Tribal Nutrition

4/28/2016

ICMR Tribal Health Research Forum meeting

Domain: Tribal Nutrition

11th April 2016

National Institute of Nutrition (ICMR) Jamai-Osmania, Hyderabad

9 NNMB States Each State

ITDA-120 Vill./State 90 old 30 new 40 HHs/villages

Area 1 Area 2 Area 3 Area 4 Area 5

HHs SE & Fasting Glucose Demography

Nutrition K & P of Adults (H & Assessment N) 24 hour dietary recall H/o Chronic morbidity H/o of current morbidity Dry blood spots (DBS) BP measurements

1 4/28/2016

Prevalence (%) of underweight ( Weight for Age,

60 Karnataka Kerala T.N A.P M.P W.B Maharashtra Orissa Gujarat

50 48.8

45.1 43.1 41.6 40

32.2 32.9

28.3 30 23.8 25.5

0 Underweight

Prevalence (%) of underweight ( Weight for Age, India 2008-09

60 Karnataka Kerala T.N A.P M.P W.B

50 48.8

45.1 43.1 41.6 40

32.2 32.9

28.3 30 25.5 23.8

0 Underweight

2 4/28/2016

PREVALENCE (%) OF UNDERNUTRITION (< Median – 2SD) AMONG TRIBAL PRESCHOOL CHILDREN AND PERIOD OF SURVEY

P <

0.001 P < 0.001

t Percen

Using WHO child growth standards

CONSEQUENCES OF UNDERNUTRITION

Source: WHO 2002; Lancet-2003

3 4/28/2016

Fragile Home Food Security / Seasonal Food Paucity Lack of Storage/Savings for Lean Months/Lack of capacity for bulk purchase

Spending time outside home

Farming/ca Bread ttle Gender Inadequ Delayed Clothes preferenc ate BF winning Less rearing/po e and compli Household Time ultry domestic mentar Saving violence y Goods Poor for Inadequate Use of & feedingReduc addition care of Child Househol No Educ Mother Care special Inappropri ed Alcohol al d Work ation and preparat ate infant food money ion of and child during Feedin sickne Sicknes food feedingLow Market g ss Milk Cal/ low beliefs cultural foods s Care Little - Family Dilutio nutrient n

Support density Socio

MOTHERS SEEKS SOLUTIONS FOR TIME Delayed CONSTRAINT / non- Delay in care Recognit Tasty/Accep Universal table Reach seeking ion of under Marketin Non nutrition recognition Inadequate by g of of Nutritional “Ready MARKET ENTRUST nutritional Education family to Eat FOODS status Food” CARE TO Inadequate DISPLACE/REPL responsiveness of Colorful & ELDER Affordable ACE HOME Variety health system and FOODS SIBLING ICDS

Problem in Low Poor Supplement birth Referral ary Nutrition weight UNDERNUTRITION CONTINUES 7

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

4 4/28/2016

Age adjusted States-wise prevalence of hypertension among tribal men and women of ≥20 years age from 9 states in India

60 Men Women 54.4 50 50 45

40 36.7 34.5 32.6 29.8 30 28.6 29.1 27.1 26.3 26.4 23.7 24.4 22.8 21.6 19.4 20.1 20

11.5 10 7

CURRENT NUTRITION INTERVENTION PROJECTS OF NIN, HYDERABAD

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

5 4/28/2016

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

District level Mapping and determinants of undernutrition in various states

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

6 4/28/2016

Map Showing Cluster of Districts according to Prevalence of Underweight (based on weight for age) Low

Moder ate

High

7 4/28/2016

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.

8 4/28/2016

Source: Census of India.

Percent Tribal population in the State to the total population of the State

11.9

5.7

0.0 INDIA: 8.6

2.9 68.8 0.0 13.5 33.8 12.4 2 86.5 0.6 86.1 1.3 35.1 14.8 21.1 5.8 26.2 94.4 30.6 43 31.8

9.4 22.8

Andaman & 7.0 7.5 7.0 Nicobar Island

1.1

1.5 0.0

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.

9 4/28/2016

Sex Ratio among Scheduled Tribes

924

999 INDIA:990

963 1032

948 960 985

976 952 1013 958 1002 981 3 984 9999 1007 1003 1020 983

9771 0.9 1029

990 937 Andaman & 993 Nicobar Island

981

1035

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

INDIA:75

9 1 5 7 3

3 13

Andaman & 2 5 12 Nicobar Island

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.

10 4/28/2016

Number of Integrated Tribal Development Agencies by State

INDIA:190 5

5 4 19

1 5 9 31 12 14 19

16 21

5 1 Andaman & 8 Nicobar Island

Source: Statistical profile of Scheduled tribes in India. Ministry of Tribal Affairs, GOI.2010

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.

State wise Estimates of Under 5 mortality among Scheduled tribes in India

122

93 INDIA:123

100 66

151 91 84

103 126 119 112 89 85 169 107 112 79 143 99

93 122

Andaman & 93 142 97 Nicobar Island

Source: Census of India, 2001

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.

11 4/28/2016

State wise estimates of Infant Mortality among Scheduled tribes of India

66 INDIA:84

71 104

100 65 61

72 85 82 77 64 61 110 75 77 57 95 70

66 92

Andaman & 66 95 68 Nicobar Island

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

INDIA: 212

172

359 153 318 390

359 261 148 269 145 8 261 269

104 258

Andaman & 178 134 Nicobar Island

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.

12 4/28/2016

Average consumption of Cereals & millets at Household level (g/CU/day)

POOLED:419

378 426 456 610

400 451 1

394

397

330

Source: NNMB 2009

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.

Average consumption of Pulses & legumes (g/CU/DAY)

POOLED:30

54 27 10 48 20

39 19

Source: NNMB2009

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.

13 4/28/2016

Average consumption of Green Leafy Vegetables (g/CU/day)

POOLED:22

8 17 78

13 13

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)

POOLED:41

65 30 44 23 46

36 45

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.

14 4/28/2016

Average consumption of Roots & tubers (g/CU/day)

POOLED:46

35 74 44 86

40 30

27 73

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)

POOLED:22

8 11 11

17 9

46 30

36 29

Source: NNMB2009

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.

15 4/28/2016

Average consumption of Fish & Other flesh foods (g/CU/day)

POOLED:13

10 2 19

1 34

Source: NNMB2009

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.

Average consumption of milk& milk products (g/CU/day)

POOLED:21

63 7 2

1 16

27 42

15 12

Source: NNMB2009 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.

16 4/28/2016

Average consumption of Fats& Oils (g/CU/day)

POOLED:10

14 7 8

6 15

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)

POOLED: 9

8 5 4

3 20

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.

17 4/28/2016

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 the effectiveness of intense versus usual IEC interventions on diet and lifestyle modifications delivered by existing community-level health-workers (ASHA or equivalent) on population level blood pressure.

DIVISION OF NUTRITION CENTRE FOR PROMOTION OF NUTRITION RESEARCH & TRAINING…(ICMR)

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)

18 4/28/2016

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)

Prehypertension Hypertension

44.8% 42.5% 39.8% 38.0%

33.0%

25.9% 24.4% 23.1% 21.9% 19.9%

Dhar Junagadh Puducherry Chamba Total Reference: JNC VII [Hypertension =140/90 mmHg, Pre-hypertension= 120-139/80-89 mmHg

19 4/28/2016

PREVALENCE OF HYPERTENSION & PRE HYPERTENSION (PHASE II)

Prehypertension Hypertension

42% 39%

35% 34% 34% 31% 29%

21% 19% 19%

13% 12%

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) Pre-diabetes Diabetes

30.3% 28.6%

24.1% 22.0%

13.5% 13.1% 11.7% 9.7% 8.6%

3.6%

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)

20 4/28/2016

IMPROVING HEALTH AND NUTRITIONAL STATUS OF SAHARIYA TRIBAL POPULATION OF RAJASTHAN BY INTERSECTORAL CONVERGENCE AS A SUSTAINABLE MODEL OF INTERVENTION

STATUS: Baseline has been completed. Intervention to be initiated

PARTNERS: 1. Desert Medicine Research Centre (ICMR), Jodhpur 1. Government of Rajasthan

Achievements in Reproductive and Child Health Division of RCH, ICMR

21 4/28/2016

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 package and determine its utilization for improving the maternal and child health care services.

Design: Case control study in Dindori District of MP among Baiga tribe including 500 women in 24 villages Utilization Interve Contr Improv Phase I: IEC of MCH ntion ol ement developed and care Village Villag Z=X-Y imparted through services (X) e (Y) public health Antenatal 85.2% 69.8% 15.4% system care T.T. 90.7% 88.5% 2.2% vaccinati Phase II: Impact on evaluation survey IFA 91.6% 86.4% 5.2% is ongoing Consump tion Hospital 41.7% 17.4% 24.3% delivery

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

22 4/28/2016

Indigenous knowledge of health care practices during pregnancy, childbirth and postnatal period among the Karbi tribe of North East India Objectives: • 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, reproductive morbidity, immunization, dependency on healers, scope of western medical accessibilities, utilization of local medicinal resources etc. • Genealogy: To trace out the mother-child health disorder in family

• Interview of allopathic practitioners both public and private, 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.

23 4/28/2016

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 on breast feeding practices, nutrient rich foods, micronutrients, sanitary practices, childhood illnesses, immunization and health services specially focussing on malnutrition related experience, meaning and behaviour of mothers and family members. • To identify community members, mothers and family members understanding on perceived barriers to access and utilization of health services related to nutrition. • To identify and propose local control strategies for intervention to mitigate malnourishment amongst tribal children.

24 4/28/2016

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 Koli constituting 90.03% of the total ST population

Progress: FGD 6 KII 14 Mothers of undernourished children 65 Mothers of normal children 71 Family members of undernourished children 71 Family 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 and clustering by socioeconomic risk factors among various primitive tribes in Odisha • To study community level factors influencing infant and child mortality • To study the relative role individual mothers competence/genetic frailty versus environmental/community factors influence on child death clustering • To assess a comparative pictures of extent of clustering among various Primitive Tribal Groups

Study population: Four major primitive tribal groups(Bondo, Joangs, Dongria khond and Paudi Bhuyian)

25 4/28/2016

Study site and study population:

• Four major primitive tribal groups(Bondo, Joangs, Dongria khond and 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 child feeding practices in the tribal blocks of Dahod district

• 2. To synthesize evidence based and contextually relevant health promotion intervention through community mobilzation, capacity building and facilitation of existing government services with special emphasize on anganwadi centers and ICDS

Target Population: tribal women of childbearing age (15 to 49 yrs) mainly pregnant women and mothers having children lees than 9 months of age.

Study area: tribal dominated blocks of dahod, Jhalod and Limkheda. The indigenous tribal community is bhil.

