4/28/2016 1 ICMR Tribal Health Research Forum meeting Domain: Tribal Nutrition 11 th April 2016 National Institute of Nutrition (ICMR) Jamai-Osmania, Hyderabad Each State ITDA-120 Vill./State 9 NNMB States 40 HHs/villages Area 1 Area 2 Area 3 Area 4 Area 5 HHs SE & Demography Nutrition Assessment 24 hour dietary recall H/o of current morbidity K & P of Adults (H & N) BP measurements Fasting Glucose H/o Chronic morbidity Dry blood spots (DBS) 90 old 30 new
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4/28/2016
1
ICMR Tribal Health Research
Forum meeting
Domain: Tribal Nutrition
11th April 2016
National Institute of Nutrition (ICMR)
Jamai-Osmania, Hyderabad
Each State
ITDA-120 Vill./State
9 NNMB States
40 HHs/villages
Area 1 Area 2 Area 3 Area 4 Area 5
HHs SE & Demography
Nutrition Assessment
24 hour dietary recall
H/o of current morbidity
K & P of Adults (H & N)
BP measurements
Fasting Glucose
H/o Chronic morbidity
Dry blood spots (DBS)
90 old 30 new
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2
23.8 25.5
28.3
32.232.9
41.643.1
45.1
48.8
0
10
20
30
40
50
60
Underweight
Karnataka Kerala T.NA.P M.P W.BMaharashtra Orissa Gujarat
Prevalence (%) of underweight ( Weight for
Age, <Median –2SD) among <1 year Tribal
Children in 9 states in India 2008-09
23.825.5
28.3
32.2 32.9
41.643.1
45.1
48.8
0
10
20
30
40
50
60
Underweight
Karnataka Kerala T.N
A.P M.P W.B
Prevalence (%) of underweight ( Weight for
Age, <Median –2SD) among Tribal Preschool
Children in 9 states in India 2008-09
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Pe
rce
nt
PREVALENCE (%) OF UNDERNUTRITION (<
Median – 2SD) AMONG TRIBAL
PRESCHOOL CHILDREN AND PERIOD OF
SURVEY
P < 0.001 P < 0.001
Using WHO child growth standards
Source: WHO 2002; Lancet-2003
CONSEQUENCES OF UNDERNUTRITION
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Less Time for
Child Care and
Feeding
Poor care of Mother
Bread winning
Household Work
Farming/cattle
rearing/poultry
Fragile Home Food Security /
Seasonal Food PaucityLack of Storage/Savings for Lean Months/Lack of capacity for bulk purchase
Tasty/Acceptable
Universal Reach
Colorful & Variety
Affordable
Marketing of
“Ready to Eat Food”
Inadequate &
Inappropriate infant and child feeding
Inadequate BF
Delayed complimentar
y feedingReduc
ed food
during sickne
ssLow
Cal/ low nutrient density
Milk Dilutio
n
No special
preparation of food
Gender preferenc
e and domestic violence
MOTHERS SEEKS SOLUTIONS FOR TIME
CONSTRAINT
MARKET FOODS
DISPLACE/REPLACE HOME
FOODS
UNDERNUTRITION CONTINUES 7
Use of addition
al money
Clothes
Household Goods
Alcohol
Saving
Education
Sickness Care
Market foods Little
Family Support
Non recognition
of nutritional
status
Inadequate Nutritional Education
Poor Referral
Problem in Supplement
ary Nutrition
Inadequate responsiveness of health system and
ICDS
Spending time outside home
Delayed/ non-
Recognition of under
nutrition by
family
Low birth
weight
ENTRUST CARE TO ELDER SIBLING
Delay in care seeking
Soci
o-c
ult
ura
l bel
iefs
A multi-component Health and
Nutrition Education interventions
to improve nutritional status of
vulnerable population groups in
high burden districts in the select
states
This project is an ICMR multi-center project and it is being implemented in the states of Telangana, Andhra Pradesh, Gujarat Jharkhandt, Haryana, and Rajasthan
Study Coordinator: Dr.G.S.Toteja, Head, Nutrition – ICMR
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5
45
19.4
28.6
20.1
29.1
11.5
21.6
54.4
32.6
27.1
36.7
22.8
29.8
26.323.7
7
24.4
50
34.5
26.4
0
10
20
30
40
50
60
70
Men Women
Age adjusted States-wise prevalence of
hypertension among tribal men and women of
≥20 years age from 9 states in India
DISHA (Diet and lifestyle
InterventionS for Hypertension
Risk reduction through
Anganwadi Workers and
Accredited Social Health
Activists) Study in selectTribal
areas of Adilabad, Andhra
Pradesh
CURRENT NUTRITION INTERVENTION
PROJECTS OF NIN, HYDERABAD
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OBJECTIVE
To assess the effectiveness of intense versus
usual IEC interventions on diet and lifestyle
modifications delivered by existing
community-level health-workers (AWW/ASHA
or equivalent) on population level blood
pressure.
PROGRESS OF STUDY
Ongoing at 10 locations in the country one of
the centre at tribal district Adilabad-
Telangana. The study is 3 phases
Phase I: Baseline study (Completed)
Phase II: Intervention development and
implementation
Phase III: Impact evaluation
Objectives
To assess the nutritional status and
associated factors among tribal
children in various states
The study findings will be useful for
the development of district specific
intervention strategies for control and
prevention of undernutrition.
The study was done in
MP, Gujarat, Meghalaya, Haryana, And
hra Pradesh, Pudhucherry
District level Mapping and
determinants of undernutrition
in various states
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Map Showing Cluster of Districts
according to Prevalence of Underweight
(based on weight for age)
Low
Moderate
High
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DEVELOPMENT OF TRIBAL
DIETRAY ATLAS
It is a dietary atlas of tribal India, in which
information on Diet and nutritional status
of various tribal populations in India will
be illustrated with
maps, diagrams, photographs and tables.
The Tribal Atlas will be organized into
different Regions and Tribes.
At each map, an explanatory note is
provided to understand better.
The Atlas will be a powerful visual tool that
deals with tribal nutrition in India.
