Assessment of nutritional status in relation to socio economic determinants among Sabar tribes of Jhargram district of West Bengal, India

INTRODUCTION

Proper nutrition is fundamental to good health and development over a prolonged period which is neglected in several components of body composition. Gender, age, nutrition, physical activity and hormonal status are the main determinants of body composition among healthy adults.¹ Undernutrition may have a significant effect on body composition as it develops due to nutritional deficiency which results in organ dysfunction, reduced body mass, abnormal blood chemistry and worsened clinical outcomes.²

Sabar is one of the most backward tribal communities in West Bengal, traditionally living in the deep forest areas. They mostly belong to a low economic stratum depending predominantly on daily wage labour (100 days work). Their level of education is very low and most of them are non-literate. They live mostly in mud houses and very few of them got brick build houses made by the central government housing scheme without proper kitchen and toilet facilities.

The tribal population is at a high risk of undernutrition because of the socio cultural, socio economic and environmental factors influencing food intake and health-seeking behaviour.^3,4 The basic problem of the tribal people is poverty. The problems of the low standard of living, hunger, starvation malnutrition, agricultural illiteracy, disease, poor sanitary and housing facilities are serious compared to the non-tribals.⁵

World Health Organization has recommended that anthropometry could be used to assess the nutritional and health status of adults.⁶ According to the 2001 census, the total population of Sabars in West Bengal was 43,599. Sabars are the 10th largest group in West Bengal, comprising 1.0% of the total tribal population. It was observed that the health status of the tribes was comprehensive area-specific and health related studies were limited.⁷ Carolyn and Harpham⁸ observed that the health status of a population is influenced by environmental conditions, health services, characteristics of the population and socio-economic condition. Several research studies on the tribal population of India revealed that the prevalence of chronic energy deficiency was high among the tribal population. Women being vulnerable section, the impact on their health is much high. The health and nutritional status of the tribal population clearly indicates that the goal of health for all cannot be fully achieved unless due to attention is paid to the vulnerable sections of the society i.e., the tribal population especially women and children.⁹

Diez¹⁰ related individual health outcomes to socio-economic characteristics of the community and the community health infrastructure. However, such work on native Sabar tribal population of different age groups is scanty in reality. Thus, the present study on children and adult male and female Sabar tribes was carried out to correlate the health status and related socio-economic parameters.

The objective of the present study was to assess the nutritional status of the Sabar population on the basis of body composition and to study the correlation of the nutritional status with socio-economic factors.

METHODS

This cross-sectional study was conducted among 169 sabar children, adolescents and adult people having age range 8 to 60 years of Jhargram district of West Bengal from January to March 2019. Participants were selected at random based on their availability during fieldwork/camp from three different villages of Lalgarh district, block Binpur, Paschim Midnapore. Necessary permission was obtained from local administration and community leaders along with NGO organizations. The participants were informed and explained about the purpose of this survey and consent from each adult and guardian for children was taken before data collection.

Socio-demographic characteristics like age, occupation education, income, house type sanitation, electrification, smoking habit, number of children in a family were collected from participants in case of adults and from the mother in case of the children by using a pretested questionnaire to access the socio-economic status.

Anthropometric measurements of body height and body weight were measured by standard technique. Body height and body weight were recorded to the nearest 0.5cm/kg by anthropometric rod for height and weight machine for weight. BMI (body mass index) was calculated by using the formulae BMI = weight (in kg)/ height (m2). Participants were divided into three BMI categories in accordance with WHO (1995)⁶

Undernutrition (BMI <18.5 kg/m²)

Normal (BMI 18.5 – 24.9 kg/m²)

Overweight (BMI ≥25.0 kg/m²)

For statistical analysis, descriptive statistics were done to get mean and standard deviation. The chi-square test was used to see the association between the different socio-demographic variables and nutritional categories. One way ANOVA and independent sample t-test were performed to find out significant difference among different socio-demographic categories in mean body height, body weight and BMI.

