oil (61.3%) and canola oil (53.3%) were the most frequently used cooking oils. Sunflower oil (35.8%), corn oil (30.7%) and butter (21.2%) were also used in cooking. Fat was trimmed off meat in 85% of cases, but 7% of households never trimmed fat off meat. Most participants (83%) added salt to food during cooking. The most popular sandwich fillings and toast spreads included jam (79.9%), butter (59%), peanut butter (51.8%), cheese spread (49.6%) and margarine (45.3%).

Determinant of household shopping pattern

Religion (32.4%), budget (18%), nutritional values (18%) and health-related factors (13.7%) were the factors that most influenced food choice when shopping (Table 5). Compared with Muslims, Christians were more likely to list budget, nutritional value and palatability but less likely to list religion as the most important factors influencing their food choice when shopping ([chi square] = 78.504, P < 0.001).

DISCUSSION

The present paper examines continuity and change in the food habits and traditional dietary practices of SSA migrants following migration to Australia. The traditional foods that were difficult to source for these migrants were found to be staples such as sorghum or maize, protein sources such as camel meat and specific fruits and vegetables. For many foods that were not available in Australia, the Africans made substitutions with similar foods found in their host country. However, they continued to eat many of the foods known in their COB, such as rice, pasta, semolina and enjera (traditional bread). The new foods adopted from Australia included pizza, breakfast cereals and McDonalds and KFC products. Other foods adopted were new vegetables and fruits, as well as olive or canola oil. Frying remained the major form of cooking. The majority of the sample used salt in cooking but trimmed the fat from meat. There was evidence that these African migrants had embraced the takeaway culture (33% eat takeaways at least once a week). However, the majority (86%) ate their main meal as a family and 76% ate breakfast regularly.

Our study presents a broad picture of the food habits of sub-Saharan migrants. The relatively small numbers of specific African racial groups did not allow us to explore any racial or tribal differences. The data that are available regarding the dietary patterns in sub-Saharan Africa indicate that the diet in the COBs is predominantly composed of a variety of wild and cultivated green vegetables, legumes (mainly dried beans, dried peas and peanuts), tubers (mainly all kinds of potatoes, yam, cassava), green and plantain bananas, wild and cultivated tropical fruits, cereals (mainly maize and sorghum) and occasional animal products, notably dried fish and meat. (21,22) These eating patterns have been consistent over decades (Table 6) and foods such as palm oil, potato, plantain and green banana, maize and cassava flour, yam, cassava leaves, beans and peanut butter are staples. As can be seen from Table 6, food consumed in urban areas is primarily produced in rural areas and frying remains the most popular cooking practice in urban areas.

As in previous studies of migrant populations in Australia, (5-7) we observed dietary acculturation among migrant SSAs. A strength of the present study was the use of a theoretical framework for the exploration of this process. Consistent with the model of Goode et al. (12) and Jerome et al., (11) our data indicate that dietary acculturation has included the addition of foods from the dominant culture, the retention of some traditional foods and some substitutions for traditional foods. A component of the dietary acculturation of these African families was the adoption of mainstream Australian foods. The embracing of fast food such as pizza may have a negative impact on nutritional intake. (27) However, it must also be noted that the Africans had made several dietary adoptions, namely, breakfast cereal, vegetables and sandwiches that would have potentially a favourable impact on their dietary intake.

The SSA migrants found it hard to source staple foods such as sorghum, and meats such as camel and goat, therefore it is not possible to determine whether they would 'reject' these foods if they were widely available. However, the lack of availability required food substitutions and menu manipulations to occur. Potentially, such substitutions and replacements have large nutritional impact on the diet of SSA migrants. For example, given the very low fat content of camel meat (28) the substitution of lamb for camel meat would appreciably increase dietary fat intake. Further examples of substitution are Liboke (a dish based on fresh water fish) with pork (in non-Muslim sub-Saharans), maize grain with mashed sweet corn/peas, yam/cassava root/plantain banana with potatoes and cassava/sorghum/yam flour with potato flour. In the majority of cases unprocessed low-energy dense foods and food high in fibre are being replaced with foods that are refined high-energy dense and low in fibre. In order to achieve the taste of traditional foods butter, salt, sugar and oil have been added to these substitute foods. This has obvious implications for dietary intake of salt, fat and simple carbohydrates. This exemplifies 'cultural hybrid-dishes' that result from dietary acculturation.

