Health and Nutritional Status of the Indian Tribes of Tripura and Effects on Education
IN THIS ARTICLE
Tribal communities in India mainly consist of forest dwellers who have accumulated a rich knowledge on the uses of various forests and forest products over the centuries. According to Article 342 of the Indian Constitution, the Scheduled Tribes are the tribes or tribal communities or part of or groups within these tribes and tribal communities which have been declared as such by the President through a public notification. India possesses a total of 427 tribal communities, of these more than 130 major tribal communities live in North East India, which is comprised of the 8 states Meghalaya, Mizoram, Manipur, Tripura, Sikkim, Assam, Nagaland and Arunachal Pradesh. The major tribal communities of the North East India have been categorized into sub-tribes and if these sub-tribes are taken into account the total number of tribal groups reach up to 300.
Tribal groups constitute about 8.2 % of the total population in India (Indian Government Census, 2001). According to government statistics, tribes can be found in approximately 461 communities with almost 92 % of them residing in rural areas, mostly in remote underserved forest regions with little or no basic civic amenities like transport, roads, markets, health care, safe drinking water or sanitation. Tribal communities therefore lag behind other communities with respect to attainment of income, education, health and other requisites for good community nutrition. Of the 86 million tribals who are 8.2 percent of the population, 80 percent live in the Middle India belt of Andhra Pradesh, Orissa, Jharkhand, Chhattisgarh, Madhya Pradesh, Northern Maharashtra and Southern Gujarat. Around 12 percent or 10.2 millions live in the Northeast. The rest are spread over the remaining States. Scheduled tribes are distributed throughout the country except Pondicherry, Haryana, Punjab, Chandigarh, and Delhi.Table 1 & 2 will represent in brief the Demographic statistics of Tribals of NE India and under the areas of Tripura Tribal Areas Autonomous District Council (TTAADC).
After the first influx of refugees came as the Hindu Bangladeshi immigrants, the State of Tripura enacted the Tripura Land and Land Revenue Act 1960 that stipulated that only registered land would be recognized. Most tribals being illiterate did not register the community land they were living on for a thousand years according to their customary law. So they were declared encroachers on the land that was their habitat for hundreds of years.
The land that was alienated from them was used to resettle the Hindu East Pakistani immigrants whose influx continues till today. Because of the influx, its tribal proportion has come down from 58 percent in 1951 to 31 percent in 2001. The tribes have lost more than 60 percent of their land to the immigrants. That is at the basis of the tribal insurgency in the State.
The population of Tripura is characterized by social diversity. People of the Scheduled Tribes (ST) comprise about one-third of the population. Nineteen tribes are represented in the population of Tripura, the two largest being the Tripuri and Reang, which together accounted for 71 per cent of the tribal population in 2001. There is also a plurality of languages and dialects; the two official languages of the State are Bengali and Kokborok. The overwhelming majority of tribal people (97.4 per cent) live in rural areas.
The burden of infant mortality, maternal and child mortality are being borne disproportionately by the schedule caste and tribes as compared to other caste groups. (IIPS: 2000) The NFHS data show that 53 percent of children in rural areas are underweight in India and this varies across states. In some states this figure is as high as 60 percent who are underweight especially among the schedule tribes in the poorer states. This paper will discuss about the health and nutritional status of the tribal peoples and its effect on their higher studies, with special reference to the state of Tripura. The paper also highlights certain areas like the health status of the tribals of Tripura in relation to sex ratio, birth and mortality rate, life expectancy, nutritional status, maternal and child health care practices, sexually transmitted diseases, genetic disorders, etc.
2. Health Status of tribes of Tripura
Lack of personal hygiene, poor sanitation, poor mother--child health services health servicesManaged care The benefits covered under a health contract , absence of health education, lack of national preventive programmes, and lack of health services are responsible for the poor health of the tribals. Problems like in-sanitary food supplies, water contamination, and poor food in-take reflect on the health status of tribals. The tropical disease like malaria is still widespread in the tribal areas. Hence, better nutrition and good environmental health are the important aspects of village health services.
2.1 Birth and mortality rate
The tribal population has a much lower Infant Mortality Rate (IMR) as compared to the scheduled castes but moderately higher than the other population.
