Chapter 4 Chapter ^ : DliTWllUTION OF ilCKLi glLU NiH©§l=8ilN IN BIPPi«i«NT POPULATION OROUPt OF MAHARASHTRA. ^.1 : Introduction Since first report of sickle cell hemoglobin in India, several workers studied the presence of sickle cell hemoglobin in differrent parts, in India.(Fig ^.1.1) These reports showed that sickle cell hemoglobin is mostly confined to tribal groups and backward communities in India. Most of these reports were based on sickling test only. (Table '^. 1 . 1) . In Maharashtra, about 20'/. population is of either scheduled tribes or scheduled caste, (Scheduled means as per the list enclosed in scheduled of the constitution of India.) Many of these tribal and caste groupes have not been studied systematicaly. Hence study was undertaken to assas the distribution of sickle cell hemoglobin in different tribal, scheduled caste and other caste groups. In Maharashtra, a peculiar caste system exists which in turn reflects the caste system that is followed in India for last hundreds of years. All these castes are endogemous and no marriage is permitted in between the two castes. This system is divided into 3 major groups. 1. Upper caste groups- These include Maratha, Brahmin which were ruling this a.rea,. Their socio economic status is high as compaired to other caste groups. They are land lords and their main occupation is farming and they are doing it with help of labourers from lower caste groups. ^8 INDIA Fig ^.i . i : Figure showing distribution of Sick c e hemoglobin in cliffpr-c?nt parts cif India. S. Scheduled caste groups- This group includes Navabudhas which were previously called as tiahar , Chambhar, Mang caste groups. These castes are socio-economical1y backward and they were considered untouchables by the upper caste groups. They were mainly doing labour work in farms owned by the upper class. 3. Scheduled Tribe groups- Tribals are the primitive, isolated population groups known as aboriginals (Adivasi). They are socioeconomically backward. They still ara confined to the forest hilly area of middle and north of Sahyadri ranges, Satpura and forest of central India (Nandad, Chandrapur, Yavatmal, Gadchiroli districts of Maharashtra.) They constitute about 9'/. of the total population of Maharashtra. They follow their own social systems and have remained aloof for long time from other rural and urban population groups. These people practice agriculture in the jungle tract and supplement it by gathering jungle products and selling them. The major tribal groups from Maharashtra comprise of Warli, Katkari, Thakur and Mahadeo Koli from Sahyadri region; Bhi11, Pawara and Kokana from Satpura region and; Pardhan, Madia, Gond, Kolam, Andha, Rajgond and Korku from Vidarbha region. -^9 Pawara Kolam Katkari Madia ^ig -^.l.E ! Phot ograph showinq tribal people, Table ^.1.1 iTable showing the prevalence of sickle cell trait in different caste and tribal groups as studied by different workers in Maharashtra. TRIBE PLACE NO .TESTED SICKLE CELL REFERENCES TRAIT •/. Banjara Dhule l^ 0 Negi 1976('^^) Aurangabad 16 0 Negi 1976(^^) Bhill Aurangabad lOS 1 .9 Negi 1976(44) Dhule 82 15.7 Negi 1976(44) M 186 8.6 Kate et al 1978(45) Ahmadnagar 33 0 Negi 1976(44) Nasik 261 S.'^ Gorakshekhar 1988(46) Gond Nagpur 53 0 Sukla K.Solanki 1958(12) Amravat i 29 17.2 Negi 1976(44) Katkar i Sahyadr i 262 8.0 Sanghvi 1962(48) Pune 61 0 Negi 1976(44) Raigad 109 5.5 Negi 1976(44) Thane 70 1 .4 Negi 1976(44) Raigad 966 5.2 Kate et al 1978(45) Raigad 61^ 5.37 Mukherjee 1979(49) ^:ofc:4niS Th(^np \^Q 4,2 Sanghvi 1962(49) Thane 86 2.3 Negi 1976(44) Kolam Yavatmal 1^^ 18.7 Rao et al 1990(50) Korku Amravat i 172 9.3 Negi 1976(44) Kunb i Nagpur 116 9.5 Sukla &. Solanki 1958(12) Pune 50 0 Negi 1976(44) Mahadeo koli Nasik 50 0 Negi 1976(44) Pune 181 0.5 Negi 1976(44) Mad ia Chandrapur 105 20.52 Kate et al 1978(45) 167 16. 