Post on 21-Feb-2023
Vol. IV Issue-X October 2014 Asian Journal of Research in Social Sciences & Humanities ISSN 2250-1665
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Why tribal children look differently? an empirical analysis of health and nutritional status of tribal
children in Kerala
Dr. K. Gangadharan*, Vinesh Kumar K. V.** *Professor and Head , Department of Applied Economics Kannur University (Principal Investigator ICMR-Ad-Hoc Project)
**Research Assistant, ICMR-Ad-Hoc Project, Department of Applied Economics Kannur University
Acknowledgements.
The research paper was the outcome of a study undertaken with the full financial assistance of I C M R extended to the Department of Applied Economics, Kannur University for the Research Project titled Maternal and child health among Tribals in Kerala, Strategies for Rational Deployment of health infrastructure and health man power.
Introduction.
Under nutrition kills the skills and potentials in the life of
children and it ultimately kills the potentials for the
development of the nation. Under nutrition is a serious
public health problem among children in the developing
countries. Child under nutrition is one of the measures of
health status that the world health organization (WHO)
recommends for equity in health. The percentage of children
under age five years who are underweight is almost 20 times
as high in India as would be expected in a healthy, well-
nourished population and is almost twice as high as the
average percentage of underweight children in Sub-Saharan
African countries. The UNICEF data for 2013 reveals that 50
percentage of the global under five deaths reported from five
countries they consist of India, Nigeria, Congo, Peru and
Pakistan. This reveals the intensity of the problems affected
by the Asian and Africancountries. The majority of death in
developing countries are associated with under nutrition and
occur in children who are only or moderately undernourished.
These rates are higher in socially and economically
underprivileged communities.
Malnutrition is a prevalent issue in all developing
countries (Black et al 2003 and UNICEF 1993). In India this is
further aggressive and critical because of 8% ethnic share in
70% of rural population as reported by NNMB (1978) taking
unbalanced diet because of poverty stress. The 18% of
Indian population constitutes 170 million children below age
six years (Rao et al 2005) and one third of this bulk is
malnourished. India has a high infant mortality rate of 57 per
1000 children. The IMR shows increasing trend in tribal
dominant states. The tribal populations of India are
recognized as socially and economically underprivileged. The
vast majority of the tribal populations reside in rural areas of
the country.
Tribes constituted separate socio cultural groups having
distinct customs, traditions, marriage, kinship, property
inheritance system and living largely in agricultural and pre-
agricultural level of technology. Tribal have very close
association with the ecosystem and the environment because
of their fulfillment of daily nutritional requirements with food
foraged from nature. Their dependency on nature and
impoverished economy may affect the nutritional status as
compared to their counterparts in the general population.
Poor nutrition is a serious problem in tribal communities.
There are various factors responsible for this malnutrition
ABSTRACT
Prevalence of hunger and malnutrition among the tribal children children below age group five are always there in their
hamlets for years together because of the forest habitats, extreme poverty and taboos. `The study was conducted during
2013-14 in the forest belt of Thirunelli Panchayath in Wayanad District in Kerala where 203 children belongs to 100
households below the age of 5 years from four major tribal groups. A sample survey was conducted for collecting their
anthropometric measurement, diet, health checkup and family history and also a medical camp was organized to get clear
cut measurement of basic chronic and communicable health problems and also to measure the hemoglobin level of the
children. The study shows that health and nutrition status of tribal children is very poor and it is mainly due to lack of
nutritional and health awareness, bad perception about health followed by them, non-availability of health services, worst
infrastructure facilities in the existing health centers.
Key words: health, nutrition, stunting, underweight, wasting, deprivation, anthropometric, disease burden,
Vol. IV Issue-X October 2014 Asian Journal of Research in Social Sciences & Humanities ISSN 2250-1665
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problem. The diagram 1 indicates the important factors and
determinants of tribal status of tribal children.
Fig. No 1 Factors affecting Health and nutritional status of tribal children
The tribal population of Kerala, as per the 2011census,
is4.84lakhs. The proportion of tribal population constitute
1.45% of total population in Kerala. Wayanad is the largest
tribal District with 18.83% of the total tribal population in
Kerala. The study was contemplated to assess the nutritional
status of Paniyachildren, the largest tribal group in Wayanad
district
Objectives
To examine the volume and magnitude of prevalence of
malnutrition in the Under-Five age group of four tribal group
children in Thirunelly panchayath
To identify the important determinants that affects the
prevalence of acute malnutrition in the children below five
years of age among the four tribal group children in
Thirunelly panchayath.
