|
 
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| ORIGINAL ARTICLE |
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| Year : 2021 | Volume
: 8
| Issue : 2 | Page : 63-69 |
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Nutritional profile of Kolagur tribal women in Yercaud, Tamil Nadu, India: An exploratory study
R Durga Priyadarshini, D Annette Beatrice
Department of Home Science, Women's Christian College, Affiliated to the University of Madras, Chennai, Tamil Nadu, India
| Date of Submission | 09-Dec-2020 |
| Date of Decision | 27-May-2021 |
| Date of Acceptance | 08-Aug-2021 |
| Date of Web Publication | 30-Dec-2021 |
Correspondence Address:
Dr. D Annette Beatrice
Department of Home Science, Women's Christian College, Affiliated to the University of Madras, Chennai, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijamr.ijamr_274_20
Background: Malnutrition is a long-standing global health issue to which the tribal population are highly vulnerable. Timely diagnosis and appropriate treatment is crucial. Aim: The aim of the study is to assess the nutritional status of tribal women in Kolagur, Yercaud, using anthropometric, biochemical, clinical, and dietary assessment parameters. Subjects and Methods: An exploratory study was carried out among women (n = 100) between 18 and 60 years of age from Kolagur, a tribal village in Yercaud taluk, Salem district, Tamil Nadu, India. Information on sociodemographic profile of participants was collected using a structured interview schedule. Anthropometric, biochemical, clinical, and dietary parameters were assessed using appropriate standard techniques/tools. Nutrient intake was computed using Diet Cal software and the statistical analysis was done using IBM SPSS statistics software version 25. Results: Majority of the participants were malnourished of which 25% were underweight, 20% were obese, and 17% were overweight. The mean waist-to-hip ratio (mean ± standard deviation: 0.87 ± 0.13) was marginally higher than the normal cutoff value for women. The prevalence of anemia was much lower where only 21% had mild anemia, 5% had moderate anemia, and 1% had severe anemia. About 21% were prediabetic and 9% were diabetic. Majority (51%) of the participants had altered blood pressure levels with 20% in hypertension Stage 2, 19% in prehypertensive stage, and 12% in hypertension Stage 1. The mean intake of nutrients such as energy, thiamine, ascorbic acid, and folate was significantly higher than the recommended dietary allowances (RDA), whereas the mean intake of fat, retinol, riboflavin, pyridoxine, calcium, and iron was significantly lesser than the RDA. Conclusions: The findings of this study highlight the urgent need for well-planned nutrition-oriented health policies at the community level to eradicate the double burden of malnutrition. Keywords: Kolagur, malnutrition, nutritional status, tribal women
How to cite this article:
Priyadarshini R D, Beatrice D A. Nutritional profile of Kolagur tribal women in Yercaud, Tamil Nadu, India: An exploratory study. Int J Adv Med Health Res 2021;8:63-9 |
How to cite this URL:
Priyadarshini R D, Beatrice D A. Nutritional profile of Kolagur tribal women in Yercaud, Tamil Nadu, India: An exploratory study. Int J Adv Med Health Res [serial online] 2021 [cited 2023 Mar 25];8:63-9. Available from: https://www.ijamhrjournal.org/text.asp?2021/8/2/63/334371 |
| Introduction | |  |
The health status of women and children is the key for sustainable development of a nation as women are custodians of family health. Owing to various determinants such as biological and physiologic factors, poor economic status, cultural beliefs, and gender disparities, women tend to face more serious health issues than men.
Women, especially from the tribal population, are at double the risk for malnutrition as the indigenous population lag behind on several health indicators compared to general population.[1] Most of the tribal communities live in geographically isolated areas accounting for up to 8.6% (104,281,034 persons) of India's total population. As per the 4th National Family Health Survey's report (2015–2016), about 31.7% of the tribal population in India were thin/underweight, 10% were overweight/obese, and 59.9% of them were anemic.[2] This may be due to limited access or inadequate utilization of health-care services, distinct social-cultural values, inadequate dietary intake, and less awareness about the importance of health and nutrition. Timely diagnosis and treatment is highly crucial since it has a lasting impact on the health and development of upcoming generation. Further, a proper comprehension of tribal women's health status would help policymakers to develop appropriate health measures for implementation.
