Assessment of zinc inadequacy among tribal adolescent population of central India - A cross-sectional study.

Background & objectives: Zinc is a crucial micronutrient in adolescence, required for promoting growth and sexual maturation. Adolescents of some tribes may be at high risk of zinc deficiency due to dietary inadequacy and poor bioavailability of zinc from plant-based diets. This study aimed to evaluate the risk of zinc deficiency by estimating prevalence of inadequate zinc intake, prevalence of low serum zinc and stunting among tribal adolescents. Methods: A cross-sectional community-based survey was conducted among adolescents (10-19 yr) in three purposively selected districts where Bhil, Korku and Gond tribes were in majority. Structured data collection instrument comprising information about sociodemographic characteristics and dietary recall data was used. Anthropometric assessment was conducted by standardized weighing scales and anthropometry tapes, and blood sample was collected from antecubital vein into trace element-free vacutainers. Serum zinc was estimated using an atomic absorption spectrophotometer. Results: A total of 2310 households were approached for participation in the study, of which 2224 households having 5151 adolescents participated. Out of these enlisted adolescents, 4673 responded to dietary recall (90.7% response rate). Anthropometry of 2437 participants was carried out, and serum zinc was analyzed in 844 adolescents. The overall prevalence of dietary zinc inadequacy was 42.6 per cent [95% confidence interval (CI) 41.2 to 44.1] with reference to the estimated average requirement suggested by International Zinc Nutrition Consultative Group (IZiNCG) and 64.8 per cent (95% CI 63.4 to 66.2) with Indian Council of Medical Research-recommended requirements. Stunting was observed in 29 per cent (95% CI 27.2 to 30.8) participants. According to IZiNCG cut-offs, low serum zinc was detected in 57.5 per cent (95% CI 54.1 to 60.8) of adolescents, whereas it was 34.4 per cent (95% CI: 31.2-37.5) according to the national level cut-off. Interpretation & conclusions: Risk of dietary zinc inadequacy and low serum zinc concentration amongst adolescents of the Gond, Bhil and Korku tribes is a public health concern.

Menstrual Hygiene Practices in Indian Tribal Females: A Systematic Review and Meta-Analysis.

India is native to many tribal communities: Bharia (Madhya Pradesh), Bihl (Rajasthan), Santhal (Bihar, Jharkhand), Bodo (Assam, West Bengal), and many more. They reside in isolated geographical regions, which poses challenges in reaching out to them. In addition, they still have firm beliefs and taboos regarding menstruation. Knowledge about menstrual health and hygiene is one of the most important aspects of tribal health. Therefore, it is important to synthesize the results of menstrual hygiene data from the Indian tribal population. We have calculated the pooled prevalence of sanitary pad use, dustbin disposal, and hygienic reuse of menstrual materials. Online databases, namely PubMed, Cochrane Central, CINAHL, Pan African Journals, EBSCO, and Google Scholar, were searched. After the removal of duplicates, a quality check, and screening of cross-references, 19 articles were selected for final review. Statistical analysis was done by Revman 5.4 and STATA 17.0. A p-value of <0.05 was considered statistically significant. PRISMA guidelines were followed. The protocol registration number was CRD42022331376. This is a non-funded article. The pooled prevalence of sanitary pad use in Indian tribal females was 2% (95% CI 1 to 3). The pooled prevalence of dustbin disposal of menstrual material was 1% (95% CI: 0.00 to 0.02). The pooled prevalence of hygienic reuse of menstrual materials was 1%. Sanitary menstrual hygiene practices are very less prevalent in Indian tribal females. Awareness programs and tribal health policies need to be accelerated for the promotion of menstrual hygiene. Also, literature on the use, disposal, and storage of menstrual adsorbents is scarce in Indian tribes. Health research in this area needs to be emphasized.

Indigenous Foods to Address Malnutrition: An Inquiry into the Diets and Nutritional Status of Women in the Indigenous Community of Munda Tribes of Jharkhand, India.

