High Prevalence of Undernutrition Among Adult Kora Mudi Tribals Of

ANTHROPOLOGICAL SCIENCE Vol. 000, 000–000, 2005

High prevalence of undernutrition among adult Kora Mudi tribals of Bankura District, West Bengal, India KAUSHIK BOSE1*, SANJIB GANGULY1, HASINA MAMTAZ1, ASHISH MUKHOPADHYAY1, MITHU BHADRA1

1Department of Anthropology, Vidyasagar University, Midnapore-721 102, West Bengal, India

Received 6 March 2005; accepted 27 May 2005

Abstract A cross-sectional study was undertaken to determine the anthropometric profile and nutritional status of adult Kora Mudis, a tribal population of Bankura District, West Bengal, India, based on their body mass index (BMI). A total of 500 adult (18.0 < age ≤ 65.0 years) Kora Mudis from two villages (Phulberia and Siromonipur, approximately 160 km from Kolkata) were studied. Anthropo- metric measurements, including height, weight, circumferences, and skinfolds, were measured using standard protocols. BMI was calculated and utilized as a measure of nutritional status. The extent of undernutrition (BMI < 18.5) was found to be very high (52.2%). The frequency of undernutrition was higher in women (56.4%) than men (48.0%), although this difference was not statistically significant. Using the World Health Organization criterion, the prevalence of undernutrition is classified as ‘very high’. In order to fully understand the causes and consequences of adult undernutrition, further research is needed not only among this ethnic group but also on the other tribal populations of India.

Key words: India, tribal population, Kora Mudis, body mass index, undernutrition

Introduction gupta, 2002; Sahani, 2003; Dash Sharma, 2004; Gusain, 2004; Bose and Chakraborty, 2005). In view of this, the The tribes of India comprise about 8% of the total popula- objective of the present study was to report the anthropomet- tion of the country, probably the largest tribal community ric characteristics and determine the nutritional status, based population in the world (Topal and Samal, 2001). The Koras, on their BMI, of adult Kora Mudis. whose mother tongue is Kora, an Austro-Asiatic language, are tribal inhabitants of three eastern provinces of India: Materials and Methods West Bengal, Orissa, and Bihar. The majority of the Koras in West Bengal are found in the districts of Bardhaman, Prior permission and ethical approval was obtained from Puruliya, Medinipur, Birbhum, Bankura, and Hugli. Kora local community leaders as well as relevant authorities seems to be a generic name signifying the occupation of before commencement of the study. Information on ethni- earth digging. They have four endogamous groups: Mudi city, age, occupation, and educational status were obtained Kora, Kurmi Kora, Nagbanshi Kora, and Dhangar or Orang from all subjects with the help of a questionnaire. The data Kora (Mandal et al., 2002). Information on Kora Mudis is were collected from two villages, Phulberia and extremely scanty and there is no published data dealing with Siromonipur, in Bankura District of West Bengal. These vil- their anthropometric characteristics. lages (Figure 1) are located approximately 20 km from Although adult nutritional status can be evaluated in many Bankura town (the district capital of Bankura District) and ways (Lohman et al., 1988; Lee and Nieman, 2003), the 160 km from Kolkata (the state capital of West Bengal). The body mass index (BMI) is most widely used because its residents of all houses in the two villages were contacted and investigation is inexpensive, non-invasive, and suitable for a total of 500 adults (250 men and 250 women; large-scale surveys (James et al., 1988; WHO, 1995; Ulijas- 18.0 < age ≤ 65.0 years) were included in the study. The zek and Kerr, 1999; Bose and Chakraborty, 2005; Khongs- response rates were 72% and 86%, for men and women, dier, 2005). Thus, BMI is the most established respectively. The vast majority of the subjects were illiterate anthropometric indicator used for assessment of adult nutri- and very low-wage earning manual laborers, of low socio- tional status (Moy and Atiya, 2003). In general, data are economic status. scarce on the nutritional status of the various tribal popula- All anthropometric measurements were made by trained tions of India (Tanuja et al., 1995; Yadav et al., 1999; Yadu investigators using the standard techniques of Lohman et al. et al., 2000; Khongsdier, 2001, 2002, 2005; Gogoi and Sen- (1988). Height, weight, circumferences, and skinfolds were recorded to the nearest 0.1 cm, 0.5 kg, and 0.1 mm, respec- * Corresponding author. e-mail: [email protected] tively. Circumferences and skinfolds were measured using phone: +91-33-2591-2019; fax: +91-3222-275329 measuring tape and Harpenden skinfold callipers, respec- Published online 13 September 2005 tively. Technical errors of measurements (TEM) were com- in J-STAGE (www.jstage.jst.go.jp) DOI: 10.1537/ase.050306 puted and were found to be within acceptable limits

