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BRIEF RESEARCH ARTICLE
Year : 2022  |  Volume : 66  |  Issue : 4  |  Page : 516-519  

Community-based approach to combat micronutrient deficiencies among irular tribal women: An education intervention


1 Assistant Professor (SG), Department of Sciences, Amrita School of Physical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, Tamil Nadu, India
2 Assistant Professor, Department of Sciences, Amrita School of Physical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, Tamil Nadu, India
3 Research Scholar, Department of Sciences, Amrita School of Physical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, Tamil Nadu, India
4 Research Scholar, Department of Social Work, Amrita School of Social and Behavioural Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, Tamil Nadu, India
5 Professor, AMRITA CREATE, Amrita School of Computing, Amrita Vishwa Vidyapeetham, Coimbatore, Tamil Nadu, India

Date of Submission26-Oct-2021
Date of Decision23-Oct-2022
Date of Acceptance25-Oct-2022
Date of Web Publication31-Dec-2022

Correspondence Address:
Jancirani Ramaswamy
Department of Sciences, Amrita School of Physical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.ijph_1985_21

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   Abstract 


Tribal women may suffer from poor nutritional health, lack of awareness of micronutrients, reduced dietary diversity, underutilization of micronutrient supplements and locally available food resources, poor hygiene, and sanitation. This study aims to examine the impact of educational intervention on the micronutrient status of the tribal women (n = 714, 15–60 years) in 15 hamlets of Coimbatore district, Tamil Nadu, by census sampling method. Self-structured pretested questionnaires, participatory learning methods, and focus group discussions were adopted to record the background information (anthropometry, clinical signs of micronutrient deficiency, hemoglobin, and dietary assessments). Even though there was no increase in body mass index (BMI), there was a significant change in age, income, and BMI with hemoglobin levels. Impact analysis showed significant behavior change in the utilization of locally available micronutrient-rich foods, improved access to supplements, and dietary diversity. Sustained attempts to educate tribal women proved to be effective in attaining their nutritional security and in the families.

Keywords: Education intervention, food security, micronutrients, nutrition security, tribal women


How to cite this article:
Ramaswamy J, Natarajan T, Haridas S, Palanisamy K, Nedungadi P. Community-based approach to combat micronutrient deficiencies among irular tribal women: An education intervention. Indian J Public Health 2022;66:516-9

How to cite this URL:
Ramaswamy J, Natarajan T, Haridas S, Palanisamy K, Nedungadi P. Community-based approach to combat micronutrient deficiencies among irular tribal women: An education intervention. Indian J Public Health [serial online] 2022 [cited 2023 Feb 1];66:516-9. Available from: https://www.ijph.in/text.asp?2022/66/4/516/366582



Micronutrients are essential in minute quantities that involve in enzymatic reactions and metabolic activities in the body, which fulfills the needs of the biological system. According to WHO, iodine, iron, and Vitamin A deficiencies are the main health issues globally, and the mission is to carry out research and implement micronutrient programs.[1] The recent Comprehensive National Nutrition Survey in India observed a high prevalence of anemia (24%–41%), iron deficiency (17%–32%), folate deficiency (23%–37%), and Vitamin B12 deficiency (14%–31%).[2],[3] National Family Health Survey-5 data showed that 57.0% of women in the reproductive age group (15–49 years) were anemic.

Tribal population suffer from a triple burden of disease; in fact, it is tetrad, namely, communicable diseases, noncommunicable diseases, mental health, malnutrition, and addictions complicated by poor health-seeking behavior. Traditional food formulations are important sources of many nutrients for the most vulnerable sections of society.[4],[5] Tribal food culture and choices are intertwined with issues of preferences and availability. Access to diverse and better foods can enhance nutrient absorption and availability.[6],[7] Health-care services and awareness of taking proper diet for proper physical growth and development can be improved by nutritional education, training, and campaign along with changing improved socioeconomic status. Information and Communication Technology tools can play a significant role as a driver of such change. The knowledge gained during intervention programs can be leveraged to prepare nutrient-rich products at their home and prevent micronutrient imbalance at household levels.[8]

A pilot study conducted in randomly selected tribal villages informed researchers regarding poor nutritional health, underutilization of micronutrient supplements, and sanitation status of the tribal community. The educational intervention of tribal women will improve their knowledge, attitude, and practices toward healthy food habits, intake of micronutrient supplements, and nurturing good food choices to enrich their micronutrient needs.

An experimental pre- and posttest design was adopted in randomly selected tribal villages of Coimbatore District, Tamil Nadu. This study involved baseline and endline evaluations of educational intervention in the four selected clusters of Coimbatore District involving 15 tribal hamlets as subclusters with 714 tribal women in the age groups of 15–60 years by census sampling method.