RESULTS

Table 1 shows the socio-demographic characteristics of the Sabar population. It represents age, educational status, family income, occupation, house type, smoking habit, alcohol intake and source of drinking water. The participants were categorized into children (8 to 17 years), adult male and adult female (18 to 60 years) group. A total of 169 subjects were taken from tribal villages of the Jhargram district. The educational status of the participants was divided into - non literate, primary (class I to V), secondary (class VI -X) and college level (class XI and above). The income group was categorized into - Low-income group (monthly up to Rs 3000), moderate income group (monthly Rs 3000-4000) and high-income group (monthly Rs 4000-5000). Types of houses were divided into three types kutcha (made of mud and bamboo), semi pucca (made of brick wall and floor, the roof was thatched) and pucca houses (made of brick and cement). The Source of drinking water was mainly two – tubewell and tap water. Sanitary latrine is rare in these villages, so it is categorized into - present and absent. Most of the adult males were smokers and alcoholics. Thus habit among male participants was categorized into – smoker (49%), non-smoker (28%), and other forms of tobacco like gutka, khaini (22.14%), alcoholic (81%), non-alcoholic (19%). Sex wise occupational status of the male participants (81%) included 100 days labour, agriculture worker, cattle farming, small businessman and others. Occupation of female participants was mainly collection of wood from the forest, cattle farming, leaves collection from the forest and 100 days labour.

The distribution of the socio-economic characteristics of the studied population indicated 37.73% adult males and 5.26% adult females were non literate, but a maximum number of males (32%) and females (36.84%) had educational status up to primary level and meagre 19.29% males and 3.77% had education level up to undergraduate level. The maximum number of male and female children (38.59%) had education up to madhyamik or secondary level (Class X). Adult males and females reported their monthly income upto Rs 3000 to Rs 4000 by 100 days’ work or collection of wood and leaves from forest or agriculture labour. 47% of Sabar people collect their drinking water from tubewell and 52% from supplied tap water. 49% of male Sabar people were smokers and 22% use tobacco in another form. Similarly, 81% of males were addicted to alcohol use. It was also remarkable that 76% of people did not use sanitary latrine due to lack of facilities in their villages. 59% people of these Sabar villages had semi pucca house followed by 28 % with pucca houses. 96% people of these Sabar villages has electricity. 37% male Sabar people in this locality were daily labour followed by 22 % agriculture workers but females (49%) were wood collectors followed by cattle farming.

Table 2 represents Mean±SD values of physical parameters -body height, body weight and BMI of preadolescent (8-12 years), adolescent (13-17 years) children, adult male and female sabar tribes of Jhargram district of if West Bengal. Children and adolescent male and female as well as adult male and female sabar people when compared, it was found that male children, adolescent and adult sabars showed significantly higher values in physical parameters than their female counter part.

Table 3 demonstrate the nutritional status of the studied Sabar population-based on BMI where the prevalence of undernutrition (BMI <16, CED grade III) for children, adult males and adult females was 49.1%, 0%, and 3.5%. The same for CED grade II (BMI 16-16.9) was 22%, 3.7% and 10.5% respectively for Sabar children, adult males and adult females. Prevalence of CED grade I (BMI 17-18.4) undernutrition was 11.8%, 7.5%, and 14% respectively. 81.1% adult males and 68.4% adult females were normal BMI range but 7.5% adult males and 3.5% adult females were in the overweight category.

Table 4 represents the result of one-way ANOVA as well as independent sample t-test for anthropometric variables among different socio-demographic characteristics of the studied population. In case of family income statistically significant difference was observed for mean body height (F = 9.52, P = 0.0002) for adult females but no significant difference was found in the case of adult males, i.e., increase in family income do not affect their body height, body weight and BMI. But in the case of Sabar children family income significantly (P<0.01-0.001) influence their body height, body weight and BMI. Regarding the source of drinking water BMI (22.6±2.48) was found to be significant in adult males using water from tubewell but body height for adult females was significantly higher (151.33±5.21) than those females using tap water. No significant difference was found in body height, body weight and BMI among children using tubewell or tap water as a source of drinking water. Interestingly educational level significantly affects the anthropometric parameters of Sabar children but no such difference was found in adult males and females when education level was considered except BMI of adult male Sabar. When smoking habit was considered as socio-demographic character for adult male statistically significant difference was observed in the case of BMI (F=7.14, P= 0.00) when smokers, non-smoker and other forms of tobacco were compared.