It is significant that 83% of our study population added salt to cooking and 60% nominated frying as the cooking method of choice. This is in contrast to studies of the Australian population in which only 25% used discretionary salt, (29) and although there are no data on the number of Australian who regularly fry food, market research indicates that roasting meat, pasta, curry and stir-fry are the most popular foods and methods of cooking for Australian families. (30) Interestingly, although only 49% of Australian men and 64% of Australian women rarely or never eat the fat on meat, (29) 85% of African migrants in the present study trimmed the fat from meat. Trimming the fat from meat may, for Africans, be a method of limiting what is perceived to be a strong and unpleasant, to the African palate, flavour of Australian produced meat. (4)

Dietary acculturation has an economic as well as nutritional impact. The majority of the available traditional and food items are sold in outlets that specialise in Indian (e.g. sorghum flour), Vietnamese, Italian and Greek foods (black eye or mung beans, seasonal plantain bananas and a variety of vegetables) or in Australian supermarkets (pasta, meat, semolina, flours and cakes). However, many of these foods such as yam, plantain bananas and sorghum have limited availability and are cost-prohibitive. As a result, it is difficult for particularly low-income migrant families to maintain traditional eating habits. This, then, is a significant environmentally imposed dietary acculturation issue.

Our data indicate a change in the meal format, with 86% eating the main meal together as a family. This is a departure from the traditional eating pattern, which dictates that men, women and children eat separately. (25,31) In rural areas at dinner men eat with the men; women have a separate dining table, while the assembled children are served food on a communal plate (no individual plates regardless of the child's age). It is expected that the older children will look after the younger ones. In urban areas, too, men, women and children do not eat together as a family, but urban women usually share the dining table with children whereas the men have their 'private plates' as they are traditionally understood to be the sole breadwinners in some sub-Saharan countries. Changes in traditional eating pattern may have significant effects on social dynamics within the family. A study of Victorian families, conducted by Campbell et al., indicated that 63% of the respondents eat the evening meal together '4 or more times a week'. (32) Although African migrants dramatically changed how they ate their main meal, this change was in fact in the direction of a family meal whereas Australians are moving towards a more fragmented meal with family members eating together on fewer occasions. (32)

It is not usual in sub-Saharan Africa to eat breakfast. (24) The finding that 76% of our sample ate breakfast regularly indicates another aspect of dietary acculturation, a departure from the traditional meal format, with potential social and nutritional impacts. The National Nutrition Survey 1995 found that 77% of Australians eat breakfast five or more days a week. (33) Therefore, within an average of 5-10 years of arrival in Australia these African migrant families had acculturated to eating breakfast. This change could have favourable nutritional spin-offs. For example, the consumption of fortified breakfast cereals could potentially improve intake of micronutrients.

With respect to meals eaten away from home, comparative African data from the South African National Food Consumption Survey found that in South Africa meals eaten away from home are customarily eaten at the homes of family, friends or neighbours (39%) rather than at takeaway outlets (3%). (25,34) By contrast, our data indicate that 33% of SSA households in Australia ate takeaways at least once a week. This is in line with current takeaway consumption in Australia with 30% of the population consuming takeaways once a week. (35) Economic changes occur when SSAs move from traditional pursuits to new forms of employment in Australia. The change in gender role and the demands related to the new environment create a situation where the post-migration lifestyle becomes increasingly busy and complex, hence leading to a greater demand for, and reliance on, convenience foods. (9) This dramatic change in eating habits occurred rapidly, within 5-10 years these African migrants have acculturated to the regular consumption of readily available foods prepared outside the home, principally fast foods. A sense of belonging and acceptance by the wider community can also be associated with the purchase and consumption of new foods including prepared foods outside the home. In addition, Africans may have a cultural construction of takeaway foods as highly valued. (31) A perception of eating pattern that may be heightened by exposure to advertising. The rapid move towards a wider use of takeaways in SSAs is of concern as current data indicate that an increase in consumption of these foods is associated with obesity and chronic disease. (36)

