Possible causes of malnutrition in Melghat, a tribal region of Maharashtra, India

Water, sanitation and hygiene (WaSH) practices and diarrhoea prevalence among children under five years in a tribal setting in Palghar, Maharashtra, India

Providing safe drinking water, sanitation and hygiene (WaSH) in geographically isolated settings is a global public health priority. Prevalence of WaSH practices among mothers and diarrhoea among their children (birth to 59 months) was studied in nine randomly selected tribal villages of Mokhada in Palghar, Maharashtra, India. A community-based cross-sectional survey among 577 mother-child pairs was performed. Participants were recruited from the anganwadi list of enrolled children through household visits. WaSH index was used for assessing WaSH practices. Well was the major (47%) drinking water source. Almost 70% treated and covered the stored drinking water. Nearly 75% of the mothers used soap for washing hands before food and 35% after defecation. Open drains and open defecation were observed in 99% and 50% of households, respectively. The median score for drinking water index was 3 (interquartile range (IQR) = 2), personal hygiene index (PHI) was 2 (IQR = 2), household hygiene index (HHI) was 2 (IQR = 1) and composite index (CI) was 6 (IQR = 2). Prevalence of diarrhoea among children was found to be 33.4% and was significantly associated with poor HHI (p = .007), PHI (p < .001) and CI (p < .001). Measures to provide basic WaSH resources combined with efforts to create awareness would ensure improved WaSH practices and prevent diarrhoea.

Proximate determinants of tuberculosis in Indigenous peoples worldwide: a systematic review

BACKGROUND

Indigenous peoples worldwide carry a disproportionate tuberculosis burden. There is an increasing awareness of the effect of social determinants and proximate determinants such as alcohol use, overcrowding, type 1 and type 2 diabetes, substance misuse, HIV, food insecurity and malnutrition, and smoking on the burden of tuberculosis. We aimed to understand the potential contribution of such determinants to tuberculosis in Indigenous peoples and to document steps taken to address them.

METHODS

We did a systematic review using seven databases (MEDLINE, Embase, CINAHL, Global Health, BIOSIS Previews, Web of Science, and the Cochrane Library). We identified English language articles published from Jan 1, 1980, to Dec 20, 2017, reporting the prevalence of proximate determinants of tuberculosis and preventive programmes targeting these determinants in Indigenous communities worldwide. We included any randomised controlled trials, controlled studies, cohort studies, cross-sectional studies, case reports, and qualitative research. Exclusion criteria were articles in languages other than English, full text not available, population was not Indigenous, focused exclusively on children or older people, and studies that focused on pharmacological interventions.

FINDINGS

Of 34 255 articles identified, 475 were eligible for inclusion. Most studies confirmed a higher prevalence of proximate determinants in Indigenous communities than in the general population. Diabetes was more frequent in Indigenous communities within high-income countries versus in low-income countries. The prevalence of alcohol use was generally similar to that among non-Indigenous groups, although patterns of drinking often differed. Smoking prevalence and smokeless tobacco consumption were commonly higher in Indigenous groups than in non-Indigenous groups. Food insecurity was highly prevalent in most Indigenous communities evaluated. Substance use was more frequent in Indigenous inhabitants of high-income countries than of low-income countries, with wide variation across Indigenous communities. The literature pertaining to HIV, crowding, and housing conditions among Indigenous peoples was too scant to draw firm conclusions. Preventive programmes that are culturally appropriate targeting these determinants appear feasible, although their effectiveness is largely unproven.

INTERPRETATION

Indigenous peoples were generally reported to have a higher prevalence of several proximate determinants of tuberculosis than non-Indigenous peoples, with wide variation across Indigenous communities. These findings emphasise the need for community-led, culturally appropriate strategies to address smoking, food insecurity, and diabetes in Indigenous populations as important public health goals in their own right, and also to reduce the burden of tuberculosis.

FUNDING

Canadian Institutes of Health Research.

Implementing Perennial Kitchen Garden Model to Improve Diet Diversity in Melghat, India

Lack of diet diversity causing micronutrient deficiency is common in developing countries and is gaining attention due to the hidden consequences of impaired physical and cognitive development. This paper describes the propagation of a sustainable perennial kitchen garden (KG) model to address household (HH) diet diversity in Melghat. Nutrient dense plants, comprising of minimum one tree (perennial) and one green leafy vegetable (GLV) were given to participating HHs along with qualitative interventions. Baseline survey was conducted in winter 2011 followed by seasonal surveys over 2 years to record changes in KG practices, dietary intake and childcare practices. Marked increase from 4% at baseline to 95% at endline was seen in the KG maintainance. Increased diversity was seen in all food categories other than cereals and pulses. Variety of GLVs consumed increased over the two winters as well as the 2 summers. However, no change in the quantity of GLV consumed was noted which was attributed to the duration of the study period being insufficient for the trees to grow and provide adequate leaves for consumption. Notably, livelihood component was not promoted and HHs were encouraged to harvest and distribute excess seeds to relatives and neighbours. The study generated huge demand from HHs within the intervention and neighbouring villages. It concludes that a well designed perennial KG along with imparting adequate knowledge can be a sustainable practice to increase diet diversity and GLV intake which would help address micronutrient deficiencies in the community.