A technological approach to “Reaching the Unreached” – Leveraging teleophthalmology services in Rural Gujarat

Purpose: Early detection of sight?threatening disorders by technological applications like teleophthalmology and prompt treatment can help decrease visual impairment. This study evaluated the role of teleophthalmology in underserved rural areas along with cost?saving estimates for the end user. Methods: A prospective, observational, cross?sectional hospital?based study was conducted over 3 months. First 1000 teleconsultations were included. None of the patients denied providing informed consent. The patients were consulted at the eight vision centers and three satellite centers of the hospital in the nearby rural and tribal regions closer to their residential places. These vision and satellite centers were connected to the base hospital like a hub and spoke model with a teleophthalmology network. Results: Cataract (n = 301, 30.1%) and refractive error (n = 290, 29%) were the most common diagnosis. 42.1% of patients were referred to base hospital for further evaluation. Thus, a total of 57.9% of patients were not required to visit the base hospital for initial consultation, saving time and money. Furthermore, 15.1% of patients were provided medical treatment at the vision center and satellite center, which helped in making teleophthalmology cost?saving for the patients. An average of Rs. 621/? were saved per patient for the community in our study. Conclusion: Networked teleophthalmology model can be an affordable and feasible tool for providing eye care delivery services in rural and tribal regions of Gujarat and the whole country, especially for the end user. Thus, it may be a workable model in ophthalmology practice with substantial cost saving to the community.

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.

Study On Consumer Behaviour With Respect To Brand In Online Shopping Of Durable Product Among Tribal's Of Ranchi District

Consumer behavior can be defined as the activities and the actions of people and organization that purchase and use economic goods and services, including the influence on these activities and actions. Marketers expect that by understanding what causes the consumers to buy particular goods and services, they will be able to determine which products are needed in the marketplace, which are obsolete, and how best to present the goods to the consumers. In the changing digital era, people buying online have drastically increased when compared to offline shopping. Existence of many online platforms has increased the choices for the consumers. It is a common rule in economics, that when there are more choices for the consumer, there is more competition. The online platforms has also developed there specializations like Myntra for fashion, amazon for electronics, big basket for food and so on. This specialization in online platforms has actually given various new factors for the consumers to compare the products. After the arrival of these many platforms, consumers have changed their view over the branding of products. There are consumers who are loyal to the brands in few products and there are also consumers who find only the best deals irrespective of branding. This paper studies the consumer's choices and behavior towards the brands in online shopping in a survey method.

Development, validation & pilot testing of a questionnaire to assess healthcare seeking behaviour, healthcare service utilization & out-of-pocket expenditure of Particularly Vulnerable Tribal Groups of Odisha, India

Background & objectives: Assessing healthcare seeking behaviour (HSB), healthcare utilization and related out-of-pocket expenditures of Particularly Vulnerable Tribal Groups (PVTGs) of India through a prism of the health system may help to achieve equitable health outcomes. Therefore, this comprehensive study was envisaged to examine these issues among PVTGs of Odisha, India. However, there exists no validated questionnaire to measure these variables among PVTGs. Therefore, a study questionnaire was developed for this purpose and validated. Methods: Questionnaire was constructed in four phases: questionnaire development, validity assessment, pilot testing and reliability assessment. Nine domain experts face validated questionnaire in two rounds, followed by a single round of quantitative content validity. Next, the questionnaire was pretested in three rounds using cognitive interviews and pilot-tested among 335 and 100 eligible individuals for the two sections healthcare seeking behaviour (HSB-Q) and maternal and child healthcare service utilization (MCHSU-Q). Internal consistency reliability was assessed for de novo HSB-Q. Results: On two rounds of expert-driven face validity, 55 items were eliminated from 200 items. Questionnaire showed moderate to high content validity (item-level content validity index range: 0.78 to 1, scale-level content validity index/universal agreement: 0.73; scale-level content validity index/average: 0.96 and multirater kappa statistics range: 0.6 to 1). During the pre-test, items were altered until saturation was achieved. Pilot testing helped to refine interview modalities. The Cronbach alpha and McDonald’s omega assessing internal consistency of HSB-Q were 0.8 and 0.85, respectively. Interpretation & conclusions: The questionnaire was found to be valid and reliable to explore healthcare seeking behaviour, maternal and child healthcare utilization and related out-of-pocket expenditure incurred by PVTGs of Odisha, India.

