Changing Perspectives in Tribal Health: Rising Prevalence of Lifestyle Diseases among Tribal Population in India

Unlocking the Therapeutic Potential: Sitagliptin's Multifaceted Approach in Drug-Resistant Epilepsy through a Novel Mechanism Inhibiting Protein Kinase C-γ and a Long-Term Potentiation Pathway

Drug-resistant epilepsy is a prominent challenge in chronic neurological disorders. Valproate, commonly used to treat epilepsy, can fail due to various side effects and interactions, necessitating the exploration of alternative treatments. Our study primarily investigated sitagliptin's potential as a therapeutic agent for drug-resistant epilepsy. Employing computational modeling and enzyme assay testing, three lead compounds, emixustat, sitagliptin, and distigmine bromide, were evaluated against the target enzyme protein kinase C-γ. In vivo, experiments on a pentylenetetrazolium-induced lamotrigine-resistant epilepsy model were conducted to test sitagliptin's antiseizure effects, compared with the standard phenobarbital treatment. Emixustat and sitagliptin showcased strong inhibitory properties, while distigmine bromide was less effective in the enzyme assay. Mechanistic insights revealed sitagliptin's ability to modulate the seizure grade and first myoclonic jerk latency via oxidative stress markers, like reduced glutathione and glutathione peroxidase emphasizing its antioxidative role in epilepsy. Additionally, it demonstrated anti-inflammatory effects by significantly reducing proinflammatory markers interleukin-1β and interleukin-6. The modulation of key genes of the long-term potentiation pathway, particularly protein kinase C-γ and metabotropic glutamate receptor 5, was evident through mRNA expression levels. Finally, sitagliptin showed potential neuroprotective properties, limiting pentylenetetrazolium-induced neuronal loss in the hippocampal region. Collectively, our findings suggest sitagliptin's multidimensional therapeutic potential for drug-resistant epilepsy specifically via a long-term potentiation pathway by inhibiting protein kinase C-γ.

Prevalence of Hypertension in Indian Tribal Population: a Systematic Review and Meta-analysis

Hypertension is a serious condition that significantly increases the risks of several cardiovascular diseases. An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension, and two-thirds of them live in low- and middle-income countries. Indigenous (tribal) populations are not exceptional to the threat of hypertension. Hence, there is a need to highlight the rising prevalence of hypertension among Indian tribes and to bring them under health care programmes. This paper reports the systematic review and meta-analysis of the literature on the prevalence of hypertension among Indian tribes by following the PRISMA guidelines. Three databases, viz. PubMed/Medline, Google Scholar and Scopus, were included. The gender-wise pooled prevalences were calculated, and forest plots were depicted. Other analyses were performed, including heterogeneity test, meta-regression and sub-group analysis. Of the 1010 studies obtained, 42 were included in this review. These studies covered tribal populations in different regions of India. The pooled prevalence of hypertension among men, women and combined were 23.66% (95% confidence interval (CI): 23.25 to 24.07%), 23.37% (95% CI: 22.99 to 23.75%) and 16.68% (95% CI: 16.10 to 17.28%) respectively. Considerable heterogeneity was found among these studies. The situation of increasing prevalence, as evident from this review, is worrisome as the hypertension epidemic will affect the poor tribal communities that cannot afford to pay for treatment expenses. Therefore, people's access to public health services must be improved. This review discusses the recent initiatives to reduce the burden of hypertension and other noncommunicable diseases in India and highlights the need of implementation research to strengthen these initiatives.

Prevalence and causes of visual impairment in Dongaria indigenous (tribal) community. Tribal Odisha eye disease study # 12

Purpose

To document the spectrum and magnitude of eye disorders and visual impairment in the Dongaria-a Particularly Vulnerable Tribal Group in the Rayagada district of Odisha, India.

Methods

A door-to-door screening protocol included a record of basic health parameters, visual acuity for distance, and near and flashlight examination of the eyes. Spectacles were dispensed to those who improved; those who failed the screening were referred to fixed (primary and secondary) eye care centers.

Results

We examined 89% (n = 9872/11,085) of people who consented for screening. The mean age was 25.5 ± 18.8 years; 55% (n = 5391) were female; 13.8% (n = 1361) were under-five children, and 39% (n = 3884) were 6 to 16 years. 86% (n = 8515) were illiterate. 12.4% (n = 1224) were visually impaired, of which 9.9% had early moderate VI, and 2.5% had severe VI and blindness. Uncorrected refractive error was detected in 7.5% (n = 744) and cataracts in 7.6% (n = 754); among the adults, 41.5% (n = 924/2227) had presbyopia. In children, 20% (n = 790) had vitamin A deficiency, 17% (n = 234) had global acute malnutrition, and 18% (n = 244) were stunted for their age. Almost two-thirds (62%, n = 6144) confirmed habitual intake of alcohol, and 4% (n = 389) of adults had essential hypertension. Following the screening, 43.5% (n = 837) of referred patients reported to the fixed centers, and 55% (134/243) of people advised underwent cataract surgery. Spectacles were dispensed to 1496 individuals.