Current evidence indicates that taste and cost are the major determinants of food choice and purchase. (37) In the USA Glanz et al. found that factors affecting food choices include taste, cost, nutrition, convenience and weight concerns in that order. (38) Furthermore, data from 15 European member states as part of the Pan-European Survey of Consumer Attitudes to Food, Nutrition and Health found the top five influences on food as 'quality/freshness' (74%), 'price' (43%), 'taste' (38%), 'trying to eat healthy' (32%) and 'what my family wants to eat' (29%). (39) In our study population, however, there was a strong effect of religion on food purchase. The effect of religion on food habits is well documented, both in migrant and non-migrant populations. (40,41)

In migrants, the impact of religion on food habits depends on many factors, including the degree of religious loyalty and the religion followed. (41) For SSA migrants who follow Islam, food choice is more likely to be governed by many factors, but the main one nominated in the present survey was prohibition (food forbidden by Islam) and the doctrine of eating as prescribed by the Qur'an (e.g. appropriate food during Ramadan, fasting). The significance of religion and its close relationship to eating is summarised by Sack, who states, 'everyone eats, and many people endow their eating with religious significance'. (41) It is interesting that 14-18% of subjects nominated health and nutrition as salient for food choice. Further investigation is required to elucidate the meanings and constructions of these terms for African migrants.

Despite the trends observed with the SSA migrants, it should be noted that the theory of acculturation is played out in different ways within and across ethnic groups. Socio-demographic characteristics, economic factors and the social environment play a significant role in shaping the degree of acculturation. For example, it is well known that children acculturate more easily than adults; and that migration at younger age accelerates the acculturation process (42,43) whereas migrants from the same ethnic group acculturate at varying rates and attain different levels of assimilation to the mainstream culture depending on generation and length of stay or gender role and equality issues. (44) Finally, maintaining or relinquishing traditional foodways is one way of renegotiating the power between the 'host' and the 'migrant/refugee'. This process may itself depend on the occasion and whether a boundary needs to be maintained. That is, food is used to establish a boundary--a way of saying 'I am different from you'.

CONCLUDING REMARKS

From the present study findings we can conclude that change in food habits among SSA migrants does occur. Changes have been reported in terms of food procurement, introduction of commercially prepared foods at the expense of home-cooked meals, preparation methods and meal pattern. Changes in SSA dietary practices have occurred with the replacement of traditional foods by alternative Australian foods, supplementation or introduction of new foods and modification of recipes. Such changes may have both positive and negative nutritional and social consequences for migrant Africans. It should be noted that SSA migrants have succeeded in retaining some of their traditional foods. Rapid modernisation and the Anglo-Australian culture interact in a complex way with traditional eating and socialisation practices of SSA migrants. Understanding these forces can allow effective health promotion and community development strategies to be developed for the future health of SSA migrants and their communities.

ACKNOWLEDGEMENTS

The current data were collected as part of the author's (Andre M.N. Renzaho) PhD thesis. Because of the breadth of the data and word limits, the chapter on post-migration food habits of SSA migrants and refugees was not included in the thesis. The author (Andre M.N. Renzaho) would like to thank the following: Anastasia Mwangi, Amina Hussein, Elisabeth Ngari, Munira Muhamed, Nabiha Muhamed and Wemi Oyekanni for their help with data collection. The author (Andre M.N. Renzaho) would also like to thank the African Review Panel for mobilising the SSA migrant population and the overall SSA community living in Victoria for endorsing the study and generously taking part in the study. The authors acknowledge grant assistance provided by the Ian Potter Foundation.

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Andre M.N. RENZAHO (1) and Cate BURNS (2)

Schools of (1) Health and Social Development and (2) Exercise and Nutrition Science, Deakin University, Burwood, Victoria, Australia

Correspondence: A.M.N. Renzaho, School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia. Email: [e-mail] or [e-mail]

A.M.N. Renzaho, PhD, MPH, Honorary Fellow

C. Burns, BSc, Dip Diet, PhD, Research Fellow

A. Renzaho conceived, designed and coordinated the project, performed the statistical analysis, drafted and edited the manuscript and incorporated reviewers' comments. C. Burns was A. Renzaho's PhD supervisor, revised the initial manuscript and proofread the accepted version.