Table 3, 4, and 5 will highlight the birth and mortality rate of the individuals in the state which is found to be varied in different assessment years.
Special estimates of IMR at the district level were prepared. These estimates show that the IMR in Tripura were 41 and 43 infant deaths per 1,000 live births for males and females respectively. The estimates show higher mortality than the latest SRS estimates (35 for males and 34 for females for 2000–02) for Tripura. District-level estimates indicate that Dhalai had the highest IMR, followed by South,North and West Districts. For girls, IMR was above 50 in Dhalai and South District. Even this was, however, below the all-India IMR of 60 (according to the SRS Bulletin of April 2005).
According to the report of the Tripura Tribal Areas Autonomous District Council (TTAADC), requirements of the health care facilities in the area are not proportional to the increasing demand of the people due to the fact of population explosion.
2.2 Maternal and child health care practices
Child bearing imposes additional health needs and problems on women -physically, psychologically and socially. Maternal mortality was reported to be high among various tribal groups. The chief causes of maternal mortality were found to be unhygienic and primitive practices for parturition. From the inception of pregnancy to its termination, no specific nutritious diet is consumed by women. On the other hand, some pregnant tribal women reduced their food intake because of simple fear of recurrent vomiting and also to ensure that the baby may remain small and the delivery may be easier. The consumption of iron, calcium and vitamins during pregnancy is poor. The habit of taking alcohol during pregnancy has been found to be usual in tribal women and almost all of them are observed to continue their regular activities including hard labour during advanced pregnancy. More than 90 per cent 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. Services of paramedical staff are secured only in difficult labour cases.
As far as child care is concerned, both rural and tribal illiterate mothers are observed to breast-feed their babies. But, most of them adopt harmful practices like discarding of colostrum, giving prelacteal feeds, delayed initiation of breast-feeding and delayed introduction of complementary feeds. Vaccination and immunization of Infants and children have been inadequate among tribal groups. In addition, extremes of magico-religious beliefs and taboos tend to aggravate the problems.
Tripura has made remarkable progress in Routine Immunization by increasing coverage throughout the State. As per the National Immunization schedule of Govt. of India, Routine Immunization is carried out in the State including ADC area to cover all children in the age group of up to 1 year. Overwhelming response has been shown in connection with Immunization of DPT. 120.6% children throughout the State has been immunized through DPT whereas the performance of all India level is 94.7 % as per record of Govt of India Ministry of Health & Family Welfare ( Monitoring & Evaluation Division ) during the year 2006-2007. The success is same for the period of 2006-2007 in connection with OPV also (94.6 VS 120.8%). In connection with B.C.G vaccination our performance (140.9%) is much better than that of all India performance which is 100.1%. During the year 2006-07 B.C.G vaccine was given to 679251 children which is much better for the period of 2005-2006 where the total was 64775 children. Measles Vaccine are also being given to children in an effective manner. The achievement of proposed need assessment is 122.2% in the State which is higher than the percentage of all India level ( 90.4 %) for the period of 2006-2007. In connection with Tetanus immunization (except Mothers) state performance (81.9% achievement of proposed need assessed) for the period of 2006-2007 is better than all India level performance which is 79 %. 37 Point Tribal Development Package was announced by the Hon'ble Chief Minister on 15th September 2003. The Package has one of the components on Immunization for all Children and pregnant women in ADC area for implementation by Health & FW Department.
There are vast differences in the health status of mothers and children between tribal and non-tribal populations. The indicators comparing the maternal and child health, highlighting the under-achievements among the tribals, are summarized in Table 8.
Compared to the NFHS 2 survey, the infant mortality, under-five mortality, and neonatal mortality have decreased, the proportion of home deliveries is at a standstill. There was a fall in the median months of exclusive breastfeeding, while it had shown improvement among others from 1.3 months to 1.9 months. The total fertility rate (Table 8) had shown a slight increase compared to the NFHS 2 survey.