Conclusion

Visual impairment and malnutrition are high in Dongaria indigenous community. Permanent health facilities and advocacy would improve this community's health and health-seeking behavior.

Prevalence of diabetes mellitus in Indian tribal population: a systematic review and meta-analysis

BACKGROUND

Diabetes mellitus (DM), a significant public health problem across the nations, is among the top ten leading causes of death. More than 370 million indigenous people (referred to as tribal people in India) are spread across 90 countries. India has the largest tribal people of 104 million. Tribal populations are not exceptional to the threat of type 2 DM (T2DM) and other non-communicable diseases, and hence, public health programmes are addressing this problem. This paper reports the systematic review and meta-analysis of the literature on the prevalence of T2DM.

METHODS

We conducted a systematic review and meta-analysis of the literature to understand the prevalence of T2DM among the tribal populations of India, following the guidelines of the PRISMA Statement for Reporting Systematic Reviews and Meta-Analysis. The gender-wise prevalence was recalculated by extracting the data wherever possible. Forest plots were depicted based on the prevalence, and other analyses were performed.

RESULTS

On initial searches from three databases, 5422 citations were identified, and ultimately 27 studies were included in the review. These studies were undertaken amongst different tribes in different parts of India. The pooled prevalence of T2DM among men, women and combined were 6.04% (95% confidence interval (CI): 5.55% to 6.57%), 6.48% (95% CI: 6.01% to 6.99%) and 4.94% (95% CI: 4.72% to 5.17%), respectively. Considerable heterogeneity was found among these studies.

CONCLUSION

This systematic review provides an overview of the prevalence of T2DM among the Indian tribal population. The pooled overall prevalence is slightly lower than the general population. This situation is worrisome as the epidemic of T2DM will affect the poor tribal communities, who can least afford to bear the health care costs. Hence, the public health care services must be strengthened in all tribal areas. This review further warrants establishing surveillance of T2DM in tribal areas.

Health profile of people living in the Gare Palma mining area of Tamnar block, Raigarh, Chhattisgarh, India

Introduction

A community-based health survey was conducted in Tamnar block, Raigarh district of Chhattisgarh, India.

Methodology

A total of 909 individuals (adults) were selected from 909 households from 33 sampled villages from March 2019 to February 2020. All individuals were clinically examined, and observations were recorded.

Results

Among adults older than 18 years, hypertension was observed in 21.7%. Type II diabetes was observed in only 4.0% of individuals. Tuberculosis was seen in 23 (2.5%) individuals.

Discussion

Common morbidities were similar in tribal and non-tribal communities living in the same area. For communicable diseases, being male, having nutritional deficiencies, and smoking were independent risk factors. For non-communicable diseases, the independent significant risk factors identified were being male, an altered body mass index, disturbed sleep, smoking, and nutritional deficiencies.

Enablers & challenges of tribal women & health system for implementation of screening of non-communicable diseases & common cancers: A mixed-methods study in Palghar district of Maharashtra, India

Background & objectives

Non-communicable diseases (NCDs) and cancers of breast, oral cavity and cervix contribute to around 5.87 million (60%) deaths in India. Despite this, there is limited evidence on preparedness of the tribal health system in mitigating these conditions. This mixed-methods study aimed at identifying enablers and challenges using a multistakeholder approach for the screening of NCDs and common cancers in a tribal block of Maharashtra, India.

Methods

This study was conducted in a tribal community of Dahanu taluka in Palghar district of Maharashtra. A total of nine focus group discussions (FGDs) among tribal women and accredited social health activists (ASHAs), 13 key informant interviews (KIIs) among auxiliary nurse midwives (ANMs) and community health officers (CHO) and facility surveys of five public health facilities were conducted. The FGDs and KIIs were conducted using guides, recorded digitally, transcribed, analyzed and triangulated to identify emerging themes.

Results

The tribal women had limited knowledge about NCDs and common cancers. Paucity of health facilities, out-of-pocket expenditure, misconceptions, belief on traditional healers and inability to prioritize health were identified as major challenges. The ASHAs were recognized as a key connecting link between health system and community while provision of culturally appropriate IEC materials and adequate training were recognized as critical enablers by healthcare providers in implementing screening for NCDs and common cancers.

Interpretation & conclusions

The study recommends incorporating socioculturally relevant strategies in the tribal population and strengthening health facilities in terms of infrastructure and training with involvement of ASHAs for successful implementation of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) through health and wellness centres.

Health status of Koraga community: A pilot study among a particularly vulnerable tribal group of Udupi District, Karnataka, India

Background & objectives

Undertaking tribe-specific assessment of health status provides the required data for planning appropriate interventions. Hence, a study was conducted to assess the health profile of the Koraga tribe.

Methods

This community-based cross-sectional study was conducted among a particularly vulnerable tribal group, the Koragas residing in the Udupi district. Data were collected using a pro forma and were analyzed using the SPSS software version 16.0.