Methods and Materials
The purpose of the present cross-sectional investigation
was to assess the nutritional condition of203 children in the
age group 0-6 years (below 6 years) who belongs to four
tribal communities namely Paniya,VettaKuruma, Kattunaikans
and Adiya in Wayanad district of Kerala. The sample size of
different community distributed to 124 children from Paniya
community, 52 from Kattunaikka, 32 from Adiyaand 20 from
Vettakuruma community. Total of 100 household selected
from Thirunelly panchayath. The identification of morbidity
and health problems of children among these communities
identified through the clinical diagnosis by doctors in the
study areas. Crown-heel length was measured using infant
meter with the child lying supine, height with Martin's
anthropometric and body weight using standard weighing
machine. Thechi square test was also undertaken to compare
nutritional indicators by the tribal group.A structured schedule
was used to interview the mothers to assess their socio
economic status and record the child’s anthropometric
data.Anthropometric measurements, (height and weight)
were measuredfollowing WHO recommendation.WHO growth
standards were used for assessment of nutritional status of
the children. Weight for age, height for age and weight for
height were calculated in standard deviation values
(transformed as Z scores) using reference median as
recommended by WHO. Children who were more than <-3SD
below the reference median on the basis of weight for age ,
height for age and weight for height nutritional indices
were considered to be underweight, stunted and wasted
respectively.Hemoglobin estimation was done using
cynmethemoglobin method. Anemia was diagnosed when
hemoglobin concentration was less than 12 g/dl for children
below 6 years of age. The frequency of anemia was found to
be same among boys and girls. So, the sample of both the
sexes has been combined in the present study. A sort of
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qualitative approach was also included in the study to uses
the strategy required for the PHC for providing better health
care analysis.
Statistical analysis
SPSS 20.0 was used to test of significance (Pearson’s Chi
square test) to find out the association of nutritional status of
thepaniya children with other tribal group children.P
values<0.05 were considered as significant.
Results andDiscussion
The total study sample size surveyed was 203. Six
children were excluded in hemoglobin because they were just
below the minimum age group. Age and gender wise
analysis of under nutrition among preschool tribal childrenis
as follows.
Table 1 Prevalence of underweight among various
tribal group in Thirunelly Panchayath
Figures in parenthesis shows percentage
The table 1 shows that the severe malnutrition is high in the
Paniya tribes compared to the other tribal group in thirunelly
panchayath. Gender wise comparison of this malnutrition
reveals that the high percentage of tribes belongs to the
category of Paniya both under the male and female sections.
Table 2. Prevalence of stunting among various tribal
group in Thirunelly Panchayath
Figures in parenthesis shows percentage
The Table 2 shows that stuntingis high in the paniya tribes
than the other tribal groups. Inadequate nutrition in the
paniya tribes is just one of several causes for growthof
stunting. Other contributors to stunting include chronic or
recurrent infections, sometimes in combination with intestinal
parasites in these tribal group. Chronic diseases and systemic
disorders that involve the nervous, circulatory, or
gastrointestinal systems may be a cause of growth failure in
the tribal communities.
Table 3 Prevalence of wasting among various tribal
group in Thirunelly Panchayath
Figures in parenthesis shows percentage
The tribal groups in Wayanad district faces serious nutritional
problem. The serious wasting in these tribal groups can be
caused by an extremely low energy intake (e.g., caused by
famine), nutrient losses due to infection, or a combination of
low intake and high loss. Infections and conditions associated
with wasting include tuberculosis, chronic diarrhea, and
superior mesenteric artery syndrome.
Table 4 Prevalence of hemoglobin anemia among
various tribal group in Thirunelly Panchayath
Figures in parenthesis shows percentage
Table 4 depicts anemia among the boys and girls under the
0-5 year age group. High prevalence of anemic in paniya
preschool children. Fifty six percentage are males and sixty
eight percent are femalesfrom the paniya tribal group .The
present study by and large has revealed that the problem of
anaemia is still continuing among the tribal children in
wayanad district. Due to two main reasons, that is, socio
Economic status and lack of awareness about nutrition, many
children suffer from anaemia. The monthly income of
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households has shown that majority of them belonged to low
income group. On the other hand, lack of nutrient food
availability is the problem. In our study, tribal women
reported high prevalence of anemia with increase in the
number of pregnancies and this will further affect the health
of the newborn child.
Table 5 Percentage Distribution of Disease burden
on of malnourished tribal children in Thirunelly Panchayath
The table 5 depicts the burden of skin infections specifically
on scalp of severe malnutrition of paniya preschoolchildren.