Background: Indigenous people globally experience poor nutrition outcomes, with women facing the greater burden. Munda, a predominant tribe in Jharkhand, India, live in a biodiverse food environment but yet have high levels of malnutrition. Objectives: To assess diets and the nutritional status of Munda tribal women and explore associations with their Indigenous food consumption, dietary diversity, and socioeconomic and demographic profiles. Methods: A cross-sectional study with a longitudinal component to capture seasonal dietary intake was conducted in 11 villages of the Khunti district, Jharkhand. Household surveys and FFQs, supplemented with 2-d 24-h dietary recall and anthropometric assessments on 1 randomly selected woman per household were conducted. Results: Limited access to diverse foods from a natural food environment (Food Accessed Diversity Index score of 0.3 ± 0.3) was observed. More than 90% women in both seasons had usual nutrient intakes below the estimated average requirements for all nutrients except protein and vitamin C; 35.5% of women were underweight. The mean Minimum Dietary Diversity Score among women (MDDS) was low [2.6 ± 0.6 in wet monsoon; 3 ± 0.7 in winters (acceptable ≥5)]. Higher MDDS contributed to higher usual nutrient intakes (P <0.001). Indigenous food intakes in both seasons (wet monsoon and winter) were low, e.g. Indigenous green leafy vegetables [10.5 and 27.8% of the recommended dietary intake (RDI), respectively], other vegetables (5.2% and 7.8% of RDI, respectively), and fruits (5.8 and 22.8% of RDI, respectively). Despite low intakes, the Indigenous food consumption score was positively associated with usual intake of vitamin A, riboflavin, vitamin C, pyridoxine, and calcium (P < 0.05) in the wet monsoon and thiamine, riboflavin, and zinc (P < 0.001) in winters. After adjusting for covariates, Indigenous food consumption was associated with a higher usual intake of vitamin A (P  < 0.001) in the wet monsoon season. Conclusion: Contextual food-based interventions promoting Indigenous foods and increasing dietary diversity have the potential to address malnutrition in Munda women.

Diet Quality, Nutritional Adequacy and Anthropometric Status among Indigenous Women of Reproductive Age Group (15-49 Years) in India: A Narrative Review.

In India, indigenous communities are nutritionally vulnerable, with indigenous women suffering the greater burden. Studies and surveys have reported poor nutritional outcomes among indigenous women in India, yet systematic documentation of community-specific nutrition data is lacking. We conducted a narrative review of 42 studies to summarise the nutritional profile of indigenous women of India, with details on their food and nutrient intakes, dietary diversity, traditional food consumption and anthropometric status. Percentage deficits were observed in intake of pulses, green leafy vegetables, fruits, vegetables, flesh foods and dairy products when compared with recommended dietary intakes for moderately active Indian women. Indices of diet quality in indigenous women were documented in limited studies, which revealed poor dietary diversity as well as low consumption of diverse traditional foods. A high risk of nutritional inadequacy was reported in all communities, especially for iron, calcium, and vitamin A. Prevalence of chronic energy deficiency was high in most communities, with dual burden of malnutrition in indigenous women of north-eastern region. Findings from this review can thus help guide future research and provide valuable insights for policymakers and program implementers on potential interventions for addressing specific nutritional issues among indigenous women of India.

A Cluster Randomized Controlled Trial of a Home-Delivered Food Box on Food Security in Chickasaw Nation.

BACKGROUND: The 2010 Child Nutrition reauthorization called for the independent evaluation of innovative strategies to reduce the risk of childhood hunger or improve the food security status of households with children. OBJECTIVE: The research question was whether the Packed Promise intervention reduces child food insecurity (FI-C) among low-income households with children. DESIGN: This study was a cluster randomized controlled trial of 40 school districts and 4,750 eligible, consented households within treatment and control schools. PARTICIPANTS/SETTING: Data were collected at baseline (n = 2,859) and 2 follow-ups (n = 2,852; n = 2,790) from households with children eligible for free school meals in participating schools in 12 rural counties within the Chickasaw Nation territory in south central Oklahoma in 2016 to 2018. INTERVENTION: Each month of the 25-month intervention, for each eligible child, enrolled households could choose from 5 types of food boxes that contained shelf-stable, nutritious foods ($38 food value) and a $15 check for purchasing fruits and vegetables. MAIN OUTCOME MEASURES: The primary outcome was FI-C. Other outcomes included household and adult food security, very low food security among children, and food expenditures. STATISTICAL ANALYSES PERFORMED: Differences between the treatment and control groups were estimated by a regression model controlling for baseline characteristics. RESULTS: The Packed Promise project did not significantly reduce FI-C at 12 months (29.3% prevalence in the treatment group compared with 30.1% in the control group; P = 0.123) or at 18 months (28.2% vs 28.7%; P = 0.276), but reduced food insecurity for adults by 3 percentage points at 12 months (P = 0.002) but not at 18 months (P = 0.354). The intervention led to a $27 and a $16 decline in median household monthly out-of-pocket food expenditures at 12 and 18 months, respectively. CONCLUSIONS: An innovative intervention successfully delivered nutritious food boxes to low-income households with children in rural Oklahoma, but did not significantly reduce FI-C. Improving economic conditions in the demonstration area and participation in other nutrition assistance programs among treatment and control groups might explain the lack of impact.ClinicalTrials.gov ID: NCT04316819 (http://www.clinicaltrials.gov). FUNDING/SUPPORT: This article is published as part of a supplement supported by the US Department of Agriculture, Food and Nutrition Service.

Non-response to first-line anti-tuberculosis treatment in Sikkim, India: a risk-factor analysis study.