2.3 Life expectancy
The expectation of life is the average number of years remaining to be lived by those surviving to that age.The expectation of life at birth is a component of the HDI. As there are no estimates of vital rates (birth rates, death rates, infant mortality rates) at the district level for Tripura, estimates of life expectancy at the district level, for males and females separately, were prepared by adapting available techniques of indirect estimation to data available for the State. In 2001, life expectancy at birth for males and females in Tripura was 71 years and 74 years respectively (Table 9). In terms of life expectancy, attainments in Tripura are higher than the national average, which is 61 for males and 62.5 for females (SRS 2003). There is, however, inter-district variation. Women in the West District live five years longer than women in Dhalai, and men in the West District live four years longer than men in Dhalai.
2.4 Genetic disorders and Sexually Transmitted disease
Primitive tribal groups of India have special health problems and genetic abnormalities like sickle cell anaemia, G-6-PD red cell enzyme deficiency and' sexually transmitted diseases. Genetic disorders especially sickle cell disease and G-6-PD have been found to occur in high frequency among various tribal groups and scheduled caste population. The sickle cell disease has been found in 72 districts of Central, Western and Southern India. About 13 lakh G-6-P D deficient are present in tribal population. The prevalence is especially high among the tribes and scheduled castes of Madhya Pradesh, Maharashtra, Tamil Nadu, Orissa, Assam (more than 15 per cent) especially in hyperendemic malarial zones (DST, Report 1990). Prevalence rate up to 40 per cent of sickle cell trait has been reported in some tribes i.e. Adiyan, Irula, Paniyan, Gonds. Sexually transmitted diseases (STDs) are most prevalent disease in the tribal areas. VDRL was found to be positive in 17.12 per cent cases (reactive in dilution of 1:8 or more) of polyandrous Jaunsaris of Chakrata, Dehradun. Out of 17 per cent, 9.92 per cent was found among males and 7.19 per cent among females. Among the Santals of Mayurbhanj district, Orissa, 8.90 per cent cases (reactive in dilution of 1:8 or more) of VDRL were observed, out of which 4.99 per cent were females and 3.91 per cent were males.
AIDS is as yet not a big concern in Tripura, only five full-blown cases (and 79 HIV-positive cases) have been identified. The State is in the low-risk category in terms of HIV prevalence rates. However, it is of concern that knowledge about AIDS is thin. In the NFHS-2 survey, 56 per cent of rural women had not heard about AIDS, and 58 per cent did not know any method of prevention.
2.5 Sex ratio
In the 1991 Census, the sex ratio of the tribal population was 972 females per thousand males against 927 for the total population. The highest sex ratio for scheduled tribes among various States has been reported from Orissa (1002) and the lowest from Goa (889). The sex ratio of tribals is more favorable to females than the general population (972/1000 males vs. 927/1000).
However, there is a wide variation among the different groups and states (1002 in Orissa to 889 in Goa). The geriatric population (above 60 years of age) among tribals is 6.1%. Though this is actually an increase from 5.6% in 1981 in comparison to the general population (7.9%), the proportion is less. The dependency ratio among tribals is 83.9% and in the general population is 69%.Literacy is increasing (47% in 2001 from 29.6% in 1991) but still lower than the general population (65%) and the gap between the literacy rates of STs and the general population continues almost at the same level of 17-18% for the last three decades. Almost 65% women are illiterate against the national fi gure of 46%.High drop-out rates of 79% from formal education are a major problem.
The sex ratio (or ratio of females to 1,000 males) is a simple indicator of gender equality. Among the countries of the world, India is unique in that the data show a decline in sex ratios in the twentieth century. Tripura, however, does better than the national average both in terms of the absolute value of and trends in sex ratio (Figure 4). In 2001, the overall sex ratio was 948 (946 in rural Tripura and 959 in urban Tripura), while the corresponding ratio for India was 933. The sex ratio among the major tribes was higher than the State average. The sex ratio among SC, though lower than among ST, was higher than the State average in both rural and urban areas. The child sex ratio (or sex ratio among children aged 0–6 years) was 966 as compared to the Indian average of 927. The child sex ratio was greater than 1,000 – a very favourable outcome – in four blocks, and above 990 in another four blocks. However, there was a small decline in the child sex ratio in South District and Dhalai in the 1990s.
