UNIT 3 HEALTH AND NUTRITION OF THE

TRIBALS
Structure
3.0 Objectives
3.1 Introduction
3.2 Health Status of the Tribal
3.3 Factors Influencing Health and Nutrition of the Tribal
3.4 Diet and Nutritional Status of the Tribal
3.5 Health Strategies
3.6 Let Us Sum Up
3.7 Further Readings and References

3.0 OBJECTIVES
Good health is difficult to define, but it is certainly more than just the absence of
disease. It reflects a state of mental, social and physical fitness and well – being
of the individual and is strongly influenced by his or her lifestyle. Health and
nutrition are very intimately related aspects of an individual’s biological status.
Both are under the influence of hereditary and environmental factors.
After reading this unit you will be able to:
 Understand the health status and health problems faced by the tribal
communities,
 Understand the various factors influencing the health of the tribal communities,
 Understand the nutritional status and able to assess the nutritional deficiencies
that characterize the health of the tribal communities, and
 Understand the scope and area of social work intervention in tribal health and
nutrition problems and will be able to develop health strategies on how to
work with the tribal communities.

3.1 INTRODUCTION
Human beings need a wide range of nutrients to lead a healthy and active life and
these being derived through the diet which man consumes daily. Food contains
various substances that are required for growth, development and maintenance of
the body. These substances are called nutrients which are proteins, carbohydrates,
fats, vitamins, and minerals. The amount of each nutrient that is required by man
depends upon his age and physiological status. Adults need nutrients for maintaining
constant body weight and ensuring proper body functions. Infants and young
children who are growing rapidly require nutrients not only for maintenance of
body functions but also for growth. Infants and young children require relatively
more nutrients (2-3 times) per kg body weight than the adults. In special
32 physiological conditions like pregnancy and lactation, adult women need additional
nutrients to meet extra demand for foetal growth and maternal tissue expansion in Health and Nutrition
of the Tribals
pregnancy and milk secretion during lactation. These extra intakes of nutrients are
essential for the normal growth of an infant in uterus and during the early postnatal
life.
Health is a multifaceted aspects and has been defined by WHO as “a state of
complete physical, mental and social well- being and is not merely the absence of
disease or infirmity”. Health and the related problems are very much interlinked
with the socio-economic conditions of the community, particularly the tribes who
are living in remote and inaccessible areas where health care and development
services of the government are not available. So there is an urgent need to
understand the concept of health among tribes and their traditional knowledge and
health seeking behaviour. The health seeking behaviour of the tribal groups is
associated with their beliefs, customs and practices. Health status of different
communities particularly the tribal group is influenced by their way of life including
their social and economic conditions, nutrition and living conditions, dietary habits,
taboos and superstitions, etc.
In this unit we will be discussing on the health and nutritional status, health problems
of the tribal communities in general and the various factors influencing it. Also we
will discuss the urgent and emerging issues concerning tribal health and nutrition.
This will enable us to develop health strategies for social work intervention.

