This study aimed to determine the prevalence of hypertension among tribal adults in Narayanganj block of Mandla District, Madhya Pradesh, India. The researchers conducted a cross-sectional study of 300 tribal adults using random sampling. They found that 22% of participants had hypertension and 31.7% had prehypertension. Risk factors like older age, male gender, alcohol use, and tobacco use were significantly associated with hypertension. The study concluded that hypertension is an emerging health problem among tribal populations and health services need to focus on prevention and management of hypertension and associated risk factors.

1. Title - A Cross Sectional study of Hypertension among
Tribal adults in a Tribal block of Mandla District
Madhya Pradesh
Authors
o Presenting Author - Dr. Rahul Kewal Kumar , Dept. of Community
Medicine, NSCB Medical College, Jabalpur (M.P)
oDr. Rajesh Tiwari , Professor, Dept. of Community Medicine, NSCB
Medical College, Jabalpur
oDr. Asha Ram Tyagi , Asst. Professor , Dept. of Community Medicine,
NSCB Medical College , Jabalpur
oDr. Neeraj Rai, Asst. Professor. Dept. of Community Medicine , NSCB
Medical College, Jabalpur.

2. Introduction
• Hypertension is one of the most Important Public Health
challenges worldwide.
• Ranked third by WHO as a cause of disability adjusted life-year.1
• One in three adults worldwide has raised blood pressure .1
• Treating blood pressure until less than 140/90 mmHg is
associated with a reduction in cardiovascular complications.2

3. Introduction Contd…
Increasing prevalence of hypertension across the time among tribes has
been observed by independent researchers.
 NNMB Tribal Survey - 2008-09 estimated the prevalence of Hypertension
among Tribals as 24 %.3
 S. A. Rizwan et al; (2014) in a study on Indian Tribes found The pooled
estimate of hypertension prevalence was 16.1%.4
 Isolated studies carried out among Lepchas of Sikkim, tribes of Andhra
Pradesh, Rajasthan, and Orissa have documented the hypertension
prevalence in the range of 15 to 42 per cent.5

4. Rationale
Above mentioned studies 5,6,7 suggests that the prevalence of
hypertension is on a higher side among Tribals. Further
studies among the tribal population may reduce the morbidity
& mortality patterns, also ample avenues of prevention of
such silent killer disease could well be explored.

5. Objectives
To find the Magnitude of Hypertension among Tribals
To find the associated risk factors.

6. Material & Methods
• Study Design - Cross sectional study
• Study Area - Narayanganj block of Mandla District
• Study Period - 01 October to 30th September 2015.
• Study Subjects - Adult Tribal subjects
• Inclusion Criteria - Adults who are Permanent Residents

7. Materials & Methods
Exclusion Criteria
• Terminally ill patient
• Mentally Retarded Individuals.
• Pregnant , & Post Partum Females.
• Adults not willing to be the part of study.
• Patients of Hypertension on Medication.
Sample size - N= Z2 PQ/L2
P = Prevalence (25% in rural as estimated by National Nutrition
Monitoring Bureau, NIN ) 6
Q= 100-P
L = Allowable error was 5 ( 20% of Prevalence )
Z = Confidence Level (for 95% confidence limits, it is 1.96)
N= 288 , Rounded off to 300.

8. Study Technique – Multistage random sampling
One Block was randomly selected from the Nine blocks
of Mandla District – Narayanganj Block
10 % of the Villages from the block were chosen for the
study by lottery method.
10 % of 189 Villages = 18.9 , Rounded to 20 Villages
From Each Village 15 study subjects were selected [300
/ 20 = 15] using the pen point drop method to locate
the direction of the first household & Performa was
filled till Fifteen Subjects were Completed.

