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ORIGINAL ARTICLE
Year : 2012  |  Volume : 1  |  Issue : 4  |  Page : 233-238

Morbidity pattern in tribals and non tribals above the age of 5 years of Gundlupet forest area, Mysore district, India


1 Department of Preventive and Social Medicine, Dr. B. R. Ambedkar Medical College, Bangalore, Kadugondana Halli, Bangalore, India
2 Department of Physiology, Dr. B. R. Ambedkar Medical College, Bangalore, Kadugondana Halli, Bangalore, India

Date of Web Publication27-Dec-2012

Correspondence Address:
Syed Sadat Ali
Department of Physiology, Dr. B. R. Ambedkar Medical College, Kadugondana Halli, Bangalore
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.105109

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  Abstract 

Background and Objectives: According to 2001 census conducted by Government of India, more than 8.2% of the total Indian population constitutes of tribals. Reliable and comprehensive data on disease level, patterns and trends in tribal areas are required to monitor local epidemics and to assess the effectiveness of public health programs to prevent and control diseases. There are very few studies done to assess the health status and morbidity pattern among the tribal and non tribal population and it prompted us to undertake this study.
Materials and Methods: A cross-sectional study was carried out between March 2010 - January 2012 in the forest areas of Gundlupettaluk, Mysore, India. Of the 33 tribal hamlets present, 18 hamlets were selected at random and the villages adjacent to these hamlets were included in non tribal population constituting intended homogenous population without mix up. Data were statistically analyzed using SPSS-I. The standard normal test (Z) was used to compare the equality of proportions having specific type of diseases among tribal and non tribal population. P value of < 0.05 was considered to be statistically significant.
Results: Observations from our study revealed statistically significant proportion of Skin disorders and Dental disorders (P < 0.05) among tribal population compared to non tribal population. Nutritional deficiency, Respiratory infections, Intestinal disorders, Ophthalmic disorders and ENT disorders were also prevalent among both the tribal, as well as non tribal population, however, the difference in proportions between tribal and non tribals were not statistically significant.
Conclusion: There was increased prevalence of morbid conditions like skin disorders and dental disorders among tribal population compared to non tribal population. Further research surveys among tribal population, elucidating the health status and insighting the probable reasons behind morbidty and mortality thus highlighting a need for an integrated approach towards reducing the morbidity rates and improving the health, as well as nutritional status in tribal population would be invaluable.

Keywords: Morbidity, non tribals, nutrition, tribals


How to cite this article:
Divakar SV, Balaji P A, Ali SS. Morbidity pattern in tribals and non tribals above the age of 5 years of Gundlupet forest area, Mysore district, India. J NTR Univ Health Sci 2012;1:233-8

How to cite this URL:
Divakar SV, Balaji P A, Ali SS. Morbidity pattern in tribals and non tribals above the age of 5 years of Gundlupet forest area, Mysore district, India. J NTR Univ Health Sci [serial online] 2012 [cited 2020 Sep 28];1:233-8. Available from: http://www.jdrntruhs.org/text.asp?2012/1/4/233/105109


  Introduction Top


Tribals are a social group residing in definite area away from civilization and have cultural homogenecity and unifying social organization. India is home to 84.33 million people classified as tribals, corresponding to 8.2% of the total population. There are 461 groups of tribes who are spread over 26 states and Union Territories with majority (87%) found in central belt of the country. Included in these categories are 74 tribes who have been identified as Primitive Tribal Groups (PTG, now called Particularly Vulnerable Group) characterized by pre-agricultural levels of technology, extremely low level of literacy and extreme poverty. [1]

In general, they live in isolated, scattered and difficult to reach terrain generally near hills and shrinking forests on which they depend for their livelihood. Majority of tribal literacy is meager and exist below poverty line making the economic, education and nutritional status worse compared to the general population. [1]

In most tribal communities, medical care, treatment and etiology of disease are defined within the social context. It is important to identify processes by which tribalsrecognize sickness and the ways to counteract it. The illness could well be attributed to the evil eye, magic or offending some deity, the treatment for which could be through folk medicine or magico-religious methods. Religious rites are used mainly to treat diseases like small pox and propitiating the deity concerned, most of which tribals believe can cure the plagues, which are associated with various diseases. No comprehensive strategy has been formulated to deal with tribal health problems, as there is not enough knowledge available on their customs, beliefs and practices, which are intimately connected with the treatment of disease. [2]

Further, there is a broad understanding of health problems and morbidity of the general population, particularly of urban and rural communities, but such information on tribal population is limited. Studies pertaining to morbidity among different tribal groups are very few, and lack of comparisons because of different criteria. Hence, the present study was carried out to study the morbidity pattern among tribals and compare with non tribals.


