|Year : 2021 | Volume
| Issue : 3 | Page : 132-136
Perception of noncommunicable diseases among the tribals of the Gudalur Valley, Nilgiris, Tamil Nadu
Royson Jerome Dsouza1, Roshina Sunny1, Pooja B Sambhalwar2, Saranya Hariharan2, Smitha Mohanraj1, Nandakumar Menon1
1 ASHWINI-Gudalur Adivasi Hospital, The Nilgiris, Tamil Nadu, India
2 Tata Institute of Social Sciences, Mumbai, Maharashtra, India
|Date of Submission||16-Feb-2021|
|Date of Decision||24-Mar-2021|
|Date of Acceptance||12-Apr-2021|
|Date of Web Publication||05-Jul-2021|
Dr. Royson Jerome Dsouza
ASHWINI-Gudalur Adivasi Hospital, Kotharvayal, Gudalur, The Nilgiris - 643 212, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Introduction: Noncommunicable diseases (NCDs) pose a significant burden on global health with the increasing prevalence in rural and tribal communities. Although several studies show an alarming trend in adverse outcomes in Indian tribes, there have been only a few reports assessing their perception of NCDs. This study was conducted to address this gap to design better health strategies to reduce the burden of NCDs among the tribal communities. Methodology: This was a hospital-based cross-sectional descriptive study done in Gudalur Adivasi Hospital in The Nilgiris district, Tamil Nadu. The study participants included the five tribal communities belonging to the Particularly Vulnerable Group (formerly Primitive Tribal Group) living in the Gudalur and Pandalur Taluks. After approval from the Ethics committee of the Association for Health Welfare in the Nilgiris (ASHWINI), the data were collected using a predesigned, semi-structured, interviewer-administered questionnaire. The results were entered into an Excel sheet and exported to SPSS software (version 19) for the analysis. Results: The interviewed tribals belonged to the Paniya tribe (54%), Bettakurumba tribe (25%), Moolakurumba tribe (7%), Kattunayakan tribe (6%), and Irula tribe (8%) of whom 43% were illiterate. Seventy-eight percent of the tribals were aware of the presence of NCDs in their community. The most common source of information is ASHWINI and the other health care facilities. The association of unhealthy diet and family history with NCDs was reported by 72% and 25% of the interviewed tribals, respectively. However, the other risk factors like lack of physical activity (7%), old age (2%), and environmental factors (3%) were poorly understood. Similarly, the association between alcohol, tobacco, and NCDs was acknowledged by only 10% and 4% of the interviewed tribals. The importance of screening was understood by 72% of the interviewed tribals. Conclusion: This study showed that there is a severe lack of awareness of NCDs among the tribal population of the Gudalur and Pandalur taluks of the Nilgiris district in Tamil Nadu. The importance of health promotion in reducing the burden of NCDs is well recognized. There is an urgent need for implementing adequate strategies to correct the knowledge, attitude, and practices of the tribal communities towards NCDs.
Keywords: Noncommunicable diseases in rural areas, perception of noncommunicable diseases, tribal health
|How to cite this article:|
Dsouza RJ, Sunny R, Sambhalwar PB, Hariharan S, Mohanraj S, Menon N. Perception of noncommunicable diseases among the tribals of the Gudalur Valley, Nilgiris, Tamil Nadu. Curr Med Issues 2021;19:132-6
|How to cite this URL:|
Dsouza RJ, Sunny R, Sambhalwar PB, Hariharan S, Mohanraj S, Menon N. Perception of noncommunicable diseases among the tribals of the Gudalur Valley, Nilgiris, Tamil Nadu. Curr Med Issues [serial online] 2021 [cited 2021 Dec 4];19:132-6. Available from: https://www.cmijournal.org/text.asp?2021/19/3/132/320642
| Introduction|| |
Noncommunicable diseases (NCDs) are a major health burden globally, especially so in resource-poor tribal communities in India.,, Cardiovascular disease, cancer, diabetes, and chronic lung disease are among the major NCDs. It has been shown that NCDs are the major cause of death in rural India. The tribal communities in India are the most disadvantaged with regard to their health indicators as well as their socio-economic determinants of health with the highest Infant mortality rate, under-five mortality rate, anemia, and under-nutrition compared to the rest of the Indian population., The recent National Family Health Survey-4 (NFHS-4) report also suggests a rising burden of hypertension and diabetes among the scheduled tribes of India as compared to the general population. The World Health Organization report (2010) suggests that extreme poverty could inflict behavioral risk factors that lead to NCDs which in turn further affects the economies of the affected families and communities.