In Tamil Nadu, the tribal population accounts for up to 1.10% of the total population (7.2 lakhs) as per the Census of India (2011) and there are about 36 tribal groups of which 6 are primitive tribes.[3] Under the tribal subplan, villages with more than 50% of the tribal population are declared as Integrated Tribal Development Programme (ITDP) villages and there are about 287 ITDP villages located in seven districts of Tamil Nadu, namely Salem, Namakkal, Villupuram, Tiruvannamalai, Tiruchirappalli, Dharmapuri, and Vellore.[4] ITDP primarily focuses on poverty eradication, education, and protection of the livelihood of tribal families. With few published studies on the health status of tribal women from the ITDP coverage areas in Tamil Nadu, there are numerous ITDP villages where women's health status remains unexplored.[5],[6],[7],[8],[9],[10],[11] Hence, the present study was undertaken to assess the nutritional status of women residing at Kolagur, an ITDP tribal village at Yercaud taluk, Salem district, Tamil Nadu.
| Subjects and Methods | | |
Study design and sample selection
The present study is exploratory in nature. The place of study was Kolagur which is a secluded tribal village in Yercaud taluk of Salem district, Tamil Nadu, India. It is one of the 67 tribal villages of Yercaud taluk that is under the ITDP of Tamil Nadu. The area of Kolagur village spans about 290.85 hectares at an altitude of approximately 800 m above sea level which is much lower than the altitude of Yercaud hills (1515 m above sea level) as it is situated in a valley. The total population size of Kolagur village is 1371 with 676 males and 695 females according to Census of India (2011).[12] Villagers are either primarily employed as daily wage workers at construction and plantation sites or self-employed as agriculturists or small business owners.
After obtaining prior permission from the local tribal authority, all women belonging to the age group of 18–60 years were invited and oriented about the study's purpose and implications. Based on their willingness to participate, they were enrolled for the study and written informed consent was obtained. A hundred and two women agreed to participate in the study. However, two women were pregnant and were excluded from the study. The study protocol was approved by the Independent Institutional Ethics Committee.
General information
A structured interview schedule was prepared and tested for its validity. The interview schedule was translated to the participants' regional language “Tamil” and was used to collect the sociodemographic details of the participants such as age, educational qualification, occupation, and family income.
Anthropometric assessment
Anthropometric measurements such as height, body weight, body mass index (BMI), minimum waist circumference (MWC) maximum hip circumference (MHC), and body fat were measured using standard methods.[13] Waist hip ratio (WHR) was calculated. The height (cm) of the participants was measured to the value nearest to 0.1 cm using a stadiometer. Participants were asked to stand straight with barefoot on the sensor plate of Omron HBF-375 Karada Scan body composition monitor and the values of body weight (kg), BMI (kg/m2), and body fat (%) displayed on the monitor's digital screen were recorded.
The participants were classified as underweight (<18.5 kg/m2), normal (18.5–22.9 kg/m2), overweight (23–24.9 kg/m2), and obese (>25 kg/m2) based on BMI cutoff values recommended by the World Health Organization (WHO) for Asian population. The normal cutoff for body fat percentage for women is <35%.[14]
MWC and MHC were measured to the nearest 0.1 cm by using nonstretchable measuring tape. The participants were asked to stand erect with feet together and abdomen relaxed. The measuring tape was placed evenly around the body in the midway of the iliac crest and lower most margin of the ribcage to measure the MWC. The measuring tape was extended down to the buttock's maximum level of extension and the MHC was measured. The MWC and MHC measurements were used to calculate the WHR. WHR of 0.85 was considered to be ideal for women as suggested by the WHO (2008).[15]
Biochemical assessment
Blood samples were collected from the antecubital fossa vein of the participants after an overnight fast to determine the blood hemoglobin and fasting blood glucose. All the biochemical analyses were performed by the internationally recognized and accredited Lister Metropolis Laboratory, Salem, Tamil Nadu.