A pretested questionnaire that was evaluated initially for its content validity and face validity for its overall content in the local language elicited the background information and was used to deliver the content for nutrition education intervention through a direct interview schedule. Their baseline and endline scores were consolidated, compared, and evaluated to prove the efficacy of the intervention. All the participants were subjected to elicit baseline and endline information on sociodemographic profile, general health status, dietary practices (24 h dietary recall), anthropometric measurements, examination of clinical signs, and hemoglobin estimation for 7 consecutive days.

The education intervention program was planned for 8–9 months (June 2019 to February 2020) through participatory learning method, developing information, education, and communication materials and modules through interpersonal communication techniques, live demonstrations, videos, and tutorials for effective learning. Four modules (locally available food and its importance, importance of nutrients in health, micronutrients food sources, function and deficiency, value-added foods for micronutrient deficiency) were delivered simultaneously with every 10 sessions by program nutritionist executed as per the guidelines provided in the educational module and supervised by the researcher group. Community champions were developed in each cluster for sustainable follow-up and reinforcement. The data were computed and analyzed with the SPSS Inc., (IBM) package.

On an average, tribal women consumed less than three-fourth of their daily requirement when compared with the Recommended Dietary Allowance (RDA) recommended by ICMR. The consumption of food and food groups was found to be deficit among all the food groups. Cereals and millets and fats and oil consumption was found to be a deficit of around more than 70% (71.25% and 73.33%, respectively). Consumption of fruits (−98.26%) and nuts and oil seeds (−98.67%) was nearly 100% deficit when compared to the RDA. Among the intake of all other food groups, the intake of pulses, other vegetables, green leafy vegetables, milk and milk products, animal foods, and sugar and jaggery were lowest in deficit percentage (32.50%, 18.67%, 42.0%, 22.33%, 20.0%, and 48.59%, respectively) of the recommended intake.

A study by Kirthika and Janci Rani et al. in 2020 revealed the household intake of the tribal population.[9] The percent adequacy was calculated for the food group consumption and compared with the RDA. As shown in [Figure 1], only 25% of tribal women were able to meet at least 50% of the requirements and 37.50% met up to 50%–70% of their daily requirements in terms of cereals and millets. Majority (80.36%) met at least 50% of their daily requirement for pulses, at least 50% requirement in terms of other vegetables, and 64.29% in terms of green leafy vegetables, (83.93%) met at least 50% of milk and milk products requirement and 98.21% were met with at least 50% for meat and meat product requirement. Intake of fats and oils and sugar and Jaggery majority was found to be with more than 100% of their daily requirement. Nutritional intake and dietary practices among tribal women are comparatively very low to the nationally recommended standards.
Figure 1: Food group intake as percentage of the RDA among Tribal women. Explains the food group consumption of the selected tribal women in terms of percent adequacy when compared with the standard RDA recommended by ICMR. RDA: Recommended dietary allowance.

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Dietary diversity in the diet has been conventionally measured as counts of consumption of diverse food groups over a longer period.[10] A cutoff score of <4 food groups is considered a minimum dietary diversity (MDD). This study reveals that the majority (80.39%) of women did not meet the recommended MDD of more than four food groups and only (16.11%) of them had received a diversified diet with an inclusion of 5–6 food groups in their daily diet during the baseline study. It was observed that there was a paradigm shift in their dietary mean dietary scores after intervention. Majority 48.46% included 5–6 food groups and only 44.96% had included less than four food groups in their daily diet. It is also noted that a minuscule proportion (3.50%) of the selected tribal women included more than six food groups in their daily diet during the baseline study, and after the intervention, it has improved to around 6.58%.

Initially, 10.26% and 23.29% of the selected population had Bitot's spots and poor vision, respectively. It was recorded in the present study that anemia is reflected with brittle nails (36.83%), pale nails (11.76%) and white spots in nails (14.43%) during the baseline period. The prevalence of multi vitamin deficiency was observed with the following symptoms such as cracked lips (26.69%), week gums and teeth (48.46%), sore tongue (2.8%), brown spot on teeth (44.26) and bleeding gums (35.99%). Majority (86.55%) of the selected women had hair breakage initially. The education intervention had a noteworthy impact in reducing the clinical symptoms of micronutrient deficiencies.

The mean BMI for 15–20 years girls was 18.65 ± 3.08 during the baseline period and increased to 19.30 ± 3.03 during the endline period after the intervention. A similar increment was found in the age group of 21–30 years from 19.71 ± 3.80 to 20.35 ± 3.62 before and after the intervention period.

