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233
Journal of Dr. NTR University of Health Sciences 2012;1(4): 233-238
Address for correspondence
Dr. Syed Sadat Ali,
Department of Physiology, Dr. B. R. Ambedkar Medical College,
Kadugondana Halli, Bangalore, India.
E-mail: drsadatali@gmail.com
Morbidity pattern in tribals and non tribals above
the age of 5 years of Gundlupet forest area, Mysore
district, India
Sarjapura V. Divakar, P. A. Balaji1
, Syed Sadat Ali1
Departments of Preventive and Social Medicine, 1
Physiology, Dr. B. R. Ambedkar Medical College, Bangalore,
Kadugondana Halli, Bangalore, India
ABSTRACT
Background and Objectives: According to 2001 census conducted by Government of India, more than 8.2% of the total Indian
populationconstitutesof tribals.Reliableandcomprehensivedataondiseaselevel,patternsandtrendsintribalareasarerequiredtomonitor
local epidemics and to assess the effectiveness of public health programs to prevent and control diseases. There are very few studies done
to assess the health status and morbidity pattern among the tribal and non tribal population and it prompted us to undertake this study.
Materials and Methods: A cross-sectional study was carried out between March 2010 - January 2012 in the forest areas of
Gundlupettaluk, Mysore, India. Of the 33 tribal hamlets present, 18 hamlets were selected at random and the villages adjacent to
these hamlets were included in non tribal population constituting intended homogenous population without mix up. Data were
statistically analyzed using SPSS-I. The standard normal test (Z) was used to compare the equality of proportions having specific
type of diseases among tribal and non tribal population. P value of < 0.05 was considered to be statistically significant.
Results: Observations from our study revealed statistically significant proportion of Skin disorders and Dental disorders (P < 0.05)
among tribal population compared to non tribal population. Nutritional deficiency, Respiratory infections, Intestinal disorders,
Ophthalmic disorders and ENT disorders were also prevalent among both the tribal, as well as non tribal population, however, the
difference in proportions between tribal and non tribals were not statistically significant.
Conclusion: There was increased prevalence of morbid conditions like skin disorders and dental disorders among tribal population
compared to non tribal population. Further research surveys among tribal population, elucidating the health status and insighting the
probable reasons behind morbidty and mortality thus highlighting a need for an integrated approach towards reducing the morbidity
rates and improving the health, as well as nutritional status in tribal population would be invaluable.
Key words: Morbidity, non tribals, nutrition, tribals
INTRODUCTION
Tribals are a social group residing in definite area away
from civilization and have cultural homogenecity and
unifying social organization. India is home to 84.33
million people classified as tribals, corresponding to
8.2% of the total population. There are 461 groups
of tribes who are spread over 26 states and Union
Territories with majority (87%) found in central belt
of the country. Included in these categories are 74
tribes who have been identified as Primitive Tribal
Groups (PTG, now called Particularly Vulnerable
Group) characterized by pre-agricultural levels of
technology, extremely low level of literacy and
extreme poverty.[1]
In general, they live in isolated, scattered and difficult
to reach terrain generally near hills and shrinking
forests on which they depend for their livelihood.
Majority of tribal literacy is meager and exist below
poverty line making the economic, education and
Original
Original Article
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DOI:
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Divakar, et al.: Morbidity pattern in tribals and non tribals
Journal of Dr. NTR University of Health Sciences 2012;1(4)
nutritional status worse compared to the general
population.[1]
In most tribal communities, medical care, treatment
and etiology of disease are defined within the social
context. It is important to identify processes by which
tribalsrecognize sickness and the ways to counteract
it. The illness could well be attributed to the evil
eye, magic or offending some deity, the treatment for
which could be through folk medicine or magico-
religious methods. Religious rites are used mainly to
treat diseases like small pox and propitiating the deity
concerned, most of which tribals believe can cure the
plagues, which are associated with various diseases. No
comprehensive strategy has been formulated to deal with
tribal health problems, as there is not enough knowledge
available on their customs, beliefs and practices, which
are intimately connected with the treatment of disease.[2]
Further, there is a broad understanding of health
problems and morbidity of the general population,
particularly of urban and rural communities, but such
information on tribal population is limited. Studies
pertaining to morbidity among different tribal groups
are very few, and lack of comparisons because of
different criteria. Hence, the present study was carried
out to study the morbidity pattern among tribals and
compare with non tribals.
MATERIALS AND METHODS
The present study was carried out between March 2010
and January 2012 in the forest areas of Gundlupettaluk,
Mysore. Ethical clearance was obtained from
institutional ethics committee of DR. B R Ambedkar
Medical College, Bangalore. Of the 33 tribal hamlets
present, 18 hamlets were selected at random to obtain
33% sample of the total available tribal population.
Correspondingly, the villages adjacent to these hamlets
were included in the study as non tribal population
constituting intended homogenous population without
mix up. After obtaining consent, data was collected
through house to house visits by individual and family
scheduling. Laboratory parameters performed in our
study were Hemoglobin estimation by Tallquist’s
method, peripheral blood smear was done in suspected
cases of fever, example: Malaria. Detailed general
and systemic examinations of all the systems of both,
tribal and non tribal population were performed by
same group of competent doctors. The diagnosis of
morbid conditions were mainly based on history and
clinical finding by competent doctors. As it was a
cross-sectional survey involving forest region, only the
above limited laboratory parameters were assessed.