Need for the Atlas
• Understanding the type, magnitude and
factors associated with undernutrition
among tribals is very essential for
development of sustainable plans for
tribal welfare.
• The required information will be
collected from several organizations
including various institutes of ICMR
, Anthropological survey of
India, Department of Anthropology from
various Universities, TRIs of different
States. Published data on diet and
nutrition since 2000.
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Source: Census of India.
Percent Tribal population in the State to the total population of the State
13.5
5.7
1.3
22.8
21.1
0.6
11.9
26.243
2.9
0.0
30.6
9.4
14.8 5.8
0.0
12.42
7.0
1.5
7.0
1.1
35.1
86.5
68.8
31.8
86.1
0.0
7.5Andaman & Nicobar Island
33.8
94.4
Source: Census 2011
The tribal population of the country, as per 2011 census, is 8.6%of the total
population. More than half of the Scheduled tribal population is concentrated in the
states of Chattisgarh, Madhya Pradesh, Maharashtra, Odisha, Gujarat and Rajasthan.
Numerically important tribes are Gonds, Bhils and Santals.
INDIA: 8.6
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Sex Ratio among Scheduled Tribes
Andaman & Nicobar Island
948
999
958
1029
984
952
924
1003
963
1020
97710.9
9819999
985
993
1035
990
981
1002
976
1032
983
10133
937
960
1007
INDIA:990
Source: Census2011
The sex ratio among the tribes of India is 990, highest found in Arunachl
Pradesh followed by Odisha, Chattishgarh and Assam and lowest found in
Rajasthan
Number of Particularly vulnerable Tribal groups in India
Andaman & Nicobar Island
1
9
13
7
2
3
53
12
5
2
6
1
1
5
INDIA:75
Particularly Vulnerable tribes characterized by: a) pre-agricultural level of
technology b) stagnant or declining population c) extremely low level of literacy d)
subsistence level of economy.
There are 75 particularly vulnerable tribal groups in India, the highest number
found in the state of Odisha and Andhra Pradesh.
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Number of Integrated Tribal Development Agencies by State
5
5
21
31
1
14
19
16
912
19
8
7
5
9
5
1Andaman &
Nicobar
Island
4
INDIA:190
There are 190 Integrated Tribal Development agencies in India. In addition, there are
259 Modified Area Development Approach scheme, 62 clusters and 75 Particularly
vulnerable tribal projects for the development of tribal populations.
Source: Statistical profile of Scheduled tribes in India. Ministry of Tribal Affairs, GOI.2010
State wise Estimates of Under 5 mortality among Scheduled tribes in India
151
93
112
122
169
126
122
112
100
143
93
85 107
84
97
83
93
85
89
103
66
99
119
142Andaman & Nicobar Island
91
79
INDIA:123
As per 2001 census, the under five mortality among scheduled tribes in India was
123 per 1000 live births. The highest figure found in the state of
Chhattisgarh, followed by Madhya Pradesh, Rajasthan, Andaman & Nicobar
Islands, and lowest found in Arunachal Pradesh.
Source: Census of India, 2001
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State wise estimates of Infant Mortality among Scheduled tribes of India
100
66
77
92
110
85
83
77
71
95
66
61 75
61
68
60
66
61
64
72
104
70
82
95Andaman & Nicobar Island
65
57
INDIA:84
Source: Census of INDIA, 2001
According to Census 2001, the IMR among scheduled tribes in India was 84/1000
live births. The highest found in the state of Madhya Pradesh, Arunachal, and
Rajasthan and lowest found in the state of Mizoram
State wise estimates of Maternal Mortality Ratio among Scheduled tribes of India
318
261
258
269
359
261
359
172
269
104
1488
145
153
390
134
81
178
97
Andaman & Nicobar Island
INDIA: 212
Source: SRS Bulletin, June 2011.
The Maternal Mortality Rate among tribes of India was 212. The MMR was found
highest in Assam, Uttar Pradesh, Rajasthan and lowest in the state of Kerala.
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Average consumption of Cereals & millets
at Household level (g/CU/day)
378
456
4511
400
426
394
397
610
330
POOLED:419
The average intake of cereals and millets was 419 g/cu/day against 460g of
RDI. The highest intake was found in the state of West Bengal and lowest in
Kerala.
Source: NNMB 2009
Average consumption of Pulses &
legumes (g/CU/DAY)
27
48
29
15
3919
54
10
20
POOLED:30
In the NNMB states surveyed, the mean intake of pulses and legumes was
30g/cu/day, which is 75% of RDI. The highest found in the state of Maharashtra
and lowest in West Bengal.
Source: NNMB2009
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Average consumption of Green Leafy
Vegetables (g/CU/day)
17
14
8
65
78
8
13
13
8
POOLED:22
Source: NNMB2009
The average consumption of green leafy vegetables was 22g/cu/day, below
the RDI of 40g. The intake was found highest in the states of West Bengal
and Odisha.
Average consumption of
other vegetables (g/CU/day)
30
23
38
47
36
45
65
46
44
POOLED:41
Source: NNMB2009
The mean intake of other vegetables was 41g/cu/day, which forms 69%
0f RDI. The highest intake found in Gujarat and lowest in Maharashtra.
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Average consumption of Roots &
tubers (g/CU/day)
27
35
18
40
30
86
73
4474
POOLED:46
Source: NNMB2009
The average consumption of roots and tubers was 46g/cu/day
marginally lower compared to RDI of 50g, with highest intake found in
the state of West Bengal followed by Gujarat, Kerala and lowest in
Maharashtra.
Average consumption of fruits (g/CU/day)
8
9
46
11
30
36
29
17
11
POOLED:22
The mean intake of fruits was 22g/cu/day with highest found in the state
of Andhra Pradesh followed by Tamil Nadu, Karnataka and Kerala.
Source: NNMB2009
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Average consumption of Fish &
Other flesh foods (g/CU/day)
10
2
4
10
18
1
34
21
19
POOLED:13
The mean intake of fish and other flesh foods was 13g/cu/day. The
consumption was high in the state of Kerala followed by Andhra
Pradesh, West Bengal and Karnataka.