Status : Ongoing since January 2015

26 4/28/2016

or Empowerment 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 sustaining positive health seeking behavior in the community • To enhance the level of awareness, change in attitude, beliefs & practices/behavior on issues related to child health among community/ mothers of under-5 children through diverse ‘Change Agents’ • To assess the impact of the above interventions in the community 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.of women 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

27 4/28/2016

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 6 months 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 recognized and classified and find out factors involved in selection of different treatment options • To know the management of malaria among children <5 years of age in the tribal community • Intervention to modify the behavior for minimizing time laps between onset of disease and diagnosis and complete treatment at health facility, vector breeding source reduction and personal protection

Study site and population: 3 districts with high tribal population( Banswara 72.3%, Dungarpur 65.1% and Udaipur 47.9%)

Expected outcome: Findings may be useful for tribal malaria control programme.

28 4/28/2016

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 on IMNCI algorithm (eDSS-IMNCI)\ • Design and development of electronic clinical decision support system in a local dialect following iterative design process in consultation with IMNCI experts, state and regional health administration and end-users • Implementing the prototype in study block and testing its efficacy in terms of usability, utilization, adherence, cost and child health outcomes

Target population: children born during the enrollment phase in the tribal villages of Jetpur-Pavi taluka of Vadodara district(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, Kattankulathur 2. PSG Institute of medical Sciences and Research, Coimbatore 3. 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.

29 4/28/2016

Thank You

30 4/28/2016

AVERAGE DAILY HOUSEHOLD INTAKE OF FOOD STUFFS AS % OF RDA

Cereals 91

Pulses 75

GLVeg 56

Other Veg 69

Roots & Tubers 92

Milk & MP 14

Fats & Oils 50

Sugar & Jaggery 30

0 50 100 150 Per cent 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.

AVERAGE DAILY HOUSEHOLD INTAKE OF NUTRIENTS AS % OF RDA

Protein 78

Energy 77

Calcium 79

Iron 44

Vitamin A 46

Thiamin 100

Riboflavin 36

Niacin 91

Vitamin C 110

Free F.Acid 51

0 50 Per cent RDA 100 150

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.

31 4/28/2016

Median Energy (Kcal) consumption at household level (CU/day)

Pooled:1857

2034 1550 2416

1840 1840

2002

1802

1743

1702

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)

Pooled: 46.9

67.5 42.7 52.5

42.5

48.9

48.5

40.9

39.6

40.5

Source: NNMB2009

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

32 4/28/2016

Average Iron (mg) consumption at household level (CU/day)

Pooled:12.2

17.5 11.8 13.6

11.8 14.3

9.6

10.0

11.5

10.0

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)

Pooled: 277

180 187 500

777 133

198

268

133 196

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.

33 4/28/2016

Average Thiamine (mg) consumption at household level (CU/day)

Pooled:1.2

1.1 1.9 1.5

1.1 1.2

0.7

0.9

1.1 1.0

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)

Pooled: 0.5

0.5 0.8 0.5

0.5 0.6

0.6

0.5

0.5 0.4

Source: NNMB2009

The median intake of riboflavin was 0.5, ranged from 0.4mg in Kerala to 0.8 in the state of Gujarat.

34 4/28/2016

Average Niacin (mg) consumption at household level (CU/day)

Pooled: 14.6

10.9 14.3 25.4

17.1

11.9

11.3

13.9

16.0

14.8

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)

Pooled: 43.8

42.1 26.1 52.1

93.6 16.0

34.0

30.6

33.4 45.1

Source: NNMB2009 The median intake of Vitamin –C was 43.8mg, ranged from 16mg in the state of Maharashtra to 93.6mg in Odisha.

35 4/28/2016

Average Free folic acid (µg) consumption at household level (CU/day)

Pooled: 51

75 40 64

52 44

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)

Pooled: 20.8

31.1 13.3 13.1

10.8 23.3

21.7

23.2

17.9

30.0

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.

36 4/28/2016

Per cent prevalence of clinical signs of total Vitamin –A deficiency among preschool children

Pooled: 1.5

0.2 5.1 0.7

0.3

0.5

3.4

0.2

1.1 2.5

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)

Pooled: 3.0

0.2 0.3 0.2

0.2 3.3

18.0

1.4

2.2 0.0

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.

37 4/28/2016

Prevalence of goitre among adolescent girls (12-18years)

Pooled: 4.4

0.7 1.2 2.9

0.9 7.7

15.4

3.6

3.9 1.8

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)

Pooled: 1.8

0.1 0.3 0.2

0.1 0.1

11.5

0.1

0.2 0.1

Source: NNMB2009

The prevalence of goitre among adult males was 1.8% and found highest in the state of Andhra Pradesh.

38 4/28/2016

Prevalence of goitre among adult women (>18years)

Pooled: 3.9

0.4 1.8 2.3

2.2

6.0

10.2

3.3

2.3 4.5

Source: NNMB2009

The prevalence of Goitre among adult women was 3.9%, found highest in the state of Andhra Pradesh followed by Maharashtra, Kerala and Karnataka.

Prevalence of underweight (

Pooled:35.7

48.8 32.9 41.6

45.1 43.1

32.2 23.8

28.3 25.5

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.

39 4/28/2016

Prevalence of underweight (

Pooled: 51.9

46.9 52.4 52.3

57.7 63.7

50.7

42.6

47.2 43.6

Source: NNMB2009

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.

Per cent prevalence of stunting (

POOLED: 34.6

45.7 28.4 22.2

41.0 44.0

30.6

25.8

22.8 50.7

Source: NNMB2009

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.

40 4/28/2016

Per cent prevalence of stunting (

POOLED:54.7

53.8 63.6 45.9

64.6 60.7

52.1

39.4 .

46.1 53.7

Source: NNMB2009

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.

Per cent prevalence of wasting (

POOLED:24.1

32.2 36.0 32.4

23.1 20.6

22.7 14.2

22.2 15.5

Source: NNMB2009

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.

41 4/28/2016

Per cent prevalence of wasting (

POOLED:21.9

21.0 23.8 27.2

19.9 29.3

19.2 21.7

19.0 15.4

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

9.9 20.7 29.9

53.7 27.7

17.0 28.4

17.8 44.8

Source: NNMB2009

The prevalence of hypertension among adult men was 25.2%, highest found in the state of Odisha and Kerala and lowest Gujarat.

42 4/28/2016

Prevalence of hypertension (SBP>140, DBP>90) among adult women (>20yrs)

POOLED:23.1

6.3 23.9 30.1

48.8 19.3

20.8 25.5

18.4 35.8

Source: NNMB2009

The prevalence of hypertension among adult women was 23.1% with highest prevalence in the state of Odisha and lowest in Gujarat.

Nutrition Status of 5-9 years Children based on BMI (SD Classification)

0.4 Kerala 71.6 28 0.5 Obese Tamil Nadu 59 Normal 40.5 Thiness 0.6 Karnataka 53.2 46.3 0.4 Andhra Pradesh 64.6 35 0.3 Maharasthra 45.1 44.6 2.4 Gujarat 54.4 43.2 2 Madhya Pradesh 74.6 23.3 0.3 Odisha 72.1 27.6 1 West Bengal 72.9 26.1 1 Pooled 62.1 37

0 10 20 30 40 50 60 70 80

Source: NNMB2009

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.

43 4/28/2016

Nutrition Status of 10-13 years Children based on BMI (SD Classification)

1 Kerala 62.6 36.4 0.7 Tamil Nadu 46.5 52.8 0.2 Karnataka 40.4 59.3 1 Andhra Pradesh 63.6 35.4 0.2 Maharasthra 39.9 59.9 Obese 3.2 Normal Gujarat 54.5 42.3 Thiness 0.8 Madhya Pradesh 59.3 39.8 0.6 Odisha 70.9 28.5 2.3 West Bengal 76.3 21.4 1.3 Pooled 56.5 42.2

0 10 20 30 40 50 60 70 80

Source: NNMB2009

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.

Nutrition Status of 14-17 years Children based on BMI ( SD Classification)

1.9 Kerala 77.7 20.4 0.2 Tamil Nadu 67.2 Obese 32.6 Normal 0.4 Thiness Karnataka 55.8 43.7 0.4 Andhra Pradesh 82.4 17.2 0.1 Maharasthra 62.4 37.4 1.2 Gujarat 81.7 17.1 0.8 Madhya Pradesh 78.6 20.6 1.1 Odisha 87.9 11 1.3 West Bengal 88.2 10.6 0.8 Pooled 76.2 23.1

0 20 40 60 80 100

Source: NNMB2009

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.

44 4/28/2016

Distribution of Adult men (≥18 years) according to BMI (SD classification) (Asian cut-off)

Obese Normal CED

8.7 Kerala 57.4 33.9 9.8 Tamil Nadu 50.9 39.3 8 Karnataka 47.2 44.8 6.5 Andhra Pradesh 55.1 38.4 5.4 Maharasthra 42 52.6 14 Gujarat 54.7 31.3 3.5 Madhya Pradesh 57.7 38.8 3.4 Odisha 58 38.6 5 West Bengal 51.6 43.4 7 Pooled 52.8 40.2

0 10 20 30 40 50 60 70

Source: NNMB2009

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.

Distribution of Adult Women (≥18 years) according to BMI classification (Asian cut-off)

Obese Normal CED

12.3 43.5 Kerala 44.2 10.1 Tamil Nadu 45.9 44 10 Karnataka 39.6 50.4 7 Andhra Pradesh 44.1 48.9 4.8 Maharasthra 32.7 62.5 13.5 Gujarat 49.9 36.6 4.8 Madhya Pradesh 49.3 45.9 3.6 Odisha 44.1 52.3 4.8 West Bengal 39.6 55.6 8 Pooled 43 49

0 20 40 60 80

Source: NNMB2009

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.

45 4/28/2016

Prevalence of Hypertension among Adult Men (>20Yrs)

Normal Pre-Hypertension 18.5 Hypertension Kerala 36.7 44.8 45 Tamil Nadu 37.2 17.8 28.4 Karnataka 43.2 28.4 45.3 Andhra Pradesh 37.7 17 27.1 Maharasthra 45.2 27.7 30.1 Gujarat 60 9.9 38.9 Madhya Pradesh 40.4 20.7 15.5 Odisha 30.8 53.7 24.9 West Bengal 45.2 29.9 32.3 Pooled 42.5 25.2

0 20 40 60 80

Source: NNMB2009

Among adult men the overall prevalence of hypertension was67.7% with 42.5% of stage1 hypertension and 25.2% of stage 2 hypertension.

Prevalence of Hypertension among adult Women (>20Yrs)

Normal 28.2 Pre-Hypertension Kerala 36 35.8 Hypertension 46.2 Tamil Nadu 35.4 18.4 36.3 Karnataka 38.2 25.5 43.2 Andhra Pradesh 36 20.8 41.3 Maharasthra 39.4 19.3 39.1 Gujarat 54.6 6.3 43.6 Madhya Pradesh 32.5 23.9 17.3 Odisha 33.9 48.8 29.3 West Bengal 40.6 30.1 37.9 Pooled 39 23.1

0 10 20 30 40 50 60

Source: NNMB2009

Among adult women the overall prevalence of hypertension was 62.1% with 39% of stage1 hypertension and 23.1% of stage 2 hypertension.