Table 1 Demographic characteristics of participants

Factor                           Description                 n (%)

Gender                           Male                         28 (20.1)
                                 Female                      111 (79.9)
Region of origin                 Central                      26 (18.7)
                                 Eastern/Southern             99 (71.0)
                                 Western                      14 (10.4)
Religion                         Christian                    71 (51.1)
                                 Muslims                      68 (48.9)
Marital status                   Married                     115 (83.3)
                                 Separated                     8 (5.8)
                                 Divorced                      4 (2.9)
                                 Widowed                       9 (6.5)
                                 Never married                 2 (1.5)
Living with your partner         Yes                         109 (79.0)
                                 No                           29 (21.0)
Educational level in country of  Never attended school        12 (8.6)
  birth                          Primary school               15 (10.8)
                                 High school                  60 (43.2)
                                 Technical/tertiary           52 (37.4)
Schooling in Australia           None                         35 (25.2)
                                 High school                   2 (1.4)
                                 Technical/tertiary           49 (35.3)
                                 English classes              53 (38.1)
Employment status                Employed                     52 (38.0)
                                 Not in labour force.         52 (38.0)
                                 Unemployed                   33 (24.1)
Occupation                       Professional                 29 (25.4)
                                 Skilled                      20 (17.5)
                                 Home duties                  47 (41.2)
                                 Non-working                  18 (15.8)
Income ($)                       <15 000                      14 (10.7)
                                 15 000-22 000                19 (14.5)
                                 22 000-29 000                33 (25.2)
                                 30 000-37 000                28 (21.4)
                                 38 000-45 000                12 (9.2)
                                 46 000-53 000                 9 (6.9)
                                 [greater than or equal to]   16 (12.3)
                                   54 000
Parent migration status          Refugee                      74 (54.0)
                                 Family reunion               21 (15.3)
                                 Financial/economic           17 (12.4)
                                 Education opportunities      25 (18.2)
Country of origin's ex-colonial  English colony               38 (27.3)
  rule                           Non-English colony          101 (72.7)
Family in refugee camps prior    Yes                          27 (19.7)
  to migration                   No                          110 (80.3)

Table 2 Food items least consumed by sub-Saharan Africans living in
Victoria

                                                 Traditional food items
                                                 found in Australia but
Traditional food items  Adopted new food items,  least consumed because
in inadequate supply    consumed least because   they do not taste like
and/or unavailable      of different taste       those back home

Sorghum flour           Figs                     Cassava roots
Black eye beans         Artichoke                Cocoyam
Camel meat              Swamp cabbage            Millet flour
Camel milk              Snow peas                Sugar cane
Cassava flour           Asparagus                Passion fruit
Cassava leaves          Chayote                  White baits
Cocoyam leaves                                   Amaranth
African doughnuts
Sweet potato leaves
Palm oil
Maize flour
Maize grains

Table 3 Australian substitutes for traditional dishes that are
inaccessible or unavailable (n = 97)

Traditional food that are not                               % Households
accessible                          Australian substitutes  affected (d)

Camel meat                          Lamb                    38.1
Maize flour (thick maize porridge/  Semolina/polenta        33.0
  meal)
African vegetables                  Bok choy/Chinese (c)    27.8
Camel milk                          Cow's milk              20.6
Cocoyam/plantain banana/cassava     Potatoes                11.3
Sorghum                             Wheat                   10.3
Maize grain (Githeri) (a)           Mashed sweet corn/peas   7.2
Thick sorghum porridge/meal         Noodles/pasta            7.2
Fresh water fish                    Sea fish                 3.1
Plantain banana                     Rice                     3.1
Tropical fruit                      Summer fruit/apple       2.1
Sorghum flour, cassava flour, yam   Potato flour             2.1
  flour
Liboke (based on fresh water        Pork                     1.0
  fish) (b)
Smoked wild meat/goat meat          Barbecue (beef)          1.0
Fermented thick maize meal          Pizza                    1.0

(a) Special Kikuyu (Kenya) dish.
(b) Liboke is a Lingala word and this dish is widely eaten in central
Africa. Lingala is widely spoken in central Africa (Congo, Democratic
Republic of Congo, Central Africa) and is the national language of the
Democratic Repuhlic of Congo.
(c) Other vegetables used include silver beet, spinach, cabbage and,
rarely, lettuce.
(d) Multiple responses. Does not add up to 100.

