Perception, practices and understanding of teenage pregnancy among the adolescent girls in India: A scoping review protocol.

Introduction: Teenage pregnancy is a subject of concern among adolescents. Inadequate knowledge and misperceptions about pregnancy are major contributing factors to teenage pregnancy. Without a proper understanding, adolescents are involved in unsafe sexual practices, which results in pregnancy. So, perception and understanding are important aspects to explore among adolescents. In this planned scope review, all eligible studies will be identified around the perception, practices, and understanding of teenage pregnancy among married and unmarried adolescent girls. Methods: The Arksey and O'Malley (2005) scoping review framework and the Joanna Briggs Institute Reviewers' Manual (2015) will be used for the planned scoping review. The population, concept, and context strategy (PCC) will be used to develop the research question, search strategy, and eligibility criteria. Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews (PRISMA ScR) will be used for the findings of the study. For the literature search, authors will use Google Scholar, PubMed, and ResearchGate electronic databases with specific words such as "teenage", "adolescence", "pregnancy", "perception", "knowledge", "awareness" and "abortion". Result: The planned scoping review will be helpful in addressing the lack of adolescent misperception, malpractices, and misunderstandings regarding teenage pregnancy. It can provide detailed information about teenage pregnancy in the Indian context. Conclusion: The evidence synthesis and gap analysis will be helpful in suggesting insights into the issue of teenage pregnancy, which will be helpful in future policies and programs.

Prevalence of hemoglobinopathies among Malayali tribes of Jawadhu hills, Tiruvannamalai district, Tamil Nadu, India: a community-based cross-sectional study.

BACKGROUND: Hemoglobin (Hb), a red pigment of red blood cells (RBCs), carries oxygen from the lungs to different organs of the body and transports carbon dioxide back to the lungs. Any fault present in the Hb structure leads to undesirable functional effects of the RBCs, such as sickle cell anemia (SCA), thalassemia, etc. Hemoglobinopathies affect around 7% of people in both developed and developing countries globally. The aim of the present study was to determine the prevalence and carrier frequencies of hemoglobinopathies including SCA, thalassemia, and other abnormal Hb variants among Malayali tribes in the Jawadhu hills of Tiruvannamalai district, Tamil Nadu, India. METHODS: A community-based cross-sectional study was carried out among 443 Malayali tribes inhabiting the Jawadhu hills of Tiruvannamalai district from July 2022 to September 2022. The RBC indices were analyzed using an automated 5-part hematology analyzer (Mindray, BC-5150) and hemoglobin fractions were done using the HPLC system (Bio-Rad, D-10) following standard protocols. FINDINGS: A total of 443 participants were screened, out of whom 14.67% had an abnormal Hb fraction, 83.30% were identified as normal, and 2.03% were borderline. Notably, the study revealed a prevalence of 0.68% for the α-thalassemia trait and 13.99% for the ß-thalassemia trait. INTERPRETATION: Haemoglobinopathies, specifically the ß-thalassemia trait, were most prevalent among the Malayali tribal population of Tamil Nadu residing in the Jawadhu hills of Tiruvannamalai district. Hence, we need special attention for creating awareness, increasing hemoglobinopathies screening programs, and improving the importance of tribal health conditions by the government and non-governmental organizations (NGOs) for the betterment of the ethnic tribes.

The patterns, trends and major risk factors of suicide among Indian adolescents - a scoping review.