46 4/28/2016

DIET AND NUTRITIONAL STATUS OF TRIBES OF SOUTHERN REGION

Dhimsa dance by tribal women of Araku valley-visakhapatnam

Bhagata tribal women of Araku valley

47 4/28/2016

Chenchu mother and child- Andhra Pradesh

Chenchu collecting forest produce- honey, turtle

48 4/28/2016

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

49 4/28/2016

Average Food Intake (g/CU/day) of Household as % RDA among Chenchu – Andhra Pradesh

98 Cereals& millets 96 73 pulses&legumes 71 19 Green leafy veg. 5 64 Other veg, 77 AP tribes Roots& tubers 80 66 Chenchu 18 Milk & milk products 14 71 Fats & oils 89 28 Sugar & Jaggery 13

0 50 100

Median Nutrient Intake of Households (per/CU/day) as % of RDA among Chenchu – Andhra Pradesh

81 Protein 10 86 Energy 84 52 Calcium 37 56 Iron 58 33 Vitamin A 30 AP tribes 58 Thiamin 75 Chenchu 43 Riboflavin 50 71 Niacin 71 85 Vitamin C 92 20 Free folic acid 20

0 50 100

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 to SD Classification (

% Chenchu 70 NNMB 54.7 60 50.7 52.1 44.2 50

30 19.2 12.5 20

0 Underweight Stunting Wasting

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 (

% Boys 70 54.8 Girls 60 50.4 43.3 50 41 40

30 13.7 13.3 20

10 0 Underweight Stunting Wasting

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.

50 4/28/2016

Distribution (%) of Adult Males according to BMI Classification among Chenchu – Andhra Pradesh

% Chenchu 70 55.1 NNMB(AP) 60 45.9 50 41.2 38.4 40

30 12.9 20 6.5 10

0 CED Normal Overweight

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

% Chenchu 70 NNMB(AP) 60 48.9 46 42.4 44.1 50

20 10.6 7 10

0 CED Normal Overweight

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

120 16-1-17.0 17.1-18.5 18.6-20 21-25

100 100 92.3

80 80

60 50 46.6

40 30 30 26.6 20 20 20 10 10 6.6 5 6.1 0 0 0 0 0 0 1.5 0 0 Bhagata Konda Dora Konds Raj Konds Lambada Yerukula

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.

51 4/28/2016

Nutritional Status of Tribal Groups in ITDA Bhadrachalam Khammam District – Telangana State Fig Average Food intake (g/CU/day) of households as % RDA

98 Cereals & Millets 104.3 72 Pulses &Legumes 85 20 Leafy Vegetables 10 NNMB (AP 63 Tribal Survey Other Vegetables 83.3 2009) Present 80 Roots & Tubers 72 Survey(2007) 18 Milk & Milk Products 20 70 Fats & Oils 70 27 Sugar & jaggery 16.7

0 20 40 60 80 100 120

Fig. Median nutrient intake of households (CU/day)as % RDA

81 Protein 81.7 82 Energy 86.8

Calcium 78 65 34 Iron NNMB (AP Tribal 34.3 Survey 2009) Vitamin A 33 Present Survey 12.5 (2007) Thiamin 58 50 Riboflavin 43 35.7 Niacin 71 72.5 Vitamin C 85 66.5 Free Folic 40 Acid 39

0 20 40 60 80 100 120 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

70 65.4 NNMB (AP Tribal Survey 2009) 60 Present Survey (2007) 50.7 52.1 50 46.4

30 21.3 19.2 20

0 Underweight Stunting Wasting

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

60 58.3 55.1 NNMB (AP Tribal 50 Survey 2009) Present Survey (2007) 40 38.4

31 30

10 6.5 0.8 0 CED Normal Overweight Source: J.Hum.Eco. 21(2), 79-86, 2007

52 4/28/2016

Fig Distribution (%) of Adult Females According to BMI Classification

60 58.5 NNMB (AP Tribal 48.9 Survey 2009) 50 Present Survey 44.1 (2007) 40 40

10 7

1.4 0 CED Normal Overweight

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 Yercaud Taluk, Salem District Tamil Nadu

Cereals Pulses Fruits & Fats and Milk & meat Age (g) (g) Vegetables(g) Sugar(g) Products(g) (years) Mean % Mean % Mean % Mean % Mean % intake deficit intake deficit intake deficit intake deficit intake deficit 1-3 Boys 69.6 -54 30 -40 4.6 -94 9.6 -81 137 -54 Girls 70.7 -53 20 -60 6.4 -92 8.5 -83 150 -50 4-6 Boys 118 -21 20 -59 14.6 -82 9.7 -81 78.9 -74 Girls 120 -20 19 -61 19.7 -75 19.7 -61 80 -60 7-9 Boys 157 -37 20 -67 28.5 -72 9 -89 85 -58 Girls 135 -46 28 -53 11.6 -88 9 -89 23.3 -88 10-12 Boys 213 -33 26 -56 34.2 -73 2.8 -97 90 -55 Girls 219 -31 22 -63 26.3 -79 2.4 -97 46 -77 13-15 Boys 218 -49 30.5 -56 27.6 -79 2.1 -97 46 -69 Girls 216 -38 20.5 -59 28.3 -84 2.7 -96 25 -83 16-18 Boys 322 -8 30.5 -39 20.6 -89 3.4 -95 85 -43 Girls 317 -9 21.8 -56 19.5 -89 2.4 -97 80 -47

Source: R.Parmalavalli Stud-Tribes Tribals, 10(2): 183-187 (2012)

The intake of fruits and vegetables, fats and sugar was grossly inadequate. The deficit in the cereal intake was more among 1-3Yr children and school age children.

53 4/28/2016

Nutrition Status of under five children among tribes of Gudalur, Nilgiris,Tamil Nadu

Nutritional Status for Children under 5 years 6

26 28 Normal Grade I Grade II Grade III

Source: Association for Health Welfare in the Nilgiris, Thottamoola, Gudalur. The Nilgiris.643212 INDIA .www.ashwimi.org [email protected]

The nutritional status (Based on Gomez classification) of under 5 children in Gudalur block of Nilgiri district indicated the overall prevalence of underweight was 74%, with 40% of grade I, 28% grade II, and 6% grade III malnutrition.

Percent Distribution of Thin, Normal, and Overweight based on Body Mass Index for Age Z-Scores among Konda Reddi and Koya Dora Offspring.

BMI for Age (Z-score classification) Konda Reddi Koya Dora Age Overwei Overwei Sex N Thin Normal Thin Normal (yrs) ght ght N <-2SD- >+2SD- <-2SD- >+2SD- <-2SD <-2SD ≤+2SD ≤+3SD ≤+2SD ≤+3SD Boys 17 11.8 89.2 0 34 14.7 76.47 8.82 6 Girls 17 17.6 76.5 5.9 29 6.90 86.20 6.90 Boys 11 18.2 81.8 0 16 12.5 87.5 0 7 Girls 17 11.8 82.3 5.9 32 6.25 93.75 0 Boys 22 9.1 77.3 13.6 27 11.1 88.9 3.70 8 Girls 25 8.0 88.0 4.0 18 5.55 88.9 5.55 Boys 30 10.0 83.3 6.7 39 10.3 79.4 10.3 9 Girls 25 12.0 88.0 0 23 8.7 86.9 4.32 Boys 15 20.0 73.3 6.7 19 10.5 74.8 15.7 10 Girls 22 27.3 72.7 0 17 5.89 88.2 5.89 Boys 3 0 66.7 33.3 11 36.4 54.5 9.09 11 Girls 13 7.7 84.6 7.7 18 22.2 72.2 5.55 Boys 11 18.2 63.6 18.2 17 23.5 70.6 5.9 12 Girls 22 18.2 72.7 9.1 22 27.3 72.7 0 Boys 6 16.7 83.3 0 17 11.8 58.8 29.4 13 Girls 25 20.0 82.0 8.0 22 18.7 78.1 3.12

Source: Appalanaidu P & Others , DJ The Daws Journal , vol.2,No.2, July –December 2013.

The table provides the prevalence of under nutrition (based on BMI) among school age children of Konda Reddi and Koya Dora tribes. The prevalence of thinness was relatively higher in the age group of 10-13 Yrs than 6-9 Yrs. in both the tribes. The overweight and obesity was more or less similar in both the tribes.

54 4/28/2016

Average daily nutrient intake of Jenu Kuruba children,Karnataka

6 47.7 7 to 9 Energy 46.8 51 10+(B) 51.4 10+(G)

99.5 Protein 89 74 75.5 117.7

Calcium 88 82.2 106.4

50.8 Iron 57.2 82.5 99.6

44.3 β 55.3 Carotene 56 56.2

0 20 40 60 80 100 120

Source: Jai Prabhakar and Gangadhar, Anthropologist,13(2)159-162,2011.

The energy intake was more or less 50% of RDA among Jenu Kuruba children. The protein intake was better among 6-9 year children than 10+Yrs children. The intake of iron and β carotene was lower in younger group than older age group.

Average daily nutrient intake of Yerava Children

6 42.7 7 to 9 Energy 40 53.9 10+ (B) 63.2 10+ (G)

87.7 Protein 69.5 67.6 59

90.9 Calcium 93.7 72.6 85.6

39 Iron 44.8 65.6 79.6

53.1 β 83.2 Carotene 82.6 76.7

0 20 40 60 80 100

Source: Jai Prabhakar and Gangadhar, Anthropologist,13(2)159-162,2011.

The intake of energy was comparatively lower in 6-9 yrs than 10+ yrs Yeruva tribal children. Similar observation was also made with regard to the intake of iron and β carotene. However, the intake of protein was higher in 6-9 Yrs children than 10+ children.

55 4/28/2016

Prevalence of underweight, stunting and wasting among under five children of Kadu kuruba tribe of Mysore district, Karnataka

90 0-11 84.2 .12-23 80 78.9 80 24-35 36-47 70 66.7 48-59 61.1 60 60

47.4 47.1 50 46.2 46.2 45 41.9 38.7 40 35.5 30.8 30

0 Underweight Stunting Wasting

Source: J Clin Diagn Res. 2014 Jul:8(7);JC01-JC04, Published online 2014 Jul 20.

Among Kudu Kuruba tribe, it was observed that, the prevalence of underweight, stunting and wasting was increased with increase in age up to 36 months and then come down by 48-60 months of age. The prevalence of all the types of under nutrition was higher at age 24-47 months‟ children

Prevalence of Hypertension among Jenu Kuruba Tribe of Mysore District, Karnataka Age –Wise Prevalence of Hypertension 35 30.9 30 26.7 25.9 24.4 25 23.4 Pre-hypertension 21.3 Hypertension Stage 1 20 17.7 Hypertension Stage 2 15 11.8 11.8

10 5.4 5 3.5 1 0 20-30 31-40 41-50 51-60

Source: Basavanagowdappa Hathur, Internation Journal of Halth & Allied Sciences-Vol.2-2013 Sex Wise Prevalence of Hypertension 35 29.8 Male 30 Female

25 23.5

19.5 20

15 13.6

10 4.7 5 2.9

0 Pre-hypertension Hypertension stage 1 Hypertension stage 2

Source: Basavanagowdappa Hathur, Internation Journal of Halth & Allied Sciences-Vol.2- Issue 4. Oct-Dec 2013 The overall prevalence of hypertension among Jenu Kuruba was 21.7%.The prevalence among men was higher with 28.2% than women (16.5%). The prevalence was increased with increase in age.

