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.

Non-invasive assessment of adrenocortical function as a measure of stress in the endangered golden langur.

The golden langur (Trachypithecus geei) is an endangered primate endemic to northern India and Bhutan. The main stressors to the species are habitat degradation and fragmentation. Non-invasive fecal glucocorticoid metabolite (fGCM) analysis is a powerful tool for assessing stress associated with environmental disturbances in wildlife. However, interspecific differences in glucocorticoid metabolism require careful selection of the antibody used in their quantification. The goals of this study were to: 1) validate an enzyme immunoassay (EIA) to determine fecal GC metabolite (fGCM) concentrations in the golden langur and 2) compare fGCM concentrations between golden langurs living under different environmental conditions. We compared five enzyme immunoassays for determining stress related physiological responses in golden langurs by performing an adrenocorticotropic stimulation test in both sexes. Our validations identified an 11-oxoaetiocholanolone EIA detecting 11, 17 dioxoandrostanes as the most suitable assay for monitoring adrenocortical activity in the species. FGCM concentrations from semi-captive temple langurs were significantly higher than respective stress steroid concentrations in free-ranging or pet/zoo langurs. This study presents a validated practical method for non-invasive monitoring of adrenocortical function in this rare and declining species.

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 of type 2 diabetes among tribal population of india: a multi-centric cross-sectional study.

BACKGROUND: The perception among healthcare workers is that the Indian tribal (indigenous) population are less affected by diabetes. This paper reports the prevalence of type 2 diabetes and its associated factors among tribal populations from six districts across India. METHODOLOGY: Random blood glucose (RBG) and fasting blood glucose (FBG) were measured for 8486 and 3131 adults, respectively, with a glucose meter. FBG ≥ 126 mg/dL (7.0 mmol/L) and RBG ≥ 200 mg/dL (11.1 mmol/L) were used to diagnose diabetes. In addition, blood pressure, anthropometric (height, weight, waist and hip circumferences), socio-demographic (age, gender, education, type of tribe and type of village) and behavioural data (tobacco smoking, non-smoking tobacco use and alcohol consumption) were collected. RESULTS: The overall prevalence of type 2 diabetes, based on RBG, was 4.77% (95% CI: 4.33-5.25). The prevalence of type 2 diabetes and prediabetes, based on FBG, was 6.80% (95% CI: 5.95-7.74) and 8.69% (7.72-9.73), respectively. The prevalence of type 2 diabetes was significantly associated with age (p<0.001), smokeless tobacco use (p < 0.05), hypertension (p < 0.001) and obesity (p < 0.01). CONCLUSION: The prevalence of type 2 diabetes among the Indian tribal population reported in this study is less than the national average of 7.3% for the general population. Hypertension and obesity were the major risk factors. Due to changing behavioural patterns, including dietary behaviour, there is likely to be an increase in the prevalence of hypertension and obesity, which further leads to increased prevalence of type 2 diabetes. Hence, appropriate interventions are to be initiated by the primary healthcare system.

Hypertension Prevalence, Awareness, Treatment, Control and Risk Factors in Tribal Population of India: a Multi-Centric Cross-Sectional Study.

The prevalence of hypertension is increasing in the tribal population of India. Lifestyle modifications, including dietary changes and acculturation, are the main reasons for the high prevalence of hypertension among the Indian indigenous (tribal) population. This paper reports hypertension prevalence, awareness, treatment, control and risk factors among tribes in five districts of different geographical zones of India. A cross-sectional study was conducted among the adult tribal population of 7590 from these states. Data related to blood pressure, anthropometry, demographic and behavioural variables were collected with prior consent from the participants. The prevalence of hypertension is 34.0% and 28.3% among men and women, respectively. Of the total hypertensives, 27.5% were aware of their hypertension status; of them, 83.9% were receiving treatment, and blood pressure was in control among 33.5% of patients who were receiving treatment. Age, alcohol intake, sedentary lifestyle, Particularly Vulnerable Tribal Groups status and body mass index are found to be significantly associated with the prevalence of hypertension. The prevalence of hypertension is high among these tribal populations, which could be due to modernization and acculturation. Awareness and treatment-seeking behaviour are poor. Hence, early screening, awareness campaigns for seeking treatment, and health promotion are immediately required. Comprehensive health promotion programs need to promote lifestyle modification and re-orientation of the primary health care system to improve availability and accessibility to hypertension screening and treatment.