3.2 HEALTH STATUS OF THE TRIBAL

The tribal groups in India inhabit widely varying ecological and geo-climatic
conditions (hills, forests, deserts, etc.) and are at different stages of social, cultural
and economic development process. The scheduled tribes differ considerably from
one another in their biological characteristics, language, cultural practices and
beliefs, and in their socio-economic characteristics. The health of these tribal
groups is a function of the interaction between socio-cultural practices, genetic
characteristics and the environmental conditions (Basu, 1996). The overall health
status of the tribal community is dependent upon the effects of environment in
which they live, genetic characteristics, cultural patterns and the lifestyles of the
tribal groups, health care delivery service in tribal areas, and their detached attitude
largely accepting the modern health care services at the initial stages of the disease.
The problems of tribal health cannot be studied in isolation from the general
population of India. Tribal suffer from the same diseases as others with marked
preponderance of infective over degenerative diseases. The tribals who have
remained isolated will soon be exposed to the rapid pace of development and
industrialization in our country (Tiwari S.C., 1994). The general health problems
of the tribal resemble those of the rural and underprivileged sections of our society.
These comprise malnutrition, anaemia, parasitic infections like diarrhoeal and
respiratory disorders. The life of the tribal is so affected with these disorders, right
from birth that the average life expectancy is much lower in contrast with the
national average of 58-50 years (Verma C Ishwar 1994).
Basu (1996) suggested that there is an urgent need for initiating area specific,
group specific, health need specific, action research studies among the tribal
communities in India so that the health oriented action research studies ultimately
help the authorities in formulating effective need based health care strategies among
various tribal groups in India. Widespread poverty, illiteracy, malnutrition, non- 33
Development of availability of safe drinking water and sanitary living conditions, poor maternal and
Tribals
child health service, ineffective coverage of national health programmes and
consanguineous marriages have been found to affect the health status of the tribal
adversely and also responsible for some of the specific illnesses including genetic
disorders. Unfortunately, proper health services are not available in many of the
tribal areas. Understandably, the common beliefs, customs and practices connected
with health and disease influence their choice of treatment methods. The inadequate
nature of facilities in many tribal areas, lack of respect in the staff manning these
facilities for the indigenous culture and further inadequate attention towards these
patients is often responsible for the non-acceptance and distrust of the tribal
towards the modern medicine.
It has been found that certain states like Madhya Pradesh, Orissa, Rajasthan,
Gujarat, Assam and in some other areas, certain diseases like goitre, yaws, malaria
and guinea-worm are endemic (Government of India, 1989). Primitive tribal groups
of India have special health problems because of their ignorance, unhygienic
conditions, and lack of health education and non-availability of health care facilities
in their habitation areas. There is general agreement that the health status of the
tribal population in India is very poor and many scholars have tried to establish
this with the help of morbidity, mortality and health statistics. The low health status
of tribal community in general is closely linked with factors such as their poverty,
illiteracy, lack of infrastructure facilities for medical care in the area where they
inhabit.
The gradual encroachment by the modern society on the natural resources of the
tribal and depleting them of their habitat and exposing them to the apparently alien
modern acculturation is a continuing stress which could result in a variety of health
problems both mental and physical.
Therefore in order to have a better understanding of tribal health let’s discuss the
tribal concept of health and perception of disease and disease causation along with
the health problems and dimensions.