According to the WHO (2011), blood hemoglobin level between 11.0 and 12 g/dL was considered as normal, 9.0–10.9 g/dL as mild anemia, 7.0–8.9 g/dL as moderate anemia, and hemoglobin <7.0 g/dL as severe anemia.[16] With reference to fasting blood glucose, a level of <100 mg/dL is considered normal, a level between 100 and 125 mg/dL is defined as impaired fasting glucose, and a level of ≥126 mg/dL is defined as diabetes mellitus according to the American Diabetes Association, 2017.[17]
Clinical assessment
Clinical parameters such as blood pressure levels were measured using a sphygmomanometer and the pulse rate was recorded using Omron HEM-7120 blood pressure monitoring device. The cuff was placed on the nondominant hand and the participant was asked to be seated with their arm resting on the table at heart level. Measurements of both blood pressure and pulse rate were taken twice and the average value was recorded for further analysis.
According to the American Heart Association's Hypertension Guidelines 2017, systolic blood pressure of <120 mmHg and diastolic blood pressure of <80 mmHg are considered to be normal. Systolic blood pressure between 120 and 129 mmHg and diastolic blood pressure <80 mmHg are considered prehypertension. When the systolic blood pressure and diastolic blood pressure ranges between 130–139 mmHg and 80–90 mmHg, respectively, it is considered as hypertension Stage 1 and blood pressure level of ≥140/≥90 mmHg is considered to be hypertension Stage 2.[18]
Dietary assessment
Nutrient intake was determined by the information collected using a 24-h dietary recall for 3 non-consecutive days which covered 3 nonconsecutive days consisting of two weekdays and one weekend. Standard measuring cups and spoons were used as a reference for the participants to measure their food intake. The participants were asked to recall in detail about what they ate the previous day and the information was recorded accurately. The nutrient intake was computed using a validated software called “Diet Cal.”[19]
Nutrition education program
Nutrition education program was planned and conducted with the aim to create awareness about the importance of consuming nutritious foods and its benefit on health. Participants were also given individual diet counseling after data collection. Visual aids such as charts with pictorial representation of a healthy food plate and food pyramid were used to deliver the message effectively.
Statistical analysis
Percentage distribution was used for sociodemographic characteristics and biochemical and clinical parameters of the participants. Mean and standard deviation were computed for the anthropometric measurements. Average nutrient intake computed using “Diet Cal” software was compared with RDA using Student's t-test.[20] P < 0.05 was considered to be statistically significant. Percentage difference was calculated to assess the level of adequacy/inadequacy of nutrient intake as compared to RDA. Data analysis was carried out using IBM SPSS statistics, version 25 (IBM Corpp., Armonk, NY, USA).
| Results | | |
Sociodemographic profile
[Table 1] presents the sociodemographic profile of Kolagur tribal women. Women were categorized into two age groups since they reflect the number of people undergoing similar biological, psychological, and social development. Of the 100 participants, majority (58%) belonged to early adulthood (18–40 years) and 42% belonged to middle adulthood (40–60 years).
With regard to their educational qualification, 99% of the participants were literate with their education levels ranging from primary school to postgraduation. About 36% of the participants were daily wage workers involved in construction work, plantation, and woodcutters. Thirty percent were homemakers, 25% worked as agriculturists who grow millets, paddy, and coffee plantations, and 9% were small business owners as cooks and tailors.
Results of the family income of participants showed that 77% fell under low-income category (Rs. 1000–5000), 17% fell under the middle income category (Rs. 5000–10,000), and 6% of families fell under high-income category (Rs. 10,000 and above). Participants who belonged to high-income category were small business owners and those who belonged to middle- and low-income category were predominantly agriculturalists and daily wage workers.
Nutritional status
[Table 2] presents the mean value of anthropometric measurements and percentage distribution of biochemical and clinical parameters. [Figure 1] displays the percentage distribution of the participants according to their BMI status. [Table 3] presents the mean nutrient intake of the participants compared to the RDA, its level of significance, and also the percentage differences between mean nutrient intake and RDA that are presented as a percentage of adequacy/inadequacy. | Figure 1: Percentage distribution of Kolagur tribal women according to body mass index
Click here to view |
Anthropometric measurements
The mean height and mean body weight of the participants were 152.40 ± 5.84 cm and 50.15 ± 10.20 kg, respectively [Table 2]. Therefore, the mean BMI was 21.64 ± 4.52 kg/m2. Percentage distribution of participants according to their BMI revealed that about 38% were within normal BMI, 25% were underweight, 20% were obese, and 17% were overweight [Figure 1].