To address the burden of NCDs the communities need to have the necessary knowledge, attitude, and practices about NCDs. Although there are several reports on the adverse effects of NCDs on the health status of the tribes of India, there is a paucity of literature regarding the tribal perceptions about NCDs. The Gudalur and Pandalur taluks of Nilgiris, Tamil Nadu is home to 20,000 individuals belonging to five main tribal communities (Adivasi) namely Paniya, Bettakurumba, Mullakurumba, Katunayakan, and Irula. These five Adivasi groups are among the 75 Particularly Vulnerable Tribal Groups identified by the Government of India. They are very marginalized and resource-poor communities living in remote villages and in mountainous terrains. This study looked at the perception of NCDs among these Adivasi who visited the Gudalur Adivasi Hospital (GAH) for their healthcare needs. GAH is a 50-bed secondary care hospital that is run by Association for Health Welfare in the Nilgiris (ASHWINI) a registered charitable Society. These Adivasis are still largely illiterate with poor health status. Understanding their perception of NCDs would help us design appropriate interventions that could result in a significant overall improvement in their health.
| Methodology|| |
The study population included the tribal communities living in the Gudalur and Pandalur block of Tamil Nadu. ASHWINI is a not-for-profit organization that has been working for the past 30 years, to improve the health determinants of this population. A total of 200 tribal health volunteers from the first tier, 17 tribal health animators (public health nurses) in the health centers across eight geographical areas who form the second tier, and a 50-bed secondary care hospital- GAH, which forms the third tier of the health system [Figure 1].
|Figure 1: Health care system managed by Association of Health Welfare in the Nilgiris.|
Click here to view
Study period and participants
This hospital-based cross-sectional descriptive study was done in GAH. The data collection was done in September and October 2019. All consenting tribal patients and their bystanders, 20 years of age and above, were included through consecutive sampling. Severely ill patients were excluded from the study.
Approval was obtained from the accredited Institutional Review Body of ASHWINI (IRB No. 20191009-03).
Two Master of Public Health Trainees visited the outpatient waiting area and wards and gathered the data using a pre-designed, semi-structured, interviewer-administered questionnaire. Information was collected about the sociodemography of participants, knowledge regarding NCDs, risk factors, and attitude and practice towards screening. The diseases covered were Diabetes, Hypertension, cancers, Cardiovascular Diseases, and Chronic Respiratory Diseases. Consent was taken before interviewing the study participants. An average of 10 min was spent on each person for obtaining information and confidentiality was maintained during the interviews. The data collected were entered into an Excel sheet and exported to the Statistical Package for Social Sciences for Windows (SPSS Inc. Released 20017, version 23.0. Armonk, New York, USA) for the analysis. All the variables were summarized as proportion and expressed as a percentage.
| Results|| |
The study included 102 participants who belonged to one of the five tribes of the Nilgiris in Tamil Nadu. The Paniyas (54%), Bettakurumbas (25%), Moolakurumbas (7%), Kattunayakans (6%), and Irulas (8%). Of these, 43% were illiterate and the rest had some form of education [Table 1]. The interviewed tribal population was assessed for their knowledge and source of information on NCD's. The source of information was primarily from ASHWINI or other health care facilities (67%) [Table 2]. The majority (78%) were aware of all the common NCD's prevalent in their community [Table 3].