Table 5 represents the association between socio-demographic variables and nutritional categories of the Sabar population of Jhargram. Significant associations were obtained in educational status and family income in children. Only family income had a significant association with nutritional status in adult females but no significant association was found in male adult nutritional status with socio-economic parameters. 83.33% of undernourished adult males were found with low to moderate (Rs 3000 - 4000 per month) family income, absence of use of sanitary latrine and running tap water as a source of drinking water. In the case of adult Sabar females, 87.5% of women are undernourished with low family income (less than Rs 3000), 7.5% are undernourished with the absence of sanitary latrine and 53.33% are undernourished with the use of running tap water as a source of drinking water.

DISCUSSION

This cross-sectional study was conducted to determine the effect of socio-demographic factors on health conditions among Sabar tribes (adult males, adult females and children) between age 18 to 60 years for adults and 9 to 19 years for children and adolescents of Jhargram district of West Bengal India. It has been observed that the prevalence of undernutrition is maximum for male children (74 -90%) and female children (89 -28%). To find the socio-demographic factors of health condition, a chi-square test was performed which revealed statistically significant association for different variables like family income, educational status with nutritional categories. Adult females showed significant association only with family income but adult males showed no such association with socio-demographic factors. On the other hand, family income depicted a statistical impact on body weight and body height for both adult males and females as well as children. The education level of Sabar children significantly (p<0.001) affects their body weight, body height and BMI. The smoking habit of adult males significantly (p<0.001) influence their BMI value.

In a similar study of Sabar males of Purulia district, Das et al. explained that family size and family income influence the living standard specifically housing and sanitary condition should be better and should influence their health status.¹

The current study focuses on a similar association of family income with health status and nutritional level for Sabar people of Jhargram.^11,12

This study has revealed that education also influences the health status of Sabar tribes. 37.73% adult males and 5.26% adult females were non-literate. 32% adult males and 36.84% adult females had education levels up to primary standard which is much lower than the tribal literacy rate of India and state level literacy of West Bengal (68.2%). This study shows a statistically significant (p<0.001) association between educational level and anthropometric variables like body weight, body height and BMI among Sabar tribal children (both males and females). But adult Sabar males and females showed no significant association between nutritional status and educational level when one way ANOVA test was performed. This result does not corroborate with the previous study conducted in India.^13-15

Other aspects of health are family size is related to family income regarding nutritional status that affects the standard of living especially housing and sanitary condition. Smaller the family size and the better the family income, better will be the domain of health.^11,12

Ghosh et al. found that the prevalence of undernutrition among tribal women of West Bengal depends on literacy and the number of children in the family. In contrast, a positive association was not elicited with the educational levels of tribal women in Kainatty and their nutritional status.^16,17 But the prevalence of undernutrition might be due to the use of smoking tobacco among them.¹⁸ Probably due to similar reasons we have found undernutrition (33.33%) among Sabar adult males in our study.

Therefore, the present study indicates a higher risk of undernutrition among tribal adolescents (9-18 years) due to socio economic, socio cultural and environmental factors influencing food intake and health seeking behaviour like the use of sanitary latrine, use of safe drinking water and sufficient nutrition through food. Besides inadequate health care facilities, illiteracy and socio-economic disadvantages among the tribal populations perpetuate the vicious cycle of undernutrition.¹⁹ Poor accessibility and affordability of nutrients due to low income and social status of tribal population along with lack of knowledge and perception about nutritious diet, illiteracy, rigid customs and beliefs leads to many health problems among tribal adolescents but still struggle to perceive for necessary health facilities.^20,21

Maximum male Sabar adults participants are daily wage labour (37.7%) i.e., 100 days workers and landless agricultural workers (22.64%). So, they are mainly from low to medium income families. Female Sabar adults mostly earn money from wood collection (49.12%), leaves and cattle cultivation (33%) and 100 days labour (17.5%). So, they are also in low to middle income group. Female adults mostly suffer from Vertigo (21.05%) of which 35.71% are undernourished. Pain in different parts of the body mainly the knee, pelvic and shoulder region (38.59%) along with headache (71%) occur due to work related stress (carrying an excessive load on their head) of which 28.57% were undernourished. 24.56% of female Sabar suffered from gynaecological problems of which 21.4% were undernourished.