Source: NNMB2009
Average consumption of milk& milk
products (g/CU/day)
7
27
16
63
42
15
1
2
12
POOLED:21
The mean intake of milk and milk products was 21g/cu/day, which forms
only 14% of recommended level of 150ml. The intake ranged from 1ml in
Odisha to 63ml in Gujarat.
Source: NNMB2009
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Average consumption of Fats& Oils
(g/CU/day)
7
14
4
15
14
6
12
8
9
POOLED:10
Source: NNMB2009
The mean intake of fats and oils was 10g/cu/day against 20g of
recommended level. The intake was highest in the state of Maharashtra and
Gujarat and lowest in Karnataka.
Average consumption of Sugar& Jaggery
(g/CU/day)
58
20
18
10
4
8
3
4
POOLED: 9
Source: NNMB2009
The average intake of sugar & jaggery was 9g/cu/day which forms only 30%
of RDI, highest intake found in the state of Maharashtra and Karnataka and
lowest in Odisha.
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MULTICENTRE INTERVENTION STUDY ON HYPERTENSION
“Effectiveness of diet and lifestyle intervention through IEC tools with AWCs as the centre of knowledge
dissemination for hypertension risk reduction”
OBJECTIVE: To assess theeffectiveness of intense versus usualIEC interventions on diet and lifestylemodifications delivered by existingcommunity-level health-workers (ASHAor equivalent) on population level bloodpressure.
DIVISION OF NUTRITIONCENTRE FOR PROMOTION OF NUTRITION RESEARCH &
TRAINING…(ICMR)
36
TASK FORCE STUDY ON
HYPERTENSION
STATUS: Ongoing at 10 locations in the country (including 7 tribal sites) which are (Adilabad (AP); Udaipur (Rajasthan); Kalahandi(Odisha); Ranchi (Jharkhand); Chamba (HP); Dhar (MP); Dibrugarh(Assam)
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RECRUITMENT FIGURES IN TRIBAL SITES
Total number of interviews completed= 23,947
Number of Blood Pressure Measurements= 21,867
Number of Anthropometric Measurements= 21,867
Number of Blood Samples Collected= 18,033 (Approx. 1
Lakhs determinants)
PREVALENCE OF HYPERTENSION & PRE HYPERTENSION (PHASE I)
44.8%
42.5%
38.0%
33.0%
39.8%
24.4%25.9%
21.9%19.9%
23.1%
Prehypertension Hypertension
Dhar Junagadh Puducherry ChambaTotal
Reference: JNC VII [Hypertension =140/90 mmHg, Pre-hypertension= 120-139/80-89 mmHg
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PREVALENCE OF HYPERTENSION & PRE HYPERTENSION (PHASE II)
39%
34%
31%29%
42%
35%
13%
21%
12%
19%
34%
19%
Prehypertension Hypertension
Kalahandi Alidabad Udaipur Ranchi Dibrugarh Total
Reference: JNC VII [Hypertension =140/90 mmHg, Pre-hypertension= 120-139/80-89 mmHg
PREVALENCE OF DIABETES (PHASE I)
30.3%
22.0%
28.6%
13.1%
24.1%
13.5%
8.6%
11.7%
3.6%
9.7%
Pre-diabetes Diabetes
Dhar Junagadh Puducherry
Chamba Total
Diabetes: Blood Glucose ≥ 126 mg/dl; Pre-diabetes: Blood Glucose 110-125 mg/dl (Report of the expert committee on the diagnosis and classification of diabetes
mellitus, 2006)
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IMPROVING HEALTH AND NUTRITIONAL STATUS OF SAHARIYA TRIBAL POPULATION
OF RAJASTHAN BY INTERSECTORAL CONVERGENCE AS A SUSTAINABLE MODEL
OF INTERVENTION
PARTNERS:
1. Desert Medicine Research Centre
(ICMR), Jodhpur
1. Government of Rajasthan
41
STATUS: Baseline has been completed. Intervention to be initiated
Achievements in Reproductive and Child Health
Division of RCH, ICMR
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Impact assessment of an intervention package to improve maternal and child
health services among primitive Baiga tribe of Dindori district in M.P
Objectives: To develop an intervention packageand determine its utilization for improving thematernal and child health care services.
Design: Case control study in Dindori District of MPamong Baiga tribe including 500 women in 24villagesPhase I: IEC developed and imparted through public health system
Phase II: Impact evaluation survey is ongoing
Utilization
of MCH
care
services
Interve
ntion
Village
(X)
Contr
ol
Villag
e (Y)
Improv
ement
Z=X-Y
Antenatal
care
85.2% 69.8% 15.4%
T.T.
vaccinati
on
90.7% 88.5% 2.2%
IFA
Consump
tion
91.6% 86.4% 5.2%
Hospital
delivery
41.7% 17.4% 24.3%
Assessing the status of micronutrients with special reference to Zinc in
adolescents of Bhil, Gond, Korku and Pardhi tribes of MP
Objectives: To assess zinc, other micronutrient
status among adolescents of Bhil, Gond, Korku,
and Pardhi tribes of MP
Methodology: Cross-sectional, community based study with Cluster Random Sampling (PPS)
Outcome :
• Prevalence of inadequate dietary intake of zinc, calcium, copper, iron, energy, protein , fat.
• Prevalence of stunting and other clinical profiles of Zn deficiency
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Indigenous knowledge of health care practices during pregnancy, childbirth and postnatal period among the Karbi tribe of
North East IndiaObjectives:• To find out the different traditional healing practices
around childbirth among Karbi tribe and the sustainable utilization of such resources.
• To find out the interaction between traditional and western medicine system of medicine.
Methodology:• Documentation of Case studies eg. maternal mortality, fetal
loss, child mortality, under 5 mortality, reproductivemorbidity, immunization, dependency on healers, scope ofwestern medical accessibilities, utilization of local medicinalresources etc.
