|Year : 2013 | Volume
| Issue : 4 | Page : 270-274
Hypertension: An emerging threat among tribal population of Mysore; Jenu Kuruba tribe diabetes and hypertension study
Basavanagowdappa Hathur1, Madhu Basavegowda2, Nagaralu Channabasappa Ashok2
1 Department of Medicine, Jagadguru Sri Shivarathreeshwara University Medical College (JSS University), Mysore, Karnataka, India
2 Department of Community Medicine, Jagadguru Sri Shivarathreeshwara University Medical College (JSS University), Mysore, Karnataka, India
|Date of Web Publication||7-Feb-2014|
102, 2nd Main, 2D Cross, Vijayanagar 1st Stage, Mysore - 570 017, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Cardiovascular diseases are leading cause of morbidity and mortality. Such phenomenon is not only seen in urban and rural population, but is also evident among the tribal population. There is a need to understand the burden of hypertension among people residing in Jenu Kuruba Tribe of Karnataka. Objectives: (i) To estimate the prevalence of hypertension in the Jenu Kuruba tribal population and (ii) To describe the age- and sex-wise pattern of blood pressure (BP). Materials and Methods: A population-based cross-sectional study was carried among 1,290 individuals aged between 20 and 60 years. Information about their sociodemographic characteristics, risk factor profile was collected in a pretested proforma by interview technique. Measurements of BP were performed as per standard procedures. Results: Mean systolic and diastolic BP (SBP and DBP) among the study subjects was 123.07 ± 14.09 and 77.43 ± 10.33 mmHg, respectively. Mean SBP and DBP were significantly higher with increase in age and were also significantly different for men and women. Overall prevalence of hypertension was 21.7% (95% confidence interval (CI) =19.45-23.95%). Prevalence of hypertension among men was 28.2% and among women was 16.5%. Conclusions: Hypertension is emerging as a significant public health problem even among Jenu Kuruba tribal population.
Keywords: Hypertension, prevalence, Jenu Kuruba tribe, south India
|How to cite this article:|
Hathur B, Basavegowda M, Ashok NC. Hypertension: An emerging threat among tribal population of Mysore; Jenu Kuruba tribe diabetes and hypertension study. Int J Health Allied Sci 2013;2:270-4
|How to cite this URL:|
Hathur B, Basavegowda M, Ashok NC. Hypertension: An emerging threat among tribal population of Mysore; Jenu Kuruba tribe diabetes and hypertension study. Int J Health Allied Sci [serial online] 2013 [cited 2019 Sep 16];2:270-4. Available from: http://www.ijhas.in/text.asp?2013/2/4/270/126748
| Introduction|| |
India has the second largest concentration of tribal population in the world. Indian tribes constitute around 8.3% of nation's total population. The term "indigenous" has prevailed as a generic term for many years. In some countries, there may be preference for other terms including tribes, first people, aboriginals, ethnic groups, adivasi, janajati, etc.  There are 635 tribes in India located in five major tribal belts across the country and were inhabiting in hilly and plain forest regions.  There are a number of studies on the tribes, their culture and the impact of acculturation on the tribal society. Health is a prerequisite for human development and is an essential component for the well-being of the mankind. The health problems of any community are influenced by interaction of various socioeconomic and political factors.
World is in the stage of epidemiological transition and the noncommunicable diseases are overtaking the communicable diseases. Such phenomenon is not only seen in urban and rural population, but is also evident among the tribal population. Several small and large scale studies have been carried out in the urban and rural population regarding noncommunicable diseases. There aren't any published data available regarding diabetes and hypertension among Jenu Kuruba tribe.
In the name "Jenu Kuruba", the prefix Jenu means "Honey", Kuruba indicates their caste name, Kuruba is the name of large shepherd community of Karnataka district. Jenu Kuruba community has a significant presence in Mysore and Kodagu districts. In Mysore district they are concentrated in Hunsur, HD Kote and Periyapatna taluks. Jenu Kurubas are traditional food gatherers and shifting cultivators. Presently shifting cultivation is banned and restrictions imposed by the government on the use of forest products, the traditional occupation of the Jenu Kurubas is severely affected and at present they are laborers in the forest and horticulture department and are very much influenced by the lifestyle of the urban people. But, lack of education, poverty, isolation, and remoteness they are largely affected and suffer a lot. 
The present paper is a report of the interim analysis carried out with data that is obtained from the Jenu Kuruba tribal population residing in Hunsur taluk, Mysore district, Karnataka, India. The objective of this paper was to estimate the prevalence of hypertension in the Jenu Kuruba tribal population and to describe the age- and sex-wise pattern of blood pressure (BP).
| Materials and Methods|| |
The study protocol was approved by the Institutional Ethics Committee.