BACKGROUND: Adolescence is an essential stage for the development of mental health, and suicide is among the leading cause of mortality for adolescents around the world. In India, the suicide rate among adolescents has been increasing in recent years. The scoping review was conducted to map the evidence and address gaps by examining the existing pattern, and trends, and identify the major risk factors of suicide among Indian adolescents. METHODS: The study was conducted as per the Arksey and O'Malley scoping review framework and the Joanna Briggs Institute Reviewers' manual. The systematic search was performed using electronic databases such as PubMed, Google Scholar, EMBASE, and PsycINFO, by using specific keywords. After the screening, 35 articles were identified according to the inclusion criteria. RESULTS: The evidence on the trends of suicide among adolescents showed that the suicide rate has shown an alarming increase in recent years. The evidence pattern showed that hanging and poisoning were the commonly selected methods used by adolescents. The most commonly reported risk factors were mental health problems (54.28%), negative or traumatic familiar issues (34.28%), academic stress (22.85%), social/lifestyle factors (20%), violence (22.85%), economic distresses (8.75%), relationship factor (8.75%). CONCLUSION: By synthesizing and summarising the patterns, trends, and key risk factors of suicide among Indian adolescents, this scoping review provides a broad understanding of the literature already in existence. In order to effectively tackle these issues, the finding highlights the urgent need for extensive and targeted suicide prevention measures.

Perception, practices, and understanding related to teenage pregnancy among the adolescent girls in India: a scoping review.

BACKGROUND: Teenage pregnancy is a concerning public health problem in India. Misperception and misunderstanding about pregnancy and its preventive methods lead to pregnancy when adolescents are involved in unsafe sexual intercourse. This scoping review aims to discuss the evidence on the perception, practices, and understanding related to teenage pregnancy among adolescent girls in the Indian context. METHOD: The Arksey and O'Malley scoping review framework and Joanna Briggs Institute Reviewers' Manual were used for the scoping review. The Population, Concept, and Context strategy (PCC) ensured the review questions, eligibility criteria, and search strategy. The Systematic Review and Meta-analysis: Extension for Scoping Review (PRISMA-ScR) was used. A literature search was done using electronic databases by specific keywords such as "teenage", "adolescences", "pregnancy", "perception", "knowledge", "awareness", etc. Relevant grey literature was identified through further searching. The review included studies that fulfil inclusion criteria having female adolescent groups aged from 10 to 19 years in the Indian context between the years 2000 and 2021. RESULT: We found 40 eligible studies; more than half of these were from southern (35%) and northern (27.5%) regions, and studies from the rest of India were very sporadically distributed. Most studies (72.5%) were published in the last 10 years. The relevant extracted data from individual studies were synthesized and presented in the two major sections, perception, practices, and the second one, understanding and experiences among teenage girls. The understanding of pregnancy and teenage pregnancy-related preventive methods was detailed analysis in about 72% of papers whereas other aspects, such as perception (22.5%), practices (25%), and experiences (7.5%) were discussed in the remaining papers related to pregnancy among adolescent girls. CONCLUSION: Evidence in the selected studies shows that understanding and practices are the major areas that were primarily explored, where perception, practices and experiences are the topics that are relatively less investigated. Literature synthesis derives misconception, lack of understanding, and practices without knowing the consequences are the key factors responsible for early pregnancies. Future interventions like increasing awareness, providing comprehensive reproductive knowledge, convenient health care aids, and proper counselling are adequate measures for minimalising the problem. The present analysis showed that studies are limited in their scope concerning various aspects of teenage pregnancy in India, so this scoping review gives essential perspectives on future research and implementation plans and policies in this field.

Knowledge, practices and influencing factors defining unhealthy food behavior among adolescents in India: a scoping review.

Unhealthy food behaviors are the major contributing factors to the rising burden of non-communicable diseases (NCDs) among adolescents in India. Knowledge and practices related to unhealthy eating are significant factors influencing adolescents' food behavior. In this scoping review, we aim to map evidence and identify gaps on knowledge, practices, and the influencing factors associated with unhealthy food behavior among Indian adolescents by examining the existing literature. Arksey and O'Malley's scoping review framework and the Joanna Briggs Institute Reviewers' manual were used for this review. After the screening, 33 articles were identified according to the inclusion criteria. Data extraction was performed according to the study objectives, followed by narrative summarization. The studies included a total of 20,566 adolescents. Most studies reported insufficient knowledge about healthy food choices among adolescents. Diet intake patterns among the adolescents showed a lower amount of fruits and vegetables and an increase in fried items, sugar-sweetened beverages, packaged food, and fast food in both sexes, with a broader association with peer influence (21.2%), parental unhealthy food behavior (15.1%), place of residence (6.06%), emotional status (6.06%), and mass media exposure (18.1%). The scoping review highlights the need for targeted interventions aimed at improving the knowledge and practices of Indian adolescents by promoting healthy food choices and sensitizing them about the risk of non-communicable diseases. The analysis of evidence around adolescent dietary behavior in India shows a monotonous, limited, and narrow range in scope, indicating the extended need for research.