3. Nutritional status of tribes of Tripura
The health and nutrition problems of the vast tribal population of India are as varied as the tribal groups themselves who present a bewildering diversity and variety in their socio-economic, socio-cultural and ecological settings. The malnutrition is high among the tribal population. Nutritional deficiency leads to diseases like endemic goiter goiter:see thyroid gland. , anemia, pellagra and beriberi beriberi(bĕr`ēbĕr`ē), deficiency disease occurring when the human body has insufficient amounts of thiamine (vitamin B1). The deficiency may result from improper diet (e.g. . Nutritional anaemia is a major problem for women in India and more so in the rural and tribal belt. This is particularly serious in view of the fact that both rural and tribal women have heavy workload and anaemia has profound effect on psychological and physical health. Anaemia lowers resistance to fatigue, affects working capacity under conditions of stress and increases susceptibility to other diseases. Maternal malnutrition is quite common among the tribal women especially those who have many pregnancies too closely spaced. Tribal diets are generally grossly deficient in calcium, vitamin A, vitamin C, riboflavin and animal protein.
A study by Mishra (2005) using the National Family Health Survey (NFHS-2) found that in almost all the states of India, tribal households had a higher incidence of childhood stunting (52.3%) than non-tribal households (42.8%). Using the same dataset, Nagda (2004) reported an anemia prevalence of more than 80% among tribal children. Several studies have also reported deficient intake of calories and protein among tribal populations relative to the Indian RDA, which may be an explanation for the high rates of stunting among this group (Rao et al., 1994; Yadav and Singh, 1999; Agte et al., 2005; Mittal and Srivastava, 2006). Iron deficiency is recognized as the major cause of anemia in tribal communities (Reddy et al., 1995; Vyas and Choudhry, 2005) and several studies have reported that deficiencies of micronutrients such as iron and zinc often occur together. Hence the high rates of anemia among tribal populations provide additional evidence of the possibility of marginal zinc deficiency in tribal areas. This is further supported by the high prevalence of stunting and the highly deficient dietary energy intakes in the tribal populations since intake of both zinc and iron are known to be highly correlated with dietary energy intake (Willett, 1998). At least one study has shown that zinc intake of populations in tribal regions was significantly lower than that of any of the other regions studied (Agte et al., 2005). Tribal populations still largely depend on agriculture and forest products for their livelihood and they follow a relatively homogenous lifestyle with their food habits, dietary practices and general pattern of living (Patwardhan, 2000). Most tribes still rely on their indigenous foods, which usually consist of wild unconventional forest products although some cultivate grains and other farm products for subsistence (Singh and Arora, 1978). The most frequently used cereals are maize, millet or rice and these form part of a major meal at least once daily (Kapil et al., 2003). Earlier studies indicated that, comparatively, the overall health of the tribal population is inferior to that of people elsewhere in India and that poor environmental sanitation and unhygienic personal practices predispose tribal populations to high risk of infection (Nagda, 2004; Mishra, 2005). Findings from a recent national survey showed that 82.4% of tribal households did not have latrines and 78.1% did not have drainage facilities in their homes (NFHS-2, 1998), a situation that predisposes children to diarrhoeal disease. The survey also found that the prevalence of diarrhoea and acute respiratory infection (ARI) was higher among tribal children than children of non-tribal mothers. Similarly, the study by Nagda (2004) suggested that childhood diarrhoea, ARI, anemia and fever were major causes of infant mortality in tribal areas.
India's abysmal track record at ensuring basic levels of nutrition is the greatest contributor to its poverty as measured by the new international Multi-dimensional Poverty Index (MPI). About 645 million people or 55% of India's population is poor as measured by this composite indicator made up of ten markers of education, health and standard of living achievement levels.
Developed by the Oxford Poverty and Human Development Initiative (OPHI) for the United Nations Development Programmes (UNDP) forthcoming 2010 Human Development Report, the MPI attempts to capture more than just income poverty at the household level. It is composed of ten indicators: years of schooling and child enrollment (education); child mortality and nutrition (health); and electricity, flooring, drinking water, sanitation, cooking fuel and assets (standard of living). Each education and health indicator has a 1/6 weight, each standard of living indicator a 1/18 weight.