Some of the diseases were persisting for longer
duration as per the history obtained and when we
examined, they had presented with similar symptoms
and corresponding clinical signs. Example, dental caries
persisted from long duration, scabies also had persisted
similarly and so on. Hence, all the data collected
accounted for the prevalence of the disease rather than
incidence of the different morbid conditions.
Random stratified sampling based on age groups
was done to show the morbidity patterns among
different age groups. Proportion of overall morbidity
(diseases) wise grouping comparing that among tribals
and non tribals was also done in case of individuals
presenting one or more disease states simultaneously
[Figures 1-3].
Statistical analysis
Data were statistically analyzed using software
Statistical Package for the Social Sciences (SPSS-I).
The standard normal test (Z) was used to compare the
equality of proportions having specific type of diseases
among tribal and non tribal population. P value of
< 0.05 was considered to be statistically significant.
RESULTS
Of the proposed 2050(33.04%) sampled population,
1870(30.14%) could actually be studied because of
non-response from 8.78% sampled population who
were absentees during repeat visits [Table 1].
Figure 1: Morbidity pattern comparing between tribal and non tribal
population
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Divakar, et al.: Morbidity pattern in tribals and non tribals
235
Journal of Dr. NTR University of Health Sciences 2012;1(4)
Tribal – About 47.52% of tribal population had
suffered once from one or other type of illness and
27.24% had suffered from more than one illness
during last 12 months. Average number of episodes
suffered per ill person was 2.22%. Major sicknesses
reported at the time of survey among tribal populations
were nutritional deficiencies (14.68%), skin infections
(12.78%), diarrheal disorders (12.25%) followed by
dental disorders (10.98%).
Non tribal
About 50.05% of non tribal population had suffered
once from one or more illness and 16.68% had
suffered from more than one illness during last
12 months. Average number of episodes suffered per
ill person was 1.64%. The sicknesses reported among
non tribal population were respiratory infections
(12.78%), nutritional deficiencies (12.57%), diarrheal
disorders (10.22%) and dental disorders (5.2%).
Among intestinal disorders, diarrhea and parasitic
infestations were more common among (15.63%)
tribal respondents as compared to nontribal (14.63%)
population and this difference was statistically not
significant (P > 0.05).
Concerned to ophthalmic diseases, more tribals (2.85%)
compared to non tribals (2.17%) had eye diseases. This
difference was statistically not significant (P > 0.05).
Due to wide range of age group, cataract accounted
less percentage and it was observed that 21 (2.64%)
tribals and 16 (1.73%) non tribals who had cataract
were above the age of 60 years. The other eye disease
detected was conjunctivitis which accounted for very
meager percentage of total morbidity status among
both tribal and non tribal population in the younger and
middle age groups.
Among the skin disorders, 10.45% of the tribals were
found to have scabies compared to 1.62% among
non tribals and the difference was highly statistically
significant (P < 0.01). Other skin infections like
eczema and pyoderma were very meager in proportion.
Majority of morbid conditions among different
age groups showed an increased preponderance
among the two extremities of the age groups of
the study population that is the age group between
5 to 15 years and age group above 60 years
[Tables 1 and 2] presented with greater proportion
of morbid conditions among both the tribal and non
tribal population when compared to all the other age
groups as depicted in the Tables 3, 4 and 5.
TABLE 1: DISTRIBUTION OF THE TOTAL STUDY POPULATION
Population studied Area Total population Sampled Non responses Studied
Tribal Hamlets-18 2929 970(33.12) 23 947(32.3)
Non tribal Villages-28 3276 1080(32.97) 157 923(28.17)
Total 6205 2050(33.04) 180 1870(30.14)
Figures in parenthesis indicate percent
Figure 3: Distribution of morbidity patterns in different age groups
among non tribal population
Figure 2: Distribution of morbidity patterns in different age groups
among tribal population
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Divakar, et al.: Morbidity pattern in tribals and non tribals
Journal of Dr. NTR University of Health Sciences 2012;1(4)
TABLE 5: DISTRIBUTION OF MORBIDITY PATTERNS IN DIFFERENT AGE GROUPS AMONG NON TRIBAL
POPULATION
Age group (years)
Morbidity 5-15 16-25 26-45 46-60 >60 Total
Nutritional deficiency 40 18 30 12 16 116(12.57)
Respiratory infections 16 11 24 31 36 118(12.78)
Intestinal disorders 42 15 27 16 35 135(14.63)
Skin disorders 15 07 08 12 09 51(5.52)
Ophthalmic diseases 02 01 01 - 16 20(2.17)
Ear nose throat diseases 11 6 4 01 4 26(2.82)
Dental disorders 10 09 11 06 12 48(5.20)
Figures in parenthesis indicate percent
TABLE 4: DISTRIBUTION OF MORBIDITY PATTERNS IN DIFFERENT AGE GROUPS AMONG TRIBAL POPULATION
Morbidity Age group (years)
5-15 16-25 26-45 46-60 >60 Total
Nutritional deficiency 41 13 34 15 36 139(14.68)
Respiratory infections 37 21 16 10 19 103(10.88)
Intestinal disorders 43 23 32 16 34 148(15.63)
Skin disorders 16 11 31 24 39 121(12.78)
Ophthalmic diseases - 02 - 04 21 27(2.85)
Ear nose throat diseases 12 5 4 2 6 29(3.06)
Dental disorders 13 15 32 15 29 104(10.98)
Figures in parenthesis indicate percent
Individuals with more than one disease condition
simultaneously among tribal and non tribal population:
Table 6 depicts that among tribal population,
258 (27.24%) had suffered from more than one
disease and among non tribals, 154(16.68%) had
suffered from more than one disease with Z value
of 5.55 and the observed difference was statistically
significant with P < 0.01.