• Genealogy: To trace out the mother-child health disorder infamily
• Interview of allopathic practitioners both public andprivate, nurses, midwives, traditional healers, etc. to co-relate cultural aspects with availability, implementation,and scope of accessibility of different MCH schemes
Literature review of traditional childbirth practices among various tribes in
Maharashtra
Overall Aim: To review all (qualitative and quantitative) published/unpublished articles and annual reports describing the practices during pregnancy, delivery and postnatal period among tribal population of Maharashtra since 1990 onwards
Expected outcome: to categorize useful and harmful practices with a view to encourage good practices and develop interventions to reduce harmful practices.
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Studies on Child Health
Examining Cultural Meanings, Experiences and
Behaviours Associated with Child Malnutrition in Two Tribal Districts of
Maharashtra to Contribute to Malnutrition Control Strategies
Objectives
• To document awareness of community members,mothers, family members and health care providers onbreast feeding practices, nutrient rich foods,micronutrients, sanitary practices, childhood illnesses,immunization and health services specially focussing onmalnutrition related experience, meaning and behaviourof mothers and family members.
• To identify community members, mothers and familymembers understanding on perceived barriers to accessand utilization of health services related to nutrition.
• To identify and propose local control strategies forintervention to mitigate malnourishment amongst tribal
children.
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Study site and study population:• Thane district of Maharashtra• Total ST population :14.75%, with a 63%
proportion of the rural population in 9 talukas are tribal (range
22.62% to 90.56%).• 44 tribes -five major tribes are Warli, Koli
Malhar, Thakur, Katkari and Mahadev Koliconstituting 90.03% of the total ST population
Progress:FGD 6KII 14Mothers of undernourished children 65Mothers of normal children 71Family members of undernourished children 71Family members of normal children 65
Outcome: Cultural epidemiological framework has never been utilised in nutrition studies. This study will help identify how various facets of nutrition are perceived by people, and how
Clustering of infant mortality among primitive tribes of Odisha
Objectives:
• To assess family level death clustering andclustering by socioeconomic risk factorsamong various primitive tribes in Odisha
• To study community level factors influencinginfant and child mortality
• To study the relative role individual motherscompetence/genetic frailty versusenvironmental/community factors influenceon child death clustering
• To assess a comparative pictures of extent ofclustering among various Primitive TribalGroups
Study population: Four major primitive tribal groups(Bondo, Joangs, Dongria khond and PaudiBhuyian)
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Study site and study population:
• Four major primitive tribal groups(Bondo, Joangs, Dongria khondand Paudi Bhuyian)
• Study design: Both quantitative and qualitative study. 600 respondents(400 case and 200 controls groups)
Outcome: • Underlying causes of child mortality among primitive
tribes will be identified
• Fact sheets will be prepared for grass root level workers/ NGOs/ health intervention agencies
• Finding will help Govt / programme managers to design / plan interventions for reducing morbidity / mortality among
primitive tribes
Status: Ongoing since June 2015
Participatory health facilitation intervention to promote maternal health, feeding attitude to
recommended IYCF practices in tribal Gujarat .
Objectives:
• To assess key determinants of infant and young childfeeding practices in the tribal blocks of Dahod district
• 2. To synthesize evidence based and contextuallyrelevant health promotion intervention throughcommunity mobilzation, capacity building andfacilitation of existing government services with specialemphasize on anganwadi centers and ICDS
Target Population: tribal women of childbearing age (15 to49 yrs) mainly pregnant women and mothers havingchildren lees than 9 months of age.
Study area: tribal dominated blocks of dahod, Jhalod andLimkheda. The indigenous tribal community is bhil.
Status : Ongoing since January 2015
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orEmpowerment and Engagement of Community in
Strengthening Child Health among Tribal Population
Objectives:
• To create awareness & build capacity of the Adolescents,Traditional Tribal Healthcare Practitioners, Medical
Practitioner &VHSNCs members on issues related to Child health for
sustainingpositive health seeking behavior in the community
• To enhance the level of awareness, change inattitude, beliefs &
practices/behavior on issues related to child health amongcommunity/ mothers of under-5 children through diverse
‘ChangeAgents’
• To assess the impact of the above interventions in thecommunity
on issues related to child health
Study Area: Tamilnadu (Thiruvallur District) & Karnataka
(Mysore District). Study Population: Irular from Tamilnadu &
Jenu Kuruba from Karnataka Status: Under process for FC
Outcome parameters:
• Change in rates of child health specific awareness, attitudes & practices among the mothers of U5 children
• Increase in rates of Immunization coverage , no.ofwomen feeding
colostrums, early initiation BF and exclusive BF for six months of age & timely complementary feeding
• Decrease in number of children with ARI and Diarrhea, number of children with malnutrition
• Increase in awareness of Adolescent Girls, VHSNC members, Traditional Healthcare Practitioners & Medical Practitioners on issues related to child health resulting in increased community engagement in child healthcare
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Epidemiology of Anemia in Pre-school Tribal Children of Eastern Gujarat with Reference to
Etiological factors.
Objectives:
• To study the epidemiology of anemia in pre-school children of the tribal area
of eastern Gujarat
• To study etiology and pathophysiology of anemia and nutritional impact on
anemia prevalence
Study area and Population:: tribal pre-school children (age 6months to 5 years) from the Taluka santarampur(80%tribal), District Panchmahals in Gujarat
Expected outcome: generating awareness, providing knowledge regarding the symptoms and causes of the anemia, malaria and gastrointestinal infections and malnutrition, willingness to approach the nearer Primary Health Centre (PHC) for disease diagnosis and treatment amongst them.
Status: under process for FC
A study of treatment seeking behaviour for malaria and its management in children less than
5 years of age in tribal population of southern part of Rajasthan, India.
Objectives:
• To study the basis on which the fever was recognizedand classified and find out factors involved in selectionof different treatment options
• To know the management of malaria among children <5years of age in the tribal community
• Intervention to modify the behavior for minimizingtime laps between onset of disease and diagnosisand complete treatment at health facility, vectorbreeding source reduction and personal protection
Study site and population: 3 districts with high tribalpopulation( Banswara 72.3%, Dungarpur 65.1% andUdaipur 47.9%)
Expected outcome: Findings may be useful for tribal malariacontrol programme.