Prevalence of Hypertension Among Tribal Population in India: A Systematic Review and Meta-Analysis

Hypertension is an important worldwide public-health challenge and it is accountable for 7% of Disability Ad-justed Life Years (DALY) loss, and by the end of 2025 about 29% of world’s population is likely to suffer from hypertension. Tribal population constitute about 8% of the total population in India. Among tribal population, study on hypertension will provide an interesting outcome because studies across the world have shown a lower prevalence. The objective of the study was to estimate the pooled prevalence of hypertension among adult tribal populations in India and also to analyse the possible sources of heterogeneity in the estimate. A systematic search was performed in PubMed, Google scholar, Scopus, Embase MEDLINE, and journals for arti-cles published between 2001 and 2020. This is a systematic review and meta-analysis done on hypertension among tribal populations of India. Three authors independently reviewed the articles, performed quality as-sessment and data was extracted. Pooled estimate of hypertension was calculated. Subgroup analyses was performed. A total of 26 articles with a total number of subjects of 75,543 were included in the study. The pooled estimate of hypertension prevalence was 25.1% (95% CI: 24.7, 25.4). There was significant heteroge-neity among the studies (I2 = 98.2 and Q = 1289.37). It is essential to conduct larger cohort studies and ran-domised controlled trials to determine the causes of the increased prevalence of hypertension among the tribal population. The prevalence of hypertension among tribal population are essential as a source of prima-ry information and for rational planning of health services and will help public-health policy-makers to assign sufficient priority and resources for its management and prevention.

Community-Based Approach to Combat Micronutrient Deficiencies Among Irular Tribal Women: An Education Intervention

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.

SALIENT FEATURES OF ODISHAN TRIBAL MUSIC

The tribal music is passed down from one generation to next generations. In Odisha every tribal community has its own cultural values, which guide their socio-economic life. Odishan tribal music with its closed-group form of ethnicity is remarkable in the sense that it can never be studied in isolation from the social and ritual contexts of the people concerned. Odishan tribal music possesses a well-built community basis. The fact can be comprehended in the domains of musical-socialization, kinds of ownership, levels of participation and nature of specialization. The tribes-folk and their inbuilt artistic instincts, and intricate engineering skills passed down hundreds of generations, come together to create layered musical magic in a single instrument, using tools and materials that grew, or were found on their lands and forests. Odishan tribes have also possessed a variety of sub-cultures, racial and linguistics variations, which on their part; spill over beyond the administrative boundaries of the state of Odisha into the neighboring states

Sociodemographic profile of patients with snakebite in Jharkhand

Background:Snakebites are a very serious issue that affects people all around the world. The world health organization (WHO) has recently classified snake bites as one of the neglected tropical diseases.Methods:It was an observational, prospective and cross-sectional study conducted at the department of general medicine, (Rajendra institute of medical sciences, Ranchi). A total of 60 patients suffering with first time snakebite were selected for this study by using a purposive sampling technique. Demographic data of the 60 selected cases were recorded in pre-designed standard study forms by means of structured personal interview of patients and attendants after taking informed consent.Results:The mean age � standard deviation of participants� age was 37.35�.123.There were 61.7% tribal people and 38.3% non-tribal people. Out of 60 cases included in this study, 93 % were from rural area and only 7% belonged to urban areas. The sociodemographic analysis showed that 93% patients were belonging to lower socioeconomicstatus and 7% were belonging to middle socioeconomic statusConclusions:The present study concluded that majority of the snakebite fresh cases in Jharkhand belonged to male gender. Majority of cases fell in the age range of 16-48 years, majority of casesbelonged to tribal community and rural areas.

Issues in Utilisation of MCH Services: Qualitative Insights from Tribal Women of Himachal Pradesh, India

Mothers and children in any country comprise a large vulnerable population subgroup. In order to address the myriad health needs of women and children, maternal and child health (MCH) services have been bolstered in India. Tribal women are facing many hurdles in the utilisation of MCH services which is ultimately affecting their health outcomes.This study aimed to explore the issues and challenges faced by tribal women during the utilisation of MCH services. Beneficiaries were facing issues like hospital environment and sub-centre issues, travelling/ transportation problems, lack of family support, awareness issues, and personal, social, and political issues while utilising maternal and child health services of tribal areas.It was concluded that there is a need to reduce the problems faced by tribal women regarding the utilisation of MCH services to enhance their level of satisfaction in order to promote maternal and child health which will ultimately help in achievement of SDGs.

