WHY TRIBAL CHILDREN LOOK DIFFERENTLY? AN EMPIRICAL ANALYSIS OF HEALTH AND NUTRITIONAL STATUS OF...

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,


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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


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


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


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.

References

• Gopalan, C. (2005). Linear Growth as an Index of

Nutritional Status, Bulletin of the Nutrition Foundation of

India, 26 (2); 1-4.

• Chakrabarty ,S& Bharati, P.(2010). Nutritional Status

among the Shabar Tribal Children Living in Urban, Rural

and Forest Habitats of Orissa, India. Italian Journal of

Public Health, 8(7); 303-309.

• Subal Das &Kaushik Bose. (2011). Assessment of

Nutritional Status by Anthropometric Indices in Santal

Tribal Children. Journal of Life Science, 3(2); 81-85.

• Ghosh, R.,& Bharati, P.(2006). Nutritional status of

Adults among Munda and Pod Populations in a Peri

Urban Area of Kolkata City, India. Asia Pacafic Journal of

Public Health,18(2);12-20.

• Jai Prabhakar S.C, Gangadhar. M.R. (2009) Prevalence of

Anemia in Jenukuruba Primitive Tribal Children of Mysore

District, Karnataka. Anthropologist, 11(1); 49-51.

• National Family Health Survey 1998-99 (NFHS-2) India,

International institute for Population Sciences, Mumbai,

India, 2001

• Pradhan S, &Sharma, K. (2011). Nutritional Status of Bhil

Tribal Children in Madhya Pradesh, India: A Cross

Sectional Study. Studies of Tribes Tribal’s,9(1);37-40.

• Shrivastava, V. K et.al.(1979). Protein energy

malnutrition among pre-school children in a Rural

Population of Lucknow. Indian Pediatric ,16(6);507-513.

• Shriya, A .S & Mini, K. S,(2013). Nutritional Status of the

Children Below 3 years of Age in Tribal Villages of

Chikhil Taluka , Gujarat, Indian Journal of Research

,2(12);97-99 .

• Rao, V.et.al.(2005). Under nutrition and Childhood

Morbidities among Tribal Preschool Children Indian

Journal of Medical Research,122(1);43-47

• World Health Organization (WHO). Child Growth

Standards: Method and Development. Department of

Nutrition for Health and Development; 2006

• World Health Organization,2005 Worldwide Prevalence of

Anemia 1993-2005.

• Zere. E Mclntyre D. (2003).Inequalities in under five

Child Malnutrition South Africa International Journal of

Equity Health , 2(7),1-10.

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