9. Methodology Contd…
Study Technique
• Personal Interview, Anthropometric measurements & Clinical
Examination
Study Tools
• Blood Pressure Measuring Apparatus (Calibrated)
• Weighing Machine
• Measuring Tape
• Stethoscope
• Pre- Designed Questionnaire
(The operational definition of hypertension was taken from The
Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation, and Treatment of High Blood Pressure.)7
Statistical analysis - Analysis was done using SPSS (Version 20, IBM,
USA) & Epi Info 7 (CDC Atlanta, USA)

10. Results
Table No.1 Distribution of Socio demographic Variables
S. No. Socio demographic Variables Distribution (n= 300)
1. Age in Years a) 18-29
b) 30 - 39
c) 40 – 49
d) 50 – 59
e) ≥ 60
95 (31.6%)
76 (25.3%)
62 (20.6%)
46 (15.3%)
21 (7.0%)
Mean Age = 39.07 ±4.25
2. Gender a) Male
b) Female
127 (42.3%)
173 (57.7%)
3. Education Level a) Illiterate
b) Primary
c) Middle School
d) High sec. & Higher Sec. School
e) Graduate & Above
79 (26.3%)
50 (16.7%)
98 (32.7%)
58 (19.3%)
15 (5.0%)
4. Socio-economic class
(According to Modified B.G Prasad’s Classification)
Class III
Class-IV
Class-V
11 (3.6%)
155 (51.6%)
133 (44.4%)
5. BMI (Kg/M2) a) ≤ 18.49
b)18.5-24.99
c) 25.0-29.99
d) ≥ 30
64 (21.3%)
219 (73.0%)
16 (5.3%)
1(0.34%)

11. Results Contd….
Table No.2 Distribution of Substance of Addiction
S. No. Substance of Addiction Distribution (n=300)
1. Alcohol Yes = 98 (29.3%)
No = 202(70.7%)
2. Tobacco Smoking in any form Yes = 19 (6.3%)
No = 281 (93.7%)
3. Smokeless Tobacco in any form Yes = 182 (60.7%)
No = 118 (39.3%)

12. Results Contd…
TABLE NO.3 DISTRIBUTION OF BLOOD PRESSURE LEVELS AMONG STUDY
SUBJECTS
S. No. Blood Pressure Categories Distribution
(n=300)
Mean Systolic BP
123.0 ± 16.03
Mean Diastolic BP
79.92± 9.86
1. Normal 136 (45.3%)
2. Pre Hypertension 98 (32.7%)
3. Hypertension Stage I 45 (15.0%)
4. Hypertension Stage II 21 (7.0%)

13. Results Contd….
Table No. 4 Distribution Of Hypertension Cases With Associated Risk Factors
S. No. Associated Risk Factors Distribution of
Hypertensive cases
n= 66
Statistical Significance
1. Age in Years a) 18 –29
b) 30 39
c) 40 –49
d) 50 59
e) ≥ 60
08 (12.1%)
12 (18.2%)
17 (25.7%)
18 (27.3%)
11(16.7%)
{χ2 = 31.03, P< 0.001 }
2. Gender a) Male
b)Female
41 (62.12%)
25 (37.88%)
χ2 Males Vs Females =
13.57, P< 0.001
3. Addiction a)Alcohol
b)Tobacco
( Both Smokeless &Smoking)
Yes - 31 (47%)
No - 35 (53%)
Yes - 49 (74.24%)
No - 17 (25.76%)
χ2 = 7.85 , P= 0.0050
χ2 = 3.177 , P= 0.07
4. BMI (Kg/m2) a)≤ 18.49
b)18.5-24.99
c)25.0-29.99
d)≥ 30
19 (28.8%)
45 (68.2%)
2 (3%)
0
χ2 trend among Tribals
with hypertension & Non
Hypertensive Tribals with
BMI = 3.573 , P= 0.058

14. Discussion
Total 66 subjects (22%) were found to be hypertensive and 98
(31.7%) were found to be Pre Hypertensive out of 300.
 NNMB Tribal Survey - 2008-09 found the overall prevalence of
Hypertension among Tribal adults as 24%.5
 Kokiwar Prashant et.al (2012)- 19.04% in rural central India.8
 Basavanagowdappa, et al. (2013) found prevalence among
Jenu Kuruba Tribe was 21.7%.9
 Sachdev et al. (2011) found prevalence in tribal population of
Rajasthan was 16% to 30%.10

15. Discussion Contd…
• Association of Hypertension with age was significant showing
a linear trend of age with hypertension.( P< 0.001 ).
 Basavanagowdappa, et al.(2013) observed that a linear trend
is observed with increase in age.9
 Manimunda et al. (2011) found increasing trend in the
prevalence of hypertension with increasing age.11
 NCD Risk Factor Survey, 2007-08, Madhya Pradesh found the
pattern was increasing with age.12