Burden of Oral Precancer and Cancer among an Indigenous Tribal Population of South India – An Evaluative Study

Context: Oral cancer is of major concern in the Indian subcontinent and is found to be high among low socioeconomic groups. One such high?risk group is considered to be the tribal people, who are economically and socially marginalised. Aims: The aim of the present study is to assess the prevalence of oral cancer and precancer lesions among the Narikurava population in Puducherry state, India. Methods and Material: A total of 329 Narikurava tribal people were included in this study. Data was collected by clinical examination of the oral cavity by door?to?door screening. The oral cavity was examined for white/red lesions, ulcerative changes, leathery changes and tissue growths. Statistical Analysis Used: Prevalence was calculated in terms of percentages. Descriptive statistics included the calculation of percentages, mean, and standard deviation. Results: The prevalence of precancer in the population is 48.3%. The majority of the lesions were observed in the buccal mucosa: 41.6% had white lesions, 9.1% had red lesions, 0.3% had ulcerations or growth, and 28.3% had leathery changes followed by the labial mucosa: 0.6% had white lesions, 0.6% had red lesions, 0.3% had ulcerations or growth and 16.4% had leathery changes. Conclusions: The present study observed a high prevalence of precancerous lesions among the Narikurava tribe. The main reason for the high prevalence is attributed to tobacco and tobacco?related habits. Hence, cancer control activities should be prioritised. Designing a model to detect precancer and cancer early and to constantly monitor the detected cases in such populations is of utmost importance

Evaluation of the Integrated Child Development Services Scheme in aHilly Tribal District of Manipur: A Cross-Sectional Study

Introduction: The Integrated Child Development Services (ICDS) Scheme, the largest program for promotion of maternal and child health nutrition in India, is operational for more than four decades. Objective: To evaluate Integrated Child Development Services Scheme in Kangpokpi District of Manipur in terms of input, process and outcome indicators. A community-based cross-sectional studyMethod: was conducted at a tribal hilly district of Kangpokpi in Manipur. The study included ICDS staff and beneficiaries of 35 randomly selected Anganwadi Centres (AWCs). Data related to ICDS was collected by using interview schedules and checklists. The descriptive data were expressed in terms of mean, standard deviation and percentage. Association between important background characteristics and Anganwadi centre attendance was analysed using chi-square test. Ethical clearance was obtained from the institutional Ethic Committee of JNIMS, Imphal before conducting the study (study period: May 2018 to April 2021) Input indicators: The study found that 86% anganwadi centres were run inResults: anganwadi worker’s own house. Two-thirds of the anganwadi workers (65.7%) were found to have separate toilet and 22.9% had separate kitchen. Process indicators: Even though the proportions of beneficiaries accessing services from anganwadi centres were high, the number of days Supplementary Nutrition (SN) was provided in a month was comparatively low (mean: 2.97 and SD: 0.618 for under-6 children and mean: 1 and SD: 0.000 days for adolescent girls, pregnant women and lactating mother in a month) due to frequent interruption of supplementary nutrition supply. There was no supplementary nutrition stock in 74.3% of the anganwadi centres on the day of visit. Outcome indicators: Regarding the nutritional status 90% of Under-6 children were found to be normal, 9% underweight and 0.6% severely underweight. The Integrated Child Development Services Programme in the study area wasConclusion: found to have several short-comings both in terms of inputs and process. There were not only inadequate facilities and infrastructure, but the anganwadi centres also lacked essential equipment like weighing machines and medicine kits, rendering a vital activity like growth monitoring to be almost completely absent. Supervisory visits were far below satisfactory.

An ethnographic approach to understand cultural perspectives of tribes on branding practice for sick children in Odisha, India

Background & objectives: Traditional beliefs on child healthcare at time lead to potentially harmful practices like branding. However, there is a gap in people’s perceptions, attitudes and beliefs about branding practice. Therefore, the present study was undertaken to document the cultural motivation, ability and opportunity for branding practice in a tribal district of Odisha, India. Methods: Initially, such practices were observed in the tribal community for three months. Then, 18 in-depth interviews were conducted - ten among women having under-five children, and eight among traditional healers. Six focus group discussions were conducted with community health workers as well. The responses were digitally recorded, transcribed and translated and were further used for thematic framework analysis. Results: The primary determinants of branding practice were cultural beliefs compounded with low-health literacy, proximity to conventional care and influence of family and friends. The key driver for branding practices was traditional cultural beliefs on child healthcare decisions and health-seeking behaviours. Opportunities in the health system – availability and quality of health services – frequently drive them to seek healthcare from the system structure and routine health communication improves their ability to make better healthcare decisions. Interpretation & conclusions: Culture significantly affects the conceptualisation of illness and care-seeking pathways in a society. The indigenous community used to consult local traditional healers for their health concerns. While the government has made efforts to increase community health literacy through various platforms and multiple stakeholders’ engagements, the doorstep availability of modern care and health promotion interventions remains critical for meeting the health needs of the indigenous community.