Setting: Sikkim, India, has the highest proportion of tuberculosis (TB) patients on first-line anti-tuberculosis regimens with the outcome 'failure' or 'shifted to regimen for multidrug-resistant TB (MDR-TB)'. Objective: To assess the factors associated with non-response to treatment, i.e., 'failure' or 'shifted to MDR-TB regimen'. Methods: We conducted a retrospective cohort study using Revised National Tuberculosis Control Programme data of all TB patients registered in 2015 for first-line TB treatment. In addition, we interviewed 42 patients who had not responded to treatment to ascertain their current status. Results: Of 1508 patients enrolled for treatment, about 9% were classified as non-response to treatment. Patient factors associated with non-response were urban setting (adjusted odds ratio [aOR] 2.39, 95%CI 1.22-4.67), ethnicity (being an Indian tribal, aOR 1.73, 95%CI 1.17-2.57, Indian [other] aOR 1.83, 95%CI 1.29-2.60 compared to patients of Nepali origin) and those on retreatment (aOR 2.40, 95%CI 1.99-2.91). Of the patients interviewed, 28 (67%) had received treatment for drug-resistant TB. Conclusion: In Sikkim, one in 11 patients had not responded to first-line anti-tuberculosis treatment. Host-pathogen genetics and socio-behavioural studies may be required to understand the reasons for the differences in non-response, particularly among ethnic groups.

Contexte : L'état de Sikkim, en Inde, a la proportion la plus élevée du pays de patients atteints de tuberculose (TB) sous protocole antituberculeux de première ligne avec pour résultats « échec ¼ ou « passé à un protocole de TB multirésistante (TB-MDR) ¼.Objectif : Evaluer les facteurs associés à une non réponse au traitement (« échec ¼ ou « passé à un protocole de TB-MDR¼).Méthode : Nous avons réalisé une étude rétrospective de cohorte grâce aux données du programme national révisé pour la lutte contre la tuberculose de tous les patients TB enregistrés en 2015 pour un traitement de TB de première ligne. Nous avons également interviewé 42 patients ayant une non réponse au traitement pour vérifier leur statut actuel.Résultats : Sur les 1508 patients enrôlés en traitement, environ 9% ont été classés comme non réponse au traitement. Les facteurs liés au patient associés à l'absence de réponse ont été un contexte urbain (odds ratio ajusté [ORa] 2,39 ; IC95% 1,22­4,67), l'ethnicité (appartenance à une tribu Indienne, ORa 1,73 ; IC95% 1,17­2,57, autres populations Indiennes, ORa 1,83 ; IC95% 1,29­2,60, par comparaison aux patients d'origine Népalaise) et aux patients en retraitement de TB (ORa 2,40 ; IC95% 1,99­2,91). Parmi les patients interrogés, 28 (67%) ont reçu un traitement pour TB pharmacorésistante.Conclusion : Au Sikkim, un patient sur 11 avait une non réponse au traitement antituberculeux de première ligne. Des études de génétique hôte-pathogène et des études sociocomportementales pourraient être requises afin de comprendre les raisons des différences dans la non réponse, surtout entre les groupes ethniques.

Marco de Referencia: El estado de Sikkim en la India presenta la proporción más alta de pacientes cuyo desenlace del tratamiento antituberculoso de primera línea se clasifica como 'fracaso' o 'cambiado a un esquema contra la tuberculosis multirresistente (TB-MDR)'.Objetivo: Evaluar los factores que se asocian con la falta de respuesta al tratamiento ('fracaso' o 'cambiado a un esquema contra la TB-MDR').Métodos: Se llevó a cabo un estudio de cohortes, a partir de los datos del Programa Revisado Nacional contra la Tuberculosis, de todos los pacientes registrados en el 2015 en tratamiento antituberculoso de primera línea. Además, se entrevistaron 42 pacientes (que no respondieron al tratamiento), con el fin de verificar su situación actual.Resultados: De los 1508 pacientes inscritos para tratamiento, cerca del 9% se clasificaron sin respuesta al tratamiento. Los factores del paciente que se asociaron con la falta de respuesta fueron los siguientes: un entorno urbano (OR ajustado [ORa] 2,39; IC95% 1,22­4,67), la etnia (pertenencia a grupos tribales, ORa 1,73; IC95% 1,17­2,57 u otras poblaciones indias ORa 1,83; IC95% 1,29­2,60 cuando se compararon con los pacientes de origen nepalés) y el retratamiento antituberculoso (ORa 2,40; IC95% 1,99­2,91). De los pacientes entrevistados, 28 habían recibido tratamiento por TB farmacorresistente (67%).Conclusión: En Sikkim, uno de cada 11 pacientes no respondió al tratamiento de primera línea contra la TB. Se precisarían estudios genéticos de la interacción entre el hospedero y el patógeno y estudios sociales conductuales que permitan comprender las razones de las diferencias en la falta de respuesta, sobre todo entre los diferentes grupos étnicos.