A cross-sectional study on socio-demographic status and status of non-communicable diseases among tribal community of Tamia block in Chhindwara district

INTRODUCTION

There are 104 million tribal people in India. Spread across 705 tribes, they account for 8.6% of the country’s total population. Madhya Pradesh being one of the most tribal populated states in India and has the highest tribal population in the country touching a galloping number of 15.31 million and covering 21.1% of the state’s population.¹ Tribal communities cannot be assumed and clubbed together as one homogeneous group. They belong to different socio-cultural and ethnic-lingual groups, having diverse faith and are at different levels of development-economically, educationally, culturally and politically. They inhabit the different ecological and geo-climatic conditions of varied regions of the country.² Their way of life is culturally distinct, and they mostly reside in isolated rural hamlets in mountainous, forested, or desert places with challenging terrain. Tamia is a hilly block located in the heart of the Chhindwara district. Due to its geographical and attractive beauty, it has come to be considered as a treasure house. It houses an ancient and rare collection of artifacts belonging to the tribes of the district.³ The majority of indigenous people live in poverty with little access to even the most basic amenities, especially health care. In the previous decades, various contributors have worked on communicable disease shown high burden of infectious diseases like malaria and tuberculosis in tribal community but recent study suggested a high burden of NCD leading cause of deaths accounted for most of the deaths (66%), followed by infectious diseases (15%) tribal community in India.^4,5 There is a need for continuous efforts from all stakeholders of the governance to search NCDs risk factor in tribal community. The Central Council for Research in Ayurvedic Science administered the Tribal Health Care Research Programme (THCRP) across 14 states through 14 affiliated institutes as one of the humongous programs run by Ministry of AYUSH, Government of India for the improvement of the tribal community across the nation.⁶

Objective

The present study aimed to assess the health status, socio-demographic status, living conditions and status of non-communicable diseases among tribal community in selected villages of Tamia block in Chhindwara district, Madhya Pradesh.

METHODS

Study design

This is an observational cross-sectional survey study conducted between July 2021 and March 2022 (total 09 months) with due approval from the institutional ethical committee (IEC clearance number: F.No.: 5-5/2021-22/RARI-Gwl/Tech/547 dated 25.06.2021).

Study setting

A door-to-door survey was conducted by the THCRP team. The seven villages (Mankadei, Jhilpipariya, Jogimuar, Khulsan, Lahgadua, Muttor, and Nagri) of Tamia block in Chhindwara District, Madhya Pradesh were surveyed through 118 visits in the duration of 9 months.

Participants

Total 5953 participant of all age groups and both sex were included for the study belonging to a tribal community of seven villages of Tamia block by purposive sampling method.

Variables

Qualitative variables

In this current study various socio-demographic variables were included such as age, sex, place of residence, marital status, religion, educational status, caste, socio-economic status, and various types of non-communicable disease and information regarding living condition of the people, types of houses they live, sources of drinking water, sanitary facilities, prevention from vector borne diseases, drainage system, types of fuel used for cooking etc were recorded.

Qualitative variables

Haemoglobin percentage, blood sugar level, height & weight for BMI grading, blood pressure level etc were recorded. All categorical variables were presented in frequencies and percentages.

Data source/measurement

Selected seven villages were visited weekly by a dedicated team of project comprising of doctors and other personnel trained for the field survey to conduct population survey. The officials of health department and administrative of district, block and villages concerned were informed in advance for conducting visit, collecting data, organizing awareness & health camps. The data of individuals, households and villages were captured on health status, socio-demographic status, living conditions and status.

Non-communicable diseases using uniform proforma for the purpose, the team visited tribal population of these seven villages and face to face interviews were conducted using structured questioners regarding all variables. Verbal informed consent was taken from the participants prior to collecting any related information for the study. For those who were younger than age 18, parental consent was obtained. The automatic glucometer gluneolite for random blood sugar level, automatic haemoglobinometer mission for haemoglobin level and manual sphygmomanometer for recording blood pressure were used. Measuring tape and digital weighing scale were used to record BMI grading. Privacy and confidentiality of the interviews and information gathered was assured for all participants.

Bias

The enrolment of participant was done on the basis of information provided by them and/or cast mentioned in their ration card or panchayat document, so chances of selection bias are there. The project staffs were trained to conduct survey and documentation of data to minimize bias.

Sample size

Considering the prevalence (p) of NCD in selected population is 50%. A margin of error (e) is taken as 2% in the estimation of prevalence. The required sample size is calculated by below formula

n=(((Z^2)(α/2))×(p) (1-p))/e^2, Where Z_(α/2) (Value of normal variate) =1.96 (α is the level of significance) n=2401.

The sampling will be performed through the cluster sampling procedure so a design effect of 2 is considered in the sample size and required sample size is 2401×2=4802. Adding a non-response rate of 20% in the data collection, require sample size will be 4802 +961 =5763 (Approximately 5800)

Statistical method

Data was coded and entered using Excel software package in the computer. Collected data analyzed with the help of excel by using different quantitative methods and descriptive statistical methods.