Based on application of chi-square test except
with regard to nutritional disorders, there was no
statistically significant difference in the proportion
of morbidity status between males and females
in both tribal, as well as in non tribal population.
Nutritional disorders were more prevalent among
females compared to males in both tribal, as well as
non tribal population with P < 0.05 of significance.
Peripheral blood smear was done in suspected cases
of fever, example: Malariabut there wasno positive
cases found in both tribal and non tribal population.
DISCUSSION
The present cross-sectional comparative study was
carried among tribals and non tribals residing at
TABLE 3: MORBIDITY PATTERN IN STUDY POPULATION
Morbidity Tribal Non tribal Z value P value
Nutritional deficiency 139(14.68) 116(12.57) 1.32 0.23
Respiratory infections 103(10.88) 118(12.78) 1.27 >0.2013
Intestinal disorders 148(15.63) 135(14.63) 0.61 >0.5455
Skin disorders 121(12.78) 51(5.52) 5.43 <0.00006*
Ophthalmic diseases 27(2.85) 20(2.17) 0.95 >0.3446
Ear nose throat diseases 29(3.06) 26(2.82) 0.31 >0.7539
Dental disorders 104(10.98) 48(5.20) 4.57 <0.000005*
Figures in parenthesis indicate percent, *= highly statistically significant
TABLE 2: DISTRIBUTION OF STUDY POPULATION
ACCORDING TO AGE
Age group(years) Tribals Non tribals
5-15 190(20.06) 210(22.75)
16-25 163(17.21) 177(19.18)
26-45 300(31.68) 268(29.04)
46-60 88(9.29) 103(11.16)
>60 55(5.81) 76(8.23)
Figures in parenthesis indicate percent
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Divakar, et al.: Morbidity pattern in tribals and non tribals
237
Journal of Dr. NTR University of Health Sciences 2012;1(4)
Gundlupettaluk of Mysore district to study the
morbidity pattern among tribals and non tribals aged
above 5 years. While studying the morbidity pattern
in the study population it was found that 73.92%
tribal and 63.92% non tribal study population reported
illness during past 12 months.
Nutritional deficiencies
More tribal (14.68%) compared to (12.57%) non
tribal population suffered nutritional deficiencies.
However, this observed difference was statistically not
significant (P > 0.05). Hanumantha R observed that
12.4% tribals of Jenukurabas of Karnataka, compared
to 7.2% among non tribal counterparts suffered from
nutritional deficiencies.[3]
In a study conducted involving southern Indian
tribes, malnutrition was pervasive among tribals and
deficiencies in gross amounts of calcium, vitamin
A, vitamin C, riboflavin, and animal protein were
observed and also were known for their caloric and
protein deficiencies.[4]
Respiratory infections
These were reported more (12.78%) by non tribal
compared to (10.88%) tribal counterparts and this
difference was statistically not significant (P > 0.05).
In a ICMR study (1990) indicated among the tribes
of Morena district of Madhya Pradesh, 7.1% of them
suffered from respiratory infections.[5]
The respiratory
disease including upper respiratory tract infection was
more commonly prevalent(14.9% in Bondo, 16.6% in
Didayi, 13.6% in Kondha and 8.3% in Juanga) and
similar observations were made in Birhor (11.2%) and
Sahariya (56.9% inchildren aged 5-14 years) tribes of
Madhya Pradesh.[6,7]
Skin disorders
More tribal (12.78%), as compared to (5.52%)
non-tribal respondents had skin infections and
this difference was highly statistically significant
(P < 0.01). Among the skin infections, scabies was
found to be highly prevalent. Saraswathi S reported
that skin infections were 13.74% among Desikonda
tribes, while it was 13.15% among Kutiakondha
tribes.[6]
Ina data collected at Regional medical
research centre (RMRC), Bhubaneswar, 20.6% of
Bondo, 6.9% of Didayi, 10.7% of Juanga and 15%
of KutiaKondha tribes wereaffected with scabies
(both infective and non-infective), whichis comparable
with the findings in Birhor primitive tribe (7%) of
Madhya Pradesh.[6]
Ophthalmic diseases
More tribal (2.85%) compared to non tribal (2.17%)
had eye diseases out of which tribal (2.64%) and
non tribal (1.73%) had cataract but this difference
was statistically not significant (P > 0.05). 33%
Desikondatribals, 32.33% of Kutiakondha tribes of
Orissa suffered from eye diseases was reported by
Saraswathi S.[8]
Rajalakshmi reported that 23% of
Santal tribes of Bihar suffered from eye diseases as
compared to their (27%) non tribal counterparts.[9]
Ear nose and throat
Disorders were reported more among tribal (3.06%)
compared to (2.82%) non tribal counterparts and this
difference was statistically not significant (P > 0.05).
Rajalakshmi reported that 14% of Santal tribes of Bihar
suffered from ear nose throat diseases as compared to
their (15%) non tribal counterparts.[9]
Dental disorders
Among tribal 10.98% had dental caries while 5.20% of
non tribal and this difference was statistically significant
(P < 0.05). Saraswathi S reported that dental infections
were 58.62% among Desikonda tribes while it was
62.90% among Kutiakondha tribes.[8]
Intestinal disorders
Among this category, worm infestations were more
common among (15.63%) tribal respondents as
compared to non-tribal (14.63%) population and this
difference was statistically not significant (P > 0.05).