Knowledge, beliefs and practices towards HIV/AIDS among adolescents in India: A scoping review protocol.

INTRODUCTION: Acquired Immune Deficiency Syndrome (AIDS) is a major health concern among Indian adolescents (10-19 years). Indian adolescents lack adequate knowledge about HIV/AIDS and adopt wrong practices. The present scoping review aims to understand the status of knowledge, beliefs and practices among Indian adolescents about HIV or HIV/AIDS. The present study will also focus on their understanding and the source of knowledge and awareness regarding HIV/AIDS. METHODOLOGY: The recommendations of Arksey and O'Malley in 2005, Levac et al. in 2010 and The Joanna Briggs Institute Reviewers' manual in 2015 to conduct a systematic scoping review will be employed. The review questions, eligibility criteria and search strategy for this study will be ensured by the Population, Concept and Context (PCC) strategy. The Preferred Reporting Items for Systemic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) will be used for reporting of this scoping review. The methodological quality of all the relevant studies will be assessed by the Mixed Methods Appraisal Tool (MMAT), Version- 2018. Literature search will be carried out by using electronic databases such as PubMed, APA PsycInfo, EMBASE, and Google Scholar. Cross-references will be used to extract additional studies. ETHICS AND DISSEMINATION: As the planned study is based on secondary data and doesn't involve human and animal subjects, there is no requirement for formal ethical approval. STRENGTHS AND LIMITATIONS OF THE STUDY: The planned scoping review is the first of such study on the topic of HIV/AIDS among adolescent population in India as per the electronically available literature.There will be quality assessment of all the included studies.A thorough search strategy will be conducted as per the recommendations of the experts in scoping review search.On limitation side, the planned study will only utilize electronically available resources/evidences that are written in English language.The planned evidence based study will be of much help for the healthcare professionals and policy makers.

The patterns, trends and major risk factors of suicide among Indian adolescents-A scoping review protocol.

INTRODUCTION: Suicide is one of the serious health problems among Indian adolescents. Adolescence helps with the transition of an individual into an adult, so it is important to understand the suicidal behavior of adolescents. Several studies have been carried out in different states in India on the suicidal behavior of adolescents, but there is no review that studied the national patterns, trends, and major risk factors. Therefore, this review aims to study the patterns, trends, and major risk factors of suicidal behavior among Indian adolescents. METHODS: The study will be conducted as per the Arksey and O'Malley scoping review framework and the Joanna Briggs institute Reviewers' manual. The Population, Concept and Context strategy (PCC) will ensure the review questions, eligibility criteria and search strategy. The Systematic Review and Meta-analysis: Extension for Scoping Review (PRISMA-ScR) will be used for the findings of the study of Scoping Review. The literature search will be done using electronic databases: PubMed, Google Scholar, SCOPUS, EMBASE, Psycinfo, Web of Science, Google, and Cochrane library by specific keywords such as "patterns"; "suicide"; "trends"; "risk factors"; "depression"; "anxiety"; "mental health"; "adolescent"; "teenager"; and "youth";" India" etc. Additional studies will be considered using cross-references. ETHICS AND DISSEMINATION: This study does not involve the collection of primary data; there is no requirement of any ethical approval. STRENGTHS AND LIMITATIONS OF THE STUDY: The proposed scoping review is the first study on patterns, trends, and major risk factors of adolescent suicide in India as per the information available on the online platforms.This proposed scoping review will bring together all the previously available data into one place for better study.This evidence-based study will be highly helpful for healthcare professionals and policymakers. This study will be limited to English language and electronically available evidence.