both sexes was not significantly different from normal according to Cox’s skewness test. Thus t-tests were per- formed to test for sex differences as well as differences in mean BMI with other ethnic groups. The chi-square test (Fischer’s exact test) was utilized to compute sex differences in nutritional status. All statistical analyses were undertaken using the Statistical Package for Social Science (SPSS) pro- gram.

Results and Discussion The mean ages of both sexes (men: 32.7 years, SD = 11.3; women: 31.7, SD = 10.6) were similar. The median of height, weight, BMI, and other anthropometric variables of the Kora Mudis are presented in Table 1. The mean BMI of the Kora Mudis was very low (combined-sex mean BMI = 18.5), with women having a significantly (t = 2.08, P < 0.05) lower mean than men (18.3 vs 18.7, respectively). A noteworthy point is that the mean BMI of adult Kora Mudi women was below the WHO (1995) cut-off point (BMI < 18.5) for undernutrition. The mean BMI of the Kora Mudis was significantly lower than those of the other tribal populations of India, as reported in several recent studies (Awaradi, 1992; Khongsdier, 2001, 2002, 2005; Gogoi and Sengupta, 2002; Sahani, 2003), but slightly higher than those reported among the Bathudi tribe of Orissa, India (mean BMI of men = 18.4; mean BMI of women = 17.9) (Bose and Chakraborty, 2005). Compared to other native populations world wide, adult Kora Mudis had a significantly lower mean BMI. For example, Kirchengast (1998) reported that among !Kung San of Namibia, the mean BMIs for men and women were 19.4 and 19.1, respectively. Figure 2 summarizes the nutritional status of the present subjects based on BMI. Overall (i.e. the sexes combined), undernutrition (n = 261, 52.2%) was found at a high frequency. There was no significant difference in the frequency Figure 1. Map indicating the location of the study area (not to of undernutrition between men (48.0%) and women scale). Filled circle: location of the villages (Phulberia and Siromonipur) where the study was conducted. Table 1. Median anthropometric characteristics of adult Kora Mudis of Phulberia and Siromonipur villages, Bankura District, West Bengal, (Ulijaszek and Kerr, 1999). Body mass index (BMI) was India computed using the following standard equation: n = n = BMI = weight (kg)/height (m2). Variable Men ( 250) Women ( 250) Nutritional status was evaluated using internationally Height (cm) 159.1 147.5 accepted World Health Organization (WHO, 1995) BMI Weight (kg) 46.8 39.5 Sitting height (cm) 78.1 72.4 guidelines. The following cut-off points were used: under- 2 a < ≤ < Body mass index (kg/m ) 18.6 18.2 nutrition, BMI 18.5; normal, 18.5 BMI 25.0; over- Circumferences (cm) weight, BMI ≥ 25.0. Head 53.1 51.4 We followed the World Health Organization’s (WHO, Chest 80.5 74.4 1995) classification of the public health problem of low Minimum waist 67.9 62.2 BMI, based on adult populations world wide. This classifi- Maximum hip 80.1 77.6 cation categorizes prevalence according to percentage of a Mid upper arm 22.3 21.6 < Calf 28.8 26.4 population with BMI 18.5. Thigh 38.5 36.1 1) Low (5–9%): warning sign, monitoring required. Skinfolds (mm) 2) Medium (10–19%): poor situation. Biceps 2.9 3.7 3) High (20–39%): serious situation. Triceps 4.4 7.2 4) Very high (≥ 40%): critical situation. Subscapular 6.5 8.2 Medians of all anthropometric variables and BMI were Suprailiac 5.6 6.9 computed for each sex separately. The distribution of BMI in a Mean BMI: men = 18.7; women = 18.3. Vol. 113, 2005 UNDERNUTRITION AMONG ADULT KORA MUDIS 3