We did not find any concordant study depicting worm
infestation among tribal and non tribal population
above the age of 5 years. However, we found many
studies observed intestinal worm infestation among
under five years age group.
CONCLUSION
Our study revealed statistically significant proportion of
TABLE 6: PROPORTION OF INDIVIDUALS WITH MORE
THAN ONE DISEASE STATES SIMULTANEOUSLY
AMONG TRIBAL AND NON TRIBAL POPULATION
Morbidity pattern Tribal Non tribal Z value P value
Individuals with
more than one
disease condition
simultaneously
258(27.24) 154(16.68) 5.50 <0.01
Figures in parenthesis indicate percent
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Divakar, et al.: Morbidity pattern in tribals and non tribals
Journal of Dr. NTR University of Health Sciences 2012;1(4)
Skin disorders and Dental disorders (P < 0.05) among
tribal population compared to non tribal population.
Nutritional deficiency, Respiratory infections, Intestinal
disorders, Ophthalmic disorders and ENT disorders
were also prevalent among both the tribal, as well
as non tribal population, however, the difference in
proportions between tribal and non tribals were not
statistically significant (P > 0.05). Morbidity pattern
including nutritional status is a sensitive indicator
of community health and nutrition.[10]
Hence, further
research surveys among tribal population, elucidating
the health status and in sighting the probable reasons
behind morbidty and mortality status, thus, highlighting
a need for an integrated approach towards reducing
the morbidity rates and improving the health, as well
as nutritional status among tribal population would be
invaluable.
Limitations
1. Cross-sectional study was conducted due to
paucity of time and man power. Comparatively, a
longitudinal study is a better indicator of health
problems in a study population.
2. Morbidity status of the study population
was assessed by relevant history and clinical
examination, but it was not supported by
laboratory parameters.
3. A diet survey could not be conducted.
Recommendations
1. A longitudinal study is indicated to study the
incidence of morbidities among children below the
age of 5 years in tribal and non tribal population.
2. An in-depth study is suggested to study the
traditional mores and its impact on health, literacy
status and its influence on their health and
economic status.
3. A comprehensive control strategy with specific
interventional measure need to be evolved and
implemented specially in tribals as serious efforts
for their overall development.
4. Efforts to be taken to tackle non-responses from
both tribal, as well as non tribal population.
ACKNOWLEDGEMENTS
We acknowledge Mr. M. Puttaswamy, Assistant professor in
community medicine and statistician for his kind support in
regard to statistical analysis.
REFERENCES
1. Report of the study to understand the Health status and healthcare
systems in selected tribal areas of India. 2009. Available from:
http://www.cccindia.net/Health_Systems_Report.pdf. [Last accessed
on 23rd July 2012].
2. Rudraiah N, Vortmeyer D, Veena BH. Influence of electric field
on the unsteady dispersion coefficient in couple-stress flow.
Biorheology1988;25:879-90.
3. Rudraiah N, Vortmeyer D, Veena BH.Biorheology. Hyderabad:
National Institute of Nutrition, ICMR; 1988.
4. Basu SK. A health profile of tribal India. Health Millions1994;2:12-4.
5. ICMR. Nutritional deficiency in Astinabad village, Port Blair Annual
report;1990.
6. Annual Report. Jabalpur: Regional Medical Research Centre for
Tribals; 1993.
7. Annual Report. Jabalpur: Regional Medical Research Centre for
Tribals; 1999.
8. Saraswathi S. Health and population prospective and issue. Health
status of tribal population in Orissa. Problems and Perspectives
1990;13:171-78.
9. Rajalakshmi C. Santal women; Areas of health ignorance. Social
Change 1992;2:12-23.
10. Rao VG, Yadav R, Dolla CK, KumarS, Bhondeley MK, U key M.
Undernutrition & childhood morbidities among tribal preschool
children. Indian J Med Res 2005;122:43-7.
How to cite this article: Divakar SV, Balaji PA, Ali SS. Morbidity pattern
in tribals and non tribals above the age of 5 years of Gundlupet forest
area, Mysore district, India. J Dr NTR Univ Health Sci 2012;1:233-8.
Source of Support: Nil. Conflict of Interest: Nil.