The incidence, prevalence, and contributing factors of overweight and obesity among adolescent population of India: A scoping review protocol.

INTRODUCTION: Overweight and obesity among the adolescent population are emerging as worldwide epidemics. Its increasing occurrence in India is highly concerning. Amidst the burden of malnutrition, where undernutrition is a long-standing health problem, the rising concerns around childhood overweight/obesity has several repercussions for this population. The aim of this scoping review is to map the evidence of the prevalence and contributing factors of overweight and obesity among adolescents (10 to 19 years) in the Indian population. METHODS: The study will be conducted according to the Arksey and O'Malley scoping review framework and the Joanna Briggs institute Reviewers' manual. The Population, Concept and Context strategy (PCC) will ensure the review questions, eligibility criteria, and search strategy. The Systematic Review and Meta-analysis: Extension for Scoping Review (PRISMA-ScR) will be used for the findings of the study of Scoping Review. The Mixed Methods Appraisal Tool (MMAT), Version- 2018 will be used to assess the methodological quality of all relevant studies. Literature search will be done using electronic databases: PubMed, Google Scholar, SCOPUS, EMBASE, and Cochrane library by specific keywords such as "prevalence"; "overweight"; "obesity"; "obese"; "malnutrition"; "BMI"; "adolescent"; "teenager"; and "youth" etc. Additional studies will be considered using cross-references.

Prevalence and determinants of undernutrition among adolescents in India: A protocol for systematic review and meta-analysis.

BACKGROUND: Undernutrition is one of the serious health problems among adolescents in India where 253 million adolescents are in the age group of 10-19 years. Since adolescents represent the next generation of adults, it is important to understand the nutritional status of adolescents. Even though several studies have been carried out in different states in India on adolescent undernutrition (stunting, wasting /underweight), there is no study or review that estimated the national pooled prevalence of adolescent undernutrition and its determinants. Therefore, this review aims to determine the pooled prevalence and determinants of undernutrition (stunting, underweight/wasting) among Indian adolescents. METHODS: A systematic review of eligible articles will be conducted using preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A comprehensive searching of the literature will be made in Pub Med, EMBASE, SCOPUS, Google, Google Scholar, and Cochrane databases. The quality of the articles included in the review will be evaluated using the Newcastle-Ottawa Scale (NOS) for observational studies in meta-analyses. The pooled prevalence and odds ratio of the associated risk factors or determinants with their 95% confidence interval will be computed using STATA version 16 software. The existence of heterogeneity among studies will be assessed by computing p-values of Higgins's I2 test statistics and Cochran's Q-statistics based on chi-square with a 5% level of significance among reported prevalence. Sensitivity analysis and subgroup analysis will be conducted based on study quality to investigate the possible sources of heterogeneity. Publication bias will be assessed through visual examination of funnel plots and objectively by Egger's regression test. This review protocol has been registered at PROSPERO (CRD42021286814). DISCUSSION: By collecting and summarizing information on adolescent undernutrition can be a step towards a better understanding of the prevalence of nutritional status of Indian adolescents and how the associated factors influence the prevalence of undernutrition. This review will provide directions for further research and healthcare practitioners. This summarized finding at the national level will provide impetus to build nutritional strategies and proper healthcare services to fight against undernutrition among the most ignored population.

Sickle cell anemia/sickle cell disease and pregnancy outcomes among ethnic tribes in India: an integrative mini-review.