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.

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.

Serological survey for SARS-CoV-2 antibodies among tribal communities of Odisha post-second wave

Background & objectives: Serial national level serosurveys in India have provided valuable information regarding the spread of COVID-19 pandemic in the general population, but the impact of the ongoing pandemic on the tribal population in India is not well understood. In this study, we evaluated the seroprevalence of COVID-19 antibodies in the tribal population of Odisha post-second wave (September 2021). Methods: A population-based, age-stratified, cross-sectional study design was adopted for the survey, carried out in seven tribal districts of Odisha from 30th August to 16th September 2021. A multistage random sampling method was used where serum samples were tested for antibodies against the SARS-CoV-2 nucleocapsid (N) protein in each district, and a weighted seroprevalence with 95 per cent confidence interval (CI) was estimated for each district. Results: A total of 2855 study participants were included from the seven tribal districts of Odisha in the final analysis. The overall weighted seroprevalence was 72.8 per cent (95% CI: 70.1-75.3). Serological prevalence was the highest among 18-44 yr (74.4%, 95% CI: 71.3-77.3) and from Sambalpur district [75.90% (66.90-83.10)]. Among participants, 41.93 per cent had received at least one dose of any COVID-19 vaccine. Kandhamal district had the highest number of fully immunized participants (24.78%), and in Sundergarh district, most of the study participants (58.1%) were unimmunized.Interpretation & conclusions: This study found high seroprevalence against SARS-CoV-2 in the tribal population of Odisha. The vaccination coverage is at par with the general population, and efforts to address some knowledge gaps may be needed to improve the coverage in the future

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/m2: AOR=8.1; 95% CI=1.3-48.2 and >25 kg/m2: 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.

Preparedness of primary & secondary care health facilities for the management of non-communicable diseases in tribal population across 12 districts in India

Background and objectives: Non-communicable diseases (NCDs) are highly prevalent in the tribal populations; however, there are limited data regarding health system preparedness to tackle NCDs among these populations. We estimated the availability of human resources, equipment, drugs, services and knowledge of doctors for NCD management in the selected tribal districts in India. Methods: A cross-sectional survey was conducted in 12 districts (one from each State) with at least 50 per cent tribal population in Andaman and Nicobar Islands, Himachal Pradesh, Madhya Pradesh, Odisha and eight northeastern States. Primary health centres (PHCs), community health centres (CHCs) and district/sub-district hospitals (DHs) were surveyed and data on screening and treatment services, human resources, equipment, drugs and information systems indicators were collected and analysed. The data were presented as proportions.Results: In the present study 177 facilities were surveyed, including 156 PHCs/CHCs and 21 DHs. DHs and the majority (82-96%) of the PHCs/CHCs provided outpatient treatment for diabetes and hypertension. Overall, 97 per cent of PHCs/CHCs had doctors, and 78 per cent had staff nurses. The availability of digital blood pressure monitors ranged from 35 to 43 per cent, and drugs were either not available or inadequate. Among 213 doctors, three-fourths knew the correct criteria for hypertension diagnosis, and a few correctly reported diabetes diagnosis criteria. Interpretation & conclusions: The results of this study suggest that the health system of the studied tribal districts was not adequately prepared to manage NCDs. The key challenges included inadequately trained workforce and a lack of equipment and drugs. It is suggested that capacity building and, procurement and distribution of equipment, drugs and information systems to track NCD patients should be the key focus areas of national programmes

Non-communicable diseases as a major contributor to deaths in 12 tribal districts in India