  Materials and Methods Top


The present study was carried out between March 2010 and January 2012 in the forest areas of Gundlupettaluk, Mysore. Ethical clearance was obtained from institutional ethics committee of DR. B R Ambedkar Medical College, Bangalore. Of the 33 tribal hamlets present, 18 hamlets were selected at random to obtain 33% sample of the total available tribal population. Correspondingly, the villages adjacent to these hamlets were included in the study as non tribal population constituting intended homogenous population without mix up. After obtaining consent, data was collected through house to house visits by individual and family scheduling. Laboratory parameters performed in our study were Hemoglobin estimation by Tallquist's method, peripheral blood smear was done in suspected cases of fever, example: Malaria. Detailed general and systemic examinations of all the systems of both, tribal and non tribal population were performed by same group of competent doctors. The diagnosis of morbid conditions were mainly based on history and clinical finding by competent doctors. As it was a cross-sectional survey involving forest region, only the above limited laboratory parameters were assessed.

Some of the diseases were persisting for longer duration as per the history obtained and when we examined, they had presented with similar symptoms and corresponding clinical signs. Example, dental caries persisted from long duration, scabies also had persisted similarly and so on. Hence, all the data collected accounted for the prevalence of the disease rather than incidence of the different morbid conditions.

Random stratified sampling based on age groups was done to show the morbidity patterns among different age groups. Proportion of overall morbidity (diseases) wise grouping comparing that among tribals and non tribals was also done in case of individuals presenting one or more disease states simultaneously [Figure 1], [Figure 2] and [Figure 3].
Figure 1: Morbidity pattern comparing between tribal and non tribal population

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Figure 2: Distribution of morbidity patterns in different age groups among tribal population

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Figure 3: Distribution of morbidity patterns in different age groups among non tribal population

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Statistical analysis

Data were statistically analyzed using software Statistical Package for the Social Sciences (SPSS-I). The standard normal test (Z) was used to compare the equality of proportions having specific type of diseases among tribal and non tribal population. P value of < 0.05 was considered to be statistically significant.


  Results Top


Of the proposed 2050(33.04%) sampled population, 1870(30.14%) could actually be studied because of non-response from 8.78% sampled population who were absentees during repeat visits [Table 1].
Table 1: Distribution of the total study population

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Tribal - About 47.52% of tribal population had suffered once from one or other type of illness and 27.24% had suffered from more than one illness during last 12 months. Average number of episodes suffered per ill person was 2.22%. Major sicknesses reported at the time of survey among tribal populations were nutritional deficiencies (14.68%), skin infections (12.78%), diarrheal disorders (12.25%) followed by dental disorders (10.98%).

Non tribal

About 50.05% of non tribal population had suffered once from one or more illness and 16.68% had suffered from more than one illness during last 12 months. Average number of episodes suffered per ill person was 1.64%. The sicknesses reported among non tribal population were respiratory infections (12.78%), nutritional deficiencies (12.57%), diarrheal disorders (10.22%) and dental disorders (5.2%).

Among intestinal disorders, diarrhea and parasitic infestations were more common among (15.63%) tribal respondents as compared to nontribal (14.63%) population and this difference was statistically not significant (P > 0.05).

Concerned to ophthalmic diseases, more tribals (2.85%) compared to non tribals (2.17%) had eye diseases. This difference was statistically not significant (P > 0.05). Due to wide range of age group, cataract accounted less percentage and it was observed that 21 (2.64%) tribals and 16 (1.73%) non tribals who had cataract were above the age of 60 years. The other eye disease detected was conjunctivitis which accounted for very meager percentage of total morbidity status among both tribal and non tribal population in the younger and middle age groups.