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Testing Efficacy Of Electronic Decision Support System To Improve Adherence to IMNCI Guidelines By Medical Officers And Frontline Workers In Tribal
Settings.
Objectives:
• Rapid Program Appraisal (baseline) and Gap Analysis
• To develop and implement e-DSS prototype based onIMNCI algorithm (eDSS-IMNCI)\
• Design and development of electronic clinical decisionsupport system in a local dialect following iterative designprocess in consultation with IMNCI experts, state andregional health administration and end-users
• Implementing the prototype in study block and testing itsefficacy in terms of usability, utilization, adherence, costand child health outcomes
Target population: children born during the enrollment phase in the tribal villages of Jetpur-Pavi taluka of Vadodaradistrict(indigenous tribal communities ‘Rathva’, ‘Tadvi’ and ‘Nayka’)
Expected outcome: Help strengthening programme implementation, improve coverage and quality of care
Assessment of Haemoglobinopathies and G6PD deficiency among the tribals of Nilgiri Hills, Tamil Nadu and the impact of genetic counseling and health education programme: task force study
Participating centres:1. School of Public Health, SRM University, Kattankulathur2. PSG Institute of medical Sciences and Research, Coimbatore3. School of Bio Sciences and Technology, VIT University, Vellore
Objectives:• To screen for Haemoglobinopathies and common enzymopathies
like G6PD deficiency and their clinical manifestations.
• To determine the distribution of mutations causing haemoglobinopathies and G6PD deficiency and to evaluate the effect of genetic modifiers in ameliorating the severity of the disease.
• To provide genetic counseling and health education to young unmarried
adults and newly married couples with Haemoglobinopathies as well as
G6PD deficient individuals and assess their impact.
• To develop and validate a Genetic Disease Risk Scores (GDRS) tool for identifying high risk cases for SCD.
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Thank You
4/28/2016
31
69
56
75
91
92
14
30
50
0 50 100 150
Sugar & Jaggery
Fats & Oils
Milk & MP
Roots & Tubers
Other Veg
GLVeg
Pulses
Cereals
Per cent of RDA
AVERAGE DAILY HOUSEHOLD INTAKE OF FOOD STUFFS AS % OF RDA
Source: NNMB2009
In the 9 NNMB states surveyed, the mean intake of different food
stuffs at household level indicated that the intake of all the food
groups were lower than the suggested levels of ICMR. There was
gross deficit found in the intake of milk and milk products and sugar
and jiggery. The intake of leafy vegetables and other vegetables form
only half of the RDI.
51
110
100
79
77
78
36
46
44
91
0 50 100 150
Free F.Acid
Vitamin C
Niacin
Riboflavin
Thiamin
Vitamin A
Iron
Calcium
Energy
Protein
Per cent RDA
AVERAGE DAILY HOUSEHOLD INTAKE OF NUTRIENTS AS
% OF RDA
Source: NNMB2009
Expect the intake of Thiamine and Vitamin –C, the intake of
all the other nutrients were lower than recommended
nutrient intakes suggested by ICMR. Gross deficit was
found in the intake of Iron, Riboflavin, Vitamin-A, and Folic
acid.
4/28/2016
32
Median Energy (Kcal) consumption at household level (CU/day)
2034 1550
1840
2002
1802
1743
1702
1840
2416
Pooled:1857
Source: NNMB2009
The median energy intake for all nine states pooled was 1857Kcal/cu/day was
lower than the recommended level of 2425Kcal. Among the states the
maximum intake was observed among the tribes of West Bengal and lowest
found in the tribes of Madhya Pradesh.
Average Protein (g) consumption at household level (CU/day)
The median intake of protein, pooled for the nine states was
47g/cu/day, which forms 78% of RDA. The protein intake was highest in
Gujarat and lowest in Tamil Nadu
Source: NNMB2009
42.767.5
48.9
48.5
40.9
40.5
39.6
42.5
52.5
Pooled: 46.9
4/28/2016
33
Average Iron (mg) consumption at household level (CU/day)
11.8
10.0
11.5
14.3
17.5
9.6
10.0
11.8
13.6
Pooled:12.2
Source: NNMB2009
The median consumption of Iron was 12.2mg/cu/day far below the
recommended level of 28mg and forms only 44% of RDA. The intake
was ranged from 9.6mg in Andhra Pradesh to 17.5 in the state of
Gujarat.
Average Vitamin-A (µg) consumption at household level (CU/day)
187
133
180
268
196
198
133
777
500
Pooled: 277
Source: NNMB2009
The intake of Vitamin –A was 277µg which forms 46% of RDA. The intake
was highest in state of Odisha with 777 µg and lowest in the state of Tamil
Nadu and Maharashtra with each133 µg.
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34
Average Thiamine (mg) consumption at household level (CU/day)
1.1
1.2
1.9
0.9
0.7
1.1
1.5
1.1
1.0
Pooled:1.2
Source: NNMB2009
The median intake of Thiamine was 1.2mg, equal to RDA. It ranged
from 0.7mg in Andhra Pradesh to 1.9 mg in Gujarat.
Average Riboflavin (mg) consumption at household level (CU/day)
0.5
0.6
0.6
0.5
0.4
0.5
0.8
0.5
0.5
Pooled: 0.5
Source: NNMB2009
The median intake of riboflavin was 0.5, ranged from 0.4mg in Kerala to 0.8 in
the state of Gujarat.
4/28/2016
35
Average Niacin (mg) consumption at household level (CU/day)
10.9
11.9
14.3
13.9
11.3
16.0
14.8
17.1
25.4
Pooled: 14.6
Source: NNMB2009
The median intake of niacin for all the states pooled was 14.6mg which
forms 91.3% of RDA. The intake was ranged from 10.9mg in Madhya
Pradesh to 25.4mg in West Bengal.
Average Vitamin -C (mg) consumption at household level (CU/day)
26.1
16.0
42.1
45.1
30.6
34.0
33.4
93.6
52.1
Pooled: 43.8
Source: NNMB2009
The median intake of Vitamin –C was 43.8mg, ranged from 16mg in the state
of Maharashtra to 93.6mg in Odisha.