Further questions were based on their knowledge of the etiology and risk factors for NCD's and 34% of the interviewed tribals felt that NCDs were preventable [Table 4]. While the majority (72%) pointed out unhealthy diet as one of the risk factors for NCD's, only a small proportion felt family history (25%), lack of physical activity (7%), older age (2%), and environmental factors (3%) as the other risk factors. Alcohol and tobacco were identified as the risk factors only by 10% and 4% of the population, respectively. Similarly, 41% felt NCDs were transmitted from person to person. The importance of screening in diagnosing NCD's was stated by 72% of the interviewed tribals.
The adherence to the screening of NCDs was assessed. Of the interviewed tribals, 93% had their blood pressures checked at least on one occasion and 74% had their sugars checked. However, the attendees of screening camps organized by the health care facilities were only 33% [Table 5].
| Discussion|| |
The study shows that there is a severe lack of awareness of NCDs among the tribal population of the Gudalur and Pandalur taluks of the Nilgiris district in Tamil Nadu. Although historically, infectious diseases and trauma were presumed to be predominant health ailments among the tribals, NCDs are making their mark in recent times.,,,, While multiple studies have shown the increase in NCDs in rural India, the burden is still greatly underestimated, especially among the marginalized tribal communities.[,,, Studies conducted among the tribes of Jharkhand, Madhya Pradesh, Assam, Tripura, and Kerala have all demonstrated the rising prevalence of NCDs among them.,,,,,
The effect of unhealthy dietary habits in causing NCDs was acknowledged by 72% of the interviewed tribals in the study. The traditional practice of acquiring food from the forests either by hunting, honey gathering, etc., came to a standstill with the implementation of the forests' rights act in the Nilgiris. Consequently, the dietary habits changed which led to a surge in protein-energy malnutrition possibly contributing to NCDs.,, While communicable diseases like tuberculosis still pose a major burden on tribal health, 34% in our study assumed that NCDs were transmissible. Similarly, there was a gross misconception of other risk factors such as lack of physical activity, old age, and environmental conditions leading to NCDs.
The detrimental effects of alcohol and tobacco on NCDs are well understood and concluded by various meta-analyses.,, Studies of knowledge, attitude, and practices toward risk factors for NCDs among rural women and tribals in India showed there was low awareness with regard to tobacco as a risk factor., Similarly, only 10% and 4% of the interviewed tribals agreed to alcohol and tobacco being risk factors for NCDs. This resonates with the finding that the prevalence of alcohol use is higher in the tribal population and is a major area of concern.,,, Similarly, tobacco chewing is widely practiced among the tribals who continue to deny its ill-effects as shown in our study. NFHS-4 report states that almost 72% of the tribal men in the 15–54 years age group are using tobacco and 50% consume alcohol. Srivastava et al. found a significant association between tobacco chewing and precancerous oral lesions in the Paniya tribe of Kerala. The strategies to minimize substance abuse seems to be failing in the tribal communities necessitating more stringent actions to be employed.
The importance of health promotion strategies to prevent NCDs cannot be overemphasized., With limited access to mass media, televisions, and social media, the health care facilities remain the paramount source of information regarding NCDs for the majority of the tribal population as shown in our study. The three-tier health care model of ASHWINI makes it possible to promote health education in a door-to-door fashion with the help of dedicated health animators and volunteers [Figure 1]. Despite these measures, the knowledge and awareness of health practices seem to be grossly lacking. Education plays a major role in creating awareness and thereby resulting in the right attitude and practices about health. Nearly half the interviewed tribals were illiterate and this is reflected in their lack of knowledge of NCDs.