Data on food and nutrition show, on average, no deficit in the intake of cereals in Tripura. In 2005, the quantity purchased per person from fair price shops was 41 kg in West District, 50 kg in South District, and 62 kg in North District and Dhalai. A two-village survey on health and nutrition conducted for this Report revealed large deficits in the intake of non-cereal food items, particularly among tribal families (Table 10). Among tribal households, there were serious deficiencies in the intake of pulses and legumes, milk and milk products, fats and oils, and sugar and jaggery. Anthropometric indices also show high levels of malnutrition. The good news is a reduction in malnutrition among young children between 1998–99 and 2005–06: the incidence of malnutrition fell from 42.6 to 39 per cent in terms of weight-for-age and from 40.4 to 30 per cent in terms of height-for-age (Table 15). Levels of malnutrition in Tripura are now lower than the Indian average. Another piece of good news from our two-village study is the absence of discrimination against girls in nutritional outcomes among children and adolescents in tribal families. Nevertheless, the incidence of nutrition-related diseases is high in Tripura. In 1998–99, 59 per cent of ever-married women in the age group 15–49 were anaemic and 62 per cent of children in the age group 6–35 months were anaemic. Serious attention has to be paid to ways of tackling nutritional deprivation, particularly among women and children in Tripura.
Generally, a balanced diet provides all the food substances needed by the body for healthy growth and development. Good nutrition also includes eating the proper amount of food each day. It helps keep the body healthy and fit. When they are not able to get two meals a day, how is the concept of nutritious food applicable to them.
Lack of medical facility is another problem for them. The poor tribals do not get food regularly so they fall sick. Doctors recommend that people have medical care at the first sign of any illness. Early care can result in quicker cure. But the tribals are deprived of all these basic needs. Due to mosquitoes bites, skin diseases, jaundice, natural calamities, they suffer and do not get any treatment on time.
Hygiene problem is very common in rural as well as in tribal areas. Due to unhygienic conditions their children suffer with many diseases like measles, mumps, polio, tetanus, and whooping cough. Prevention of disease is an important part of medical care. Parents should make sure that their children receive immunization against diphtheria, German measles, measles, mumps, polio, tetanus, and whooping cough. But tribal parents are ignorant of these things.
4. Impact of health and nutrition on education of tribes of Tripura
Dropping-out of school remains a concern, particularly among Scheduled Tribe households. Over the last five years, the overall drop-out rate for primary school children (Classes 1 to V) has fallen sharply, from 50 per cent in 2001–02 to 11.6 per cent in 2005–06. At the same time, the drop-out rate is higher among children of Scheduled Tribe families (14 per cent) and Muslim children (24 per cent in 2004–05). Retention in school is more difficult at the upper primary level, and the statistics show that one-fifth of the children drop out of elementary school (Classes I to VIII). Special attention has to be paid to ensure continuation of schooling, particularly among children from tribal and Muslim families.
Tribals constitute the second largest social group in India. Access to higher education in the Tribal population as reflected by the Gross Enrolment Ratio (GER) is an issue of concern as it falls behind the rest of the population even when compared with other deprived groups. Additionally, the GER of female Tribals falls behind that of their male counterparts. These factors reflect the inequality persisting among Tribals within Indian society. Many tribal schools are plagued by high dropout rates. Children attend for the first three to four years of primary school and gain a smattering of knowledge, only to lapse into illiteracy later. Few who enter continue up to the tenth grade; of those who do, few manage to finish high school. Therefore, very few are eligible to attend institutions of higher education, where the high rate of attrition continues. Eldest members of tribes often are reluctant to send their children to school, needing them, they say, to work in the fields.
The special commitment of the National Policy on Education,1986 (revised in 1992) to improve the educational status of STs continues to be the major strength in launching special interventions and incentives to improve the accessibility for the tribals who live in the far-flung remote areas and remain isolated. Therefore, efforts for universalizing primary education continued, especially through the programme of Sarva Shiksha Abhiyan. In the field of higher and technical education, special provisions such as reservation of seats, relaxation in minimum qualifying cut-off percentages, remedial coaching and scholarships were being extended by the Department of Secondary and Higher Education.
The last decade from 1998–2008 is a period of development in the history of Tripura. From 2004 to 2009 itself total enrolment in degree college has increased from 23570 to 28917 (table13).