The mean MWC and MHC were 76.36 ± 12.44 cm and 88.56 ± 13.02 cm, respectively. Therefore, the mean WHR was 0.87 ± 0.13 which is marginally higher than the normal cutoff value for women. The mean body fat percentage (30.41% ±7.16%) of the participants was within the normal range.
Biochemical parameters
With regard to anemic status, about 73% of the participants were found to have normal blood hemoglobin levels, 21% were mildly anemic, 5% moderately anemic, and 1% severely anemic [Table 2].
Majority (70%) of the participants had fasting blood glucose levels within normal limits; 21% had impaired fasting blood glucose thereby indicating prediabetes, and 9% were diabetic.
Clinical parameters
From [Table 2], it can be inferred that 49% of the participants were found to have normal blood pressure levels, 20% were in hypertension Stage 2, 19% of them in prehypertensive stage, and 12% in the Stage 1 of hypertension. The mean pulse rate (86.14 ± 13.20 beats/min) was found to be within the normal range.
Nutrient intake
Macronutrients
The mean nutrient intake of the participants compared to the RDA for moderate workers is given in [Table 3]. The mean energy intake (2401.58 ± 624.96 Kcal/day) of the participants was found to be significantly higher than the RDA. The mean carbohydrate intake was 492.77 ± 135.71 gm/day and the mean dietary fiber intake was 44.60 ± 37.38 gm/day. The mean protein intake (57.12 ± 17.09 gm/day) was higher than the RDA but not statistically significant. The mean fat intake (14.42 ± 11.91 gm/day) was found to be significantly lesser than the RDA.
Micronutrients
The mean intake of vitamins such as thiamine (1.39 ± 0.45 mg/day), ascorbic acid (54.27 ± 83.03 mg/day), and folate (255.67 ± 225.38 μg/day) was found to be significantly higher than the RDA. However, the mean intake of beta carotene (41.52 ± 217.08 μg/day), riboflavin (0.59 ± 0.30 mg/day), and pyridoxine (1.71 ± 0.53 mg/day) was found to be much lower than the RDA. With regard to the mean intake of minerals, calcium (403.94 ± 620.02 mg/day) and iron (10.92 ± 7.05 mg/day) intake was significantly lower than the RDA. There was an insignificant increase in the magnesium intake (338.49 ± 189.15 mg/day) and decrease in the zinc intake (9.60 ± 8.29 mg/day) when compared to RDA.
Nutrition education program
Majority of the participants were physically active as 97% of them walked up the hill regularly due to the unavailability of transport facilities. On an average, they walked 3 km per day and those women who were employed had to walk more based on their worksite location. Only 3% of the participants used cycles as a mode of transportation. Hence, the focus of the nutrition education program and diet counseling session was targeted on their dietary practices with visual aids. Participants were encouraged to switch back to their indigenous and nutritious staple crop “millets.” Since consumption of a balanced diet will help to maintain good health, combat macronutrient deficiencies, and aid in the betterment of overall metabolism, emphasis was given to regular consumption of locally available fruits and vegetables as they are budget-friendly nutrient-rich foods that provide a wide variety of nutrients especially dietary fiber.
| Discussion | | |
Results of the present study indicate that majority of the women were malnourished with 25% being underweight, 20% obese, and 17% overweight, thereby indicating a double burden of malnutrition. This finding is much higher than the results reported in a study by Ghosh (2016) where the prevalence of undernutrition was 19.49% and overweight was 4.23% among Santal-Mundal tribal women.[21] Similarly, Sinha et al. reported that about 17.75% of the Bastar tribal women were underweight and 6.50% of them were overweight.[22] This emerging trend of overweight/obesity besides underweight confirms double burden of malnutrition and could potentially be attributed to demographic factors, socioeconomic status, cultural influences, and transition in diet pattern from indigenous foods to the food available from the public distribution system (PDS).