References Awaradi S.A. (1992) Anthropometric re-study of the Onge of Lit- tle Andamans. The Journal of the Indian Anthropological Survey of India, Special Issue, Volume 41, p. 54. Bose K. and Chakraborty F. (2005) Anthropometric characteristics and nutritional status based on body mass index of adult Bathudis: a tribal population of Keonjhar District, Orissa, India. Asia Pacific Journal of Clinical Nutrition, 14: 80–82. Campbell P. and Ulijaszek S.J. (1994) Relationship between anthropometry and retrospective morbidity in poor men in Calcutta, India. European Journal of Clinical Nutrition, 48: 507–512. Dash Sharma P. (2004) Nutrition and health among the tribes of India. In: Kalla A.K. and Joshi P.C. (eds.), Tribal Health and Medicines. Concept Publishing Company, New Delhi, pp. 71–98. Ferro-Luzzi A., Sette S., Franklin M., and James W.P.T. (1992) A simplified approach of assessing adult chronic deficiency. European Journal of Clinical Nutrition, 46: 173–186. Figure 2. Nutritional status of adult Kora Mudis (based on WHO Gogoi G. and Sengupta S. (2002) Body mass index among the categories of body mass index). Prevalence of overweight is negligible Dibongiya Deoris of Assam, India. Journal of Human Ecol- = = in both the sexes (male 0.4% and female 0.4%). ogy, 13: 271–273. Ghosh A., Bose K., and Das Chaudhuri A.B. (2001) Age and sex variations in adiposity and central fat distribution among eld- (56.4%). The frequency of undernutrition among Kora erly Bengalee Hindus of Calcutta, India. Annals of Human Mudis was much higher than those recently reported in the Biology, 28: 616–623. other tribal populations of India (Awaradi, 1992; Yadav et Ghosh A., Bose K, Chakravarti S., Das Chaudhur A.B., Chatto- padhyay J., Dasgupta G., and Sengupta S. (2004) Adiposity al., 1999; Yadu et al., 2000; Khongsdier, 2001, 2002, 2005; measures and their relationship with metabolic risk factors for Gogoi and Sengupta, 2002; Sahani, 2003). Using the World coronary heart disease in Bengalee Hindu men of Kolkata, Health Organization criterion (WHO, 1995), the prevalence India. Anthropological Science, 112: 115–119. of undernutrition of Kora Mudis is classified as ‘very high’. Griffiths P.L. and Bentley M.E. (2001) The nutrition transition is Only among the Bathudi tribal populations of Orissa (Bose underway in India. Journal of Nutrition, 131: 2692–2700. and Chakraborty, 2005) was the frequency of undernutrition Gusain S.S. (2004) Anthropometric measurement to monitor growth of tribal school going children. In: Kalla A.K. and higher (combined-sex 57.9%; men 52.7%; women 64.5%). Joshi P.C. (eds.), Tribal Health and Medicines. Concept Pub- From the public health point of view, immediate nutri- lishing Company, New Delhi, pp. 99–103. tional intervention programs need to be implemented for this James W.P.T., Ferro-Luzzi A., and Waterlow J.C. (1988) Defini- ethnic group. The mean BMI of the adult Kora Mudis was tion of chronic energy deficiency in adults. Report of a work- significantly lower than BMIs reported among various non- ing party of the International Dietary Energy Consultative tribal ethnic groups of India (Ghosh et al., 2001, 2004; Grif- Group. European Journal of Clinical Nutrition, 42: 969–981. James W.P.T., Mascie-Taylor C.G.N., Norgan N.G., Bristrian B.R., fiths and Bentley, 2001; Mahajan and Bermingham, 2004; Shetty P., and Ferro-Luzzi A. (1994) The value of arm cir- Yadav et al., 2004). The economic and health burden of high cumference measurements in assessing chronic energy defi- frequencies of adult undernutrition have been well docu- ciency in Third World adults. European Journal of Clinical mented (Ferro-Luzzi et al., 1992; Campbell and Ulijaszek, Nutrition, 48: 883–894. 1994; James et al., 1994; Naidu and Rao, 1994; Khongsdier, Khongsdier R. (2001) Body mass index of adult males in 12 popu- 2005). Endeavors should be made to study the consequences lations of Northeast India. Annals of Human Biology, 28: of the functional impairments commonly associated with 374–383. Khongsdier R. (2002) Body mass index and morbidity in adult low BMI in this ethnic group, and furthermore to ascertain males of the War Khasi in Northeast India. European Journal relationship of the high rate of undernutrition with morbidity of Clinical Nutrition, 56: 484–489. and mortality. Similar studies should also be undertaken Khongsdier R. (2005) BMI and morbidity in relation to body com- with the other tribal populations in India, since they consti- position: a cross-sectional study of a rural community in tute a sizeable portion of India’s entire population. More- North-East India. British Journal of Nutrition, 93: 101–107. over, since undernutrition has several underlying causes Kirchengast S. (1998) Weight status of adult !Kung San and Kavango people from northern Namibia. Annals of Human (WHO, 1995; Lee and Nieman, 2003), future investigations Biology, 25: 541–556. should aim at identifying the likely cause(s) of high rates of Lee R.D. and Nieman D.C. (2003). Nutritional Assessment. undernutrition among the Indian tribal populations. McGraw Hill, New York. Lohman T.G., Roche A.F., and Martorell R. (1988) Anthropomet- ric Standardization Reference Manual. Human Kinetics Acknowledgments Books, Chicago. Mahajan D. and Bermingham M.A. (2004) Risk factors for coro- The authors would like to thank all individuals who par- nary heart disease in two similar Indian population groups, ticipated in the study. one residing in India, and the other in Sydney, Australia. European Journal of Clinical Nutrition, 58: 751–760. Mandal H., Mukherjee S., and Datta A. (2002) India—An Illus- 4 K BOSE ET AL. ANTHROPOLOGICAL SCIENCE