The literacy rate for the total population in India has increased from 52.21% to 64.84% during the period from 1991 to 2001 whereas the literacy rate among the Scheduled tribes have increased from 29.60% to only 47.10%. Among ST males literacy increased from 40.65% to 59.17% and among ST female literacy increased from 18.19% to 34.76% during the same period. The ST female literacy is lower by approximately 21 percentage point as compared to the overall female literacy of the general population.
State literacy rate in 1991 was 60.4% and tribal literacy rate was 40.4% with a gap of 20. State literacy rate in 2001 is 73.2% and tribal literacy rate is 56.5% with a gap of 16.7. Total population of the state increased from 2,757,205 in 1991 to 3,199,203 in 2001 where as ST population increased from 853,345 in 1991 to 993,426 (which is 31.1 % of total state population) in 2001. There has been further progress since 2001. Data from the NFHS-3 conducted in 2005–06 show an overall literacy rate of 80.2 per cent for the population aged 6 and above, with literacy rates of 90.3 per cent and 78.3 per cent in urban and rural areas respectively.
This statistics along with all the health statistics clearly indicate that there is relation between the population explosion and health with higher education which is not encouraging for the tribes in comparison to the general population of the state.
It is evident from the above discussions that tribal populations are affected by various social, economic and developmental constraints that potentially expose them to high rates of malnutrition and health problems which is correlated with the lower percentage of higher education of the community. The tribal of India are heterogeneous. Although scheduled tribes are accorded special status under the fifth/sixth schedules of the Indian Constitution, their status on the whole, especially their health still remains unsatisfactory. Hence, the methods to tackle their health problems should not only be multi-fold, but also specific to the individual groups as feasible as possible.
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Table 1: Demographic statistics of Tribals of NE India, 2001 Census.
Source: Annual Report 2009-10, Ministry of Tribal affairs, Govt of India available at http://tribal.nic.in/writereaddata/mainlinkFile/File1220.pdf
Table 2: Zone wise village committee & population of TTAADC , 2005- 06
Table 3: Health statistics of India, 2006s
Source: NFHS 3: 2005-06, M/o Health & Family Welfare available at http://tribal.nic.in/writereaddata/mainlinkFile/File1220.pdf
Table 4: Health Indices of Tripura, 2007
Note: TFR-Total Fertility Rate, CPR-Couple Protection Rate, IMR-Infant Mortality Rate, MMR-Maternal Mortality Rate, SRS-Sample Registration System, NFHS-National Family Health Survey.
According to the study carried out by SRS, NFHS, Census-2001, and State Population Policy-2000, except CPR all the health indices are below the national average (Table 5).
Table 5: Health indices of Tripura, 2008
Source: SRS-2008, NFHS-3, Census-2001 and State Population Policy-2000
Table 6: Estimated infant mortality rate by district and sex, 2001
Source: Samir Guha Roy (2005).
Table 7: Health Statistic of TTAADC, 2009
Table 8: Maternal and child health indicators among tribals and others
Source: Soudarssanane M Bala, Thiruselvakumar D, “Overcoming Problems in the Practice of Public Health among Tribal of India”, Indian Journal of Community Medicine / Vol 34 / Issue 4 / October 2009
Table 9: Expectation of life at birth by sex in Tripura, by district, 1991 and 2001
Source: Samir Guha Roy (2005).
Table 10: Food group-wise mean intake per adult consumption unit as a percentage of the Recommended Daily Allowance (RDA), Tripura and selected villages of West District
Source: GOI (1998), District Nutrition Profile, and Chakravarty (2006).
Table 11: Drop-out rates among primary and upper primary school children, 2005.06
Source: Directorate of School Education, Sarva Shiksha Abhiyan Rajya Mission Tripura
Table 12: Higher Edcuation Institution in Tripura
Source: Tripura Economy in brief available at http://destripura.nic.in/tripuraeconomy.pdf
Table 13: Comparative statement indicating strength of students in the Colleges / institutions between 2004-05 to 2009-10
SOURCE: Perspective plan 2010-2020, Govt. of Tripura, available at
Table 14: Statement showing category wise number of job-seekers waiting in the live register of the Employment Exchanges of Tripura According to education level as on 31.03.2010
Source: Perspective plan 2010-2020, Govt. of Tripura, available at