56 4/28/2016

Nutritional Status among Adult Mannan Tribes of Iddukki District, Kerala

80 75.8

60 52.5

50 44.8

40 Men Women 30 23.1 20

10 1.1 2.7 0 Underweight Normal Oveweight Source:Philomenamma John and Saradha Ramadas,Department of Food Service Management and Dietetics, Avinashilingam University for Women, Coimbatore, 641 043, India

The chronic energy deficiency among women was higher than men. The prevalence of overweight was marginally high in women of Mannan tribe.

Prevalence of Anemia among Tribal Women of Reproductive age-group in Wayanad district of Kerala

BMI/grades Underweight Overweight Normal (%) Total (%) of anemia (%) (%) Severe 10.8 9.7 0 10.1 Moderate 64 46.1 57.1 55.9 Mild 22.6 40.3 28.6 30.5 Normal 2.7 3.9 14.3 3.5

Source: Shrinivasa BM, et.al., International Journal of Health & Allied Sciences –Vol 3.Issue 2. Apr-Jun 2014 The prevalence of severe and moderate anaemia was higher in individuals with chronic energy deficiency than other grades of nutritional status among tribal women of Wynad district.

Rapid Assessment of Nutritional Status of under 5 children and mothers of Attappady hills, Palakkad district of Kerala

Average intake of Food Stuffs as Percent of RDA

Attappady Rural All tribes Cereals & 79 62 Millets 72 Pulses & 158 53 Legum 49 Green leafy 33 25 veg. 33 40 Other veg. 85 75 Roots & 114 118 Tubers 146 Milk & milk 32 56 product 8 70 Fats & oils 50 45 Sugar & 67 43 Jaggery 33

0 20 40 60 80 100 120 140 160 180

Source : NIN report 2013

Except pulses and legumes and roots and tubers, the intake of all other foodstuffs was lower than the RDA among the tribes of Attappady hills. The intake of Green leafy vegetables and milk &milk products were not even 50% of RDA.

57 4/28/2016

Average intake of Nutrients as percent of RDA

Protein 68 92 77 Attappady 61 Total fat 67 75 Tribes Energy 81 67 73 Calcium 64 54 64 Iron 59 98 59 26 Vit A 16 33 131 Thiamin 75 83 Ribo flavin 54 29 43 Niacin 96 81 93 Vit C 110 70 113 29 Free Folic Acid 39 48

0 20 40 60 80 100 120 140 Percent of RDA

Source : NIN report 2013

The intake of all the nutrients, except Thiamine and Vitamin –C was lower than the recommended level. The intake of micronutrients such as iron, Vitamin- A, Riboflavin and free folic acid were grossly inadequate.

Prevalence (%) of undernutrition (

70 59.1 57.5 Attappady Tribes 60 53 NNMB Kerala Tribes

50 40

40 26.5 30 15.3 20

0 Weight for Age Height for Age Weight for Height

Source : NIN report 2013 The prevalence of underweight, stunting and wasting was higher among preschool children of tribes in Attappady compared to tribes of Kerala (NNMB).

Distribution (%) of Reproductive age women (15-45 years) according to BMI Classification* 48.4 50 44.2 43.5 42.3 Attappady Tribes 45 40 Kerala Tribes 35 30 25 20 9.3 12.3 15 10 5 0 CED Normal Overweight

Source : NIN report 2013 The prevalence of chronic energy deficiency was higher in tribal women of Attappady compared to tribal counterparts of Kerala (NNMB).

58 4/28/2016

Prevalence of Anaemia among Women of Reproductive age (15-45yrs)

Normal 14.8 Attappady Kerala 10.8

Mild 56.3 50.6

Moderate 27.8 36.6

Severe 1.1 2.0

0.0 10.0 20.0 30.0 40.0 50.0 60.0

Percent

Source : NIN report 2013

The overall prevalence of anaemia was 85% with56% had mild anaemia, 28% had moderate anaemia and 1% had severe anaemia. The prevalence of anaemia was marginally lower than figures reported for Kerala tribes.

DIET AND NUTRITIONAL STATUS OF TRIBES OF CENTRAL REGION

59 4/28/2016

Baiga tribe of Madhya Pradesh

Bison Horn Maria of Chhattisgarh

Hand pounding of millet grain by tribal women

60 4/28/2016

Collection of toddy by the tribe

Nutritional Status of Kamar Tribal Children in Chhattisgarh

120 95.77 100 91.8 84.51 87.32 83.61 Boys 80 Girls 60 47.54 40

0 Underweight Stunting Wasting

70 57.58 59.7 60 54.55 56.72 50.76 50 45.45 Boys 40 Girls 30 20 10 0 Underweight Stunting Wasting

80 70 66.67 65 Boys 60 Girls 50 50 40 33.33 30 25 20 15 10 0 Underweight Stunting Wasting

Source: Mitashree Mitra, Indian Journal of Pediatrics, Volume 74-April, 2007,Pg.381-384 Among Kamar tribal children of 4-6 Yrs, the prevalence of underweight, stunting and wasting was higher among boys than girls. Among 7-9 Yrs children underweight, stunting and wasting was less among girls compared to boys. Among 10-12 Yrs children, the prevalence of underweight among boys and wasting among girls was high, while stunting was comparable.

61 4/28/2016

Nutritional Status of Korku Tribes in Betul District of Madhya Pradesh

Mean nutrient intake of Adult male Korku

Ribo- Ascorb Calories Protein Total Carbohyd Calcium Iron Carotene Thiamin Niacin Studies flavin ic acid (kcal) (g) Fat (g) rate(g) (mg) (mg) (ig) (mg) (mg) (mg) (mg)

RDA* 2875 60 20 614 400 28 2400 1.4 1.6 18 40

I group* 2260 46.65 8.82 490.74 188.56 24.15 753.1 1.02 1.2 12.21 22.82 Adequacy 78.61 77.75 44.1 79.92 47.14 86.25 31.38 72.86 75 67.83 57.05 (%) II group** 2105 45.13 8.13 492.21 191.73 23.41 752.38 1 1.04 13.87 24.77 Adequacy 73.22 75.22 40.65 80.16 47.93 83.61 31.35 71.14 65 77.05 61.92 (%) III group *** 2105 40.32 7.95 486.32 189.01 20.83 748.93 1.01 1 11.29 22.05

I group*=19-35 years; II group**=36-55 years III group ***=above 55 years; RDA (ICMR 1991)

Mean nutrient intake of adult female Korku Asco Protei Carbo- Calciu Thia- Ribo- Niaci Calorie Total Iron Caro- rbic Studies n hydrate m min flavin n s (kcal) Fat (g) (mg) tene(ig) acid (g) (g) (mg) (mg) (mg) (mg) (mg)

RDA* 2225 50 20 461 400 30 2400 1.1 1.3 16 40

I group* 1822 38.26 6.5 403.21 169.98 16.13 742.32 0.68 0.58 9.13 16.58 Adequacy 81.89 76.52 32.5 87.46 42.49 53.77 30.93 61.81 44.61 65.21 41.45 (%)

II group** 1820 37.24 7.1 408.21 170.56 15.29 745.12 0.69 0.63 9.28 17.32

Adequacy 1814 37.7 6.64 404.92 170.21 15.69 743.38 0.68 0.59 9.15 16.82 (%) III group 81.15 75.4 33.2 87.83 42.55 82.3 30.97 61.82 45.38 65.36 42.05 *** I group*=19-35 years; II group**=36-55 years III group ***=above 55 years RDA (ICMR 1991) Source: Megha Das, Stud Tribals, 8(1):31-36 (2010)

The intake of all the nutrients among adults of in both gender were lower than recommended levels among Korku tribe of Betul district.

Nutritional status of Pandu tribe in Central India Percent prevalence of malnutrition (SD classification) in pre-school children

60 52 51.8 50

30 20.2 Percentage 20

0 Underweight Stunting Wasting

The prevalence of underweight and stunting was 52%each, and wasting was 20%, among Pandu tribal preschool children of Central India.

Percent distribution of adult male and females according to BMI classification

60 55.5 51 50 48.3 43.4

30 Male Female 20

0.7 1.1 0 CED Normal Overweight

Source: CK Dolla et al., Indian J.Prev. Soc. Med, Vol.37 No.3 & 4, Pg.110-114, 2006 The prevalence of CED was higher among females than males of Pandu tribe.

62 4/28/2016

Nutritional and Health Status of Gond and Kawar Tribal Pre-school Children of Chhattisgarh, India Mean nutrient intake per consumption unit per day among Gond and Kawar children with RDA

Nutrient 1-3 years 3-5 years intake Gond Kawar RDA Gond Kawar RDA Calories (kcal) 1009.4 1012.5 1220.0 987.5 1010.0 1220.0 Protein (gm) 30.4 32.2 22.0 31.2 32.4 22.0 Fat (gm) 5.6 5.6 25.0 4.2 4.2 25.0 Calcium (mg) 103.4 109.4 400.0 97.4 97.4 400.0 Iron (mg) 12.3 13.7 12.0 10.5 10.5 12.0 Carotene mg) 201.3 215.4 1600.0 197.4 197.4 1600.0 Thiamine (mg) 0.66 0.68 0.60 0.78 0.78 0.60 Riboflavin(mg) 0.23 0.33 0.70 0.23 0.23 0.70 Niacin (mg) 10.2 10.1 8.0 8.9 8.9 8.0 Vitamin 23.2 26.5 40.0 20.3 20.3 40.0 “C”(mg) RDA=Recommended Dietary Allowances (Gopalan et al., 2002) The intake of all the nutrients was lower than the RDA among preschool children in both Gonds and Kawar tribes.

Gradations of malnutrition among Gond and Kawar Pre-school children

Gradation of Gond Kawar malnutrition Boys Girls Boys Girls

Normal 43.48 36.36 57.28 45.83

Grade I 29.35 23.86 20.39 26.04

Grade II 16.30 19.32 14.56 21.87

Grade III 10.87 20.46 7.77 6.26

Source: Mitashree Mitra, et. al, J.Hum. Ecol., 21(4):293-299 (2007) The prevalence of grade III under nutrition was higher in Gonds than Kawar children. The overall prevalence of underweight was higher among girls than boys in both the tribes.