Concept of Health and Perception of Disease

There are 705 tribes located in five major belts in India. (Census, 2011) Each
tribe is not only geographical specific but also culture specific. Hence what is true
in one case may not be true in the other case. The tribal belief of causation of
disease can be broadly categorized into two areas. They are strong believers of
natural theory of diseases. According to them when man falls out of harmony with
nature, he suffers from illnesses and becomes susceptible to diseases and accidents.
Hence there are the rituals to restore balance and harmony with nature.
Treatment is influenced by the cause of sickness perceived by the group. The
tribals have some scientific knowledge, learnt through traditional experience. This
knowledge is part of their socio-cultural religious system. The treatment procedure
amongst the tribals can be broadly divided into preventive and curative methods.
The preventive procedures include use of charms, amulets, animal sacrifice
propitiations of disease seeking spirits, worship of God-belief in protective function
of rituals. The curative practices include first worship of deities and spirits. To the
tribals religion and medicine are not separate. It has also been found that some
tribals practice their traditional system along with western system of medicine, if
available.
34
Although the concept of well-being and the notion of the disease varies between Health and Nutrition
of the Tribals
different tribal groups, yet in tribal habitat, a person is usually considered to be
afflicted with some diseases if he/she is incapable of doing the routine work which
is usually being expected to be carried out by that individual in the society, i.e.
incapacitation from work is the universal index of poor health. Thus the concept
of ill health becomes functional one and not clinical. This is precisely the reason
among many tribal groups, e.g. Kutia Kondha, Muria, Madia, Bhattra, Halba,
Jaunsari, Santal, Lodha, Kharia, Bhil, Rathwa, Mina, Jatapu, Saora, Pando,
Khairwar, Oraon, Munda, Kinnauras, Dhodias and among many others; symptoms
such as pains and ache, weakness, scabies, prolonged cough, mild fever, wounds,
etc. are not taken seriously as symptoms of disease.
A tribal in general, hardly makes a distinction in the magnitude of fever. However,
within the limits if their own respective worldview, most of the tribal societies have
definite means for identifying and classifying various kinds of aliments and diseases.
It may be worth while to state that at least one component of health is universally
seen among the tribal societies, and that is, committing or omitting certain acts, in
other words breach of trust is thought to bring upon some kind of affliction on the
individual or a family as a whole. Measles, tuberculosis, diarrhea, cholera are
some such diseases where individual’s action may cause some concern to the
family, clan or the village. Interestingly the causation of such disease is independent
of the sanitary condition of the community/individuals. The fate of the individuals
and the community depends on their relationship with unseen force, which intervenes
in human affairs. If human beings offend them, the mystical power punish by
causing sickness, death or other natural calamities. The tribal people believe in the
presence of benevolent and malevolent spirits, the former playing a protective
role, while the latter are considered being responsible for causing disease and
epidemics.
It is common observation across the tribal culture that the ancestral spirits play
important role in the prosperity and protection of the family. And they have to be
properly honored for otherwise they will bring wrath on family members. These
spirits are believed to bring a state of physical, mental and social well-being to the
members of the family. There are many spirits who are feared because of their
power to afflict people by bringing a number of diseases. The role of the spirits,
ghosts and deities in the tribal life in the causation and treatment of diseases is so
important that the local tribal people have to seek the help of traditional diviners,
medicine men, sorcerers (Sirha, Gunia, Bhua, Jani, Bhopa, Ojha, Pujari etc.) for
appeasing, controlling or driving away the disease causing agents. The frequency
of worshipping or getting in touch with malevolent spirits is more common because
of their immediate effect on day-to-day life. Studies indicates that the tribals in
Bastar, Phulbani, Mayurbhanj, Sundergarh, Panchmahals, Purulia, Dumka,
Dehradun, Gadchiroli, Barmer, Valsad, Kinnaur, and Udaipur practices offering
through sacrifice for health related purposes is very common among them.
However, it is important for us to know that the tribal scene in India does not
present a uniform canvas in terms of beliefs and health seeking behaviour. Broadly
speaking, about four different strata of the tribal population have been discerned.
As per the strata their belief system and concept of health and disease do differ.
For example on top of the strata is the acculturates layer who have adopted more
or less the way of life of non-tribal sections forming the upper crust of the society.
They have traveled the farthest from their original tribal habitat. The second are 35
Development of the settled tribes’ agriculturist in the fringe plains who have come quite some way
Tribals
from the tribal highlander; being no longer isolated they are in the process of
transformation. Tribal from the North Eastern parts of India can be categorized in
these two strata because of their lifestyles and belief system. They are much more
advanced than the other tribes in India in terms of their understanding towards
health and disease causation. The third category is that of the highlanders who,
having hardly shifted from their habitat, have undergone little transformation and
may still practice shifting cultivation. The last category is of the still isolated backward
groups, including the so-called “primitive groups”, who are encrusted in their
original habitat, having little exposure and, consequently have preserved their original
socio-economic-cultural traits. The four-fold classification does not represent any
rigid or water tight compartments, but is meant merely for the sake of comprehension
of the scenario in a very general way.

Dimensions of Tribal Health in India

The culture of the community determines the health behaviour of the community
in general and individual members in particular. The health behaviour of the individual
is closely linked to the way he or she perceives various health problems along with
access to various health care institutions.
Primitive tribal group in India have special health problem and genetic abnormalities
like sickle cell anemia, G-6-PD red cell enzyme deficiency and STD. Insanitary
condition, ignorance, lack of personal hygiene and inadequate health education are
the main factors responsible for a majority of health problems.
Some of the problems indicated by investigations in tribal areas include:
(a) Endemic diseases like malaria, introduced from outside or otherwise like TB,
influenza, dysentery, high infant mortality and malnutrition. These diseases
also reflect that there can be the possibility of HIV infection as TB and STD
are found in great number among tribals.
(b) Venereal disease include abortion, inbreeding, addiction to opium, custom of
eating tubers of DIOSCERA (may cause sterility as it contain substances
used in oral contraception).
(c) Nutrition, anemia is a major problem for women in India and more so in rural
and tribal belt. Anemia lowers resistance to fatigue, affects working capacity
under conditions of stress and increases susceptibility to other diseases. Tribal
diets are generally grossly deficient in calcium, vitamin A, B, C riboflavin and
animal protein.
Similarly crude birth practices were found to exist in some tribal groups like
Khurias, Gonds, Santals, Kutia Khondhs of Orissa etc. More than 90 percent of
deliveries are conducted at home attended by elderly ladies of the household. No
specific precautions are observed at the time of conducting deliveries, which resulted
in an increased susceptibility to various infections. These practices also increased
the risk of mother to child transmission of disease like HIV/AIDS. Sexually
transmitted diseases are most prevalent diseases in the tribal areas. Malnutrition
was common and greatly affected the ability to resist infection, leading to chronic
illness and the post weaning period leading to permanent brain impairment. A high
incidence of malnutrition was observed in primitive tribal groups in Phulbani, Koraput
36 and Sundergarh districts of Orissa and also among Bhils and Garasia of Rajasthan
and Padars, Rabrig and Charans of Gujarat and Bondas of Orissa. [NFHS 3 Health and Nutrition
of the Tribals
(2005-06)]
Check Your Progress I
Note: Use the space provided for your answer.
1) Discuss the tribal concept of health and perception of diseases. What are
the major factors responsible for tribal health problems?
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3.3 FACTORS INFLUENCING HEALTH AND