Screening for NCDs plays a major role in early detection and reducing the burden and has been the strategy of the Government of India through several vertical programs since the 1980s. However, there has not been any significant change in the burden of NCDs since the implementation of these programs. This reflects the lack of emphasis laid on health promotion and screening programs. The scenario is much worse among the tribal population., Dedicated NGOs are striving hard to implement screening programs for diabetes and hypertension. About 74% and 93% of the interviewed population in our study had undergone screening for diabetes and hypertension, respectively. However, the screening camp-based approaches proposed by the government has not been successful as only 33% of the interviewed tribals in our study reported to have attended them. Public awareness programs, integrated management, and strong monitoring systems would be desirable for the successful implementation of these programs.,,,,
Our study had certain limitations. The interviews were conducted on attendees at the tribal health care facility based on consecutive sampling. Moreover, the sample size was small. Although all efforts were taken to include participants from all tribes and areas, it may not have been representative of the entire population. Other factors like comprehension of the questions asked and recall bias could have influenced the results. Despite these limitations, this study is the first of its kind to evaluate the tribal populations' perception of NCDs. This can help in better planning of the health promotion strategies which can be generalized to the majority of the tribal communities across the country.
| Conclusion|| |
Our study showed that there is a severe lack of awareness of NCDs among the tribal population of the Gudalur and Pandalur taluks of the Nilgiris district in Tamil Nadu. Health promotion is a crucial strategy in reducing the burden of NCDs. With a developing burden on NCDs in rural and tribal areas, there is a need for more qualitative research in the community to understand their perspective and plan strategies to prevent NCDs.
The authors would like to thank the health animators and the community health team of ASHWINI GAH l.
Research quality and ethics statement
The authors of this manuscript declare that this scientific work complies with reporting quality, formatting and reproducibility guidelines set forth by the EQUATOR Network. The authors also attest that this clinical investigation was determined to require Institutional Review Board/Ethics Committee review, and the corresponding protocol/approval number is 20191009-03. We also certify that we have not plagiarized the contents in this submission and have done a plagiarism check
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Jain Y, Kataria R, Patil S, Kadam S, Kataria A, Jain R, et al
. Burden and pattern of illnesses among the tribal communities in central India: A report from a community health programme. Indian J Med Res 2015;141:663-72.
] [Full text]
Upadhyay RP, Misra P, Chellaiyan VG, Das TK, Adhikary M, Chinnakali P, et al
. Burden of diabetes mellitus and prediabetes in tribal population of India: A systematic review. Diabetes Res Clin Pract 2013;102:1-7.
Srivastava RK, Bachani D. Burden of NCDs, policies and programme for prevention and control of NCDs in India. Indian J Community Med 2011;36:S7-12.
Kinra S, Bowen LJ, Lyngdoh T, Prabhakaran D, Reddy KS, Ramakrishnan L, et al.
Sociodemographic patterning of non-communicable disease risk factors in rural India: A cross sectional study. BMJ 2010;341:c4974.
Misra PJ, Mini GK, Thankappan KR. Risk factor profile for non-communicable diseases among Mishing tribes in Assam, India: Results from a WHO STEPs survey. Indian J Med Res 2014;140:370-8.
] [Full text]
International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-4), 2015-16: India. Mumbai: IIPS; 2017. Available from: http://rchiips.org/nfhs/NFHS-4Reports/India.pdf
. [Last accessed on 2020 Nov 14].
Rizwan SA, Kumar R, Singh AK, Kusuma YS, Yadav K, Pandav CS. Prevalence of hypertension in Indian tribes: A systematic review and meta-analysis of observational studies. PLoS One 2014;9:e95896.
Sajeev P, Soman B. Prevalence of noncommunicable disease risk factors among the Kani tribe in Thiruvananthapuram district, Kerala. Indian Heart J 2018;70:598-603.
Sathiyanarayanan S, Muthunarayanan L, Devaparthasarathy TA. Changing perspectives in tribal health: Rising prevalence of lifestyle diseases among tribal population in India. Indian J Community Med 2019;44:342-6.
] [Full text]
Arokiasamy P. India's escalating burden of non-communicable diseases. Lancet Glob Health 2018;6:e1262-3.
Nethan S, Sinha D, Mehrotra R. Non communicable disease risk factors and their trends in India. Asian Pac J Cancer Prev 2017;18:2005-10.