The overall prevalence of anemia among Kolagur tribal women (26%) was much lesser compared to other studies which had reported a higher prevalence of anemia among tribal women ranging between 60.9% and 89%.[23],[24],[25] Despite being a major public health issue, the lower prevalence of anemia among our study participants might be due to the consumption of locally available green leafy vegetables (commonly called semanji and kamanji keerai), beans, meat, and pork that are rich sources of iron.
With India deemed to be the diabetes capital of the world, the results of the present study were positively contradicting where majority (70%) of the tribal women were found to have optimal levels of fasting blood glucose. However, 21% were prediabetic and 9% were diabetic, suggesting the need for an early intervention to prevent progression from prediabetes to diabetes mellitus. In spite of the increased consumption of carbohydrates (rice) in their habitual diet which could increase fasting blood glucose levels, the participants were found to expend a good amount of physical activity as part of their day-to-day chores moving up and downhill which might be helping them to balance their energy intake and expenditure at optimal range.
About 51% of the study participants were found to have abnormal blood pressure levels with 20% in hypertension Stage 2, 19% in pre-hypertensive stage, and 12% in Stage 1 of hypertension. Our results are in line with other studies that have also reported a higher prevalence of hypertension among the tribal population.[26],[27] This could be attributed to the intake of animal foods such as meat and pork which are high in saturated fat. Further, the geographical location of Kolagur village may also contribute to the elevated blood pressure levels as a systematic review of research studies also warranted a significant correlation between altitude and hypertension.[28]
With respect to nutrient intake, the mean energy and protein intake of the participants were higher than the RDA and this can be attributed to increased consumption of cereals, majorly rice, which was consumed three times in a day. Most of the families utilize essential commodities such as rice and wheat procured free of cost and dhal, sugar, oil, and kerosene at subsidized prices from the PDS. This might also be the reason for the increased consumption of cereals. Further, pulses and legumes commonly grown in the valleys such as bean varieties and nonvegetarian foods such as meat/pork were also predominantly consumed by the participants, thereby contributing to their increased protein intake.
The mean fat intake of the participants was found to be much lower than the RDA. This can be due to their habitual preference of eating boiled foods frequently and consuming fried food rarely; hence, this healthy way of cooking might be the reason for reduced fat in their diet. With respect to micronutrients intake, nutrients such as thiamine, folate, and magnesium were found to be adequate as they consumed rice and beans predominantly. On the contrary, our study participants consumed a lesser quantity of milk, milk products, fruits, vegetables, and nuts, and hence, the intake of micronutrients such as calcium, zinc, and beta-carotene was much lesser. This can be due to their socioeconomic status and lack of or reduced awareness about the importance of consuming balanced meals with locally available foods. A similar finding has been reported by other studies indicating the increased prevalence of hidden hunger, i.e., reduced micronutrient intake among the tribal population in India.[29],[30]
The limitation of the study would be that the parents of few young unmarried women did not allow them to participate in this research due to the fear of marriage proposal rejection (claiming the woman is diseased/unhealthy if she goes for a health checkup). This stigma needs to be addressed by educating people about the importance of periodical health checkups, especially for women of childbearing age and their children.
| Conclusions | | |
Nutrition plays a critical role in the effective management of health as inadequate intake of essential nutrients leads to poor health outcomes. The nutritional status of tribal women from Kolagur was found to be quite alarming with respect to double burden of malnutrition and the increased prevalence of hypertension and prediabetes. Periodical nutrition counseling followed by health checkups can help to monitor the nutritional status of the tribal people and track the effectiveness of the nutrition education program. The government of India has taken several measures to eradicate poverty-induced malnutrition, of which one was by issuing food at subsidized price targeting the economically vulnerable through PDS where commodities such as staple grains (wheat, rice), sugar, and essential fuels are made available. Although this has created food security for the residents of the village, the availability of the same has also lead to nutrition transition from their indigenous staple crop “millets” to rice/wheat. Hence, addressing this burden of malnutrition with appropriate health policies and plans at the community level is the need of the hour.
Acknowledgment
We would like to thank the Centre for Research on New International Economic Order for helping us collaborate with Kolagur village residents. We are grateful to Women's Christian College, Chennai, for the constant support and encouragement.
Financial support and sponsorship
This study was funded by the United Board for Christian Higher Education in Asia.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1]
[Table 1], [Table 2], [Table 3]
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