This indicates that family income or per capita income and occupation have revealed a positive impact on health status which has a good agreement with the NNMB report.¹³ But in our study, no significant association has been found between occupation and number of children (in case of female) and prevalence of some diseases with nutritional status, probably due to the small sample size in our study.

Again, safe drinking water and lack of sanitation facilities have adverse effects on health and nutrition, economy and development.²²Contaminated drinking water and practice of open defecation contributes significantly to spread the communicable diseases as well as the cause of other intestinal infection. Undernutrition is prevalent in adult males (83%) and females (75%), only 24.52% male and 25% female adults use toilet in their premises. The reason might be the lack of initiatives from the government and partly the villagers who prefer to go to open space for defecation. Therefore, the whole scenario indicated the failure of government policies and the lack of awareness among Sabar tribal people of this locality. It has also been mentioned that Sabar adult females (24.6%) suffer from gynaecological problems of which 24.2% were undernourished due to this unhealthy practice, poor sanitation and hygiene standard exacerbate the severity and impact of undernutrition.

CONCLUSION

From the present study, it can be concluded that the undernutrition among Sabar tribal people especially the children and adolescents is very prominent and they are exposed to the risks of different health problems in future and nutritional issues like growth retardation in adulthood. Besides, female adult Sabar tribes mostly suffer from neurological, gynaecological and musculoskeletal disorders due to occupational hazards that they are forced to do to earn money for supporting their family. Besides the tendency of the village people to avoid the use of sanitary latrine as well as lack of latrine facilities in their premises are the main cause of gynaecological diseases. The undernutrition and other health issues of adult male Sabar people might be associated with their smoking habit alcohol intake, insufficient general awareness due to lack of education.

Long-standing history defines the negligence of the part of government and partly the conservative attitude, high percentage of non-literate people, discrimination in terms of occupation as well as a source of income might be the reason for undernutrition among Sabar tribes of Jhargram.

Therefore, to improve the health condition which depends on economic strength as well as proper education of these Sabar tribes, intervention by the state government need to be introduced along with effective health care infrastructure and health awareness among these population of Sabar tribes of Jhargram.

Recommendations

In this context Government should take initiatives, policymakers and implementing local authorities should consider socio-economic determinants of health for improvement of quality of life which in turn will give economic strength to this poor and vulnerable sabar tribal people of Jhargram.