NUTRITION OF THE TRIBAL
India is a signatory to the Alma Ata World Health Organisation (WHO) declaration
of 1978 and committed to attaining the goal of “Health for All” by 2000 A.D
through primary health care approach. However it seems to be a distant dream
seeing the present health scenario of the country. Therefore it is necessary to
realize how complex the subject is. Overall, an average Indian’s health is inferior
to his western and many Asian counterparts. The health of the average present day
tribal is poorer. Time was when tribal was considered synonymous with a healthy
human being. Some writers have dubbed this idea as a myth. However, in order
to proceed to examine the health of the tribal communities, it is well to recognize
it as a product of complex inter-play of several forces and factors some of which
can be spelt out as:
 Physical environment
 Socio-Economic state
 Nutritional availability and dietary habits
 Psycho-social culture
 Health culture and health related behaviour
 Mortality and morbidity patterns
 Genetic disease and disorders
 Tribal Medicine
 Health delivery systems
Let’s have a brief discussion on some of the vital factors influencing the tribal
health.

Physical Environment
Physical environments, has a profound impact on health in multiple ways. In the
case of tribal communities it has more importance as they have a direct and
meaningful relationship with nature. They also derive their means of subsistence
37
Development of from primary sectors like land and forest. They are dependent on the raw, natural
Tribals
resource provided by nature in their surroundings. But, today, such balance with
nature is not very common. By and large, ecosystems have suffered degradation
impairing their viability to support rising population of the tribal communities,
mainly on account of depredations of some non-tribal sections. This factor is of
importance and has been contended with.

Socio-Economic State
Next to availability of resources is the factor of socio economic organization of a
group. It has been observed that relations within a tribal group, particularly a
village community, have generally been permeated by principle of equity tending
towards a socialistic order, ensuring minimal nutritional levels for all members.
Tribal societies have often taken care of the weak and the destitute. Instances
have been cited where the entire village production of grains etc. was distributed
among the members. Such communitarian organizational-cum-distributive practices
have been withering under the impact of the current individualistic-capitalistic trends.

Nutritional Availability and Dietary Habits

Within the framework of availability of food and nutrition, we must take note of
social heritage and dietary habits of tribals. As in respect of any other society tribal
diet is regulated by certain norms and traditions. For instance, the Saora of Orissa
regards drinking milk as taboo. Under the influence of the caste society, some
communities have turned vegetarian like the Tana Bhagat of Bihar and certain
Gonds of Chattisgarh. Nevertheless, a large number of tribal communities are
eclectic in their approach to food which is derived from farm i.e. agricultural
products, as well as forest, catering to both plant and animal nutrition. The
unfortunate fact today is that there has been depletion of both tribal agricultural
land and forest. Despite legal and administrative measures, a sizeable percentage
of his land has slipped away from the tribal. Further, it is well known that
deforestation after independence has taken place on a big scale and, for this
reason and otherwise, there has been large scale destruction of wild life. Shrinking
of these resources has had devastatingly poisonous and depleting effect on
availability of food for the tribal. Further there has been curtailment in the nutrition
which went into the tribal human system through homemade alcoholic beverages.
In overall result, social and medical scientists have reported high incidence of
nutritional deficiency among vulnerable segments viz. infants, children, pregnant
women, nursing mothers.