Among the skin disorders, 10.45% of the tribals were found to have scabies compared to 1.62% among non tribals and the difference was highly statistically significant (P < 0.01). Other skin infections like eczema and pyoderma were very meager in proportion.

Majority of morbid conditions among different age groups showed an increased preponderance among the two extremities of the age groups of the study population that is the age group between 5 to 15 years and age group above 60 years [Table 1] and [Table 2] presented with greater proportion of morbid conditions among both the tribal and non tribal population when compared to all the other age groups as depicted in the [Table 3], [Table 4] and [Table 5].
Table 2: Distribution of study population according to age

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Table 3: Morbidity pattern in study population

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Table 4: Distribution of morbidity patterns in different age groups among tribal population

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Table 5: Distribution of morbidity patterns in different age groups among non tribal population

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Individuals with more than one disease condition simultaneously among tribal and non tribal population: [Table 6] depicts that among tribal population, 258 (27.24%) had suffered from more than one disease and among non tribals, 154(16.68%) had suffered from more than one disease with Z value of 5.55 and the observed difference was statistically significant with P < 0.01.
Table 6: Proportion of individuals with more than one disease states simultaneously among tribal and non tribal population

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Based on application of chi-square test except with regard to nutritional disorders, there was no statistically significant difference in the proportion of morbidity status between males and females in both tribal, as well as in non tribal population. Nutritional disorders were more prevalent among females compared to males in both tribal, as well as non tribal population with P < 0.05 of significance.

Peripheral blood smear was done in suspected cases of fever, example: Malariabut there wasno positive cases found in both tribal and non tribal population.


  Discussion Top


The present cross-sectional comparative study was carried among tribals and non tribals residing at Gundlupettaluk of Mysore district to study the morbidity pattern among tribals and non tribals aged above 5 years. While studying the morbidity pattern in the study population it was found that 73.92% tribal and 63.92% non tribal study population reported illness during past 12 months.

Nutritional deficiencies

More tribal (14.68%) compared to (12.57%) non tribal population suffered nutritional deficiencies. However, this observed difference was statistically not significant (P > 0.05). Hanumantha R observed that 12.4% tribals of Jenukurabas of Karnataka, compared to 7.2% among non tribal counterparts suffered from nutritional deficiencies. [3]

In a study conducted involving southern Indian tribes, malnutrition was pervasive among tribals and deficiencies in gross amounts of calcium, vitamin A, vitamin C, riboflavin, and animal protein were observed and also were known for their caloric and protein deficiencies. [4]

Respiratory infections

These were reported more (12.78%) by non tribal compared to (10.88%) tribal counterparts and this difference was statistically not significant (P > 0.05). In a ICMR study (1990) indicated among the tribes of Morena district of Madhya Pradesh, 7.1% of them suffered from respiratory infections. [5] The respiratory disease including upper respiratory tract infection was more commonly prevalent(14.9% in Bondo, 16.6% in Didayi, 13.6% in Kondha and 8.3% in Juanga) and similar observations were made in Birhor (11.2%) and Sahariya (56.9% inchildren aged 5-14 years) tribes of Madhya Pradesh. [6],[7]

Skin disorders

More tribal (12.78%), as compared to (5.52%) non-tribal respondents had skin infections and this difference was highly statistically significant (P < 0.01). Among the skin infections, scabies was found to be highly prevalent. Saraswathi S reported that skin infections were 13.74% among Desikonda tribes, while it was 13.15% among Kutiakondha tribes. [6] Ina data collected at Regional medical research centre (RMRC), Bhubaneswar, 20.6% of Bondo, 6.9% of Didayi, 10.7% of Juanga and 15% of KutiaKondha tribes wereaffected with scabies (both infective and non-infective), whichis comparable with the findings in Birhor primitive tribe (7%) of Madhya Pradesh. [6]

Ophthalmic diseases

More tribal (2.85%) compared to non tribal (2.17%) had eye diseases out of which tribal (2.64%) and non tribal (1.73%) had cataract but this difference was statistically not significant (P > 0.05). 33% Desikondatribals, 32.33% of Kutiakondha tribes of Orissa suffered from eye diseases was reported by Saraswathi S. [8] Rajalakshmi reported that 23% of Santal tribes of Bihar suffered from eye diseases as compared to their (27%) non tribal counterparts. [9]