The change in hemoglobin was significantly higher in the hemoglobin range of 11–12 g/dl and more than 13 g/dl with a mean difference of (0.12 ± 0.58, P = 0.035, where P < 0.05) and (1.15 ± 0.84, P = 0.0001, where P < 0.01). The incidence of moderate anemia was found to be higher in the present study with hemoglobin <9.0 g/dl. It was indicated that when income increases, BMI does not increase. Similarly with increase in income, dietary diversity and hemoglobin does not increase. Whereas there exists a significant positive correlation between income and haemogloin, age and haemoglobin, BMI and haemoglobin, income and dietary diversity, which indicates that when income, dietary diversity and BMI increases, hemoglobin also increase.

Vulnerable tribal women have less diverse daily food intake. Awareness of the nutritional capacity of their local foods can help optimize the food resources in their locality. Parameters such as hemoglobin, BMI, and clinical symptoms can be improved through long-term interventions by imparting knowledge on synergistic food combinations and for effective micronutrient absorptions. More number of trainings on the promotion of micronutrient supplements and intake of micronutrient-rich food will help the community to understand the significance of hidden hunger. Even though there was no increase in BMI, there was a significant change in age, income, and BMI with hemoglobin. Sustained attempts to educate tribal women proved to be effective in attaining their nutritional security and in the families.

Acknowledgment

The author expresses heartful gratitude to Amrita Vishwa Vidyapeetham- Centre for Tribal Excellence and Ministry of Tribal Affairs for contributing their support both instrumentally and financially.

Financial support and sponsorship

Centre for Tribal Excellence and Ministry of Tribal Affairs – Grant No: 17014/01/2018. The funding agency supported in the following design of the study and collection, analysis, and interpretation of data

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
WHO. Micronutrients; 2020. Available from: https://www.who.int/health-topics/micronutrients#tab=tab_1. Accessed February 13, 2020.  Back to cited text no. 1
    
2.
CNNS (Comprehensive National Nutrition Survey). Comprehensive National Nutrition Survey National Report. Ministry of Health and Family Welfare (MoHFW), Government of India. New Delhi, India; 2019. Available from: https://nhm.gov.in/showfile.php?lid=712. Accessed December 24, 2019.  Back to cited text no. 2
    
3.
Haridas S, Ramaswamy J, Natarajan T, Nedungadi P. Micronutrient interventions among vulnerable population over a decade: A systematic review on Indian perspective. Health Promot Perspect 2022;12:151-62.  Back to cited text no. 3
    
4.
Vasudevan S, Senthilvel S, Sureshbabu J. Knowledge attitude and practice on iodine deficiency disorder and iodine level in salt in retail and vendors among the rural population in south India: A community based observational and descriptive study. Clin Epidemiol Glob Health 2019;7:300-5.  Back to cited text no. 4
    
5.
Rakesh PS. Prevalence of anaemia in Kerala state, Southern India – A systematic review. J Clin Diagn Res 2017;11:LE01-4.  Back to cited text no. 5
    
6.
Rani PJ, Devi NT, Rangarajan M. (2017). Postpregnancy Ethnic Nutritional Practices in India: A Critical Perspective of Immunity and Infection. In Nutrition, Immunity, and Infection (pp. 465-520). CRC Press.  Back to cited text no. 6
    
7.
Natarajan TD, Ramasamy JR, Palanisamy K. Nutraceutical potentials of synergic foods: A systematic review. J Ethnic Foods 2019;6:1-7.  Back to cited text no. 7
    
8.
Kirthika P, Janci Rani PR. Identification of functional properties of non-timber forest produce and locally available food resources in promoting food security among Irula tribes of South India. J Public Health 2020;28:503-15.  Back to cited text no. 8
    
9.
Mohandas S, Amritesh K, Lais H, Vasudevan S, Ajithakumari S. Nutritional assessment of tribal women in Kainatty, Wayanad: A cross-sectional study. Indian J Community Med 2019;44:S50-3.  Back to cited text no. 9
    
10.
Rajeevan TV, Rajendrakumar S, Senthilkumar T, Kumar SU, Subramaniam P. Community development through sustainable technology – A proposed study with Irula tribe of Masinagudi and Ebbanad Villages of Nilgiri District. In: First International Conference on Sustainable Technologies for Computational Intelligence. Singapore: Springer; 2020. p. 257-67. Available from: https://doi.org/10.1007/978-981-15-0029-9_20. Accessed April 30, 2020.  Back to cited text no. 10
    


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