Genetic Disease and Disorders

There are two genetic disorders, namely sickle cell anaemia and G-6-PD deficiency
found to occur in high frequencies in Scheduled Tribe populations in Indian
subcontinent. Both male and female were equally affected in the case of sickle cell
anaemia whereas males were more affected than females in G-6-PD deficiency
cases. The sickle cell disease was found in 72 district of Central, Western and
Southern India. There were more than 35 tribal population groups showing a
frequency of more than 19 percent. The inter-linkage of some genetic characteristics
with the environment, specific disease endemicity and therapeutic problems, has
to be understood. It appears that some degree of documentation of the nature and
extent of inbreeding among some tribal communities has been done, but many
38 more tribal groups need yet to be studied.
 Health and Nutrition
Tribal Medicine of the Tribals
The tribal systems of medicine, broadly speaking, depend on herbal and psycho-
somatic lines of treatment. Inadequate attention was given to tribal medicine.
Prejudice should not cloud our approach. There is a need to delve into them for
two reasons. One to gain access to the knowledge which this section of humanity
possesses and make the best used of it to their advantage for health care and
development. Second, in the light of the international protocol seeking to take
away this knowledge for profit, it is important to retrieve and preserve tribal
medicine. Hence, intensive and extensive research should be taken up in tribal
medicine to open up new frontiers.

Health Delivery Systems

The design of the health delivery systems in the tribal areas needs to conform to
the socio-economic conditions, morbidity patterns, demographic patterns, terrain
and climate, and other indicators like nutrition status, life expectancy, disability
rates, and alcoholism etc. It should not be just a replica of what obtains in the
other rural areas of the country. Preventive approaches should be given priority
over the curative approaches due to lack of infrastructure and specialized technology.
Immunization programmes for infants and children and various other prophylactic
programmes can pay rich dividend. Secondly, the type of health care personnel
required needs consideration. Cultural differences demand posting of the right
type; inhospitable condition of the tribal areas drive away the usual run of medical
and para-medical staff. As a result health institutions remain unmanned along with
drugs and equipment in short supply.
Check Your Progress II
Note: Use the space provided for your answer.
1) What are the factors influencing health of the tribals?
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3.4 DIET AND NUTRITIONAL STATUS OF THE

TRIBAL
Health is an important aspect of development and nutrition plays a central role in
determination of health and well-being of individuals and affects growth and
development through out the life cycle. Nutritional status of the tribal depends on
the consumption of food in relation to the needs that influences the eco system in
which they live (Mohapatra and Das, 1990). The health problems of the tribals are
profoundly influenced by interplay of socio-cultural and economic factors, which
are quite distressing. Hence, it is necessary to understand the food habits of the
tribals in view of their subsistence economy, social isolation and food insecurity.
Their natural habitat renders them vulnerable to a host of astringent unsanitary
living conditions, wide spread poverty, illiteracy, ignorance, absence of safe drinking
water, lack of personal hygiene and health education, poor utilization of maternal 39
 and child health services and ineffective coverage of health services. A considerable
proportion suffers from malnutrition such as protein-energy and deficiencies of
iron, vitamin A and iodine (Roa et al., 1989; Bulliya et al., 2002). Their common
superstitious beliefs, customs, practice and taboos connected with health and
disease intimately related to treatment of diseases that affect the morbidity and
mortality. Maternal and child care is largely neglected, which is reflected in terms
of high infant mortality and maternal mortality rates (Kumar et al., 1991). Malaria,
meningitis, unspecified fevers, diarrhea, respiratory infections and neonatal tetanus
takes a heavy toll (Basu et al., 1993). A larger number suffers from various
communicable diseases like leprosy, tuberculosis, and venereal disease transmitted
through contact with non-tribals (Swain, et al., 1990). Worm infestations are high
due to semi starvation, inferior food and unhygienic food habits, which in turn
affect nutritional status. The acute food insecurity feature is commonly characterized
with malnourishment, vulnerability and poor socio economic condition. It is reported
that more than half of the tribal population is not consuming the recommended
requirement (Patel, 1985). Their diets are grossly deficient in animal protein, fats
and vital nutrients like calcium, iron, riboflavin and vitamin A. Besides scarcity of
food, they have superstitions and misconceptions regarding food in spite of all
sufferings and starvations. Further extremes of magico-religious beliefs and taboos
tend to aggravate the nutritional problems. A high prevalence of malnutrition is
reported in primitive tribal groups such as Lanjia Saura, Kutia Kondh, and Paudi
Bhuiyan. Protein-energy-malnutrition and iron and vitamin deficiencies are widely
prevalent among preschool children. High rate of micronutrient deficiency is
documented for adolescent girls, pregnant women and lactating mothers (Rao et
al., 1989; Vijayaraghavan et al., 1997). Owing to hard work along with poor
quality of food, females suffer from different ailments since their early age and
survival tasks, which result in inevitable neglect and adverse affect on health during
infancy.