Objective: To evaluate the studies which have reported the prevalence of maternal complications and outcomes for women with SCA/SCD. Healthy populations make a healthy community and improve the future for mankind. Pregnant women are an essential segment of humanity as they bear the fetus and supply nutrition for their development throughout the gestational period. Their health status and disease conditions also play a vital role in deciding the future of the offspring.Materials and methods: The Mesh terms: "Haemoglobinopathies" + "Sickle cell anemia" + "Sickle cell disease" + "Ethnic tribes" + "Pregnancy outcomes" + "India" were used to search the literature available from public databases such as "PubMed", "PubMed Central" "Google Scholar", "Science Direct" and "Scopus" and the same is checked for removing repetitions. The data was extracted and collected literature was thoroughly analysed. SCD/SCA is a commonly prevalent hereditary hemoglobinopathy disease and is related to augmented risk factors and premature mortality.Results: SCD severely affects pregnancy, which leads to the elevated occurrence of perinatal and maternal outcomes such as pre-eclampsia, eclampsia, abortions, intrauterine growth retardation (IUGR), etc., and sufficient care during the pregnancy guarantees an improved outcome. Due to the best health care conveniences, availability of drugs such as hydroxyurea, antibiotic prophylaxis, and vaccination, the life expectancy of SCD patients has greatly improved in recent times though directly related to the access and services available at the healthcare facilities for the needy and poor. Moreover, the latest innovations in the fields of prenatal screening and preimplantation genetic diagnosis (PGD), facilitate partners suffering from SCA/SCD to have a healthy child. There are no available studies on the prevalence of SCA/SCD in pregnant women among ethnic tribal populations from India.Conclusion: This review article is focused on the effects of SCA/SCD on pregnancy outcomes, the consistent follow-up, routine check-ups and successful management of complications throughout pregnancy, the various diagnostic methods toward preventive methods, curative and management therapeutic strategies and also defines the perinatal and maternal outcomes in the ethnic tribal populations of India.

Forecasting suicide rates in India: An empirical exposition.

INTRODUCTION: Suicide is a major social and health issue in India. Yearly statistics show a concerning increasing pattern of suicidal deaths in India which is higher in comparison to the global trend. There is limited evidence regarding historical analysis of suicide or any forecasting for suicide in India towards predicting the possible risks of death due to suicide. METHODS: This paper examines the trend of suicide rate and characteristics of suicide victims in India, based on the longitudinal time series data over the last 50 years-collected from the National Crime Record Bureau Reports (1969 to 2018) of the Government of India. In our analysis, we have used the time series model to forecast the suicide rates in India for the next decade. ARIMA (4,1,0) model is found to be the best fit model for forecasting the data. FINDINGS: There has been an observable and rising trend of suicide rates in India over the last five decades. The forecast indicates a continuance of rising suicide cases for an upcoming couple of years in India with a limited decline in the following years. The prediction model indicates a future relatively consistent pattern of suicide in India which does not seem to be a very encouraging trend. As we have not included the period staring the year 2020 onwards affected by Covid-19 and which has several disruptions in personal and family spaces, the projected suicide trend during the period of next two to three years (2020-22) may rise far high and then it may show a declining path. Along with this, there is a shift in means of suicide in the last couple of decades. Constituting the second-highest number of cases, Illness associated suicide was visibly a serious concern. CONCLUSION: The present analysis finds that there is no visible substantial relief for suicide deaths during the coming years in India. On the other hand, more extensive exploration of sample cases may provide important information for suicide prevention. Availability of detailed and more inclusive data will be highly useful for analysis and suicide preventive policies. Investment in public health care and other welfare activities like education and employment generation will yield visible positive results in suicide control.

Rising burden of overweight and obesity among Indian adults: empirical insights for public health preparedness.

With simultaneous efforts to address a huge burden of malnutrition, especially among children and younger women, India also encounters a mushrooming prevalence of overweight and obesity among the adult population. This study analysed data from two consecutive rounds of the National Family Health Survey (NFHS) conducted in 2005-06 and 2015-16, to present the burden of overweight and obesity among adult men and women in India. The findings highlight a rising burden of overweight and obesity, although the level and the extent of change over the study period varied across states. The district-wise analysis revealed geographical clusters of overweight and obesity. Further investigation suggests that overweight or obesity are not exclusive to urban areas, and economically well-off populations are more inclined to be overweight or obese. The trends and patterns of overweight and obesity in India argue for timely public health preparedness and interventions to avoid the rising incidence of non-communicable diseases in India.