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Morbidity pattern in tribals and non tribals above the age of 5 years of Gundlupet forest area, Mysore district, India Sarjapura V. Divakar, P. A. Balaji1 , Syed Sadat Ali1

  • 1. 233 Journal of Dr. NTR University of Health Sciences 2012;1(4): 233-238 Address for correspondence Dr. Syed Sadat Ali, Department of Physiology, Dr. B. R. Ambedkar Medical College, Kadugondana Halli, Bangalore, India. E-mail: drsadatali@gmail.com Morbidity pattern in tribals and non tribals above the age of 5 years of Gundlupet forest area, Mysore district, India Sarjapura V. Divakar, P. A. Balaji1 , Syed Sadat Ali1 Departments of Preventive and Social Medicine, 1 Physiology, Dr. B. R. Ambedkar Medical College, Bangalore, Kadugondana Halli, Bangalore, India ABSTRACT Background and Objectives: According to 2001 census conducted by Government of India, more than 8.2% of the total Indian populationconstitutesof tribals.Reliableandcomprehensivedataondiseaselevel,patternsandtrendsintribalareasarerequiredtomonitor local epidemics and to assess the effectiveness of public health programs to prevent and control diseases. There are very few studies done to assess the health status and morbidity pattern among the tribal and non tribal population and it prompted us to undertake this study. Materials and Methods: A cross-sectional study was carried out between March 2010 - January 2012 in the forest areas of Gundlupettaluk, Mysore, India. Of the 33 tribal hamlets present, 18 hamlets were selected at random and the villages adjacent to these hamlets were included in non tribal population constituting intended homogenous population without mix up. Data were statistically analyzed using SPSS-I. The standard normal test (Z) was used to compare the equality of proportions having specific type of diseases among tribal and non tribal population. P value of < 0.05 was considered to be statistically significant. Results: Observations from our study revealed statistically significant proportion of Skin disorders and Dental disorders (P < 0.05) among tribal population compared to non tribal population. Nutritional deficiency, Respiratory infections, Intestinal disorders, Ophthalmic disorders and ENT disorders were also prevalent among both the tribal, as well as non tribal population, however, the difference in proportions between tribal and non tribals were not statistically significant. Conclusion: There was increased prevalence of morbid conditions like skin disorders and dental disorders among tribal population compared to non tribal population. Further research surveys among tribal population, elucidating the health status and insighting the probable reasons behind morbidty and mortality thus highlighting a need for an integrated approach towards reducing the morbidity rates and improving the health, as well as nutritional status in tribal population would be invaluable. Key words: Morbidity, non tribals, nutrition, tribals INTRODUCTION Tribals are a social group residing in definite area away from civilization and have cultural homogenecity and unifying social organization. India is home to 84.33 million people classified as tribals, corresponding to 8.2% of the total population. There are 461 groups of tribes who are spread over 26 states and Union Territories with majority (87%) found in central belt of the country. Included in these categories are 74 tribes who have been identified as Primitive Tribal Groups (PTG, now called Particularly Vulnerable Group) characterized by pre-agricultural levels of technology, extremely low level of literacy and extreme poverty.[1] In general, they live in isolated, scattered and difficult to reach terrain generally near hills and shrinking forests on which they depend for their livelihood. Majority of tribal literacy is meager and exist below poverty line making the economic, education and Original Original Article Article Access this article online Quick Response Code: Website: www.jdrntruhs.org DOI: 10.4103/2277-8632.105109 Downloaded from http://journals.lww.com/jntr by pdF35RGXLlHl4ekKGiVeVoWG1zq0I4i+WFqUqk1ZKYbM4WE7Vpag 1f1q0dHg6Ewd1KWqqDurPHlqp2xIdzNBygEcbTO3di6TGUNEI0DKFohc6TZBjLTYDINTDOcF1Au6s1f61B+LF9/wJPgD+jpEAw== on 09/02/2023
  • 2. 234 Divakar, et al.: Morbidity pattern in tribals and non tribals Journal of Dr. NTR University of Health Sciences 2012;1(4) nutritional status worse compared to the general population.[1] In most tribal communities, medical care, treatment and etiology of disease are defined within the social context. It is important to identify processes by which tribalsrecognize sickness and the ways to counteract it. The illness could well be attributed to the evil eye, magic or offending some deity, the treatment for which could be through folk medicine or magico- religious methods. Religious rites are used mainly to treat diseases like small pox and propitiating the deity concerned, most of which tribals believe can cure the plagues, which are associated with various diseases. No comprehensive strategy has been formulated to deal with tribal health problems, as there is not enough knowledge available on their customs, beliefs and practices, which are intimately connected with the treatment of disease.