Measure of Nutrition Status

Malnutrition has been defined (Jetliffe, 1966) as a pathological state resulting from
relative or absolute deficiency or excess of one or more essential nutrients, this
state being clinically manifested or detected only by biochemical, anthropometric
or physiological tests.
Clinical examination of individuals is an important practical method of assessing
the nutritional status of an individual and a community. The method is based on
examination for changes, believed to be related to inadequate nutrition, that can
be seen or felt in superficial epithelial tissues, specially the skin, eyes, hair and
buccal mucosa, or in organs near the surface of the body, such as the parotids and
the thyroid glands. Occasionally this may be supplemented in the field by certain
physical tests with or without instrumental aids, such as the testing of the ankle
jerk. This method has the advantage as it is relatively inexpensive as neither
elaborate field equipment nor a costly laboratory is required. Though the method
is simple but it has its own limitations (Jetliffe, 1966).
Age and body weight largely determine the nutrient requirements of an individual.
Body weight and heights of children reflect their status of health and growth rate,
while adult weight and height represent what can be attained by an individual with
normal growth. Height unlike weight, once gained cannot be lost as weight is not
affected by chronic malnutrition. The nutritional goal of any country would be to
40
provide adequate nutrition and health support to its population so that they attain Health and Nutrition
of the Tribals
their full genetic potential in growth and development.
Anthropometric measurement (Vijayaraghavan, Singh and Swaminathan, 1971) of
Indian children up to 14 years belonging to well-to-do groups have shown that
they grow at rates similar to those of children in the developed countries.
Malnutrition in children in the tropics is important not only because it is common
but also because it highlights important relationships between infection, immunity
and nutrition which are of universal application.
All malnourished children show reduced growth and muscle protein deficiency.
Two ‘polar’ types of protein energy malnutrition (PEM) are recognized, they are
Marasmus and Kwashiorkor, but many children have a mixed clinical picture
(Cowen and Heap, 1993).
Marusmus occurs in infant aged under 1 year when maternal milk supply is
interrupted by death or illness and in older children in time of famine. The child
has clearly lost muscle and subcutaneous fat. The skin is dry and wrinkled and
there is no peripheral oedema. The hair is thin and dry. Body temperature is low.
The child looks anxious but moves less than normal and may be hungry, but vomit
any foods offered. Such children are susceptible to diarrhoeal and respiratory
infections, trachoma and vitamin A deficiency.
Children with Kwashiorkor are usually aged 18 months to 4 years and have been
weaned from the mother’s breast. Muscle loss occurs but subcutaneous fat is
preserved, and there is obvious peripheral oedema. The hair is dry, straight and
depigmented. The skin is scaly and glistening, peeling and hyper pigmented,
especially on the legs. The abdomen is distended and the liver enlarged. The child
is fractious and irritable and often has diarrhea. Clinical vitamin A deficiency may
be present.
Children with mixed ‘marasmic kwashiorkor’ have a varied picture with muscle
loss, oedema and damaged skin (Cowen and Heap, 1993). The diagnosis of the
malnutrition syndrome is primarily clinical. Anthropometric documentation is essential
for the individual child and for the study of the community. Body weight on a
centile chart is a measure of current nutritional status. Allowing for the presence
of oedema; body length or height indicates previous progress in growth. Children
with kwashiorkor have low serum albumin, potassium, zinc, magnesium and calcium
levels and low blood sugar, and may be anaemic with defective blood clotting.
The treatment of marasmus requires the provision of adequate nutrients appropriate
to the age of the child, with powder or cow’s milk as the basis, involving the
mother if possible at all stages. The management of kwashiorkor is more
complicated. Clinical dehydration at present should be treated with oral rehydration
solution. Adequate intake of protein and calories require frequent feeds of a
mixture of skimmed milk, vegetable oil and sugar (sucrose or glucose), followed
by cereals, pulses, rice, eggs and meat or fish according to availability. Supplement
of potassium and magnesium and vitamin A are important early treatment and
should be followed with additional iron, folic acid and B vitamins. Children with
kwashiorkor may also have tuberculosis and malaria may also complicate
convalescence (Cowen and Heap, 1993).