Table 4 What traditional food/dish from you country of birth does your
family continue to eat? (n = 104)

Dish                                       % Houscholds (j)

Enjera/Chapati/Ukhlat (flat bread) (a)     48.1
Semolina                                   32.7
Rice/Pilau                                 23.1
Meat dishes (b)                            15.4
Pasta                                      12.5
Black eye/mung beans                        9.6
Vegetables (spinach/cabbage/spring onion)   8.7
Ghari (c)                                   5.8
Ambuulo (d)                                 5.8
Hilbart Marakh (e)                          4.8
Chicken                                     4.8
Palm/peanut soup                            3.8
Mulawah (f)                                 2.9
Fried plantain banana                       2.9
African doughnuts                           2.9
Dried smoke meat                            2.9
Bamiat (g)                                  1.9
Fat cake                                    1.9
Muufo (h)                                   1.9
Other (i)                                   6.8

(a) Enjera = Somali/Ethiopian dialect; Chapati = Swahili, a language
spoken across eastern and central Africa and the national language in
Kenya, Tanzania and Democratic Republic of Congo; Ukhlat = Harari/
Ethiopia dialect.
(b) Also known as zignee (in Ethiopia), mulukya (in Arabic/South Sudan)
and Wat (in Eritrea/Ethiopia): meat/tomato/oil/red pepper/vegetables/
spices.
(c) Borrowed from Indian cooking. Refers to a seasoned bread obtained by
frying a mix of cereal flour, chilli powder, salt and oil.
(d) In Somali/Arabic dialect: corn (maize grain)/water/red beans/salt/
oil/sugar.
(e) In Somali and Harari/Ethiopia dialect: meal soup/boiled meat.
(f) In Somali dialect: thin pancake: plain flour/egg/water/oil/sugar,
usually eaten as a single dish.
(g) In Harari/Ethiopian dialect: okra stew made by mixing tamarind,
okra, meat--usually eaten with rice, salad or bread.
(h) In Amharic/Ethipian dialect. Hot bread made from maize flour or
sorghum, salt, water, sugar, yeast.
(i) Includes yam, mchicha (in Zambia) and sweet potatoes.
(j) Multiple responses. Does not add up to 100.

Table 5 Factors most influencing food choice

                            Christian  Muslims   Total
Variables                   (n = 71)   (n = 68)  (n = 139)

Nutritional value           32.4        2.9      18.0
Budget                      25.4       10.3      18.0
Health                      14.1       13.2      13.7
Palatability                 8.5        0.0       4.3
Preference/favourite         8.5        2.9       5.8
Easy to prepare              5.6        1.5       3.6
Cultural/traditional         4.2        2.9       3.6
Availability of ingredient   1.4        0.0       0.7
Religion                     0.0       66.2      32.4

[chi square] = 78.504, df = 8, P < 0.001.

Every day                         1%
5-6 times per week                1%
2-4 times per week                9%
Once a week                      22%
1-3 times per month              38%
Never or less than once a month  29%

Figure 1 How often does your family eat or buy food at a takeaway/pizza/
fast food shop? (n = 138).

Note: Table made from pie chart.

Table 6 Main food mostly consumed in sub-Saharan Africa: rural versus
urban

            Eastern/Southern Africa (a-c)  Western Africa (a,b,d)
Type        Rural          Urban           Rural           Urban