[2] Further, there is a broad understanding of health problems and morbidity of the general population, particularly of urban and rural communities, but such information on tribal population is limited. Studies pertaining to morbidity among different tribal groups are very few, and lack of comparisons because of different criteria. Hence, the present study was carried out to study the morbidity pattern among tribals and compare with non tribals. MATERIALS AND METHODS The present study was carried out between March 2010 and January 2012 in the forest areas of Gundlupettaluk, Mysore. Ethical clearance was obtained from institutional ethics committee of DR. B R Ambedkar Medical College, Bangalore. Of the 33 tribal hamlets present, 18 hamlets were selected at random to obtain 33% sample of the total available tribal population. Correspondingly, the villages adjacent to these hamlets were included in the study as non tribal population constituting intended homogenous population without mix up. After obtaining consent, data was collected through house to house visits by individual and family scheduling. Laboratory parameters performed in our study were Hemoglobin estimation by Tallquist’s method, peripheral blood smear was done in suspected cases of fever, example: Malaria. Detailed general and systemic examinations of all the systems of both, tribal and non tribal population were performed by same group of competent doctors. The diagnosis of morbid conditions were mainly based on history and clinical finding by competent doctors. As it was a cross-sectional survey involving forest region, only the above limited laboratory parameters were assessed. Some of the diseases were persisting for longer duration as per the history obtained and when we examined, they had presented with similar symptoms and corresponding clinical signs. Example, dental caries persisted from long duration, scabies also had persisted similarly and so on. Hence, all the data collected accounted for the prevalence of the disease rather than incidence of the different morbid conditions. Random stratified sampling based on age groups was done to show the morbidity patterns among different age groups. Proportion of overall morbidity (diseases) wise grouping comparing that among tribals and non tribals was also done in case of individuals presenting one or more disease states simultaneously [Figures 1-3]. Statistical analysis Data were statistically analyzed using software Statistical Package for the Social Sciences (SPSS-I). The standard normal test (Z) was used to compare the equality of proportions having specific type of diseases among tribal and non tribal population. P value of < 0.05 was considered to be statistically significant. RESULTS Of the proposed 2050(33.04%) sampled population, 1870(30.14%) could actually be studied because of non-response from 8.78% sampled population who were absentees during repeat visits [Table 1]. Figure 1: Morbidity pattern comparing between tribal and non tribal population Downloaded from http://journals.lww.com/jntr by pdF35RGXLlHl4ekKGiVeVoWG1zq0I4i+WFqUqk1ZKYbM4WE7Vpag 1f1q0dHg6Ewd1KWqqDurPHlqp2xIdzNBygEcbTO3di6TGUNEI0DKFohc6TZBjLTYDINTDOcF1Au6s1f61B+LF9/wJPgD+jpEAw== on 09/02/2023
  • 3. Divakar, et al.: Morbidity pattern in tribals and non tribals 235 Journal of Dr. NTR University of Health Sciences 2012;1(4) Tribal – About 47.52% of tribal population had suffered once from one or other type of illness and 27.24% had suffered from more than one illness during last 12 months. Average number of episodes suffered per ill person was 2.22%. Major sicknesses reported at the time of survey among tribal populations were nutritional deficiencies (14.68%), skin infections (12.78%), diarrheal disorders (12.25%) followed by dental disorders (10.98%). Non tribal About 50.05% of non tribal population had suffered once from one or more illness and 16.68% had suffered from more than one illness during last 12 months. Average number of episodes suffered per ill person was 1.64%. The sicknesses reported among non tribal population were respiratory infections (12.78%), nutritional deficiencies (12.57%), diarrheal disorders (10.22%) and dental disorders (5.2%). Among intestinal disorders, diarrhea and parasitic infestations were more common among (15.63%) tribal respondents as compared to nontribal (14.63%) population and this difference was statistically not significant (P > 0.05). Concerned to ophthalmic diseases, more tribals (2.85%) compared to non tribals (2.17%) had eye diseases. This difference was statistically not significant (P > 0.05). Due to wide range of age group, cataract accounted less percentage and it was observed that 21 (2.64%) tribals and 16 (1.73%) non tribals who had cataract were above the age of 60 years. The other eye disease detected was conjunctivitis which accounted for very meager percentage of total morbidity status among both tribal and non tribal population in the younger and middle age groups. Among the skin disorders, 10.45% of the tribals were found to have scabies compared to 1.62% among non tribals and the difference was highly statistically significant (P < 0.01). Other skin infections like eczema and pyoderma were very meager in proportion. Majority of morbid conditions among different age groups showed an increased preponderance among the two extremities of the age groups of the study population that is the age group between 5 to 15 years and age group above 60 years [Tables 1 and 2] presented with greater proportion of morbid conditions among both the tribal and non tribal population when compared to all the other age groups as depicted in the Tables 3, 4 and 5. TABLE 1: DISTRIBUTION OF THE TOTAL STUDY POPULATION Population studied Area Total population Sampled Non responses Studied Tribal Hamlets-18 2929 970(33.12) 23 947(32.3) Non tribal Villages-28 3276 1080(32.97) 157 923(28.17) Total 6205 2050(33.04) 180 1870(30.14) Figures in parenthesis indicate percent Figure 3: Distribution of morbidity patterns in different age groups among non tribal population Figure 2: Distribution of morbidity patterns in different age groups among tribal population Downloaded from http://journals.lww.com/jntr by pdF35RGXLlHl4ekKGiVeVoWG1zq0I4i+WFqUqk1ZKYbM4WE7Vpag 1f1q0dHg6Ewd1KWqqDurPHlqp2xIdzNBygEcbTO3di6TGUNEI0DKFohc6TZBjLTYDINTDOcF1Au6s1f61B+LF9/wJPgD+jpEAw== on 09/02/2023