16. Discussion Contd…
Association of hypertension with Gender
Among 127 tribal male subjects, 41 males were found to be
hypertensive (32.3%) & out of 173 females 25 females were
hypertensive (14.4%).
 Anshuman et al (2015) found higher prevalence of
Hypertension & Pre-hypertension in males in a rural study in
Madhya Pradesh.13
 Gupta et al (2004), Among the rural populations, hypertension
prevalence is 24% in men & 17 % in women.14

17. Discussion Contd…
Alcohol Consumption was significantly associated with
Hypertension.
 Todkar SS et al (2009) found a significant association of
Alcohol intake & Hypertension among Rural people.15
 Praveer Saxena et al;(2012) in Rural Tehri Garhwal found
alcoholism was significantly associated with hypertension.16
Rest of the Variables didn’t show any significance.

18. Conclusion
Hypertension is an emerging health problem among the Tribal Population.
Tobacco & Alcohol Consumption was high. So the Health services are
required to be strengthened to focus more on the changing health needs
in these areas.
Limitations
- The blood pressure measurements were taken during a single visit.
- More Statistical Tests were not applied.
Acknowledgement
We would like to thank Dr. Pradeep Kumar Kasar, Professor & Head, Dept.
of Community Medicine, NSCB Medical College, Jabalpur for his always
available guidance to us.

19. References
• 1. World Health Organization-Global Health Repository, 2012, www.who.int , (assessed on 12th Oct
2014)
• 2.Global Health Observatory (GHO) data,2013 WHO, www.who.int [ accessed on 8thsept 2014]
• 3.NNMB Tribal Survey - 2008-09 Technical Report, National Institute of Nutrition, ICMR, Hyderabad
• 4.S. A. Rizwan; Hypertension in Indian Tribes, PLOS ONE | www.plosone.org 1 May 2014 | Volume 9
| Issue 5 | e95896, Accessed on 8thnov 2014]
• 5.Mukhopadhyay B, Mukhopadhyay S, Majumder PP. Blood pressure profile of Lepchas of the
Sikkim Himalayas: epidemiological study. Hum Biol 1996; 68 : 131-145
• 6.National Nutrition Monitoring Bureau, National Institute of Nutrition. Diet & nutritional status of
population and prevalence of hypertension among adults in rural areas. NNMB Technical Report
No. 24. Hyderabad: National Institute of Nutrition; 2006)
• 7. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and
Treatment of High Blood Pressure: The JNC 7 report. Chobanian AV, Bakris GL, Black HR, Cushman
WC, Green 13. LA, Izzo JL Jr, et al. JAMA 2003; 289:2560-72.
• 8.Kokiwar Prashant et.al;/ Int J Biol Med Res. 2011; 2(4): 950 – 953
• 9.Basavanagowdappa, et al.: Hypertension among Jenu Kuruba Tribe; International Journal of
Health & Allied Sciences • Vol. 2 • Issue 4 • Oct-Dec 2013]
• 10.Bandana Sachdev, Antrocom Online Journal of Anthropology 2011, vol. 7. n. 2 – ISSN: 1973-
2880.

20. References contd…
• 11.Manimunda et al. Association of hypertension with risk factors & hypertension related
behaviour among the aboriginal Nicobarese tribe living in Car Nicobar Island, India. Indian J Med
Res 133, March 2011, pp 287-293
• 12.Integrated Disease Surveillance Project (IDSP)Non-Communicable Disease Risk Factors Survey [
MP-IDSP-NDC] 2005-06. ICMR
• 13.Anshuman Sharma, Sanjay Kumar Gupta, Sanjay S Agarwal, Manmohan Gupta, Shweta
Shrivastava, a study of pre hypertension & hypertension and its associated risk factors in a rural
area of Madhya Pradesh, National Journal of Community Medicine, Volume 6,Issue 2,Apr – Jun
2015.
• 14.R Gupta, Journal of Human Hypertension (2004) 18, 73–78.
• 15.Todkar et al; period prevalence & socio demographic factors of hypertension in Rural
Maharashtra, A cross sectional study Indian Journal of Community Medicine,2009;34(3):183-187
• 16.PraveerSaxena et al; An epidemiology study on rural population of Tehri Garhwal. IJPSM, Vol 43
(2)Apr-Jun 2012: 218-223

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