Nutritional and health status of jenukuruba tribal children in Mysore district

Introduction: Nutritional status is a sensitive indicator of community health and nutrition. It has an important role in determining health status especially in tribal children. Objective: This study was done to assess nutritional and health status among Jenukuruba tribal children in Mysore district. Methods: Community based cross sectional study done over a period of 2 years. 4207 children between the age group of 0-15 years of Jenukuruba tribal community were included. All data were recorded in a predesigned proforma. Anthropometric measurements were recorded. Weight for age, Height for age and BMI were calculated. Clinical examination was done to look for anemia, vitamin A deficiency and other morbidities. 24 hours dietary recall method used to assess dietary intake of calories and proteins. Mean energy and protein intake measured and compared with RDA of Indian standards. Results: 1393 (33.1 %) were stunted with height less than 3 centile and 1588 (35.7 %) were underweight with weight below 3 centile using WHO growth charts. 1175(27.9 %) of children were having BMI < 5 centile, 127( 3.3 %) children were overweight with BMI between 85 and 95 centile and 9(0.2%) children were obese with BMI>95 centile. 53.4% were having varying degrees of protein energy malnutrition. 2083(49.5%) of study population had microcephaly. Mean RDA of energy is deficit in all age groups when compared to revised RDA recommended by ICMR in 2010 for Indians. Conclusion: Health and nutritional status of Jenukuruba tribal children is very poor. Immediate appropriate interventional programmes are needed for improving their health and nutritional status.


Introduction
Nutritional status is a sensitive indicator of community health and nutrition and has an important role in determining health status especially in children [1]. This is more so in tribal children due to insufficient food intake, infections, lack of accessibility to health services, illiteracy, unhygienic personal habits, adverse cultural practices etc [1]. According to 2001 census [2] tribal population in India is 74.6 million (8.2% of total population), largest no seen in Madhya Pradesh, Orissa, Jharkhand. There are 573 scheduled tribes in our country and 270 tribal languages have been identified. There are 16 million tribal children (6-14years) among total 193 million children. Total population of tribal is 53 million in Karnataka which is 5.13% of Indian

Methodology
This study was a community based cross sectional study with study population of 4207 children between 0-15 years belonging to Jenu kuruba community in Mysore district. Children were selected by purposive sampling method. Predesigned proforma for data collection was used.
Preliminary site visit and enquiry of local officials, schools was done and all the Jenu kuruba households mainly in H.D. kote, Hunsur, Nanjangud, Periyapatna were listed. Explanation was done in simple language and consent forms were signed by parents for enrolment in the project. Institutional ethical committee clearance was obtained. Information regarding sociodemographic, living conditions was collected by interview method using proforma, dietary pattern by diet survey at household level by 24 hour recall method for 2 days. Standardisation of cups and measures were done periodically and RDA was compared with revised RDA recommended by ICMR in 2010 [3]. History suggestive of any chronic diseases or any acute illness in the past one month was recorded. Socioeconomic status classified using Kuppuswamy's classification modified in 2007 [4] and BG Prasad's classification [5].
Anthropometry: height, weight, chest circumference, head circumference, were recorded by standard methods by senior research fellows and research assistants under supervision of co-investigators using standard techniques. Anthropometric indices like weight for age, height for age, weight for height, BMI were calculated. WHO growth charts and IAP classification of PEM [6] used to classify PEM. Calibration of weighing machines, stadiometers, and measuring tapes are done periodically. Detailed clinical examination was done. Appropriate statistical analysis was done.

Results
Among 4207 tribal children enrolled under project, 2130(50.6%) were boys and 2077(49.4%) were girls with almost equal sex distribution (TABLE I). 96.1% live in a nuclear family with a very low percentage of joint family system ( 3.8 %). Consanguinity rate was very high with 58.8 % having consanguineous marriages. Exclusive breast feeding up to 5-6 months was practiced by 43.7%. Immunization coverage was good with 99.1% receiving primary immunization (TABLE II).   (TABLE III).   (TABLE V). 2083(49.5%) of study population had microcephaly. In the age group of 2-3 years, mean RDA of energy was deficit by 177.2 kcal, in 4-6 years, mean RDA was deficit by 155.2kcal, between 7-9 years, it was 237.5kcal deficit, between 10-12 years, it was 561.1 calorie deficit and 13-15 years deficit was 638.4 k cal when compared to revised RDA recommended by ICMR in 2010 for Indians . Mean intake of protein is more than RDA recommended by ICMR except in the age group of 13-15 years where deficit was by 6.4 gms.

Discussion
India has the second largest concentration of tribal population in the world next to Africa with varying proportions in different states. Undernutrition is an important contributing factor to high mortality in children with mild to moderate malnutrition having relative risk of 2.2 and severe malnutrition having relative risk of 6.8 for death [1]. Undernutrition along with poor environmental sanitation predisposes children to infections.
In this study, Jenu kuruba tribal children in Mysore district are suffering from varying grades of PEM similar to several other studies done in different parts of India [1,[7][8][9][10][11][12][13][14][15][16]. Clinically overt forms of PEM like marasmus and kwashiorkor were not seen in contrast to other studies where it was 0.6% to 1% [1,7]. The food and nutrient consumption was low in all the age groups. High prevalence of anemia was observed in concordance with other study [1]. Prevalence of vitamin A deficiency was very high compared to other study [1,7]. Most of the studies have usually focused on children aged 6 to 72 months, which is the young population most at risk unlike in our study which has included children up to 15 years of age. The finding of a high prevalence of vitamin A deficiency in older children in our study is of concern and warrants further studies. In some older children, Bitot spots can persist after the vitamin A deficiency has been corrected, so it may not be indicative of current vitamin A deficiency. Few studies done in India have shown high prevalence of vitamin A deficiency in older children [17,18]. .2.8% of the children had visible goiter.  95.7% are home deliveries and 9.4% are low birth weight babies with 89.3% not knowing the birth weight of baby reflects the poor health care facility availability, accessibility and maternal and child health awareness among tribal population.

Conclusion
Health and nutritional status of Jenukuruba tribal children is very poor. Immediate appropriate interventional programmes are needed for improving their health and nutritional status.
There is an urgent need to improve the socioeconomic conditions and provision of health care facilities in tribal regions. Health oriented research studies on tribal population help in formulating effective need based health care strategies among various tribal groups in India.