RESULTS

A total 5953 study participants were surveyed for this current study. Table 1 summarizes the key socio-demographic characteristics of the participants. Both Male and female were found almost equal in proportion. Participants in age group 18-30 years were found higher in proportion (28.1%) followed by 40 years and above (25.4%). Finding of the table shows that half of the adult participants were married and approximately 47% participants were single. Adult participants with no formal schooling were found higher in proportion (31.7%) as compare to others and participants having higher education (graduate and above) were found second lowest in proportion (4.1%).

In occupation, 27.4% participants were students followed by employed 25%, house maker 21% and unemployed 15.4%. Finding of the Table 1 also shows that 26.32% participants were chewing tobacco followed by Alcohol 14.68%. In this tribe, the predominant dietary choice is non vegetarian, with a relatively low consumption of fruits which has been shown in more than 50% surveyed population. Finding of the Table 2 shows that 1175 household were covered in this present study, among them 75.8% house hold had kutcha houses, 23.8% had semi pucca houses and significantly lower proportion of the household had pucca houses; more than half (58.1%) of the households were depend for their source of drinking water supply on public tap/community plant followed by tube well/borehole/well (22.5%) and house tap (19.4%); more than half of the participants (54%) had adequate source of ventilation in their houses.

Majority of the household (81.8%) did not using any method for drinking water purification whereas approximately 13% of the household were using cloth and 5.3% were using boiling method for drinking water purification; 41.2% household had no toilet facility i.e., they go for toilet in open field whereas 58.8% household had toilet facility out of which 16.8% of the household had toilet facility inside the house and 42% household had toilet facility outside the house; most of the household had open/surface drainage facility whereas 19.2% of the household had closed/ covered drainage system and three-fourth of the householders was using LPG as a cooking fuel whereas one forth was using wood coal/cow dunk cake as a cooking fuel.

Table 3 shows that more than half (62.7%) of the household were using normal net for prevention of vector born disease whereas one fourth of the household were using coil and 11.4% were not using any prevention for vector born disease. Finding of Table 4 shows that out of total population 918 (22.6%) were overweight having (BMI-25.0-29.9), and 59 (1.46%) people were having grade I obesity (BMI-30-34.9). Finding of Table 5 reveals that out of 959 screened participants for anaemia, 52.13% (6.36 % male and 45.77% female) were anaemic (Hb% level was 8–10.9 g/dl) followed by sever 1.88% anaemic (Hb% level was <8 g/dl).

Out of 953 screened participants for diabetes, most (96.53%) were having random glucose level <140 mg/dl followed by 3.25% participants having random glucose level 140-199 mg/dl (Table 6). Table 7 shows that the physical activity of most of the participants (68.50%) were sedentary followed by 21.30 moderate and 10.20% vigorous activities. Table 8 reveals that Osteoarthritis (10.52%)) was one of the most prevalent non-communicable diseases in the area followed by hypertension (5.96%). Table 9 shows that most findings of the non-communicable diseases in the age of 41 years and above.

*Represent 1329 school going children and 564 were children with no schooling. **Represents multiple response are allowed.

** Represents multiple response are allowed

DISCUSSION

Because of a number of socio-economic reasons and lack of access to contemporary healthcare services, the health situation of Madhya Pradesh's tribes continues to be a major concern. The present study aimed to assess the socio-demographic status, living conditions and status of non-Communicable diseases among tribal community in selected villages of Tamia block in Chhindwara District, Madhya Pradesh.

The data were collected from diverse tribal populations, confirming the changing disease burden irrespective of geography and cultural differences. Finding of this study revealed that majority of the participants (31.7%) had no formal schooling and this finding is supported by a study conducted in Andhra Pradesh on tribal communities.⁷ There are not much more differences in male and female ratio as previous studies say that male population is slightly higher than female population.⁸ The data of this study showed that tribal population, particularly in this area, had extremely inadequate standards of living for essential household amenities like housing, a source of drinking water, drainage facility, fuel used for cooking, and toilets. This study reveals that prevalence of anemia in the area was 54% (6.88 % male and 47.13% female), which is also observed in previous study conducted in three districts of Madhya Pradesh including Chhindwara district, anemia disease was found more than 50% in studied population and ratio of female effected was more than male.⁹ Finding of the study revealed that prevalence of osteoarthritis was highest and prevalence of hypertension was second highest. In present study, the age more than 40 years, overweight as per BMI grading, lesser fruit consumption and non-vegetarian diet were found to be risk factors for hypertension by logistic regression, it also reflected in previous study.¹⁰ Increasing age, non-vegetarian diet, least fruit intake is the most important risk factor in most studies.¹¹ Previously research work shown increased age and over weight is strong risk factor associated with osteoarthritis which has been also shown in this study.¹² In the previous decades, the tribal population had a high burden of infectious diseases such as tuberculosis and malaria.¹³ Several recent studies from various tribal regions in India suggest a high burden of NCD risk factors, potentially leading to a high proportion of deaths due to NCD.^14-17

Limitations

The participants and house hold were selected by convenient sampling method, thus there may be limitation of sufficient representation of population. The survey was convened with the help of uniform format as per information provided by the participants so there may be chance of information bias while drawing conclusion. The study faced inherent limitations due to the limited feasibility of conducting laboratory tests for differential diagnoses or prognosis of various diseases.

