Diabetes - health programs - India - prevalence - tribe
Introduction
Diabetes mellitus (DM), commonly regarded as a lifestyle disease, used to be a disease
of affluent societies in the days of yore. However, now it has encroached into the
rural and tribal communities as well. Census 2011 data shows low literacy rates among
tribal populations which could expectedly be positively correlated with the less awareness
levels about the disease prevention and healthy behaviors.[1] People in the tribal areas might not be even aware of the free services or facilities
being provided to them. A review of the epidemiology of the diabetes problem in the
tribal areas of the country would help solving this public health problem in a more
efficient way. Hence, we reviewed the available literature to understand the epidemiology
of diabetes burden in tribes of India.
Geography of Tribes
Around 15% of the country′s area is covered by tribals. If we look at the population
composition, they constitute around 8.6% (i. e., ∼104 million) of India′s total population.[2]
[3] The population of scheduled tribes had increased at a growth rate of 23.66% during
the period 2001-2011. More than half the tribal population is confined to the states
of Madhya Pradesh, Maharashtra, Odisha, Rajasthan, Gujarat, Jharkhand, and Chhattisgarh.
The highest percentage of tribal population is in Mizoram (94.43%), while the lowest
is in Uttar Pradesh (0.57%). Tribal population percentage higher than the national
average of the 8.6%, is distributed to the 20 states and 2 union territories (UTs).[4] Tribal populations lag far behind the general population in accessibility to the
essential care. Besides less participation, the low socioeconomic status adds to the
need of special healthcare for this demographic segment of the population.
Epidemiology of Diabetes in Tribes
Epidemiology of Diabetes in Tribes
A study in Telangana which compared the diabetic and prediabetic status of tribal
and nontribal populations showed the prevalence of diabetes among tribals to be almost
similar to that in the rural areas, while the prediabetic status was high and fast
approaching semiurban status. The numbers detected to be diabetics are 4.13% in tribal
and 8.8% in nontribal groups. The total number of diabetics detected in these areas
is 4.95%, while 11.57% were in the prediabetic state.[5] A study was carried out in Himachal Pradesh among 8,000 tribal individuals out of
which 4,000 were living in tribal areas and 4,000 had migrated to urban areas. Overall,
in tribes of urban areas the prevalence of central obesity (59.0%), overweight (29.3%),
and DM (fasting: 7.8%; oral glucose tolerance test (OGTT): 8.5%) was significantly
higher than that in other tribal areas. Based on OGTT, the prevalence of DM was found
to be 9.2% among central obese tribal people of urban area and 6.7% of other tribal
area. DM had shown a significantly high prevalence among the urban tribes.[6] Another study carried out in the Jhunjhunu district of Rajasthan showed the crude
prevalence of type 2 diabetes was 5.2% among tribal population and 0.7% in nontribal
subjects. The risk for diabetes was found to be equal in both tribesmen (3.0%) and
tribeswomen (2.8%). In this study, females were found to have a higher body mass index
(BMI) as compared to males.[7]
Some other studies had also been conducted for assessment of prevalence of the risk
factors of diabetes in tribal area. A study carried out in Mishing tribe of Assam
revealed that 86% reported vigorous physical activity (men 91%, women 82%; P < 0.05).
Sixty-eight percent reported to consume unhealthy diet (less than five servings of
fruits and vegetables per day), 11% had abdominal obesity, 16% were overweight, and
26% had hypertension. Nonusers of tobacco and those who consumed more fruits and vegetables
had higher prevalence of overweight.[8]
A meta-analysis done by Upadhyay et al., revealed the prevalence of DM ranging from
0.7 to 10.1% in tribal population. The prevalence for impaired fasting glucose (IFG)
varied from 5.1 to 13.5% and impaired glucose tolerance (IGT) from 6.6 to 12.9%.[9]
Health Service Needs for Tribal Areas
Health Service Needs for Tribal Areas
It is noteworthy that tribal ancestral lifestyle was dependent on hunting and gathering
food together with cultivation of limited food crops. They have now been forced to
adopt a lifestyle based on cultivation of different crops and low-wage livelihoods
in business, service, and other mixed occupations like mazdoori or labor, etc. Among
the investigated risk factors; increasing age, general obesity (BMI), and consumption
of liquor were found to have a higher contribution to risk for developing diabetes
and hypertension. The incidence rate of type 2 DM and prediabetes are on the increase
among these populations. Previously these populations were free of such kind of lifestyle-oriented
diseases. But nowadays the lifestyle patterns of these populations follows the rural
and urban lifestyles. The reason as quoted above was lack of their own occupation
and were forced to adopt new lifestyles resulting in falling a prey to new kind of
diseases.
Efforts Towards Diabetes Prevention and Control in Tribal Areas in India
Efforts Towards Diabetes Prevention and Control in Tribal Areas in India
Odisha has more than 40 lakh diabetics with incidence ranging from 12 to 16% in urban
areas and 6 to 7% in rural parts. The remote tribal-dominated districts of Odisha
have also marked an alarming rise in diabetes burden. The Odisha government has equipped
district hospitals with advanced diabetes diagnosis equipment and facilities for the
same.[10]
The Tribal Leaders Diabetes Committee (TLDC) provides leadership, guidance, and recommendations
to the Indian Health Service (IHS) on issues related to diabetes and related chronic
health conditions among American Indians and Alaska Natives. The TLDC was created
in 1998 in response to the successful partnership between IHS and tribal leaders in
establishing the process for distributing the Special Diabetes Program for Indians′
funds. It makes recommendations on diabetes-related policy and advocacy issues; provides
advice and guidance to ensure that appropriate cultural traditions and values are
incorporated in program development, research, and community-based activities; and
offers guidance to other organizations.[11]
Government of India launched National Program for Prevention and Control of Cancer,
Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in January 2008 (revised later)
for the control of noncommunicable diseases (NCDs), and this opportunity may be utilized
to strengthen activities against diabetes in tribal areas.[12]
Research Gaps in Tribal Areas
Research Gaps in Tribal Areas
All India Institute of Diabetes and Research and Swasthya Diabetes Hospital have developed
models to improve access to diabetes education, prevention, and care in three distinct
settings - rural districts, tribal blocks, and among the urban poor - in India and
China. The project focuses largely on the parts of western Gujarat and Maharashtra
where tribal population density is high.[13] India Health Study, funded by National Institutes of Health, is a feasibility study
for a prospective cohort in Delhi, India; which involves evaluation of conducting
chronic disease and diet research in India and detailed characterization of the Indian
diet.[14] Many such efforts from the various stakeholder agencies targeting both diabetes
and other NCDs are much needed, specifically in tribal areas.
Conclusion
Prevalence of diabetes in tribal areas ranges from around 1 to 10%. Intensive efforts
directed towards filling the gaps in awareness levels, further surveys, and the operational
research or other data or service gaps are required to prevent and control the problem
of diabetes in tribal areas.
Financial support and sponsorship
Nil.
How to cite this article: Kumar A, Bhatia M, Goel PK, Jain RB. Diabetes in Tribes of India: A literature review.
J Soc Health Diabetes 2016;4:41-3.