Staple      Eleusine       Sorghum meal    Boiled or       Boiled or
            (millet) meal                  fried plantain  fried
                                           bananas         plantain
                                                           bananas
            Sorghum grain  Boiled or       Yam             Yam
                           fried green
                           bananas
            Sorghum meal   Boiled or       Boiled and      Boiled and
                           fried beans     Fried           fried
                                           potatoes        potatoes
            Boiled green   Fried potatoes  Bambara         Beignets
            bananas                        groundnuts
            Boiled beans   Boiled or       Rice (Pilau)    Wheat bread
                           fried sweet                     (macaroni)
                           potatoes
            Boiled         Beignets        Eleusine        Bambara
            potatoes       (doughnut)      (millet) meal   groundnuts
            Boiled sweet   Wheat bread     Corn/maize      Rice
            potatoes       (macaroni)      grain
            Corn/maize     Chapatti/       Bambara nuts    Eleusine
            grain          Enjera                          (millet) meal
            Maize meal     Boiled or       Sorghum meal    Corn
                           fried rice
            Peas/                                          Sorghum meal
            chickpeas/
            cowpeas
Meat/       Beef           Beef            Beef            Beef
insects     Mutton         Goat meat       Mutton          Mutton
            Goat meat                      Caterpillars    Caterpillars
                                           Termites        Termites
Milk and    Cow milk       Cow milk        Cow milk        Cow milk
milk        (fermented)    powder          (fermented)     (fermented)
products    Camel milk     Cow milk                        Cow milk
            (fermented)    powder (fresh)                  powder
Fish        Salted fish    Salted fish     Dry fish        Dry fish
            Fresh fish     Fresh fish      Fresh fish      Fresh fish
Fats and    Vegetable oil  Vegetable oil   Palm oil        Palm oil
oil         Animal fat/    Margarine       Peanut/         Peanut/
            lard/ghee                      groundnuts      groundnuts
                                           butter          butter
                                           Coconut and
                                           palm nut
Leaves      Amaranths      Amaranths       Amaranths       Amaranths
            Pumpkin                        Baobab          Baobab
            Beans                          Beans           Beans
Vegetables  Cabbage        Cabbage         Okra            Okra
            Carrot         Carrot          Carrot          Carrot
            Egg plant      Egg plant       Egg plant       Egg plant
            Spring onion   Spring onion    Spring onion    Spring onion/
                                                           onion
            Tomato         Tomato          Tomato          Tomato
            Pumpkin/       Cauliflower                     Pepper
            squash
Fruit       Avocado        Avocado         Avocado         Baobab
            Bananas        Orange          Baobab          Mango
            Orange         Pawpaw          Mango           Orange
            Pawpaw         Bananas         Orange          Bananas
            Pineapple                      Bananas         Coconut
                                           Coconut         Gumvine
                                           Gumvine
Sugar       Honey          Refined cane    Honey           Refined cane
                           sugar                           sugar

                  Central Africa (a,b)
Type        Rural                      Urban

Staple      Cassava roots              Cassava roots
            Cassava meal               Cassava meal
                                       Maize grain
            Corn/maize grain           Maize meal
            Maize meal                 Boiled and fried green bananas
            Boiled green and plantain  Boiled and fried plantain
            bananas                    bananas
            Potatoes                   Beignets
            Sweet potatoes             Chapatti
            Yam                        Boiled rice
            Beans                      Potatoes
            Eleusine (millet) meal     Sweet potatoes
            Sorghum grain
            Sorghum meal
Meat/       Beef                       Beef
insects     Goat meat                  Goat meat
            Caterpillars               Caterpillars
            Termites                   Termites
Milk and    Cow milk (fermented)       Cow milk powder
milk
products
Fish        Dry fish                   Salted fish
            Fresh fish                 Dry fish
                                       Fresh fish
Fats and    Palm oil                   Palm oil
oil         Peanut/groundnuts butter   Peanut/groundnuts butter
                                       Margarine
Leaves      Sweet potatoes             Sweet potatoes
            Amaranths                  Amaranths
            Cassava                    Cassava
            Pumpkin                    Pumpkin
            Baobab                     Baobab
            Beans
Vegetables  Okra                       Okra
            Carrot                     Cabbage
            Egg plant                  Carrot
            Spring onion               Egg plant
            Tomato                     Spring onion
                                       Tomato
                                       Cauliflower
Fruit       Avocado                    Baobab
            Baobab                     Mango
            Mango                      Avocado
            Guava                      Orange
            Orange                     Sugar cane
            Pawpaw                     Pineapple
            Pineapple
            Bananas
            Sugar cane
Sugar       Honey                      Refined cane sugar

(a) Adapted from the study by Bruinsma. (23)
(b) Adapted from the study by Agbessi Dos santos and Damon. (24)
(c) Adapted from the study by Labaddarios et al. (25)
(d) Adapted from the study by Hatloy et al. (26)
Note: Some food items not listed in the above table are seen as a luxury
and hence are less frequently consumed, for example chicken, egg,
tinned/canned foods and breads. Others may be unfamiliar in African
cuisine, for example varieties of pasta. Meal (e.g. maize/sorghum,
cassava meal) is a product obtained by mixing flour obtained from
cereals and water, often eaten with spiced soups.