4/28/2016
36
Average Free folic acid (µg) consumption at household level (CU/day)
40
44
75
48
48
40
47
52
64
Pooled: 51
Source: NNMB2009
The median intake of free folic acid was 51µg, only half of the RDA of 100 µg and
is ranged from 40 µg in the state of Madhya Pradesh and Andhra Pradesh to 75
µg in Gujarat.
Average Total fat (g) consumption at household level (CU/day)
13.3
23.3
23.2
30.0
31.1
17.9
21.7
10.8
13.1
Pooled: 20.8
Source: NNMB2009
The intake of total fat was 20.8g , ranged from a low of 10.8g in Odisha to a high
of 31g in Gujarat.
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37
Per cent prevalence of clinical signs of total Vitamin –A deficiency
among preschool children
3.4
0.2
0.5
0.2 5.1
1.1
2.5
0.3
0.7
Pooled: 1.5
Source: NNMB2009
The prevalence of total clinical signs of Vitamin –A deficiency include Night
Blindness, Conjunctival Xerosis and Bitots Spot , for all the states pooled was
1.5%. and the highest prevalence found in the state of Madhya Pradesh followed
by Andhra Pradesh and Kerala.
Prevalence of goitre among adolescent boys (12-18years)
18.0
3.3
0.2 0.3
1.4
0.0
2.2
0.2
0.2
Pooled: 3.0
Source: NNMB2009
The prevalence of Goitre among adolescent boys was 3%, and it was highest in
the state of Andhra Pradesh followed by Maharashtra AND Tamil Nadu.
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38
Prevalence of goitre among adolescent girls (12-18years)
3.6
1.8
0.7 1.2
0.9
2.9
15.4
7.7
3.9
Pooled: 4.4
Source: NNMB2009
The prevalence of goitre among adolescent girls was 4.4% and found highest in
the state of Andhra Pradesh followed by Maharashtra, Karnataka and Tamil
Nadu.
Prevalence of goitre among adult men (>18years)
0.2
0.1
0.1
0.1
0.1 0.3
0.1
11.5
0.2
Pooled: 1.8
Source: NNMB2009
The prevalence of goitre among adult males was 1.8% and found highest
in the state of Andhra Pradesh.
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39
Prevalence of goitre among adult women (>18years)
Pooled: 3.9
10.2
6.0
0.4 1.8
2.2
2.3
3.3
2.3
4.5
The prevalence of Goitre among adult women was 3.9%, found highest in
the state of Andhra Pradesh followed by Maharashtra, Kerala and Karnataka.
Source: NNMB2009
Prevalence of underweight (<median-2SD) among Infants
Pooled:35.7
32.9
43.1
48.8
23.8
32.2
28.3
25.5
45.1
41.6
Source: NNMB2009
The prevalence of underweight among infants was 35.7%, which ranged
from a low of 23.8% in Karnataka and high of 45.1% in the state of
Odisha.
4/28/2016
40
Prevalence of underweight (<median-2SD) among preschool children (1-5Yrs)
52.4
63.7
46.9
42.6
50.7
57.7
52.3
47.2
43.6
Pooled: 51.9
The prevalence of underweight among preschool children was 51.9% for the
states pooled. The prevalence was highest in the state of Maharashtra
followed by Odisha, Madhya Pradesh and Andhra Pradesh.
Source: NNMB2009
Per cent prevalence of stunting (<median-2SD) among Infants
POOLED: 34.6
28.4
44.0
45.7
25.8
30.6
41.0
22.2
22.8
50.7
The prevalence of stunting, indicator of chronic under nutrition was 34.6%
among infants. The prevalence was reported to be highest in the state of
Kerala followed by Gujarat, Maharashtra and Odisha.
Source: NNMB2009
4/28/2016
41
Per cent prevalence of stunting (<median-2SD) among preschool children
63.6
60.7
53.8
39.4
52.1
.
53.746.1
64.6
45.9
POOLED:54.7
The prevalence of stunting among preschool children was 54.7% for the
states pooled ,found highest in the states of Odisha, Madhya Pradesh and
Maharashtra and lowest in the state of Karnataka.
Source: NNMB2009
Per cent prevalence of wasting (<median-2SD) among Infants
POOLED:24.1
36.0
20.6
32.2
14.2
22.7
23.1
22.2
15.5
32.4
The prevalence of wasting, indicator of current nutritional status was 24.1%.
The prevalence was highest in the state of Madhya Pradesh followed by West
Bengal and Gujarat.
Source: NNMB2009
4/28/2016
42
Per cent prevalence of wasting (<median-2SD) among preschool children
POOLED:21.9
21.0
29.3
19.2
21.7
23.8
19.0
15.4
19.9
27.2
Source: NNMB2009
The prevalence of wasting among preschool children was21.9% ranged from
a low of 15.4% in Kerala and a high of 29.3% in the state of Maharashtra.
Prevalence of hypertension (SBP>140, DBP>90) among adult men (>20yrs)
POOLED:25.2
20.7
27.7
9.9
28.4
17.0
53.7
29.9
17.8
44.8
The prevalence of hypertension among adult men was 25.2%, highest found
in the state of Odisha and Kerala and lowest Gujarat.
Source: NNMB2009
4/28/2016
43
Prevalence of hypertension (SBP>140, DBP>90) among adult women (>20yrs)
POOLED:23.1
23.9
19.3
6.3
25.5
20.8
48.8
30.1
18.4
35.8
The prevalence of hypertension among adult women was 23.1% with highest
prevalence in the state of Odisha and lowest in Gujarat.
Source: NNMB2009
Nutrition Status of 5-9 years Children based on BMI (SD Classification)
37
26.1
27.6
23.3
43.2
44.6
35
46.3
40.5
28
62.1
72.9
72.1
74.6
54.4
45.1
64.6
53.2
59
71.6
1
1
0.3
2
2.4
0.3
0.4
0.6
0.5
0.4
0 10 20 30 40 50 60 70 80
Pooled
West Bengal
Odisha
Madhya Pradesh
Gujarat
Maharasthra
Andhra Pradesh
Karnataka
Tamil Nadu
Kerala
Obese
Normal
Thiness
The prevalence of thinness among 5-9 years school aged children was 37%
and obesity was 1%. The prevalence of thinness was higher in the state of
Karnataka and lowest in Madhya Pradesh. The prevalence of obesity was high
in Gujarat.