Swaminathan K, Veerasekar G, Kuppusamy S, Sundaresan M, Velmurugan G, Palaniswami NG. Noncommunicable disease in rural India: Are we seriously underestimating the risk? The Nallampatti noncommunicable disease study. Indian J Endocrinol Metab 2017;21:90-5.
Srivastav S, Mahajan H, Goel S, Mukherjee S. Prevalence of risk factors of noncommunicable diseases in a rural population of district Gautam-Budh Nagar, Uttar Pradesh using the World Health Organization STEPS. J Family Med Prim Care 2017;6:491-7.
] [Full text]
Kumar A. A study of non-communicable disease risk factors among the tribal population of Lefunga block, Tripura: A cross sectional study. Int J Community Med Public Health 2018;5:4478-84.
Ekoé JM, Shipp J. Malnutrition-related diabetes mellitus: Myth or reality? In: The Epidemiology of Diabetes Mellitus. Vol. 18. Chichester, UK: John Wiley and Sons; 2001. p. 261-72.
al-Amin AN, Ahrén B. Relation between malnutrition and development of diabetes mellitus. Int J Pancreatol 1999;26:125-30.
Donaldson MS. Nutrition and cancer: A review of the evidence for an anti-cancer diet. Nutr J 2004;3:19.
Bhargava A, Chatterjee M, Jain Y, Chatterjee B, Kataria A, Bhargava M, et al.
Nutritional status of adult patients with pulmonary tuberculosis in rural central India and its association with mortality. PLoS One 2013;8:e77979.
Thakur JS, Garg R, Narain JP, Menabde N. Tobacco use: A major risk factor for non communicable diseases in South-East Asia region. Indian J Public Health 2011;55:155-60.
] [Full text]
Parry CD, Patra J, Rehm J. Alcohol consumption and non-communicable diseases: Epidemiology and policy implications. Addiction 2011;106:1718-24.
Mujezinović A, Čalkić L, Hasanica N, Tandir S. Tobacco and alcohol usage as risk factors of non-communicable diseases among students of Zenica University (Bosnia and Herzegovina). Med Glas (Zenica) 2018;15:81-6.
Mahajan M, Naik N, Jain K, Patira N, Prasad S, Mogri S, et al.
Study of Knowledge, Attitudes, and Practices Toward Risk Factors and Early Detection of Noncommunicable Diseases Among Rural Women in India. J Glob Oncol. 2019;5:1-10. doi:10.1200/JGO.18.00181.
Narain JP. Health of tribal populations in India: How long can we afford to neglect? Indian J Med Res 2019;149:313-6.
] [Full text]
Mohindra KS, Narayana D, Anushreedha SS, Haddad S. Alcohol use and its consequences in South India: Views from a marginalised tribal population. Drug Alcohol Depend 2011;117:70-3.
Subramanian SV, Davey Smith G, Subramanyam M. Indigenous health and socioeconomic status in India. PLoS Med. 2006;3:e421. doi:10.1371/journal.pmed.0030421.
Sreeraj VS, Prasad S, Khess CR, Uvais NA. Reasons for substance use: A comparative study of alcohol use in Tribals and non-tribals. Indian J Psychol Med 2012;34:242-6.
] [Full text]
Shrivastava S, Shrivastava P, Ramasamy J. Implementation of public health practices in tribal populations of India: Challenges and remedies. Healthc Low Resour Settings 2013;1:3.
Rahman R. Role of Health Promotion Strategies on Lifestyle and Behavioral Changes to Reduce the Number of Non-communicable Disease Patient: An Opinion. J Healthc Commun 2018;3:7. doi: 10.4172/2472-1654.100118.
Basu SK. A health profile of tribal India. Health Millions 1994;2:12-4.
Rahman SA, Kielmann T, McPake B, Normand C. Healthcare-seeking behaviour among the tribal people of Bangladesh: Can the current health system really meet their needs? J Health Popul Nutr 2012;30:353-65.
Gafoor K, Madhu K. Perception of tribes regarding the educational problems in Wayanad district. J Stud Teach Educ 2008;1:22-31.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]