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.

Prevalence and risks of hypertension among Indian tribes and its status among the lean and underweight individuals.

OBJECTIVE: With the increased worldwide prevalence of hypertension among the underprivileged populations, fewerstudies have reported such risks among Indian tribes. In the context of high prevalence of undernutrition, no such study has examined hypertension among lean and underweight Indian tribal individuals separately. METHODS: We selected total samples of 1066 adult males and 1090 adult females in 20-60 years age-group cross-sectionally to examine the status of hypertension and its risks among nine major tribes in three Indian states; separate analyses for lean and underweight tribal individuals were done. RESULTS: Increased prevalence of hypertension (females, 14.2%; males, 9.3%) was observed among the tribes with the overall percentage of individuals at adversity (hypertensive + isolated hypertensive) at more than 20% (males 20.1%; females 26.5%). Age-group-wise prevalence showed a sharp rise in the prevalence of hypertension in the 40 + year individuals; additionally, this rise was alarming among females. Undernutrition was observed to be a potential risk factor as a remarkable prevalence of hypertension was observed among the undernourished (approximately 9%) and lean tribal participants (12%). Underweight females were observed to be at higher risk. Tribal statuses were observed to be alarming than the national trends due to their very low average BMI along with high average SBP. A curvilinear prevalence of hypertension was observed while comparing through both the nutritional extremes. CONCLUSION: The increased prevalence and risks of hypertension in the background of lean and underweight status of Indian tribes indicates their epidemiological transition burdened with alarming cardio-metabolic health risks that warrant an early and consistent surveillance.

Comparing the ability of anthropometric indicators in determining the prevalence of hypertension among Indian tribes.

OBJECTIVE: We compared the ability of the selected anthropometric indicators to best predict the prevalence of hypertension among the Indian tribes. METHODS: A cross-sectional study was undertaken among 1431 adult participants (705 males and 726 females) between the ages of 20 and 60 years from six major tribes in India. Selected anthropometric indicators such as body mass index (BMI), waist-hip-ratio (WHR), waist-height-ratio (WHtR), percentage body fat (PBF), visceral fat (VF), minimum-waist-circumference (MWC) and sum-of-the-four skinfold thickness (SF4), along with the physiological parameters such as blood pressure were recorded. Discriminant analysis (DA) was performed to examine and compare the ability of the selected anthropometric indicators towards classifying hypertension among males, females and the total population. RESULTS: Significant independent association was observed for hypertension and similar conditions within gender and selected age-group categories. The overall hypertension prevalence among the studied tribes was observed at 12.6%. Standardized function coefficients (SFCs) in discriminant analysis revealed PBF(0.89, 0.36, and 0.76 for overall, males, and females respectively) as the most powerful discriminator of hypertension. In addition, visceral fat (0.74, 1.46, and 0.58 for overall, males and females respectively) was observed to be the other significant indicator of hypertensive blood pressure. These exploratory findings for the first time indicate fat deposition, rather than body density alone, as an emerging physiological and metabolic risk among Indian tribes. CONCLUSION: In the context of the highly prevalent chronic undernutrition, internal fat deposition is a major classifying factor of physiological and metabolic intolerance. It also indicates the increasing trend in lifestyle changes and the associated adversities among the Indian tribes.

Gender Disparities in the Prevalence of Undernutrition and the Higher Risk among the Young Women of Indian Tribes.