A population based cross-sectional study was carried out from March 2011 to July 2011. Adults aged between 20 and 60 years, belonging to Jenu Kuruba tribe and willing to participate in the study were included for the study, while persons with severe chronic illness, physical disability, and mental disability were excluded from the study.
The sample size for the study was estimated utilizing the prevalence rate of hypertension in Indian population. The earlier studies carried out on hypertension among tribal people in other parts of India have observed prevalence rate ranging between 15 and 30%.  Sample size of 1,600 was calculated according to an expected prevalence of hypertension (p) of 20% at 5% level of significance and an allowable error (d) of 10% on the prevalence of hypertension, using the formula Z(1–α/2) 2 pq/d 2 .
The present paper is based on the interim analysis of the phase 1 survey carried out in Hunsur Taluk. Total of 1,290 eligible Jenu kuruba tribes in the age group of 20-60 years were investigated.
The field investigators comprised of four trained field staff (one senior research fellow and three social workers). The team visited the Haadi's (tribal settlements) of the tribal population and by simple random technique a house was selected and in each selected house persons fulfilling the inclusion criteria were included in the study. The proforma was prepared based on the World Health Organization- STEP wise approach to surveillance (WHO-STEPS) approach.  A detailed interview of each person in the household was conducted which included personal information, demographic details, economic status, family history of any disease, usage of health care facility. During the course of the interview, The BP was recorded by the trained field staff (one senior research fellow and four social workers). Two measurements of BP on each study subject were recorded by a single trained field staff using a mercury sphygmomanometer (Diamond Co. Industrial Electronics and Allied Products, Electronics Cooperative Estate, Pune, Maharashtra, India). During the field training period, the field staff was adequately trained regarding the standardized method of recording the BP and their recording method was validated and cross checked randomly by senior physician (Diamond Co. Industrial Electronics and Allied Products, Electronics Cooperative Estate, Pune, Maharashtra, India). Study participants were instructed to refrain from drinking any caffeinated beverage and from smoking during the half-hour preceding the BP measurement. Both BP measurements were obtained after the subject had rested for at least 5 min in a seated position. The first BP measurement was recorded after obtaining sociodemographic information from the study subject, while the second was recorded after a brief clinical examination. All BP measurements were made on the left arm of each study subject in sitting position, using a cuff of appropriate size at the level of the heart. The cuff was slowly released at the rate of about 2 mmHg per second and the readings recorded to the nearest 2 mmHg. The first (appearance) and the fifth (disappearance) Korotkoff sounds were recorded as indicative of the systolic and the diastolic BP (SBP and DBP), respectively. 
The average of two readings of SBP and DBP was taken to describe the BP of the participant. The BP apparatus used for measuring the BP was calibrated according to manufacturer's instructions and the Crohnbach's alpha of more than 0.8 was considered as acceptable inter- and intraobserver variations.
Pretesting and standardization of the interview schedule was carried out before starting the survey. Hypertension was defined if SBP was ≥140 mmHg and/or DBP ≥90 mmHg, and/or on treatment with antihypertensive (Joint National Committee on Prevention, Detection, Evaluation and Treatment of Hypertension (JNC) VII criteria).  Newly diagnosed hypertensive patients were given health education regarding importance of medication in preventing target organ damage and cardiovascular complication and they were started on medication and suggested to follow-up at healthcare outlets in the proximity.
The data were analyzed using the Statistical Package for Social Sciences (SPSS) software Version 17.0 (SPSS, Inc, Chicago, IL). The overall prevalence of hypertension along with 95% confidence interval was calculated. Mean and standard deviation (SD) of SBP and DBP for different age group and for both gender was calculated. Student t-test and one-way analysis of variance (ANOVA) test was used to test the difference in mean SBP and DBP across different age group and gender.
| Results|| |
The survey carried out among Jenu Kuruba tribe in Hunsur taluk observed a 80% response rate. Among 1,290 respondents, nearly half (619) were in the age group of 20-30 years, the gender representation was overwhelmingly in favor of the females; 719 (55.7%) were women and 571 (44.3%) were men.
Mean age of the study population was 34.88 ± 12.23 years (men 36.15 ± 12.4 years and women 33.87 ± 11.99 years). The detailed demographic pattern of the study subjects are presented in [Table 1].