Results

A total of 273 participants aged ≥18 yr and 94 children aged ≤17 yr were recruited through screening and referral services organized in Koraga hamlets of the Udupi district. Among the adults, 59.7 per cent were females and their median age was 35 yr. About 13.9 per cent had elevated blood pressure and 18.4 per cent had impaired/elevated random blood sugar levels. About 47.6 per cent were underweight and 35.2 per cent were anaemic. Multivariate logistic regression analysis showed that individuals with morbidities were more likely to be aged ≥45 yr [45-60 yr: adjusted odds ratio (AOR)=4.3; 95 per cent confidence interval (CI)=1.3-13.8 and >60 yr: AOR=6.4; 95 per cent CI=1.7-23.7] and overweight or obese [23-24.9 kg/m^[2]: AOR=8.1; 95% CI=1.3-48.2 and >25 kg/m^[2]: AOR=7.9; 95% CI=1.6-38.4]. Of the 26 Koraga children aged ≤5 yr, 30.7 and 42.3 per cent had their height for age and weight for age below the third percentile, respectively. Further, 15.3 per cent of under-five children and 27.9 per cent of 6-17 yr old children were severely wasted. About 21.2 per cent of the children aged ≤17 yr were found to be anaemic and 56.3 per cent had symptoms of respiratory tract infection in the past 15 days.

Interpretation & conclusions

Malnutrition was prevalent among Koraga adults and children, which warrants designing and implementing appropriate social and health interventions in this population.

Particularly vulnerable tribal groups of Tamil Nadu, India: A sociocultural anthropological review

"Adivasi" is the collective term for tribes, an indigenous population, and ethnic minorities of India. In general, tribal populations live in harmony with nature and resources within their habitat and largely reside in segregates in an unpolluted and natural environment away from modern civilization. As per the 2011 census, India contains 705 scheduled tribes (STs) and subtribes and 75 primitive tribal clusters. The ST population of Tamil Nadu, India, was found to be 794,697 and broadly spread in 38 districts constituting 36 tribes, among which 6 tribes were grouped as "particularly vulnerable tribal groups" (PVTGs), namely (1) Todas, (2) Kotas, (3) Kurumbas, (4) Irulas, (5) Paniyas, and (6) Kattunayakas, as the number of population in these tribal communities is either declining or remaining static. The state government is offering lots of benefit schemes for the STs, but they have not reached the tribal groups. Health problems of tribal communities have been profoundly influenced by different factors such as social, cultural, educational, economic, and political practices. The tribal peoples are exceedingly disease prone as they do not have access to basic health-care facilities. Therefore, concerned policymakers should focus on the changing health needs of tribal communities. In this regard, the current review article has been focused on the complete details (language, occupation, worship or deity, subdivisions or other names, etc.) of these six PVTGs and also to concentrate on the kind of problems they face while living in the societies. Therefore, the government and nongovernmental organizations need to find a way to improve their livelihoods and health status.

Determinants of behavioural and biological risk factors for cardiovascular diseases from state level STEPS survey (2017-19) in Madhya Pradesh

Background

National and statewide assessment of cardiovascular risk factors needs to be conducted periodically in order to inform public health policy and prioritise allocation of funds, especially in LMICs. Although there have been studies from India which have explored the determinants of cardiovascular risk factors, they have mostly been from high epidemiological transition states. The present study assessed the determinants of cardiovascular (CVD) risk factors in a low epidemiological transition state (Madhya Pradesh) using the WHO STEPwise approach to surveillance (STEPS).

Methods

A total of 5,680 persons aged 18–69 years were selected from the state of Madhya Pradesh through multi-stage cluster random sampling. Key CVD risk factors we sought to evaluate were from behavioural (tobacco, alcohol, physical activity, diet) and biological domains (overweight or obese, Hypertension, Diabetes, and Raised serum cholesterol). Key socio-demographic factors of interest were the caste and tribe groups, and rural vs urban location, in addition to known influencers of CVD risk such as age, gender and education level

Results

Those belonging to the scheduled tribes were more at risk of consuming tobacco (OR 2.13 (95% CI [1.52–2.98]), and a diet with less than five servings of fruits and vegetables (OR 2.78 (95% CI [1.06–7.24]), but had had the least risk of physical inactivity (OR 0.31 (95% CI [0.02–0.54]). Residence in a rural area also reduced the odds of physical inactivity (OR 0.65 (95% CI [0.46–0.92])). Lack of formal education was a risk factor for both tobacco consumption and alcohol intake (OR 1.40 (95% CI [1.08–1.82]) for tobacco use; 1.68 (95% CI [1.14–2.49]) for alcohol intake). Those belonging to schedules tribes had much lower risk of being obese (OR 0.25; 95% CI [0.17–0.37]), but were at similar risk of all other clinical CVD risk factors as compared to other caste groups.

Conclusion

In the current study we explored socio-demographic determinants of behavioural and biological CVD risks, and found that in Madhya Pradesh, belonging to a scheduled tribe or living in a rural location, protects against being physically inactive or being overweight or obese. Increasing age confers a greater CVD-risk in all domains. Being a male, and lack of formal education confers a greater risk for behavioural domains, but not for most clinical risk domains. Future efforts at curbing CVDs should be therefore two pronged –a population-based strategy targeting biological risk factors, and a more focussed approach directed at those displaying risky behaviour.