CONCLUSION

Current study provides evidence for the need for investment in the health system to cater to the burden of NCDs and the involvement of communities to increase awareness regarding risk factors. In selected villages the living condition of majority of scheduled tribe population was not good. They had inadequate access to education and the basic amenities such as house facility, source of drinking water supply, fuel used for cooking, toilets within or outside the house, etc we’re not available adequately. Open drainage system is not good for the healthy environment and may lead to diseases among the tribal community. This study can be helpful for the modification in policies and programs of tribal schemes in the context of education and sanitation as well as prevention and control of non-communicable disease.

Funding: No funding sources

Conflict of interest: None declared

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

REFERENCES

1. 1. Marten JT. The Census of India of 1921. J Royal Soc Art. 1923;71(3672):355-71.
2. 2. Negi DP, Singh MM. Tribal health and health care beliefs in India: A systematic. Int J Res Soc Sci. 2018;8(1):992.
3. 3. Sharma P. District wise prioritizing for public fund utilization to improve the HDI of Madhya Pradesh. 4D Int J IT Comm. 2013;3(2):118-25.
4. 4. Narain JP. Health of tribal populations in India: How long can we afford to neglect. Indian J Med Res. 2019;149(3):313.
5. 5. Kaur P, Borah PK, Uike PV, Mohapatra PK, Das NK, Gaigaware P, Tobgay KJ, Tushi A, Mazumdar G, Marak B, Pizi D. Non-communicable diseases as a major contributor to deaths in 12 tribal districts in India. Indian J Med Res. 2022;156(2):250.
6. 6. Dangi RK, Shukla AK, Saraf S. Access to Government Information in India: Opportunities and Challenges. 2022.
7. 7. Haq J, Ramesh M, Ansari MN, Komala M, Parveen S, Nazli T, Raheem A. Socio-demographic profile of schedule tribes of five integrated tribal development agency spots at Kurnool, Andhra Pradesh in India. Int J Prev Cur Comm Med. 2021;7(2):14-9.
8. 8. Chowdhury A, Roul SK, Mete JK. The role of five years plans for tribal development in India: an overview. Turkish J Qual Inqu. 2021;12(4):587.
9. 9. Chourasia S, Kumar R, Singh MP, Vishwakarma C, Gupta AK, Shanmugam R. High prevalence of anemia and inherited hemoglobin disorders in tribal populations of Madhya Pradesh State, India. International J Haemog Res. 2020;44(6):391-6.
10. 10. Chandwani H. Prevalence and correlates of hypertension among adults in the urban area of Jamnagar, Gujarat, India: Array. Electronic Phys. 2010;2(1):52-9.
11. 11. Agrawal R, Chaturvedi M, Singh S, Gupta SC. An epidemiological study of dietary and exercise habits as co-relates of hypertension in person aged 45 and above in Agra District. Indian J Community Health. 2012;24(2):91-6.
12. 12. Allen KD, Thoma LM, Golightly YM. Epidemiology of osteoarthritis. Osteoarth Cartil. 2022;30(2):184-95.
13. 13. Tushi A, Rao SR, Pattabi K, Kaur P. Prevalence of risk factors for noncommunicable diseases in a rural tribal population of Mokokchung, Nagaland, India. The National Med J India. 2018;31(1):11-4.
14. 14. Rizwan SA, Kumar R, Singh AK, Kusuma YS, Yadav K, Pandav CS. Prevalence of hypertension in Indian tribes: a systematic review and meta-analysis of observational studies. PLoS One. 2014;9(5):95896.
15. 15. Sajeev P, Soman B. Prevalence of noncommunicable disease risk factors among the Kani tribe in Thiruvananthapuram district, Kerala. Indian Heart J. 2018;70(5):598-603.
16. 16. Negi PC, Chauhan R, Rana V, Lal K. Epidemiological study of non-communicable diseases (NCD) risk factors in tribal district of Kinnaur, HP: A cross-sectional study. Indian Heart J. 2016;68(5):655-62.
17. 17. Bhar D, Bhattacherjee S, Das DK. Behavioral and biological risk factors of noncommunicable diseases among tribal adults of rural siliguri in Darjeeling District, West Bengal: A cross-sectional study. Indian J Publ Health. 2019;63(2):119-27.