Prevalence of hypertension
Out of 1,290 subjects, 280 were diagnosed to have hypertension, thus overall prevalence of hypertension was 21.7% (95% confidence interval (CI) =19.45-23.95%). The prevalence of hypertension was 161 (28.2%) among men and 119 (16.5%) among women, respectively. Overall prevalence of stage 1 hypertension was 18% (95% CI = 15.9-20.1%) and stage 2 hypertension was 3.7% (95% CI = 2.6-4.7%) [Table 2].
Systolic BP and diastolic BP pattern
Mean SBP and DBP among the study subjects was 123.07 ± 14.09 and 77.43 ± 10.33 mmHg. [Table 3] describes the mean SBP and DBP according to age and sex. The SBP and DBP were significantly higher with increase in age and were also significantly different for men and women.
Age- and sex-wise prevalence of prehypertension, stage 1 and 2 hypertension is presented in [Figure 1] and [Figure 2]. It is observed that a linear trend is observed with increase in age and males have higher prevalence of prehypertension, hypertension stage 1, and hypertension stage 2 than their female counter parts.
|Table 3: Comparison of mean systolic and diastolic blood pressure according to age and sex|
Click here to view
The prevalence of isolated systolic hypertension was 13.9% and isolated DBP was 16.2% among the Jenu Kuruba tribal population.
| Discussion|| |
Economic and demographic transition of a country is an inevitable process. Such transitions have an influence on the occurrence of the lifestyle diseases like hypertension and diabetes among its people. The influence is evident among urban as well as rural populations, where noncommunicable diseases are replacing communicable diseases. The present study aimed to study the prevalence of hypertension among the Jenu Kuruba tribe residing in Hunsur taluk of Mysore district.
The present study documents an overall prevalence of hypertension (21.7%). An increasing prevalence of hypertension was noted with increase in age group and highest prevalence of 30% was observed among the 51-60 year age group persons. It was observed that one-third of the men and one-fifth of the women were hypertensive. The isolated systolic and diastolic hypertension was also documented and was noted to be 13 and 19% respectively.
Composite nation-wide data of National Nutrition Monitoring Bureau (NNMB) has documented hypertension prevalence of 25% among rural adults.  In the present study, the prevalence of hypertension among Jenu Kuruba tribe is similar to NNMB estimates. It is increasingly been recognized that the tribal people are facing the burden of hypertension. ,, As there was paucity of published data on prevalence of hypertension among tribal people of southern Karnataka region, comparison was made with tribes of hilly region who had similar high prevalence of hypertension. Studies carried out among the Lepchas of Sikkim Himalayas have documented hypertension prevalence of 30.7% among males and 25.77% among females. 
In a study carried out by Sachdev,  the prevalence of hypertension among selected nomadic tribes of Rajasthan was in the range of 16-30%, the hypertension estimate in our study is similar to these estimates. The prevalence of hypertension among the Nicobarese tribe was found to be 50.5%,  this is higher when compared to our estimates. In spite of high alcohol and tobacco consumption among Nicobarese tribe, high prevalence of hypertension is attributed to high prevalence of overweight and obesity.  Age-wise increase in prevalence of hypertension is also observed among the Rajasthani tribal groups and Nicobarese tribe. , However, highest prevalence of 73.5% was documented among above 60 year aged Nicobarese people. 
The present study has observed that nearly 99% of the cases of hypertension were newly detected hypertensives. Factors like lack of medical facilities, patient awareness regarding hypertension and their unwillingness to get screened for hypertension contribute to increased number of undiagnosed cases in the community. The study also reveals that many were not on any form of treatment. The study also reveals that the Jenu Kuruba tribe is people of low literacy, high poverty, and low standard of living; hence they require a special approach to tackle the problem of hypertension.
The present study has thrown light on the hitherto unknown health problem of the community. Though this study found that most of them were physically active and did not report consumption of high calorie diet, there was a high prevalence of hypertension. Economic differences between the urban and tribal populations seem to be wide, but the prevalence of hypertension is almost similar in both groups. There is a need to further evaluate the gene-environment interaction for the occurrence of hypertension among these tribes.
This supports the concept of 'shift from early adopters to late adopters' as proposed by Howson et al.,  which explains that the burden of Cardio-Vascular Diseases shifts from richer sections of the society to the poorer sections of the society.
The next immediate steps would be to identify and treat hypertensive patients adequately to prevent the complications associated with it. Gender specific and culture appropriate health information need to be disseminated to these tribes. Adequate health literacy is essential for a behavioral modification that is necessary for good cardiovascular health.
| Conclusion|| |
Hypertension is emerging as a significant health problem among the Jenu Kuruba tribe. The disorder is mostly silent and needs to be addressed at this incipient stage to prevent its long-term effects.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]