  • 4. 236 Divakar, et al.: Morbidity pattern in tribals and non tribals Journal of Dr. NTR University of Health Sciences 2012;1(4) TABLE 5: DISTRIBUTION OF MORBIDITY PATTERNS IN DIFFERENT AGE GROUPS AMONG NON TRIBAL POPULATION Age group (years) Morbidity 5-15 16-25 26-45 46-60 >60 Total Nutritional deficiency 40 18 30 12 16 116(12.57) Respiratory infections 16 11 24 31 36 118(12.78) Intestinal disorders 42 15 27 16 35 135(14.63) Skin disorders 15 07 08 12 09 51(5.52) Ophthalmic diseases 02 01 01 - 16 20(2.17) Ear nose throat diseases 11 6 4 01 4 26(2.82) Dental disorders 10 09 11 06 12 48(5.20) Figures in parenthesis indicate percent TABLE 4: DISTRIBUTION OF MORBIDITY PATTERNS IN DIFFERENT AGE GROUPS AMONG TRIBAL POPULATION Morbidity Age group (years) 5-15 16-25 26-45 46-60 >60 Total Nutritional deficiency 41 13 34 15 36 139(14.68) Respiratory infections 37 21 16 10 19 103(10.88) Intestinal disorders 43 23 32 16 34 148(15.63) Skin disorders 16 11 31 24 39 121(12.78) Ophthalmic diseases - 02 - 04 21 27(2.85) Ear nose throat diseases 12 5 4 2 6 29(3.06) Dental disorders 13 15 32 15 29 104(10.98) Figures in parenthesis indicate percent Individuals with more than one disease condition simultaneously among tribal and non tribal population: Table 6 depicts that among tribal population, 258 (27.24%) had suffered from more than one disease and among non tribals, 154(16.68%) had suffered from more than one disease with Z value of 5.55 and the observed difference was statistically significant with P < 0.01. Based on application of chi-square test except with regard to nutritional disorders, there was no statistically significant difference in the proportion of morbidity status between males and females in both tribal, as well as in non tribal population. Nutritional disorders were more prevalent among females compared to males in both tribal, as well as non tribal population with P < 0.05 of significance. Peripheral blood smear was done in suspected cases of fever, example: Malariabut there wasno positive cases found in both tribal and non tribal population. DISCUSSION The present cross-sectional comparative study was carried among tribals and non tribals residing at TABLE 3: MORBIDITY PATTERN IN STUDY POPULATION Morbidity Tribal Non tribal Z value P value Nutritional deficiency 139(14.68) 116(12.57) 1.32 0.23 Respiratory infections 103(10.88) 118(12.78) 1.27 >0.2013 Intestinal disorders 148(15.63) 135(14.63) 0.61 >0.5455 Skin disorders 121(12.78) 51(5.52) 5.43 <0.00006* Ophthalmic diseases 27(2.85) 20(2.17) 0.95 >0.3446 Ear nose throat diseases 29(3.06) 26(2.82) 0.31 >0.7539 Dental disorders 104(10.98) 48(5.20) 4.57 <0.000005* Figures in parenthesis indicate percent, *= highly statistically significant TABLE 2: DISTRIBUTION OF STUDY POPULATION ACCORDING TO AGE Age group(years) Tribals Non tribals 5-15 190(20.06) 210(22.75) 16-25 163(17.21) 177(19.18) 26-45 300(31.68) 268(29.04) 46-60 88(9.29) 103(11.16) >60 55(5.81) 76(8.23) Figures in parenthesis indicate percent Downloaded from http://journals.lww.com/jntr by pdF35RGXLlHl4ekKGiVeVoWG1zq0I4i+WFqUqk1ZKYbM4WE7Vpag 1f1q0dHg6Ewd1KWqqDurPHlqp2xIdzNBygEcbTO3di6TGUNEI0DKFohc6TZBjLTYDINTDOcF1Au6s1f61B+LF9/wJPgD+jpEAw== on 09/02/2023
  • 5. Divakar, et al.: Morbidity pattern in tribals and non tribals 237 Journal of Dr. NTR University of Health Sciences 2012;1(4) Gundlupettaluk of Mysore district to study the morbidity pattern among tribals and non tribals aged above 5 years. While studying the morbidity pattern in the study population it was found that 73.92% tribal and 63.92% non tribal study population reported illness during past 12 months. Nutritional deficiencies More tribal (14.68%) compared to (12.57%) non tribal population suffered nutritional deficiencies. However, this observed difference was statistically not significant (P > 0.05). Hanumantha R observed that 12.4% tribals of Jenukurabas of Karnataka, compared to 7.2% among non tribal counterparts suffered from nutritional deficiencies.[3] In a study conducted involving southern Indian tribes, malnutrition was pervasive among tribals and deficiencies in gross amounts of calcium, vitamin A, vitamin C, riboflavin, and animal protein were observed and also were known for their caloric and protein deficiencies.[4] Respiratory infections These were reported more (12.78%) by non tribal compared to (10.88%) tribal counterparts and this difference was statistically not significant (P > 0.05). In a ICMR study (1990) indicated among the tribes of Morena district of Madhya Pradesh, 7.1% of them suffered from respiratory infections.[5] The respiratory disease including upper respiratory tract infection was more commonly prevalent(14.9% in Bondo, 16.6% in Didayi, 13.6% in Kondha and 8.3% in Juanga) and similar observations were made in Birhor (11.2%) and Sahariya (56.9% inchildren aged 5-14 years) tribes of Madhya Pradesh.[6,7] Skin disorders More tribal (12.78%), as compared to (5.52%) non-tribal respondents had skin infections and this difference was highly statistically significant (P < 0.01). Among the skin infections, scabies was found to be highly prevalent. Saraswathi S reported that skin infections were 13.74% among Desikonda tribes, while it was 13.15% among Kutiakondha tribes.[6] Ina data collected at Regional medical research centre (RMRC), Bhubaneswar, 20.6% of Bondo, 6.9% of Didayi, 10.7% of Juanga and 15% of KutiaKondha tribes wereaffected with scabies (both infective and non-infective), whichis comparable with the findings in Birhor primitive tribe (7%) of Madhya Pradesh.[6] Ophthalmic diseases More tribal (2.85%) compared to non tribal (2.17%) had eye diseases out of which tribal (2.64%) and non tribal (1.73%) had cataract but this difference was statistically not significant (P > 0.05). 