Dimensions of Nutritional Vulnerability: Assessment of women and Children in Sahariya Tribal Community of Madhya Pradesh in India

Anthropometric indicators of children (<5 years) in the tribal population of Sahariya

Comparison of the nutrient intake of Sahariya women (15-49 years) with Indian RDA (n=209)

Nutrient Mean intake RDA (2010) Inference (%) Energy (kcal) 1478 2234 Low (33.8 deficit) Protein (g) 51.7 55 Comparable Fat (g) 12.9 15-20 Low (26.3 deficit) Iron (mg) 20.5 21 Comparable Calcium (mg) 254 600 Low (57.7 deficit) Folic acid (free 55.21 200 Low (72.4 deficit) )(µg) Vitamin A (µg) 45 (29,70)** 600 Low (77 deficit) (Min, max:4,1503) Vitamin C (mg) 6 (2,13)** 50 Low (80 deficit) (min, max:0,72) Thiamin (mg) 1.99 1.1 Comparable Riboflavin (mg) 0.72 1.3 Low (55.4 deficit) Source: Suparna Ghosh, Indian Journal of public Health volume 57,Issue 4, October-December, 2013 Niacin (mg) 17.29 14 Comparable

All the nutrients except iron and thiamine was lower than the RDA.The highest deficit was found in case of Vitamin –C, followed by Vitamin–A, folic acid and riboflavin.

63 4/28/2016

Health and Nutritional Status of a Primitive Tribe of Madhya Pradesh: Bhumia Percent prevalence of malnutrition according to SD classification in pre-school children

70 58.8 60

50 43.2 40 36.2 30 20 10 0 Underweight Stunting Wasting

The prevalence of underweight, stunting and wasting was 58.8%, 43.2% and 36.2% respectively among preschool children..

Percent Distribution of Bhumia Adult according to Body Mass Index

80 77.8 73.6 70

40 Male Female 30 26 21.4 20

10 0.2 0.4 0 CED Normal Overweight

Among adult Bhumia tribe the prevalence of CED was higher in males than females

Average consumption of Food stuffs in the Bhumias (gm/cu/day)

Food items Mean ± SD (n=475) RDA (ICMR) Cereals 475.4*±185.5 460 Pulses 28.8* ± 13.6 40 Green leafy vegetables 29.7* ± 12.7 40 Roots and Tubers 13.2* ± 4.6 50 Other Vegetables 46.5* ± 24.4 60 Flesh food 1.7* ± 1.6 40 Milk and milk products 5.5* ± 3.2 150 Oils and fats 2.2* ± 3.6 40 Sugar and jaggery 0.4* ± 0.1 30

Average Nutrient intake in the Bhumias (cu/day)

Food items Mean ± SD (n=475) RDA (ICMR) Energy(Kcal) 1810.5 *± 739.6 2425 Protein (g) 50.4* ± 21.1 60 Fat (g) 11.1* ± 6.4 20 Calcium (mg) 435.5 ± 232.2 400 Iron (mg) 15.7* ± 13.3 28 Carotene (µg) 368.1* ± 256.2 2400 Thiamine (mg) 1.3 ± 0.4 1.2 Riboflavin (mg) 0.4* ± 0.3 1.4 Vitamin C (mg) 17.8* ± 13.7 40

Source: Ajeet Jaiswal, Global Journals of Human social science, Volume 13 issue 1 Version 1.0 year 2013,

Except the intake of cereals the intake of all other foods was lower than RDA. The deficit was more with regard to intake of milk, oils& fats and sugar. With regard to intake of nutrients, except calcium the intake of all other nutrients were lower than the RDA.

64 4/28/2016

Emerging health threats among a primitive tribal group of Central India

Physical and physiological characteristics of Saharia according to random blood sugar level.

Males Females Normal sugar High sugar Normal sugar High sugar level level (>140 level level (>140 Variables (<=140mg/dl) mg/dl) „t‟ (<=140mg/dl) mg/dl) „t‟ n=153;91.08% (n=158,92%) n=153;91.08% (n=158,.92%) ) mean ± SD Mean ± SD ) mean ± SD Mean ± SD 3.03* BMI (kg/m2) 18.7±2.18 22.7 ± 3.34 4.55*** 19.1 ± 1.87 18.1 ± 1.19 * GMT (mn) 7.8 ± 3.06 10.8 ± 2.33 4.60*** 8.9 ± 2.75 9.1 ± 1.65 0.40 WSR 0.42 ± 0.03 0.46 ± 0.03 4.01*** 0.43 ± 0.03 0.43 ± 0.03 0.33 Fat percent (%) 10.4 ± 5.53 17.3 ± 7.08 3.60*** 22.2 ± 5.68 23.2 ± 0.74 1.53 WHR 0.84 ± 0.04 0.89 ± 0.05 3.36** 0.78 ± 0.05 0.81 ± 0.06 1.57 Systolic blood 119.9 ± 11.85 124.7 ± 6.78 2.39* 114.7 ± 10.23 119.1 ± 12.7 1.29 pressure (mm/Hg) Diastolic blood 79.4 ± 8.68 82.1 ± 6.56 1.47 73.2 ± 6.61 72.9 ± 7.67 0.18 pressure(mm/Hg) Blood sugar 6.7** Source: Satwanti Kapoor99.9 ± 16.3., et. al.,159.3 Journal ± 10.45 of public19.77*** Health107.5 and ± 17.49 Epidemiology179.7 ± 39.74 Vol.2(2), (mg/dl)pp.13 -19, April 2010 *

Those subjects who had high physiological characteristics were elevated blood sugar levels

Nutritional Status of Baiga Tribe of Baihar, District Balaghat, Madhya Pradesh Distribution (%) of 0-5 years Baiga Children of Baihar, Balaghat According to SD Classification

70 65.9 Present Study Rural MP 60 57.5

49.6 48.8 50 42.3 40

30 23.8

0 Weight for Age Height for Age Weight for Height

The prevalence of underweight, stunting and wasting was higher among under 5 year children of Baiga tribe compared to their rural counterparts of Madhya Pradesh.

65 4/28/2016

Distribution of Adults male according to BMI Classification

80 68.8 70

60 55.8

50 43.9 40 Present study 28.6 30 Rural MP 20

10 2.8 0.3 0 CED Normal Overweight

Distribution of Adults female according to BMI Classification

70 62.9 64.4 60

40 35.6 Present study 30.8 30 Rural MP

10 4.7 1.5 0 CED Normal Overweight The prevalence of Chronic Energy Deficiency was higher among adult men and women of Baiga tribe compared to rural adults of Madhya Pradesh. Correspondingly, the prevalence of normal grade and overweight & obesity was higher in rural adults of both sexes than Baiga tribe.

Average food consumption (g/day) of Baiga Tribe of Baihar, Balaghat (n=114)

Food items Mean Intake RDI Cereals 491 460 Pulses 23.3 40 Green leafy vegetables 21.4 40 Roots and Tubers 46.4 50 Other Vegetables 28.2 60 Flesh food 8.2 40 Milk and milk products 5.4 150 Oils and fats 7.2 40 Sugar and jaggery 6.7 30

Average Nutrient intake (per day) of Baiga Tribe, Baihar, Balaghat

Food items Mean Intake RDA Energy(Kcal) 1821 2425 Protein (g) 43 60 Fat (g) 11.5 20 Calcium (mg) 161 400 Iron (mg) 14.8 28 Carotene (µg) 922 2400 Thiamine (mg) 1.0 1.2 Riboflavin (mg) 0.9 1.4 Vitamin C (mg) 23.2 40

Source: Chakma T, et.al., J. Nutr Food Sci, volume 4 issue 3. 1000275 Barring, the intake of cereals the intake of all the other foods were lower than the recommended levels, especially, the intake of milk and milk products, oils& fats and sugar & jiggery among the Baiga tribes. The intake of all the nutrients were also lower compared to RDA, especially micronutrients such as Iron, Riboflavin, Vitamin A, and Vitamin C.

66 4/28/2016

Diet and Nutrition Status of Children in Four Tribal Blocks of Thane District of Maharashtra, India Average household consumption of foodstuffs (g/CU/day) Food items Mean Intake RDA

Cereals 505 460

Roots and Tubers 73 50 Other Vegetables 68 60

Flesh food 10 -

Milk and milk products 27 150

Average household intake of nutrients (CU/day) as compared to RDA

Food items Mean Intake RDA

Energy(Kcal) 1857 2425

Protein (g) 42 60

Fat (g) 8 20

Calcium (mg) 881 400

Iron (mg) 14.6 28

Vitamin A (µg) 75 600

Thiamine (mg) 1.3 1.2

Riboflavin (mg) 0.7 1.4

Vitamin C (mg) 27.2 40

Distribution (%) of 0-6 year children according to SD classification (

N 40

Under weight (weight for age) 68.7

Wasting (Weight for height) 30.2

Stunted (Height for age) 60.4

Source :AL. Khandare et.al., Pakistan Journal of Nutriton 7 (3): 485-488,2008 Except milk &milk products the consumption of all other foods was meeting the suggested levels. The intake of all the nutrients was lower than the RDA. The prevalence of underweight was higher followed by stunting, wasting among under five children of tribes in Thane district of Mharashtra..

Health and Nutrition status of Warli Tribal children in Thane district of Maharashtra

40 36 35 30 30

25 22 20

15 12 10

0 Normal Grade I Grade II Grade III

Source : N.S Tekala. Proceeding of National Symposium on Tribal Health.

The overall prevalence of under nutrition was 78% with 30% of grade I, 36% of grade II, and 22% of grade III , among Warli tribal children of Thane district in Maharashtra.

67 4/28/2016

DIET AND NUTRITIONAL STATUS OF TRIBES OF EASTERN REGION

Tribal women of odisha

Harvesting of finger millets

68 4/28/2016

Distribution of Body Mass Index of Tribal Women in Singhbhum district of Bihar

BMI Nutritional status Total No. % 16.0 CED Grade III (severe) 21 9.5 16.0-17.0 CED Grade II (Moderate) 38 17.1 17.0-18.5 CED Grade I (Mild) 99 44.6 18.5-20.0 Low weight Normal 46 20.7 20.0-25.0 Normal 18 8.1 25.0-30.0 Obese Grade I 0 0 >30 Obese Grade II 0 0 Total 222 100. (X=17.9)

Authors: Tanuja, D, Karmarkar, V, Sampath kumar, S. Jeyalakshmi & R. Abel

Distribution of Body Mass Index of tribal women of Singbhum district of Bihar indicated that about 71% had Chronic Energy Deficiency with 9.5% had CED grade III, 17.1% had CED grade II and 44.6% had CED grade I. The women with overweight and obesity were absolutely nil.

69 4/28/2016

Mean Nutrient Intake of the Selected Pregnant Tribal Women of Purnia East Block -Bihar

RDA (ICMR) Oraon Santhal Munda Nutrient Moderate Tribe Tribe Tribe Activity Energy (K Cal) 2525 1850.62 1896.71 1750.42 Protein (gm) 65 50.41 52.32 46.28 Fat (gm) 30 24.50 23.90 18.60 Calcium (mg) 1000 315.3 464.28 539.24 Iron (mg) 38 22.12 29.30 26.82 Thiamine (mg) 1.3 3.12 3.75 2.80 Riboflavin (mg) 1.5 1.12 1.15 1.10 Niacin (mg) 16 3.92 3.85 3.2 Ascorbic acid (mg) 40 12.25 48.56 54.52 Β-Carotene(µg) 3600 475.56 1920.41 2425.45 •Usually Oraon pregnant women do not consume green leafy vegetables •during their last trimester of pregnancy. Ref: J Obstet Gynecol Ind Vol. 54, No.1: January/February 2004, pg 42-46 The intake of all the nutrients was lower than the RDA among pregnant women of Oraon, Santal and Munda tribes.