Source: NNMB2009
4/28/2016
44
Nutrition Status of 10-13 years Children based on BMI (SD Classification)
42.2
21.4
28.5
39.8
42.3
59.9
35.4
59.3
52.8
36.4
56.5
76.3
70.9
59.3
54.5
39.9
63.6
40.4
46.5
62.6
1.3
2.3
0.6
0.8
3.2
0.2
1
0.2
0.7
1
0 10 20 30 40 50 60 70 80
Pooled
West Bengal
Odisha
Madhya Pradesh
Gujarat
Maharasthra
Andhra Pradesh
Karnataka
Tamil Nadu
Kerala
Obese
Normal
Thiness
The prevalence of thinness among 10-13 year children was 42.2% with highest
in the state of Maharashtra and Madhya Pradesh. Similarly, the prevalence of
obesity was high in Gujarat.
Source: NNMB2009
Nutrition Status of 14-17 years Children based on BMI ( SD Classification)
23.1
10.6
11
20.6
17.1
37.4
17.2
43.7
32.6
20.4
76.2
88.2
87.9
78.6
81.7
62.4
82.4
55.8
67.2
77.7
0.8
1.3
1.1
0.8
1.2
0.1
0.4
0.4
0.2
1.9
0 20 40 60 80 100
Pooled
West Bengal
Odisha
Madhya Pradesh
Gujarat
Maharasthra
Andhra Pradesh
Karnataka
Tamil Nadu
Kerala
Obese
Normal
Thiness
The prevalence of thinness was 23.1% among 14-17 year children, and the
prevalence was highest in Karnataka and lowest in West Bengal. Similarly
the prevalence of overweight and obesity was highest in Kerala and lowest
in Maharashtra.
Source: NNMB2009
4/28/2016
45
Distribution of Adult men (≥18 years) according to BMI (SD classification)(Asian cut-off)
40.2
43.4
38.6
38.8
31.3
52.6
38.4
44.8
39.3
33.9
52.8
51.6
58
57.7
54.7
42
55.1
47.2
50.9
57.4
7
5
3.4
3.5
14
5.4
6.5
8
9.8
8.7
0 10 20 30 40 50 60 70
Pooled
West Bengal
Odisha
Madhya Pradesh
Gujarat
Maharasthra
Andhra Pradesh
Karnataka
Tamil Nadu
Kerala
Obese Normal CED
The prevalence of Chronic Energy Deficiency (CED) among adult tribal men
was 40.2% and the prevalence was found highest in the state of Maharashtra
and lowest in Gujarat. Similarly, the prevalence of overweight and obesity was
highest in the state of Gujarat and lowest in Odisha.
Source: NNMB2009
Distribution of Adult Women (≥18 years) according to BMI classification(Asian cut-off)
49
55.6
52.3
45.9
36.6
62.5
48.9
50.4
44
44.2
43
39.6
44.1
49.3
49.9
32.7
44.1
39.6
45.9
43.5
8
4.8
3.6
4.8
13.5
4.8
7
10
10.1
12.3
0 20 40 60 80
Pooled
West Bengal
Odisha
Madhya Pradesh
Gujarat
Maharasthra
Andhra Pradesh
Karnataka
Tamil Nadu
Kerala
Obese Normal CED
The prevalence of CED among adult tribal women was 49% with highest in
the state of Maharashtra and lowest in Gujarat. The prevalence of
overweight and obesity was high in the state of Gujarat and lowest in
Odisha.
Source: NNMB2009
4/28/2016
46
Prevalence of Hypertension among Adult Men (>20Yrs)
25.2
29.9
53.7
20.7
9.9
27.7
17
28.4
17.8
44.8
42.5
45.2
30.8
40.4
60
45.2
37.7
43.2
37.2
36.7
32.3
24.9
15.5
38.9
30.1
27.1
45.3
28.4
45
18.5
0 20 40 60 80
Pooled
West Bengal
Odisha
Madhya Pradesh
Gujarat
Maharasthra
Andhra Pradesh
Karnataka
Tamil Nadu
Kerala
Normal
Pre-Hypertension
Hypertension
Among adult men the overall prevalence of hypertension was67.7% with
42.5% of stage1 hypertension and 25.2% of stage 2 hypertension.
Source: NNMB2009
Prevalence of Hypertension among adult Women (>20Yrs)
23.1
30.1
48.8
23.9
6.3
19.3
20.8
25.5
18.4
35.8
39
40.6
33.9
32.5
54.6
39.4
36
38.2
35.4
36
37.9
29.3
17.3
43.6
39.1
41.3
43.2
36.3
46.2
28.2
0 10 20 30 40 50 60
Pooled
West Bengal
Odisha
Madhya Pradesh
Gujarat
Maharasthra
Andhra Pradesh
Karnataka
Tamil Nadu
Kerala
Normal
Pre-Hypertension
Hypertension
Among adult women the overall prevalence of hypertension was 62.1% with
39% of stage1 hypertension and 23.1% of stage 2 hypertension.