The other diseases like bronchial asthma and vitamin
deficiency problem and atopic dermatitis is high in the paniya
tribal children than other tribal group in thirunelly panchayath
Table 3 compare the nutritional status withvarious tribal communities
***p<0.0001
The results revealed that so far as wasting and stunting is
concerned, the situation is worst.The chi sure result shows
that prevalence of under nutrition in terms of wasting,
stunting and underweight is high among the paniya
compared to other tribal group in thirunelly panchayath (p>
0.05). The findings of the present study revealed the
widespread prevalence of under nutrition among the children
of paniya tribal communities and highlight a need for an
integrated approach towards improving the child health as
well as the nutritional status in these areas.
In this study it is observed that the majority of the
Paniyahouses appeared to be clean. But actually the tribals
do not give much care forneatness and cleanliness. They do
not give any importance to their daily bath due to theacute
shortage of water and they could not keep themselves neat
and clean. They areliving in their unhygienic living conditions
which cause allergies, Skin diseases and other diseases.Major
diseases common among the tribals are fever, T.B., heart
diseases,body pain etc. In this study it is noticed that
dysentery and skin diseases iscommon among the tribal
children. The medical camp organized as part of the field
work programme and the clinical diagnosis identified that it is
mainly due to the bad drinking water and unhygienic living
condition. It is understood from this sample survey that water
scarcity is one of the major problems faced by the Paniyas.
Ninety percent of this community depend on public taps for
their water requirement. Clean environment is also essential
for the well-being of any society. It is noted that tribals do
not possess any separate arrangements for waste disposal.
Only a low percentage of the households have toilet facilities
near their house. Some of them use indigenous type toilets.
Diet pattern is the most important indicator of nutritional
status of children. It is clear from the study that the
consumption pattern of Paniyas is closely tied up with the
employment opportunities. Most of them consume food twice
a day if work is available, otherwise only once in a day. Their
main dietis rice, if rice is cooked twice, the second time they
prepare it as kanji.Three meals a day is something which
they enjoy rarely.Normally they take rice with salt alone or
salt and chilli or with 'yellow kari' which is prepared by using
potato or papaya. Diet profile of Paniya tribe is characterized
by lack of milk and milk products.
The health care delivery mechanism of primary health
centers of study area reveals acute deficiencies and
limitations in its routine functions, which resulted in the
disrupted health care services. The field visit and interaction
with the inmates and clientele of the PHC reveals that there
exists acute shortage of basic equipment and human
resources in the PHCs .The shortageof laboratory staff,
clerical staff, technicians etc. adversely affected indischarging
bio chemical tests rendering of other basic services to the
patients. Similarly in the PHCs there is no gynecologist to
provide advice and gynecological services to pregnant ladies.
Since gynecologist are not attending the PHCs they are not
getting any sort of maternal health related services during
the pregnancy stage and this will result in unidentifying
certain grave complications during pregnancy and later result
in maternal deaths. In many cases ectopic pregnancies and
its unidentification by the health staff resulted in maternal
deaths in the study area. Since hospitals are far away from
tribal hamlets and infrastructural facilities including
transportation are very poor in the area and due to financial
deprivation most of them will not prefer to go to distant
health centers for gynecological test and checkup during
pregnancy. This itself is the basic maternal health problem
faced by the females in the adolescent and reproductive age
group. Same is the case of children below 6 years of age as
the PHCs also lack pediatricians to provide proper child health
care services. Tribal children has to satisfy with the services
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rendered by mere medical graduates without having
specialized qualification in pediatric care and their many
health problems are unidentified laterlead to deformities and
even death.
Conclusion
This study found that under nutrition in the Paniya tribal
children is quite high compared to the estimates for children
in other Tribal communities in the region .The higher level of
wasting, stunting and underweight, indicate that chronic
malnutrition is more common malnutrition in the study
population. The high prevalence of underweight, wasting and
stunting in the study population and the low levels of
education and standard of living has been identified as an
important public health problem in the area. The nutritional
grades of malnutrition was significantly related to disease
burden like skin diseases, vitamin deficiency, bronchial
asthma and Atopic dermatitis. The study also reveals the
urgency of deploying qualified medical practitioners in
gynecology and pediatrics specifically and solely for the tribal
hamlets region with proper testing and diagnosing
equipment’s. Doctors should be provided with proper
residence facilities and also additional monetary incentive to
work in the tribal hamlets. There should be compulsory
provision to work in the tribal hamlets for particular time
period say at least one year and this should be implemented
on rotation basis among junior doctors on the state level
seniority maintained by health department.
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