ACKNOWLEDGEMENTS

Authors are very much thankful to Principal, Serampore College and Dept. of Physiology Serampore College for permitting us to conduct the study. Authors are also grateful to Dept. of Physiology, Serampore College for partial financial support while conducting the project. Our indebted thanks will go to Mrs. Keya Jana and Mr. Subrata Jana and local bodies of Jhargram including Panchyte Pradhan, SDO and SP Police Jhargram for helping us to organize this project. Authors are also pleased to mention the name Dr. Sourav Kumar and Miss Anindita Banerjee, faculty of Raja Peary Mohan College for their all along assistance in this project work.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Das K, Mukherjee K, Ganguli S, Pal S, Bagchi SS. Age related variation in anthropometry, body composition and nutritional status among the adult Kheria Sabar males of Purulia, West Bengal, India. Coll.Antropol. 2020:44(2):73-80.
2. 2. Campos I, Kontano P. Assessment of fluid status and body composition and control fluid balance with intermittent Hemodialysis in the critically III patients. In: Ranco C, Bellomo R, Kellum JA, Ricci Z (Eds) Critical care nephrology. Elsevier, London,2019
3. 3. Basu SK, Jindal A, Kshatriya GK, The determinants of health seeking behaviour among tribal population of Bastar district. Madhya Pradesh. South Asian Anthropologist. 1990;1:1-6
4. 4. Rao KM, Kumar RH, Krishna SR, Bhaskar V, Laxmaiah A. Diet and nutrition profile of chenchu population – a vulnerable tribe in Telangana and Andhra Pradesh, India. Indian J Med Res. 2015:141(8):688-96
5. 5. Vasudevachary AK. Tribal development in Andhra Pradesh, Kurukchetra.2006:54:33-6.
6. 6. World Health Organization (WHO) physical status: the use and interpretation of anthropometry. Technical report series no 854. Geneva.1995
7. 7. Dhargupta A, Goswami A, Sen M, Mazumder D. Study on the effect of socio-economic parameter on health status of the toto, santhal, sabar and lodha tribes of West Bengal, India Stud Tribes Tribals. 2009;7(1):31-8.
8. 8. Carolyn S, Harphan T. Measurement of health in household environmental studies in urban areas of developing countries: factors to be considered in the design of surveys. Urban Health Programme. London School of Hygiene and tropical medicine. 1992.
9. 9. Nayak SP, Sreegiri S. A study on nutrition status of tribal women in Vishakapatnam district, Andhra Pradesh, India. Int J Community Med Public Health. 2016:3(8):2049-53.
10. 10. Diez RA. Investigating neighbourhood and area effects on health. Am J Public Health. 2001;91:1783-9.
11. 11. Asiedu E, Gaekwad NB, Nanivazo M, Nkusu M, Jim Y. The impact of income per capita on health outcomes: Is Africa Different? J Economic Literature. 201;23:72.
12. 12. World Health Organization. Health and the family: Studies on the demography of family life cycle and their health implications. Geneva: WHO:1978.
13. 13. National nutrition monitoring Bureau NNMB Technical report no. 25-Diet and nutritional status of tribal population and prevalence of Hypertension among adults report on second repeat survey. National Institute of Nutrition: Indian Council of Medical Research, 2009. Available at chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/view er.html?pdfurl=https%3A%2F%2Fwww.nin.res.in%2Fdownloads%2FNNMBTribalReport.pdf&clen=12403808&chunk=true.Accessed on 20 January 2021.
14. 14. John M, Barna RK, Sarkar R. Variations in the form of malnutrition in well to do adults and the associated factors man in India. J Economic Literature. 1995;76(3):241-50.
15. 15. Nagada BL. Tribal population in Rajasthan. Studies Tribes Tribals. 2004;2(1):1-8.
16. 16. Ghosh J. Nutritional status of tribal women: An epidemiological study among Santal – Munda tribes of North 24th parganas district of west Bengal, India. Int J sci Res. 2016;5:229-32.
17. 17. Mohandas S, Amritesh K, Lais H, Vasudevan S, Ajithakumari S. Nutritional assessment of tribal women in Koinatty, Wayandi:a cross sectional study. Ind J Community Med. 2019;44(5):50-3.
18. 18. Pednekar MS. The impact of tobacco uses and/or body composition in adult mortality in urban country population. Result from Mumbai cohort society. Mumbai, India. 1991-2003;2018. Availab;e at chrome-extension:// efaidn bmnnnibpca jpcglclefindmkaj/viewer.html?pdfurl=https%3A%2 F%2Ftrepo.tuni.fi%2Fbitstream%2Fhandle%2F100 24%2F67879%2F978-951-44-7431-6.pdf%3Fsequence%3D1&clen=1433224&chunk=tr ue. Accessed on 10 July 2021.
19. 19. Mallikharjuna RK, Balakrishna N, Arlappa N, Laxmaiah A, Brahman G. Diet and nutritional status of women in India. J Hum Ecol. 2010;29:165-70.
20. 20. Lakshmi PR, Vijayakumar K, Anish TS, Shrinivas BM, Sheela B, Abraham A, et al. Anemia and body mass index of non-pregnant tribal women of reproductive age group in Palakkhad district of Kerela, India. Indian J Prev Soc Med. 2012;43;35-41.
21. 21. Jose S, Navaneetham K. A factsheet on women’s malnutrition in India. Iron initiative towards infinite potential in an anemia free India. 2008.
22. 22. Kuberan A, Singh AK, Kasav JB, Prasad S, Surapaneni KM, Upadhyay V, Joshi A. Water and sanitation hygiene knowledge, attitude, and practices among household members living in rural setting of India. J Natural Science Biology Med. 2015;6(3):69-74.