41
Development of Prevention of childhood malnutrition in a community depends on :
Tribals
 Adequate community food supplies;
 Education of mothers in the use of nutritious foods which are cheap and
available in their community; and
 Primary health care programmes including monitoring of child development,
treatment of or immunization against common infections, provision of vitamin
A supplements.
In India, prevention of childhood malnutrition is not possible at the present situation
because of the extremely inadequate infrastructure facilities for health care in rural
India, where the people are poor and there are no adequate food supplies in
interior villages, parents are illiterate, primary health centres are almost non-existent
in the village.
Check Your Progress III
Note: Use the space provided for your answer.
1) What do you understand by malnutrition?
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3.5 HEALTH STRATEGIES

Tribal groups of India have specific problems, some of those are built-in problems
of these communities and some are imposed upon them which jeopardize their
overall development and progress inclusive of their health, therefore, the health
care delivery system should be such designed for each specific needs and problems
by bringing their personal involvement. NGOs working for the development and
welfare of the tribal, collaboration of Voluntary Organisation/NGOs should be
secured to integrate and co-ordinate their activities and services with the health
development plan of the Government for the tribal population. The following
strategies may be actively followed by NGO functionaries for the health development
of the tribal population:
a) Socio-Cultural and Environment Awareness
- Formulation of realistic development plans based on needs of specific
tribal group
- Adequate understanding of socio-cultural background of different tribal
groups, perception of diseases, their beliefs and taboos, study of health
culture at micro level. Positive tribal cultural values, traditional skills
should be encouraged and to be inducted to mainstream of life.
- In most of the tribal communities, there are a number of folklores related
to health. Documentation of folklores available in different socio-cultural
systems may provide the model for appropriate health and sanitary
practices in a given eco-system.
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 - Identification of indigenous herbs for medicinal use and their preservation Health and Nutrition
of the Tribals
and documentation in the light of the TRIPS agreement.
- Development of ethno-botanical and ethno-zoological museum at the
divisional headquarters, collection, preservation and display.
- Efforts on sanitation, personal hygiene, provision of safe drinking water,
dispelling the misbeliefs and taboos, magico-religious practices etc.,
awareness of hazards of consanguineous marriages.
b) Nutrition
- Development of horticulture with emphasis on local fruits.
- Introduction of Integrated Child Development Scheme (ICDS) in all
blocks (basically strengthening the existing Government resources).
- Development of poultry and fisheries.
- Study of nutritional status and physical growth.
c) Maternal and Child Health
- Hundred per cent immunization of mothers and children with special
emphasis on measles vaccination.
- Strengthening the services of the existing health programmes related to
mother and child health and ensuring the services are accessible and
available.
- Distribution of Vitamin A.
- Oral rehydration therapy and education.
d) Genetic Disorders
- To hold training camps of medical staff for awareness of genetic disorders
and marriage counseling.
- Training of laboratory technicians in the technique of simple genetic tests
like sickling, G-6-PD enzyme deficiency etc.
- Screening of villages for sicklers and G-6-PD deficient individuals,
identified persons can be tattooed with dot marks.
e) Health education
- Chapters on horticulture, poultry, immunization, common diseases, genetic
disorders, ORS, hygiene, sex education etc. may be included in the
Middle and High school syllabus.
- Distribution of leaflets and playing of audio and, where possible, video
cassettes preferably in local dialects in weekly markets, ghotuls, schools
etc.
- Development of effective communication strategies on health education
and health care among tribal groups.
f) Training
- Organisation of short term orientation courses on tribal culture for health
workers at district and sub-divisional headquarters.
- Identification of traditional health practitioners and their training in public
health. 43
Development of - Training of tribal girls as nurses, midwives to generate better response.
Tribals
- Strengthening of tribal research institutes which may serve as base
laboratories.
g) Other Measures
- In difficult tribal/hilly areas, Mobile health teams should be formed to
provide professional services for medical care and research and collect
health information.
- In tribal areas, “Haats” (weekly market centres) are the focal point of
activity. Each “Haat” should be provided with a Primary Health Centre
(PHC).
- As some Primitive tribal Groups are reported to be stagnant or declining,
efforts should be made to delineate the causative factors.
Check Your Progress IV
Note: Use the space provided for your answer.
1) What intervention strategy may be followed to promote health and prevent
malnutrition among tribal communities in India?
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3.6 LET US SUM UP