Source: NNMB2009
4/28/2016
47
DIET AND NUTRITIONAL
STATUS OF
TRIBES OF SOUTHERN
REGION
Dhimsa dance by tribal women of Araku valley-visakhapatnam
Bhagata tribal women of Araku valley
4/28/2016
48
Chenchu mother and child- Andhra Pradesh
Chenchu collecting forest produce- honey, turtle
4/28/2016
49
Tribes of Yarkadu- Tamil Nadu
Tribal dance of Kadu-kuruba , Karnataka
Collection of honey comb by Jenu kuruba tribe, Karnataka
Collection of medicinal tuber in the forest by jenu kuruba tribes,
karnataka
4/28/2016
50
Average Food Intake (g/CU/day) of Household as % RDA amongChenchu – Andhra Pradesh
0 50 100
Sugar & Jaggery
Fats & oils
Milk & milk products
Roots& tubers
Other veg,
Green leafy veg.
pulses&legumes
Cereals& millets
13
89
14
66
77
5
71
96
28
71
18
80
64
19
73
98
AP tribes
Chenchu
Median Nutrient Intake of Households (per/CU/day) as % of RDA among Chenchu – Andhra Pradesh
0 50 100
Free folic acid
Vitamin C
Niacin
Riboflavin
Thiamin
Vitamin A
Iron
Calcium
Energy
Protein
20
92
71
50
75
30
58
37
84
10
20
85
71
43
58
33
56
52
86
81
AP tribes
Chenchu
Source: Mallikharjuna Rao K et.al., NIN Technical Report, 2013
Except the intake of cereals& millets, the intake of all other foods was lower
than the suggested levels. The intake of GLV, milk, sugar and jaggery was
grossly inadequate. The intake of all the nutrients especially Iron, Vit-
A, Riboflavin and Folic acid were grossly inadequate compared to RDA.
Prevalence (%) of under nutrition among Preschool Children according toSD Classification (<Median - 2SD) among Chenchu – Andhra Pradesh
0
10
20
30
40
50
60
70
Underweight Stunting Wasting
44.2
54.7
12.5
50.7 52.1
19.2
%Chenchu
NNMB
Except stunting, the prevalence of underweight and wasting was lower among
Chenchu tribal children compared to their tribal counterparts of Andhra Pradesh.
Prevalence (%) of under nutrition among <5 Yr Children according to SD Classification (<Median - 2SD) – By Gender among
Chenchu – Andhra Pradesh
0
10
20
30
40
50
60
70
Underweight Stunting Wasting
41
54.8
13.7
43.350.4
13.3
%Boys
Girls
Source: Mallikharjuna Rao K et.al., NIN Technical Report, 2013
The prevalence of stunting and wasting was marginally high among
boys of under 5 year age than girls.
4/28/2016
51
Distribution (%) of Adult Males according to BMI Classification among Chenchu – Andhra Pradesh
0
10
20
30
40
50
60
70
CED Normal Overweight
41.245.9
12.9
38.4
55.1
6.5
%Chenchu
NNMB(AP)
The prevalence of CED as well as overweight and obesity was high
among Chenchu men than their other tribal counterparts of AP.
Distribution (%) of Adult Females according to BMI Classification
among Chenchu – Andhra Pradesh
0
10
20
30
40
50
60
70
CED Normal Overweight
42.446
10.6
48.944.1
7
% Chenchu
NNMB(AP)
Source: Mallikharjuna Rao K et.al., NIN Technical Report, 2013
Among Chenchu women the prevalence of normal and overweight and
obesity was marginally higher compared to other tribes of AP.
Nutritional Status of adults by tribe and BMI levels in the state of Andhra Pradesh
0
6.6
0 0 0 0
10
20
50 1.5
20
10
26.630
0
6.1
30
80
46.6
65
100
92.3
50
0
20
40
60
80
100
120
Bhagata Konda Dora Konds Raj Konds Lambada Yerukula
16-1-17.0 17.1-18.5 18.6-20 21-25
Source: Varadarajan A, Stud Tribes Tribals, 7(2),137-141, 2009.
Nutritionally, Raj Gonds were better than other tribes. The prevalence of
CED was higher in Konda Dora and Yerukala tribe.
4/28/2016
52
Nutritional Status of Tribal Groups in ITDA Bhadrachalam KhammamDistrict – Telangana State
Fig Average Food intake (g/CU/day) of households as % RDA
16.7
70
20
72
83.3
10
85
104.3
27
70
18
80
63
20
72
98
0 20 40 60 80 100 120
Sugar & jaggery
Fats & Oils
Milk & Milk Products
Roots & Tubers
Other Vegetables
Leafy Vegetables
Pulses &Legumes
Cereals & Millets
NNMB (APTribal Survey
2009)PresentSurvey(2007)
Fig. Median nutrient intake of households (CU/day)as % RDA
39
66.5
72.5
35.7
50
12.5
34.3
65
86.8
81.7
40
85
71
43
58
33
34
78
82
81
0 20 40 60 80 100 120
Free Folic Acid
Vitamin C
Niacin
Riboflavin
Thiamin
Vitamin A
Iron
Calcium
Energy
Protein
NNMB (AP Tribal Survey 2009)
Present Survey (2007)
Source: J.Hum.Eco. 21(2), 79-86,2007
The tribe Konda Reddy is the main inhabitant in the ITDA area. The food and
nutrient intakes were lower than the recommended levels and more or less
comparable with the intakes of other tribal groups.(NNMB-AP)
Fig. Distribution (%) of Preschool children according to standard Deviation
(SD) Classification
50.7 52.1
19.2
65.4
46.4
21.3
0
10
20
30
40
50
60
70
Underweight Stunting Wasting
NNMB (AP Tribal Survey 2009)Present Survey (2007)
The prevalence of underweight was higher among the tribal preschool
children of ITDA, Bhadrachalam, while the prevalence of stunting was lower
compared to their other tribal counterparters.(NNMB-AP)
Fig. Distribution (%) of Adult Males according to BMI Classification
38.4
55.1
6.5
31
58.3
0.8
0
10
20
30
40
50
60
CED Normal Overweight
NNMB (AP Tribal Survey 2009)Present Survey (2007)
Source: J.Hum.Eco. 21(2), 79-86, 2007
4/28/2016
53
Fig Distribution (%) of Adult Females According to BMI Classification
48.9
44.1
7
58.5
40
1.4
0
10
20
30
40
50
60
CED Normal Overweight
NNMB (AP Tribal Survey 2009)
Present Survey (2007)
Source: J.Hum.Eco. 21(2), 79-86, 2007
The prevalence of CED was less among men while it was more among
women compared to other tribes of AP. The prevalence of overweight and
obesity was low compared to other tribes of AP (NNMB-AP)
Food intake of Tribal Children at Semmannathan village in