Nutritional Status of Preschool Children among the Shabar Tribal Community in Orissa

Age Underweight <-2SD of Normal ( months) weight for age 0-12 21.1 79.9 13-24 52.6 47.4 25-36 54.5 45.5 37-48 55.6 44.4 48-60 71.4 28.6 Sex Male 58.6 41.4 Female 39.5 60.5

Ref: Suman Chakrabarty, et.al., Proceeding of National Symposium on Tribal Health The prevalence of underweight among Shabar tribal preschool children was increased with increase age. The prevalence was more among boys than girls.

Body Composition of two tribal populations of Keonjhar, Orissa, India: A Comparison

Males Females P-values P-values Variable Bathudis Savars Bathudis Savars Age (years) 38.01 38.90 0.4977 35.57 38.01 0.0579 Height (cm) 159.37 159.60 0.6867 149.17 148.50 0.2368 Weight (kg) 46.94 49.09 0.0002 39.82 41.60 0.0031 BMI (kg/m2) 18.45 19.26 0.0001 17.90 18.84 0.002 Sum of Skin folds (mm) 24.42 31.19 0.0001 32.31 35.87 0.0001 PBF (%) 10.55 14.28 0.0001 21.70 23.20 0.001 FM (kg) 5.12 7.12 0.0001 8.77 9.80 0.001 FFM (kg) 41.82 41.97 0.7201 31.05 31.80 0.0497 FMI (kg/m2) 2.00 2.79 0.0001 3.94 4.43 0.0001 FFMI (kg/m2) 16.45 16.47 0.8769 13.96 14.41 0.0036

Ref: K Bose, S Bisai, F Chakraborty, A Khatun, H Bauri The internet Journal of Biological Anthropology. 2007 Volume 1 Number 2.

The per cent body fat and fat mass were significantly higher among Savaras compared to Bathudis in both males and females.

70 4/28/2016

Nutritional Status of Kora-Mudi Tribal Adolescent girls in Paschim Medinipur district of West Bengal

Age(year) BMI (Mean±SD) Thinness (%)

9 13.02±2.25 54.5 10 13.94±3.08 48.8 11 14.23±2.28 35.0 12 15.29±3.66 40.0 13 16.14±3.70 36.3 14 16.27±2.92 42.8 15 19.72±2.49 40.7 16 16.36±2.15 52.1 17 16.03±1.93 44.4 18 17.43±2.89 47.6 19 17.38±2.51 45.8 Total 15.38±3.18 45.1

Soumyajit Maiti et.al., IntJ Prev Med.2012 Apr:3(4):298-299

The mean BMI was increase with increase in age among Kora mudi tribal adolescent girls of Paschim Medinipur district of West Bengal.

Habitation –wise nutritional status amongst children aged 5-19 years using reference standards WHO and NCHS.

60 Urban Rural Forest 52.42 50.77 50 45.16 44.57

39.9 40 35.38 33.87

30 24.62

20.16 20

12.1 10 8.72 4.65

0 Weight for Age Height for age Weight for height BMI for age

Ref: Suman Chakrabarty, et.al., IJPH- year8, Volume 7, number 3,2010

The prevalence of under nutrition was higher among the children of forest dwellers compared to rural and urban population.

71 4/28/2016

Prevalence of under-nutrition based on BMI among Adult Juang tribe

Undernutrition Normal Overweight 70 62.9 60 57.5 51.9 50 45.6 40.9 40 36.2

10 2.4 0.95 1.7 0 Men Women Combined

Ref: M. Goswami, Journal of Anthropology 2013, Vol 9.

The prevalence CED was high among adult Juang tribe. The prevalence was high among females than males.

Mean BMI and prevalence of under-nutrition among the tribes of Eastern India

Under- Mean BMI nutrition Tribe Sex Study area Reference (Kg/m2)(SD) (BMI<18.5kg /m2) (%) Male 18.8 47.0 Mittal and Oraon Jalpaiguri Srivastava Female 19.7 31.7 92006) Male 19.5 45.2 Mondal(2007) Paschim Lodha Adhikary Female 19.3 40.7 Medinipur (2007) Male 19.5 27.0 Datta Banik et Dhimal Darjeeling Female 19.1 46.4 al (2007) Male 18.5 55.0 Ghosh and Santal Bankura Female 18.7 52.5 Mallik(2007) Male 18.9 48.4 Goswami Bhumij Balasore Female 18.5 58.3 (2012) Male 19.3 48.4 Goswami Mankidia Mayurbhanj Female 18.6 59.5 (2011) Male 19.4 51.9 Juang Keonjhar Present study Female 18.3 62.9 Male 18.4 52.7 Bose & Bathudi Keonjhar Chakraborty Female 17.9 64.5 (2005)

Ref: M. Goswami, Journal of Anthropology 2013, Vol 9.

The mean BMI among male was highest among Lodha and Dhimal tribes with 19.5 Kg/m2 and low with 18.4 among Bha thudi. Similarly, among females it was high with 19.7 among Oraon tribe and low in Bathudi with 17.9 Kg/m2.

72 4/28/2016

Diet and Nutrition status and food related traditions of Oroan tribe of New mal (West Bengal, India)

40 38.7

35 31.5 30 30 27.3

25 22.5 Men 20 17.3 women 15

10 7.5 8 6 5.4 5 3.3 0.5 0 <16.0 16-17 17-18.5 18.5-20 20-25 25-30

Ref: PCMittal, S, Srivastava, Rural and remote Health 6:385,2006

The prevalence of CED was high among males, while the prevalence of overweight and obesity was high in females among Oroan trbe of New mal, West Bengal.

Health and Nutritional Status of three adult male populations of Eastern India: An anthropometric appraisal 80 Oraon Sarak Dhimal 71.07

70 65.19

50 46.55

40 32.07 30 20.75 20 14.48 14.56

7.59 10 6.55 5.7 6.96 2.52 3.77 0.34 1.89 0 <16 16-17 17-18.5 18.5-25.0 25-30.0 Ref:Sudip Dutta Banik

The prevalence of CED was higher in Oroan tribe followed by Sarak ,Dhimal.

Nutritional Status of adult male Oraon tribe of Gumla, Jharkhand

45 39 40 35.6 35 30 25 20 17.6 15 10 7.3 5 0.5 0 <16.0 16-16.9 17-18.4 18.5-24.9 ≥25.0 Ref: R. Chakraborty, K.Bose. The internet Journal of Biogical Anthropology,vol2(1) 2007aa The prevalence of Chronic Energy Deficiency was 64% with 7.3% of grade III CED among male Oroan tribe of Gumla district, Jharkhand.

73 4/28/2016

Nutritional status of Adult Men from the Oraon Tribe in Ranchi district of Jharkhand, India.

50 46.9 45 40 35 32.07 30 25 20 14.42 15 10 6.55 5 0 <16.0 16-16.49 17-18.49 18.5-24.99

Sudip Datta Bani K, Mal.J.Nutr.14(1),91-88,2008

The prevalence of Chronic Energy Deficiency was 53% with 6.6% of grade III CED among male Oroan tribe of Ranchi district, Jharkhand

DIET AND NUTRITIONAL STATUS OF TRIBES OF NORTH EASTERN REGION

74 4/28/2016

75 4/28/2016

Prevalence of underweight (

The prevalence of underweight among children of Meghalaya was 21%, ranged from a low of 14.3% in East Garo hills to a high of 30.8% in West Khasi hills.

Prevalence of Stunting (

Pooled : 44.0 The prevalence of stunting among children of Meghalaya was 44%, ranged from a low of 29.1% in South Garo hills to a high of 63.3% in East Khasi hills.

Prevalence of Wasting (

Source: Nutritional status of below five year children in the state of Meghalaya. NIN Technical Report-2013 The prevalence of wasting among children of Meghalaya was 4.8%, ranged from a low of 1.9% in East Khasi hills to a high of 11.2% in West Khasi hills.

76 4/28/2016

Mean Diet intake among Tribes of Tripura in select villages of West District- (Village survey 2005)

Non-Tribal Tribal Food groups Sachindra Kaichand Bari Nagar Cereals and millets 109.0 102.3 Pulses and Legumes 109.7 27.0 Leaf Vegetables 75.3 108.7 Roots and tubers 32.1 92.4 Other Vegetables 180.9 135.1 Milk And Milk products 22.7 4.0 Fats and oils 92.5 20.0 Sugar and Jaggery 128.4 1.2

Ref: Sanjoy Deka 2011, Vol.3 No.03, health and Nutritional Status of the Indian Tribes of Tripura and Effects on Educationa

Except the intake of roots & tubers, all the other foods were lower among tribes than non tribes in West district of Tripura.

Edible insects consumed by Galo Tribe in Arunachal Pradesh Seasonal Mode of Scientific name Local name Parts used availability consumption Pentatomid sp Tari Dec-Feb Whole body Raw/Cooked.etc Locusta SP Mirbo Aug-Sept Whole body Cooked Apis Indica Tangik Oct-Nov Hive/Larva Raw Apis dorsata Tair Oct-Sept Hive/Larva Raw Vespa Mandrinia Iddum Aug-Sept Larva Raw Vespa Tropicana Ille Sept-Oct Larva Roasting Polistinae SP RegoReto Aug-Sept Larva Roasting Polistes SP Reli Aug-Sept Larva Roasting Vespa bicolour Gapu Aug-Sept Larva Roasting Cyrtotrechelus buqueti Tak Tapum Sept-Oct Larva Roasting Belostoma indicus Mosap Whole year Whole body Roasting/Cooked Katydids SP Takom Aug-Sept Adult Cooked Unidentified Belum Tapum Aug-Sept Larvae Cooked Unidentified Tanyi Sept-Oct Larva Cooked Unidentified Pagap Whole year Larva Cooked Unidentified Oso Nyobuk Whole year Adult Cooked Dagyom Kato * & Gopi GV ,Indian Traditional knowledge, Vol.8,No.1,Janurary 2009, pp.81-83

Dung PO- Steam Rice speciality of Arunachal:

One of the incredible features of tribal Arunachal recipes is that there is little oil and other dry or packed Indian spices. Arunachal cuisines are nutritious and healthy as the tribes regularly use herbs with medicinal properties and indigenous fresh spices which are not found in rest of Indian except in some part of the hilly areas of the Northeast. Organic vegetables, curative herbs and fermented bamboo shoots with couple of fresh scented leaves are the integral ingredients of tribal food habits.

Rice which is the staple food of the state is prepared in a variety of ways. One such is Dung PO. Two brass utensils are used for this purpose. In the local lore there is a belief that food cooked in brass utensils are always delicious. On the top, the rice is filled with some leaves to secure it from scattering as the pot is hollow from beneath and the 2nd pot is filled with water to generate steams to cook the rice. The cooked rice is wrapped in leaves to serve.