General health status of the tribal is poor as compared to the modern society.
They may suffer from some distinct health problems, not because they have some
specific type of health, but because of specific placement in difficult areas and
circumstances, in which they live. Also because of the widely varying geo-climatic
and ecological conditions the different tribal societies depending on their uniqueness
may have some specific health issues and problems of their own. We often tend
to forget that till a few decades ago, the small tribal population did not exert any
undue pressure on land, forest and other similar natural resources. The tribal
health in India unfortunately was never taken seriously. The nutritional problems of
different tribal communities located at various stage of development were full of
obscurities and a very little scientific information on dietary habits and nutritional
status were available due to lack of systematic and comprehensive research
investigations. Though some intensive field work has been done by social scientists
but some of the studies treated the problem of the tribal health in peripheral and
casual manner. For a meaningful understanding of the tribal health, it is important
to understand the people themselves their indigenous medicines and understand
how under the existing social, economic and cultural setting these needs can be
best met to the satisfaction of people themselves.

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 Health and Nutrition
3.7 FURTHER READINGS AND REFERENCES of the Tribals

 Basu Salil (Ed) (1994). Tribal Health in India, Manak Publications Pvt. Ltd.,
Delhi.
 Behera Kumar Deepak and Pfeffer (Ed) (1999). Contemporary Society:
Tribal Studies, Vol 1 to Vol 4, Concept Publishing Company, New Delhi.
 Chaudhuri Buddhadeb (Ed) (1990) Cultural and Environmental Dimension on
Health Inter-India Publication, New Delhi.
 Mahanti Neeti (Ed) (1994). Tribal Economy Health and Wasteland
Development, Inter-India Publications, New Delhi.
 Singh Bhupinder and Neeti Mahanti (Ed) (1995). Tribal Health in India,
Inter-India Publications, New Delhi.
 Mahapatra, D.K., J.Das (1990): Nutritional Ecosystem of Orissa in Cultural
and Environmental Dimension on Health (ed. Buddhadeb Chaudhuri).
Inter-India Publication, New Delhi.
 Swain, S.C., S.C Jena and P. Singh (1990): Morbidity Status of Kondha
tribes of Phulbani (Orissa). In Cultural and Environmental Dimension on
Health (ed. Buddhadeb Chaudhuri). Inter-India Publication, New Delhi.
 Tiwari, S.C (1994) Socio- cultural and Genetico-environmental
determinants of tribal health: measures for health development – “Tribal
Health in India”: edited by Salil Basu; pp.285-294.
 Ishwar C Verma, (1994) Medico-Genetic Problems of Tribal Communities-
A challenge for Indian Scientist - “Tribal Health in India”: edited by Salil
Basu; pp. 260-267.
 Government of India (1989): Report of the Working Group on Development
and Welfare of Scheduled Tribes during Eight Five Year Plan (1990-1995).
Government of India, Ministry of Welfare (November 1989): New Delhi.
 Jetliffe, Derrick B (1966): The Assessment of the Nutritional Status of the
Community (with special reference to field surveys in developing regions of
the world). World Health Organization: Geneva.
 Vijayaraghavan, K., Darshan Singh and M.C. Swaminathan (1971): Heights
and Weights of well-nourished Indian children. Indian Journal of Medical
Research, 59: 643.
 Cowen, G.O. and B.J. Heap (1993): Clinical Tropical Medicine, (First Edition).
Chapman and Hall: London.
 Patel, Shrisha (1985): Ecology, Ethnology and Nutrition: A Study of Khondh
tribals and Tibetan refugees. Mittal Publication, Delhi.
 Bulliya Gandham (2003): Secular deterioration in nutritional status of young
children: An alarming menace for the state of Orissa. Man in India, 83(1&2)
49-71.
 Basu. S.K. et al. (1993): Socio-cultural dimensions, demographic features,
maternal and child health and sexually tranmitted diseases in Santals in
Mayurbahnj district, Orissa.

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