trated Atlas of Tribal World. Anthropological Survey of India, Ulijaszek S.J. and Kerr D.A. (1999) Anthropometric measurement Kolkata. error and the assessment of nutritional status. British Journal Moy F.M. and Atiya A.S. (2003) Waist circumference as a screen- of Nutrition, 82: 165–177. ing tool for weight management: evaluation using receiver World Health Organization (WHO) (1995) Physical status: the use operating characteristic curves for Malay students. Asia and interpretation of anthropometry. World Health Organiza- Pacific Journal of Public Health, 15: 99–104. tion Technical Report Series, No. 854, World Health Organi- Naidu A.N. and Rao N.P. (1994) Body mass index: a measure of zation, Geneva. the nutritional status in Indian populations. European Journal Yadav R.J., Singh P., and Kumar A. (1999) Nutritional status of of Clinical Nutrition, 48 (Supplement 3): S131–S140. tribals and non-tribals in Bihar. Indian Journal of Preventive Sahani R. (2003) Nutritional and health status of the Jarawas: a and Social Medicine, 30: 101–106. preliminary report. Journal of Anthropological Survey of Yadav N., Roy S., Bose K., Mukhopadhyay A., and Bhadra M. India, 52: 47–65. (2004) Obesity among Punjabis of Kharagpur town: sex dif- Tanuja D., Karmakar V., Sampathkumar S., Jeyalakshmi S., and ferences. Indian Journal of Biological Science, 9: 66–75. Abel R. (1995) Nutritional status of tribal women in Bihar. Yadu P., Reddy B., and Rao Papa A. (2000) Body mass index Man in India, 75: 209–214. (BMI) among the Sugalis – a tribal population of Cuddapah Topal Y.S. and Samal P.K. (2001) Causes for variation in social District, Andhra Pradesh. Journal of Human Ecology, 11: and economic conditions among tribes of Indian Central 409–410. Himalaya: a comparative study. Man in India, 81: 87–88.