77 4/28/2016

Nutritional Status of under 5 children belonging to tribal Population Living in Riverine (Char) Areas of Dibrugarh District, Assam

35 underweight 30 Stunting Wasting 25

20 29 30.4 15 21.6 10

0 underweight Stunting Wasting

Safikul Islam et.al. Indian J Community Med. 2014 Jul-Sep; 39 (3): 169-174

The prevalence of underweight, stunting and wasting was 29%, 30.4% and 21.6% respectively among under 5 children of tribal population inhabiting Reverine areas of Dibrugarh district, Assam .

Distribution of body mass index (BMI) among Ao Naga Children of Nagaland

Boys Girls Age Under- Over- Under- Over- Normal Normal (years ) weight weight weight weight 8 22.86 77.14 0.00 22.22 77.78 0.00 9 40.00 57.14 2.86 31.43 65.71 2.86 10 36.11 61.11 2.78 38.24 61.76 0.00 11 44.44 52.78 2.78 47.22 44.44 8.33 12 42.11 55.26 2.63 29.41 70.59 0.00 13 30.56 69.44 0.00 16.22 81.08 2.70 14 31.58 68.42 0.00 17.65 79.41 2.94 15 25.71 68.57 5.71 5.56 91.67 2.78

Temsumongla Longkumer, Journal of Anthropology , Article ID 291239

The prevalence of underweight was higher in peak adolescence period in both the gender among Ao Naga children of Nagaland.

Distribution of BMI among women of Tangkhul Naga of Manipur

Classification Asian International Underweight 16.2 16.2 Normal 56.6 74.0 Overweight 25.1 9.2 Obesity 2.1 0.6

The prevalence of overweight and obesity was high with 27% (Asian) among women of Tangkul Naga of Manipur compared to other tribal groups especially in the main land.

78 4/28/2016

DIET AND NUTRITIONAL STATUS OF TRIBES OF NORTHERN REGION

Kinnaura tribal women of Himachal

Bakkerwalas Jammu & Kashmir

79 4/28/2016

Gujjar tribe Jammu & Kashmir

Nutritional Status of Adolescent Gujjar Tribal Girls of Jammu District

100 88.1 90 Low Normal High

70 67.1

60 50 48.2 50

40 30 30

20 11.9 10 2.8 0 1.9 0 13 yrs 14 yrs 15 yrs Ref: Rajni Dhingra , Stud tribes Tribals, 9(2): 133-138 (2011) The prevalence of under nutrition was high and increased with increase in age among Gujjar adolescent girls of Jammu district.

Body Mass Index Adolescent girls of Gaddi tribes of Chamba and Kangra District of Himachal Pradesh BMI Grade Diagnosis Percent <16.0 CED grade III 22.25 16.0-17.0 CED grade II 17.5 17.0-18.5 CED grade I 21.5 18.5-20.0 Low weight-normal 18.75 20.0-25.0 Normal 19.75 25.0-30.0 Obese Grade I 0.25 Ref: Shubhangna ,et.al., Stud. Tribes Tribals, 5(2):139-142 (2007) The overall prevalence of CED was 61% with 55.3% of CED grade III, 17.5% of CED grade II, and 21.5% of CED grade I. Among adolescent Gaddi girls of Chamba and Kangra districts of Hmachal Pradesh.

80 4/28/2016

Haemoglobin level of adolescent Gaddi girls

Haemoglobin level Categories Percent (g/dl) Less than 7 Severe 11.5 7-10 Moderate 72.0 10-12 Mild 16.5 Greater than 12 Normal -

Ref: Shubhangna, et.al, Stud. Tribes Tribals, 5(2):139-142 (2007)

All the Gaddi tribal adolescent girls surveyed were anaemic, with 11.5% were severe anaemia

BMI Distribution of Rural Hill women in Nainital District of Uttarakhand

BMI Grade Diagnosis Percent <16.0 CED grade III 0.0 16.0-17.0 CED grade II 1.35 17.0-18.5 CED grade I 12.56 18.5-20.0 Low weight-normal 18.83 20.0-25.0 Normal 58.29 25.0-30.0 Obese Grade I 8.97 >30 Obese Grade II 0.0

Shweta Upadhyay et.al., J Hum Ecol 33(1): 29-34 (2011)

The BMI distribution of rural hill women of Nainital district of Uttara Khand indicated that a majority of women were in normal grade and 9% had overweight.

DIET AND NUTRITIONAL STATUS OF TRIBES OF WESTERN REGION

81 4/28/2016

Nutritional Status of the Children Below 3 Years of Age in Tribal Villages Chikhli Taluka, Gujarat

80 Underweight Stunted Wasted 72.2 69.4 70 63.9 58.5 60 56.5 56.5 50.4 49.6 50 45.1 40.5 40 32.8 33.4 30 27 25 22.2 20

0 6 to 12 13 to 18 19 to 24 25 to 30 31 to 36

Ref: Shriya A. Seksaria Dr. Mini K Sheth , Indian Journal of Research, Volume :2 Issue :12 Dec 2013

The prevalence of underweight, stunting was increase with age among below 3 year tribal children of Chikli taluk of Gujarat.

82 4/28/2016

Average Household consumption (g/CU/day) of Food stuffs among Saharia tribes in Rajasthan

460 Cereals & Millets 556

40 Pulses & Legumes 15 40 Green Leaf Veg 15 50 Roots & Tubers 23 RDI 60 O Veg 32 Sahara Tribe

Milk & Milk 150 Products 46 20 Fats & Oils 11 30 Sugar & Jaggery 11

0 100 200 300 400 500 600

Source: NIN Tech Report,

At household level, barring the intake of cereals &millets the intake of all other foods was lower than RDI among Saharia tribal community of Rajasthan.

Average household intake (CU/day) of nutrients by Saharia Tribe

60 Protein 76 40 Total Fat 26 2425 Energy 2211 400 Calcium 407 28 Iron 33 600 Vitamin A 225 RDA 1.2 Thiamin 2.8 Saharia Tribe 1.4 Riboflavin 1.2 16 Niacin 24 40 Vitaim C 23 100 Free Folic Acid 78

0 500 1000 1500 2000 2500 3000 At household level, the intake of protein, calcium, iron, thiamine were above RDA, while the intake of remaining nutrients were lower compared to RDA.

Nutritional Status of 1-5 year children among Saharia Tribes of Rajasthan

60 50 72.1 67.8 40

10 13.4 0 Underweight Stunting Wasting Source: NIN Tech Report, The per cent prevalence of underweight, stunting and wasting was 72%, 67.8% and 13.4% respectively among preschool children of Saharia tribe of Rjasthan.

83 4/28/2016

DIET AND NUTRITIONAL STATUS OF TRIBES OF ISLAND REGION

84 4/28/2016

Nutritional Status of Pre-school children of Nicobarese of Andaman & Nicobar Islands 60

30 48 20 37

10 16

0 Under weight Stunting Wasting

Ref: NIN Tech. Report on Tsumani affected areas The per cent prevalence of underweight, stunting and wasting was 48%, 37% and 16% respectively among preschool children of Nicobare tribe of Andaman &Nicobar Islands..

Prevalence of Thinness (<5 centile of BMI) among adolescent Nicobarese

15 22 10 16 5

0 Boys Girls Ref: NIN Tech. Report on Tsumani affected areas The prevalence of thinness was 22% among adolescent boys and 16% among girls of Nicobarese.

85 4/28/2016

Prevalence (%) of Undernutrition among pre-school children by Gomez grades

Andamanese 14 14

Normal Mild Moderate 29 Severe

The overall prevalence of underweight was 86% with 14% severe grade and 43% of moderate grade and 14% mild grade among preschool children of Andamanese .

Prevalence (%) of Undernutrition among pre-school children by Gomez grades

Onges 10 5 15

Normal Mild Moderate Severe

Ref: V G Rao et.al., Tribal Healt Bulleten ,2003 Vol 8, RMRC Jabulpur Among Onge preschool children, the prevalence of mild grade under nutrition was 15%, moderate was 70% and severe grade was 10%.

Percentage Distribution of Jarawas Adults above 18 years according to BMI

Nutritional Status from BMI Male Female Obese 0 4.5 Normal & Low Normal 79.4 79.3 CED-I 13.8 12.6 CED –II 5.2 2.7 CED-III 1.6 0.9

Among adult Jarwas, the prevalence of CED was 21% among men and 15.3% among women. The overweight and obesity was 5% among women.

Major Food groups intake (gm/CU/day) among Jarawas Food Group Boaib area Thidong Tanmad Average area area Flesh Food: Pig Meat 567 471 515 533 Pig fat and oil, turtle oil 170 140 154 155 Larva, Mollusc, Fish, Turtle egg 165 146 185 165 Honey 115 125 150 130 Roots and Tuber 78 60 120 85 Fruits Banana, Omin, Tuyia 115 125 150 130 Processed food Biscuit, Bread, Rice 26 96 44 55 Mean intake of Nutrients (CU/day) Among Jarawas Mean Intake Nutrients RDA Boaib area Thidong Tanmad All area area Energy (Kcal/day) 2425 2770 2421 2436 2542 Protein (gm/day) 60 79 45 54 55.8 Fat (gm/day) 54 195 111 138 148 Calcium (mg/day) 400 208 119 306 217.8 Iron (mg/day) 28 11 16 9 12.0 B1 (mg/day) 1.2 2.39 3.12 1.14 2.11 B2(mg/day) 1.4 3.59 1.78 0.33 1.52 Niacin (mg/day) 16 75.93 42.88 17.33 38.83 Vitamin C (mg/day) 40 55.2 63.26 98.7 76.95 Book Chapter 6 Among Jarawas the intake of flesh foods was high, followed by honey, banana, and roots and tubers. Other foods such as rice, bread etc., were minimal. With regard to the intake of nutrients energy, fat, vitamins B1&B2, Niacin and Vitamin –C were meeting the RDA.

86 4/28/2016

Distribution of body mass index according to WHO classification (1995)

Male Female BMI Great Great Diagnosis Grade Jarawas Onges Andama Jarawas Onges Andama nese nese <16.0 CED grade III 8.00 0.00 0.00 0.00 0.00 0.00 16.0-17.0 CED grade II 12.00 7.41 0.00 18.75 10.00 0.00 17.0-18.5 CED grade I 28.00 0.00 0.00 12.50 15.00 0.00 18.5-25.0 Normal 52.00 81.48 81.82 68.75 50.00 75.00 25.0-30.0 Overweight 0.00 7.41 18.18 0.00 5.00 25.00 32.0-35.0 Overweight I 0.00 3.70 0.00 0.00 0.00 0.00 35.0-40.0 Overweight II 0.00 0.00 0.00 0.00 20.00 0.00

Ref: Ramesh Sahani, Journal of Comparative Human Biology 2013 (In press) The prevalence of CED was high among Jarwa male and females compared to Onges and Great Andamanese. However, overweight and obesity was high in both males and females of Great Andamanese followed by Onges and it was nil in Jarwas.