17 Pingle 1984(51) Mahar Nagpur ^50 22.2 Sukla &. Solanki 1958(12) (Schulded Nagpur ^82 18.0 Das et al 1961(52) Caste) Bombay 200 2.0 Sanghvi 1962(48) Aurangabad 700 5.6 Lele et al 1962(53) Aurangabad 200 12.0 Deshmukh &, Sharma 1968(54 200 0 Parikh et al 1969(55) Ra igad 190 5.8 Negi 1976(44) Thane 3^ 11.7 Negi 1976(44) Dhule 1 15 13.0 Negi 1976(44) Ahmednagar 36 0 Negi 1976 (44) Pune 13^ 0.7 Negi 1976(44) Aurangabad 85 2.3 Negi 1976(44) Kolhapur 2^8 0 Negi 1976(44) Satara 52 0 Negi 1976(44) 259 2.88 Mukherjee et al 1979(48) 732 15.^3 Mukherjee et al 1982(56) 332 3.01 Mukherjee et al 1982(56) 50 Pardhan Yavatma1 l-^S 31 , Rao et al 1990(50) Chandrapur 133 33, 8 Rao et al 1990(50) Pawara Dhule 1 10 2-^. 5 Negi 1976(4'^) Dhule laa 22, 1 Kate et al 1978('^5) Ra jgond Yavatma1 283 10. 2 Rao et al 1990(50) Chandrapur E65 13, 9 Rao et al 1990 (50) Tel i Nagpur 89 10. 1 1 Shukla &• Solanki 1958(12) Thakur Pune 50 0 Negi 1976(^^) Ra i gad 9^ 0 Negi 1976('^^) Warl i Thane 225 16. Sanghavi 1962('^8) Thane 1^ 6. Negi 1976(^'^) Thane ^E 7.0 Kate et al 1978('^5) 51 In this study 25 groups were chosen, these were from different geographic locations in Maharashtra. Most of the tribal groups are restricted to a particular area but scheduled caste groups are spread all over Maharashtra and hence scheduled caste groups were studied separataly from different geographic locations while in all other cases the caste or trjtjal groups were from same area. Fig ^.S.l and ^.2.2 is shows the different caste and tribal groups and their geographic location in Maharashtra. Total 11523 number of individuals were studied from 25 different caste or tribal groups. Sample collection: During each survey, random samples were collected after detailed cUnical eKaminatlon of each subject. For screening abnormal hemoglobins, samples were collected by finger prick method, with all necessary aseptic precautions. About 0.2 to 0.^ ml of blood was collected in 3 to ^ mL anticoagulated normal saline in a 75xl0mm glass test tube. These properly labelled samples were preserved on ice till further processing was undertaken. Analysis : All samples were centrifuged and saline was discarded. The cells were divided in to two parts. One part was hemolyzed using distilled water and haemolysate was used for hemoglobin electrophoresis using cellulose acetate membrane. After electrophoresis, whenever there were two bands or a 52 single band not corresponding to hemoglobin A, was taken as criteriaon for presence of abnormal hemoglobin, and the corresponding preserved cells were subjected to sickling test.( Fig ^.2.3) Whenever sickling test was negative, the sample was subjected to further analysis such as citrate agar gel electrophoresis. Whenever there was no electric supply available, erythrocytes were allowed to settle for E to 3 hours. Saline was removed carefully by pasture pipette and then cells were divided into two parts. One part was haemolyzed using distilled water and electrophoresis was performed using battery operated power pack. 53 Field laboratory o :>^ "O O u Oi u 3 -- e fO IT X) 3 -. ^ It -^ I. C "D £ D 0 rg O 0 fo >« c >» i: I I I I I I I I I — fum-j-in-or^QDO :o^ C -D •- U lU 1) |_ ffl C 1. ft C jjfOTiTJir'^inO'O'B c I I I I I I I I I S 0 0 -• l_ -p -•a)m^in-^r^a3c>o I+- T) u en 0 a -> a 0 '-' L 4) CT U '- r 1) a Xi T) •-• u L cr -P 0 QJ c (D L L —I i*- -p -D -a c en T! C •^ >. 2 -D 0 a 1/1 in -p -p in 01 c na u 0) u D Ul T] LL a r OJ J- LL XI 0 L J3 '^ Ifl £ C U It tJ £ <9 W to a •w •t^ Hi 0) •p •p M •H Ul n] •<-* n fli u n c u c 3 •0 3 y T3 ttj y Q) i-H n ^H 3 01 "-> 3 •a L 0 u T3 it .M • w c 4 S r -? <—4 IB t—1 r u r Qi r <D u y en OJ c 1 1 1 1 r •r< 1 1 1 1 1 1 -p J- in c -I 01 e 0 0 • fH u 4J H- 0! U 0 IP I-* a 3 .—1 0 t L u CT r 0/ a 4J t 1/1 L >« O" u 0 0) -p D> c u U u •^ 01 01 "i- r •p •^ r^ •0 C Qi in c .l-< ;^ J n 0 3 0)• r -p L in l/l P r 4J 1/1 01 c m u HI 1. 3 u> Its Oi 01 r • rt u m u. a E " nj •' ai • 4- w .M u. Fig ^.S.S : Figure showing electrophoratic pattern of mixture of abnormal hemoglobins on cellulose acetate membrane(pH 8.6). Fig h.B.3 i Figure showing hemoglobin electrophoresis pattern of field samples. %^ Table ^.l.E : Data showing sickle cell distribution in present study in different tribal groups of Maharashtra. Sr Name of the Place Total No AA AS •/. Trait No Tribal group Studied 1 Otakar Gadchi roli 102 060 0^1 40.