BACKGROUND: High undernutrition is a grave concern in India. Marginalized populations like Indian tribes have been under the serious stress of such nutritional extreme. Women, in particular, are the worst sufferers. Gender-related comprehensive studies regarding the prevalence and risks of undernutrition among the tribes have not been properly pursued in India; the vulnerability of the young females has least been examined. METHODS AND FINDINGS: We conducted a cross-sectional study during January 2011 to December 2013 among 1066 males and 1090 females (n = 2156) in the 20-60 years age group belonging to the nine major tribes; Santals, Oraons and Koras (West Bengal): Santals, Bhumijs and Bathudis (Odisha): Dhodias, Kuknas and Chaudharis (Gujarat). The undernutrition burden was estimated and such risks were analyzed for the women in comparison to the men. The overall undernutrition among the females was found to be 47.4% (95% CI 44.4-50.4) against 32.1% (95% CI 29.3-34.9) among males, indicating about a half of the female population undernourished. The odds of risks for underweight status among females were observed to be high in comparison to males with an odds of 1.9 (95% CI, 1.6-2.2; p≤0.001) for the overall undernutrition category, 1.7 (95% CI, 1.3-2.3; p≤0.001) for the mild undernutrition category, 1.3 (95% CI, 1.1-1.6; p≤0.01) for combined moderate and mild undernutrition category and 3.3 (95% CI at 2.3-4.6; p≤0.001) for severe undernutrition category. The young females were observed with a high prevalence of undernutrition along with increased risk. The 30-year mean BMI trend of the Indian population in comparison to the males, females, and overall tribal population places the tribal females at the highest risk. CONCLUSION: Indian tribes are suffering from the higher prevalence of undernutrition by further highlighting a high gender bias. The health and empowerment of adolescent and young tribal girls needs additional focus. Overall, no remarkable control on undernutrition has been achieved among Indian tribes despite various efforts.

Triple Burden of Obesity, Undernutrition, and Cardiovascular Disease Risk among Indian Tribes.

BACKGROUND: Socio-cultural transitions among individuals from vulnerable groups introduce epidemiological transition, with a concomitant increase in the prevalence of undernutrition, obesity, and cardiovascular disease risks. An accepted conventional wisdom exists for Indian tribes that they are undernourished and away from lifestyle-related diseases. However, the extent of this triple burden affecting them is unknown. In this study, we assessed this triple burden among the 9 major tribes of India. METHODS AND FINDINGS: During January 2011 to December 2013, we conducted a cross-sectional study among 1066 men and 1090 women constituting a total of 2156 adults belonging to the 9 major tribal groups: Santals, Oraons, and Koras (West Bengal); Santals, Bhumijs, and Bathudis (Odisha); and Dhodias, Kuknas, and Chaudharis (Gujarat) to estimate the prevalence of the triple burden (undernutrition, overweight or obesity, and hypertension). A high prevalence of undernutrition and hypertension was observed among the Koras (51.9%and 10.6%, respectively), Bathudis (51.3% and 12.1%, respectively), and Oraons (49.6% and 16.5%, respectively). However, the prevalence of overweight and hypertension among the Bhumijs (17.7% and 14.7%, respectively), Dhodias (23.8% and 12.9%, respectively), Kuknas (15.8% and 11.3%, respectively), and Santals of West Bengal (12.2% and 11.8%, respectively) and Odisha (15% and 9.6%, respectively) was most alarming. The prevalence of overweight or obesity among the women was 10.9% and 1.5%, respectively, with 14.0% hypertensive women. The prevalence of overweight and obesity among the men was 14.8% and 1.7%, respectively, with 9.2% hypertensive men. Undernutrition was highly prevalent among men and women. However, data from the past 30 years on systolic blood pressure (SBP) and body mass index (BMI) revealed that the studied tribes were at a higher risk than the general Indian population. In addition, a vast gender disparity with relation to the disease and risk prevalence was observed. CONCLUSION: The alarming trend of an increasing prevalence of overweight/obesity, undernutrition, and hypertension is observed among indigenous populations of India, emphasizing the incorporation of a specific health management policy.