Background & objectives: Non-communicable diseases (NCDs) are the leading cause of death in India. Although studies have reported a high prevalence of NCD in tribal populations, there are limited data pertaining mortality due to NCDs. Therefore, in this study we estimated the proportion of deaths due to NCDs among 15 yr and older age group in tribal districts in India. Methods: We conducted a community-based survey in 12 districts (one per State) with more than 50 per cent tribal population. Data were collected using a verbal autopsy tool from the family member of the deceased. The estimated sample size was 452 deaths per district. We obtained the list of deaths for the reference period of one year and updated it during the survey. The cause of death was assigned using the International Classification of Diseases-10 classification and analyzed the proportions of causes of death. The age-standardized death rate (ASRD) was also estimated. Results: We surveyed 5292 deaths among those above 15 years of age. Overall, NCDs accounted for 66 per cent of the deaths, followed by infectious diseases (15%) and injuries (11%). Cardiovascular diseases were the leading cause of death in 10 of the 12 sites. In East Garo Hills (18%) and Lunglei (26%), neoplasms were the leading cause of death. ASRD due to NCD ranged from 426 in Kinnaur to 756 per 100,000 in East Garo Hills. Interpretation & conclusions: The findings of this community-based survey suggested that NCDs were the leading cause of death among the tribal populations in India. It is hence suggested that control of NCDs should be one of the public health priorities for tribal districts in India.

Trend in seroprevalence of SARS-CoV-2 (IgG antibody) among tribal-dominated population: Findings from Jharkhand, India

Background & objectives: Serosurvey of COVID-19 provides a better estimation of people who have developed antibodies against the infection. Undertaking such a serosurvey in certain districts of India which are densely populated with prominent tribes can provide valuable information regarding seropravelance of SARS-CoV-2 antibodies among such indigenous populations. In this context, two rounds of population-based, cross-sectional serosurveys for SARS-CoV-2 IgG antibody were carried out in Jharkhand, a tribal-dominated State of India, to compare the seroprevalence of SARS-CoV-2 infection and to determine the associated demographic risk factors. Methods: The surveys were carried out in June 2020 and February 2021 in ten districts of the State of Jharkhand. Blood samples were collected from the residents of the selected districts by random sampling and tested for anti-SARS-CoV-2 antibodies using an automated chemiluminescence immunoassay platform. A total of 4761 and 3855 eligible participants were included in round 1 and round 2, respectively. Results: The age- and gender-standardized seroprevalence for COVID-19 during round 1 was 0.54 per cent (0.36-0.80) that increased to 41.69 per cent (40.16-43.22) during round 2 with a gap of eight months in between. The seropositivity among male and female participants was 0.73 and 0.45 per cent, respectively, during the first round and 51.35 and 33.70 per cent, respectively, during the second round. During the first round, 17.37 per cent of the participants were tribal with seropositivity of 0.24 per cent (0.02-0.87), and during the second round, 21.14 per cent were tribal with seropositivity of 39.14 per cent (35.77-42.59). Compared to tribal group, non-tribal participants had an adjusted odds of 1.24 (95% confidence interval=1.04-1.48) for SARS-CoV-2 seropositivity. Interpretation & conclusions: COVID-19 seroprevalence was found to be low during the first round (0.54%) of the survey, possibly due to the travel restrictions during lockdown better adherence to social distancing and wearing of face masks among the people. Understanding the dynamics of SARS-CoV-2 transmission and the susceptibility to infection at the individual as well as community level will inform decision and help policy makers to design and implement effective public health strategies to mitigate the pandemic in this State.

Epidemiological scenario of leprosy in marginalized communities of India: Focus on scheduled tribes

The Scheduled Tribes (STs) are designated among the most disadvantaged social groups in India. Until the year 2005 (pre-elimination era of leprosy in India), several leprosy-specific control field programmes were implemented, which have been discontinued subsequently. Since then, leprosy diagnosis and treatment have been integrated with General Health Services. Thereafter, specialized expertise for the early diagnosis of leprosy has been gradually diminishing, especially at the peripheral clinics in remote areas. Hence, leprosy cases usually remain undetected for a long time and persist as endemic reservoirs. The tribal population of India accounts for just 8.6 per cent of the overall population. However, 18.5 per cent of the new leprosy cases were detected within the tribal community in the year 2020, indicating a disproportionately high burden of leprosy among the tribal population. Recent data suggest that these health disparities can be mainly related to the increased marginalization of STs as compared to other communities. This shows the need to further explore the current situation of leprosy in STs so that suitable interventions can address the contributing factors, leading to health inequalities in disadvantaged socio-economic groups. Therefore, this review aims to present the current distribution of leprosy in marginalized communities with a special emphasis on STs. Further, this review discusses how resources might be mobilized for such communities to find and treat undetected leprosy patients in STs to enable effective control of leprosy through early detection and timely treatment.