Prevalence of hypertension among Nicobarese population

50.7 50.3 50

40 Male Female 30

20 Male Female Ref: Satya Prakash M et.al., I JMR,133,287-293,2011 The prevalence of hypertension was 51% and 50% among Nicobarese of Andaman &Nicobar islands.

Prevalence of hypertension among Nicobarese population

80 73.5 69.1 70 60.2 60

50 43.4 40 28.9 30

0 18-29 30-39 40-49 50-59 ≥60

Ref: Satya Prakash M et.al., I JMR,133,287-293,2011

The prevalence of hypertension was increase with age among Nicobarese similar to observed in Main land.

For many tribal and indigenous peoples, their food systems are complex, self sufficient and deliver a very broad-based, nutritionally diverse diet.

But the disruption of traditional lifestyle due to environmental degradation, and the introduction of processed foods, refined fats and oils, and simple carbohydrates, contributes to worsening health in indigenous populations.

87 4/28/2016

DIET AND NUTRITIONAL STATUS IN DIFFERENT STATES BY TRIBE

Prevalence of under nutrition (<-2SD) among tribal pre-school children

Nutritional status # State Tribe Underweight Stunting Wasting KANI 32.8 45.3 15.4 PANIYA 46.0 56.3 16.7 MANAN 49.3 54.7 26.7 Kerala KURICHOR 36.8 55.3 10.5 IRULOR 34.9 43.4 21.7 KURUMBAR 49.3 64.4 22.2 ADIYAN 36.1 55.6 11.1 MALAYALEE 43.7 40.2 20.0 Tamil Nadu IRULAR 20.6 32.4 8.8 M. NAIK 34.7 31.0 21.6 KORAGA 39.3 34.6 17.8 Karnataka HASALARU 47.3 54.5 21.8 MALIAKUDIAS GOWDA 51.4 48.6 27.0 KOYA 46.1 49.0 18.9 GOND 56.6 45.0 30.2 BHAGATHA 44.0 48.9 15.2 Andhra Pradesh VALMIKI 27.4 45.2 6.9 KONDADORA 53.1 52.4 18.6 POORJA 46.3 49.5 22.1 JATAPU 46.9 49.4 14.8 WARLI 60.4 52.5 30.2 KOKNA 67.1 58.4 34.2 MAHADEV KODI 59.6 55.6 20.2 BHIL 66.9 65.7 28.8 Maharashtra M. KOLI 52.4 51.8 28.3 THAKAR 57.3 55.5 30.8 KORKU 61.5 62.8 25.7 GOND 54.9 55.6 20.3 Madhya Pradesh KOL 36.4 58.2 20.0 GOND 43.5 52.4 23.7 KANWAR 43.1 46.6 22.4 BHILALA 66.1 69.9 29.0 BAIGA 58.9 60.0 24.4 West Bengal SANTAL 50.4 40.0 32.8 MUNDA 53.4 50.0 22.4 BHUMIYA 43.0 45.0 14.8 #: WHO Growth Standards NNMB report 2009

88 4/28/2016

Distribution of tribal adult men according to BMI grades & Hypertension BMI Grades # Hyper- State Tribe Overweight/ CED Normal tension Obesity KANI 36.4 54.6 9.0 42.5 PANIYA 36.5 56.4 7.1 41.8 MANAN 33.4 58.0 8.6 53.3 Kerala KURICHOR 34.3 55.8 9.9 34.4 IRULOR 41.7 51.7 6.6 41.9 KURUMBAR 43.0 45.4 11.6 45.9 ADIYAN 29.1 61.4 9.5 42.3 MALAYALEE 37.9 51.6 10.5 15.4 Tamil Nadu IRULAR 45.7 50.0 4.3 8.5 M. NAIK 46.6 45.0 8.4 31.6 KORAGA 39.8 52.1 8.1 25.3 Karnataka HASALARU 41.2 53.9 4.9 28.3 MALIAKUDIAS GOWDA 42.6 50.0 7.4 32.8 KOYA 39.6 52.2 8.2 15.1 GOND 55.3 41.8 2.9 12.1 BHAGATHA 31.8 62.7 5.5 22.6 Andhra Pradesh VALMIKI 33.9 51.3 14.8 18.5 KONDADORA 29.9 66.3 3.8 23.1 POORJA 29.2 67.3 3.5 19.0 JATAPU 33.3 60.5 6.2 14.8 WARLI 55.3 40.0 4.7 26.7 KOKNA 51.8 41.1 7.1 27.4 MAHADEV KODI 51.5 43.7 4.8 24.8 BHIL 56.2 39.9 3.9 30.1 Maharashtra M. KOLI 50.8 42.9 6.3 29.1 THAKAR 58.4 36.0 5.6 26.6 KORKU 27.4 63.8 8.8 15.6 GOND 45.8 48.9 5.3 32.3 KOL 27.6 70.8 1.6 13.6 GOND 38.0 58.0 4.0 22.1 Madhya KANWAR 30.7 64.8 4.5 29.1 Pradesh BHILALA 47.5 49.2 3.3 7.4 BAIGA 35.2 63.6 1.2 32.8 SANTAL 43.5 52.1 4.4 28.0 West Bengal MUNDA 52.3 41.9 5.8 45.9 BHUMIYA 46.9 46.9 6.2 33.3 #: WHO Growth Standards NNMB report 2009

Distribution of tribal adult women according to BMI grades & Hypertension

BMI Grades # Hypert- State Tribe Overweigh CED Normal ension t/Obesity KANI 39.7 45.5 14.8 34.2 PANIYA 59.6 34.4 6.0 33.3 MANAN 31.4 46.9 21.7 41.8 Kerala KURICHOR 38.3 49.7 12.0 43.3 IRULOR 45.5 46.3 8.2 23.7 KURUMBAR 47.8 42.1 10.1 27.4 ADIYAN 44.7 41.2 14.1 35.5 MALAYALEE 42.1 47.2 10.7 18.5 Tamil Nadu IRULAR 39.5 46.2 14.3 13.1 M. NAIK 51.1 37.8 11.1 26.5 KORAGA 50.3 43.1 6.6 22.9 Karnataka HASALARU 47.8 42.5 9.7 19.2 MALIAKUDIAS GOWDA 50.1 38.9 11..0 32.4 KOYA 52.6 37.8 9.6 17.5 GOND 56.9 40.4 2.7 17.0 BHAGATHA 40.5 52.7 6.8 24.9 Andhra VALMIKI 38.9 48.9 12.2 31.7 Pradesh KONDADORA 42.3 51.9 5.8 29.8 POORJA 42.4 53.0 4.6 22.1 JATAPU 47.7 43.3 9.0 23.5 WARLI 63.7 32.1 4.2 26.5 KOKNA 62.0 33.5 4.5 22.3 MAHADEV KODI 67.9 28.1 4.0 19.4 BHIL 63.6 32.4 4.0 18.1 Maharashtra M. KOLI 56.8 35.8 7.4 25.3 THAKAR 69.9 25.0 5.1 20.8 KORKU 30.1 57.7 12.2 1.6 GOND 57.0 39.5 3.5 14.9 KOL 35.7 59.7 4.6 22.4 GOND 45.4 49.4 5.2 25.5 Madhya KANWAR 43.7 50.4 5.9 26.1 Pradesh BHILALA 50.0 46.3 3.7 10.5 BAIGA 43.5 52.2 4.3 33.8 SANTAL 56.9 38.9 4.2 28.9 West Bengal MUNDA 60.7 35.2 4.1 35.6 BHUMIYA 57.5 37.4 5.1 35.2

#: WHO Growth Standards NNMB report 2009

89 4/28/2016

Second repeat survey was carried out by NNMB among tribal population in 9 States of India and the report was published in the year 2009. However, information was not available on nutrition profile by tribe in these States. Hence an attempt was made to decode the data by tribe and analysis was carried out and results were presented.

The salient observations are as follows:

Kerala: The overall prevalence of underweight (

90 4/28/2016

Tamil Nadu: The prevalence of underweight, stunting and wasting was higher among preschool children of Malayalee tribe (43.7%, 40.2%, 20% respectively) compared to Irular (20.6%, 32.4%, 8.8% respectively). The prevalence of CED was higher among men of Irular (45%), while the same was higher among women of malayalee tribe(42%). The prevalence of hypertension was higher among malayalee men (15.4%) and women (18.5%) as compared to Irular men and women (8.5%&13%).

Karnataka: The prevalence of underweight and wasting among preschool children was higher in Maliakudias Gowdas and stunting was higher in Hasaluru tribal children.The prevalence of CED was higher in adult men and women of M.Naik (46.6% & 51.1% respectively), while the prevalence of hypertension was highest Maliakudias Gowdas.

91 4/28/2016

Andhra Pradesh: The overall prevalence of underweight was higher among preschool children of Gonds (56.6%) followed by Konda Dora (53.1%), Porja, Jatapu and Koya(46%each) Bhagata (44%), and lowest in Valmiki tribes (27.4%).Similarly, the prevalence of stunting was higher in Konda Dora (52.4%) and lowest in gonds and valmiki (45% each). The prevalence of CED was highest among adult men of Gonds (55.3%), while overweight and obesity was higher (14.8%) in Valmiki tribe. Among adult women, the prevalence of CED was higher among Gonds ( 56.9%), while it was lowest in the women of Valmiki (38.9%).The prevalence of hypertension among men was highest in Konda Dora and Bhagatas (23%each) while, it was highest among women of valmiki (31.7%) and konda dora (29.8%).

Maharashtra: The preschool children of Bhil and Kokna tribes had the highest prevalence of underweight (67% each), while it was lowest (52.4%) in M.Koli. Similarly stunting was also highest in children of Bhil tribe (65.7%) followed by Korku (62.8%), Kokna 55.8%) Mahadev koli, Gond and Thakar(55%each). The prevalence of wasting was highest in Kokna children (34.2%). Chronic Energy Deficiency was higher among men of Thakar (58.4%) and Bhils (56.2%), while the same was observed to be higher in Thakar(69.9%), and Mahadev Koli(67.9%).The prevalence of hypertension among men was highest in Gond (32.3%) followed by Bhil (30.1%),M.Koli(29.1%) and lowest in Korku tribe(15.6%). Among women, the same was higher in Warli (26.5%) and lowest in Korku tribe (1.6%).

92 4/28/2016

Madhya Pradesh: The prevalence of underweight, stunting and wasting was highest (66.1%,69.9%, and 29%respectively) among children of Bhilala, and lowest in Kol tribe (36.4%, 58.2%, 20% respectively). Similarly, the prevalence of CED was highest in men and women of Bhilala (47.5% and 50%). The prevalence of hypertension was found to be highest in adult men and women of Baiga tribe (32.8%&33.8%) while it was lowest in Bhilala(7.4%&10.5%).

West Bengal: Munda tribal preschool children had highest prevalence of underweight (53.4%), while children of Santal tribe had highest stunting (50%) as well as wasting (32.8%). The prevalence of CED was highest among Munda men (52.3%) and women (60.7%). Similarly,the prevalence of hypertension was also observed to be highest in Munda men(45.9%) and women (35.6%) compared to other tribes of the state.