33% Desikondatribals, 32.33% of Kutiakondha tribes of Orissa suffered from eye diseases was reported by Saraswathi S.[8] Rajalakshmi reported that 23% of Santal tribes of Bihar suffered from eye diseases as compared to their (27%) non tribal counterparts.[9] Ear nose and throat Disorders were reported more among tribal (3.06%) compared to (2.82%) non tribal counterparts and this difference was statistically not significant (P > 0.05). Rajalakshmi reported that 14% of Santal tribes of Bihar suffered from ear nose throat diseases as compared to their (15%) non tribal counterparts.[9] Dental disorders Among tribal 10.98% had dental caries while 5.20% of non tribal and this difference was statistically significant (P < 0.05). Saraswathi S reported that dental infections were 58.62% among Desikonda tribes while it was 62.90% among Kutiakondha tribes.[8] Intestinal disorders Among this category, worm infestations were more common among (15.63%) tribal respondents as compared to non-tribal (14.63%) population and this difference was statistically not significant (P > 0.05). We did not find any concordant study depicting worm infestation among tribal and non tribal population above the age of 5 years. However, we found many studies observed intestinal worm infestation among under five years age group. CONCLUSION Our study revealed statistically significant proportion of TABLE 6: PROPORTION OF INDIVIDUALS WITH MORE THAN ONE DISEASE STATES SIMULTANEOUSLY AMONG TRIBAL AND NON TRIBAL POPULATION Morbidity pattern Tribal Non tribal Z value P value Individuals with more than one disease condition simultaneously 258(27.24) 154(16.68) 5.50 <0.01 Figures in parenthesis indicate percent Downloaded from http://journals.lww.com/jntr by pdF35RGXLlHl4ekKGiVeVoWG1zq0I4i+WFqUqk1ZKYbM4WE7Vpag 1f1q0dHg6Ewd1KWqqDurPHlqp2xIdzNBygEcbTO3di6TGUNEI0DKFohc6TZBjLTYDINTDOcF1Au6s1f61B+LF9/wJPgD+jpEAw== on 09/02/2023
  • 6. 238 Divakar, et al.: Morbidity pattern in tribals and non tribals Journal of Dr. NTR University of Health Sciences 2012;1(4) Skin disorders and Dental disorders (P < 0.05) among tribal population compared to non tribal population. Nutritional deficiency, Respiratory infections, Intestinal disorders, Ophthalmic disorders and ENT disorders were also prevalent among both the tribal, as well as non tribal population, however, the difference in proportions between tribal and non tribals were not statistically significant (P > 0.05). Morbidity pattern including nutritional status is a sensitive indicator of community health and nutrition.[10] Hence, further research surveys among tribal population, elucidating the health status and in sighting the probable reasons behind morbidty and mortality status, thus, highlighting a need for an integrated approach towards reducing the morbidity rates and improving the health, as well as nutritional status among tribal population would be invaluable. Limitations 1. Cross-sectional study was conducted due to paucity of time and man power. Comparatively, a longitudinal study is a better indicator of health problems in a study population. 2. Morbidity status of the study population was assessed by relevant history and clinical examination, but it was not supported by laboratory parameters. 3. A diet survey could not be conducted. Recommendations 1. A longitudinal study is indicated to study the incidence of morbidities among children below the age of 5 years in tribal and non tribal population. 2. An in-depth study is suggested to study the traditional mores and its impact on health, literacy status and its influence on their health and economic status. 3. A comprehensive control strategy with specific interventional measure need to be evolved and implemented specially in tribals as serious efforts for their overall development. 4. Efforts to be taken to tackle non-responses from both tribal, as well as non tribal population. ACKNOWLEDGEMENTS We acknowledge Mr. M. Puttaswamy, Assistant professor in community medicine and statistician for his kind support in regard to statistical analysis. REFERENCES 1. Report of the study to understand the Health status and healthcare systems in selected tribal areas of India. 2009. Available from: http://www.cccindia.net/Health_Systems_Report.pdf. [Last accessed on 23rd July 2012]. 2. Rudraiah N, Vortmeyer D, Veena BH. Influence of electric field on the unsteady dispersion coefficient in couple-stress flow. Biorheology1988;25:879-90. 3. Rudraiah N, Vortmeyer D, Veena BH.Biorheology. Hyderabad: National Institute of Nutrition, ICMR; 1988. 4. Basu SK. A health profile of tribal India. Health Millions1994;2:12-4. 5. ICMR. Nutritional deficiency in Astinabad village, Port Blair Annual report;1990. 6. Annual Report. Jabalpur: Regional Medical Research Centre for Tribals; 1993. 7. Annual Report. Jabalpur: Regional Medical Research Centre for Tribals; 1999. 8. Saraswathi S. Health and population prospective and issue. Health status of tribal population in Orissa. Problems and Perspectives 1990;13:171-78. 9. Rajalakshmi C. Santal women; Areas of health ignorance. Social Change 1992;2:12-23. 10. Rao VG, Yadav R, Dolla CK, KumarS, Bhondeley MK, U key M. Undernutrition & childhood morbidities among tribal preschool children. Indian J Med Res 2005;122:43-7. How to cite this article: Divakar SV, Balaji PA, Ali SS. Morbidity pattern in tribals and non tribals above the age of 5 years of Gundlupet forest area, Mysore district, India. J Dr NTR Univ Health Sci 2012;1:233-8. Source of Support: Nil. Conflict of Interest: Nil. Downloaded from http://journals.lww.com/jntr by pdF35RGXLlHl4ekKGiVeVoWG1zq0I4i+WFqUqk1ZKYbM4WE7Vpag 1f1q0dHg6Ewd1KWqqDurPHlqp2xIdzNBygEcbTO3di6TGUNEI0DKFohc6TZBjLTYDINTDOcF1Au6s1f61B+LF9/wJPgD+jpEAw== on 09/02/2023