Ear nose and throat

Disorders were reported more among tribal (3.06%) compared to (2.82%) non tribal counterparts and this difference was statistically not significant (P > 0.05). Rajalakshmi reported that 14% of Santal tribes of Bihar suffered from ear nose throat diseases as compared to their (15%) non tribal counterparts. [9]

Dental disorders

Among tribal 10.98% had dental caries while 5.20% of non tribal and this difference was statistically significant (P < 0.05). Saraswathi S reported that dental infections were 58.62% among Desikonda tribes while it was 62.90% among Kutiakondha tribes. [8]

Intestinal disorders

Among this category, worm infestations were more common among (15.63%) tribal respondents as compared to non-tribal (14.63%) population and this difference was statistically not significant (P > 0.05). We did not find any concordant study depicting worm infestation among tribal and non tribal population above the age of 5 years. However, we found many studies observed intestinal worm infestation among under five years age group.


  Conclusion Top


Our study revealed statistically significant proportion of Skin disorders and Dental disorders (P < 0.05) among tribal population compared to non tribal population. Nutritional deficiency, Respiratory infections, Intestinal disorders, Ophthalmic disorders and ENT disorders were also prevalent among both the tribal, as well as non tribal population, however, the difference in proportions between tribal and non tribals were not statistically significant (P > 0.05). Morbidity pattern including nutritional status is a sensitive indicator of community health and nutrition. [10] Hence, further research surveys among tribal population, elucidating the health status and in sighting the probable reasons behind morbidty and mortality status, thus, highlighting a need for an integrated approach towards reducing the morbidity rates and improving the health, as well as nutritional status among tribal population would be invaluable.

Limitations

  1. Cross-sectional study was conducted due to paucity of time and man power. Comparatively, a longitudinal study is a better indicator of health problems in a study population.
  2. Morbidity status of the study population was assessed by relevant history and clinical examination, but it was not supported by laboratory parameters.
  3. A diet survey could not be conducted.


Recommendations

  1. A longitudinal study is indicated to study the incidence of morbidities among children below the age of 5 years in tribal and non tribal population.
  2. An in-depth study is suggested to study the traditional mores and its impact on health, literacy status and its influence on their health and economic status.
  3. A comprehensive control strategy with specific interventional measure need to be evolved and implemented specially in tribals as serious efforts for their overall development.
  4. Efforts to be taken to tackle non-responses from both tribal, as well as non tribal population.



  Acknowledgements Top


We acknowledge Mr. M. Puttaswamy, Assistant professor in community medicine and statistician for his kind support in regard to statistical analysis.

 
  References Top

1.Report of the study to understand the Health status and healthcare systems in selected tribal areas of India. 2009. Available from: http:// www.cccindia.net/Health_Systems_Report.pdf. [Last accessed on 23rd July 2012].  Back to cited text no. 1
    
2.Rudraiah N, Vortmeyer D, Veena BH. Influence of electric field on the unsteady dispersion coefficient in couple-stress flow.Biorheology1988;25:879-90.  Back to cited text no. 2
[PUBMED]    
3.Rudraiah N, Vortmeyer D, Veena BH.Biorheology. Hyderabad: National Institute of Nutrition, ICMR; 1988.  Back to cited text no. 3
    
4.Basu SK. A health profile of tribal India. Health Millions1994;2:12-4.   Back to cited text no. 4
[PUBMED]    
5.ICMR. Nutritional deficiency in Astinabad village, Port Blair Annual report;1990.  Back to cited text no. 5
    
6.Annual Report. Jabalpur: Regional Medical Research Centre for Tribals; 1993.  Back to cited text no. 6
    
7.Annual Report. Jabalpur: Regional Medical Research Centre for Tribals; 1999.  Back to cited text no. 7
    
8.Saraswathi S. Health and population prospective and issue. Health status of tribal population in Orissa. Problems and Perspectives 1990;13:171-78.  Back to cited text no. 8
    
9.Rajalakshmi C. Santal women; Areas of health ignorance. Social Change 1992;2:12-23.  Back to cited text no. 9
    
10.Rao VG, Yadav R, Dolla CK, KumarS, Bhondeley MK, U key M. Undernutrition & childhood morbidities among tribal preschool children. Indian J Med Res 2005;122:43-7.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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