Abstract

This study was carried out to determine the prevalence of undernutrition among the Santal children of Puruliya district of West Bengal. 442 Santal children (216 boys and 226 girls) aged 5-12 years were taken from randomly selected schools of Balarampur and Baghmundi areas of Puruliya. Nutritional status was analyzed by Z-score values according to the height-for-age, weight-for-age and weight-for-height reference data of National Center for Health Statistics (NCHS). The prevalence of undernutrition among Santal children was as follows: stunting (17.9%), underweight (33.7%) and wasting (29.4%). Severe (below -3 Z-score) stunting, underweight and wasting were found in 4.98%, 7.92% and 9.51% of Santal children, respectively. In girls, prevalence of stunting (21.7%) and wasting (35.8%) was higher in comparison to boys (13.8% stunting and 22.7% wasting).

Key words: Bengal, Santal, Tribal, Undernutrition.

Santal, the third largest tribe in India, lives in many states including Bihar, Jharkhand, Orissa, Tripura etc. In West Bengal, Santals represent 54.27% of total tribal population and they are spread over in vast areas of Purba and Paschim Medinipur, Bankura and Purulia(1). This tribe lives in remote places and is characterized by poverty, illiteracy, and nutritional problems. The health status of this community remains unreported excepting few studies(2,3). The prevalence of undernutrition in children is an indicator of community health status. The nutritional status of Santal children has not been investigated recently in West Bengal. The present study was undertaken to assess the severity of undernutrition in Santal children of 5-12 years of age of Puruliya district of West Bengal.

The study was conducted on 442 Santal children (216 boys and 226 girls) aged 5-12 years from four primary schools of Balarampur and Bagmundi area of Puruliya district of West Bengal. The socio-economic status of each subject was assessed by modified Kuppuswamy’s scale(4). The study was carried out in accordance with the revised ethical guidelines for human experimentation of Helsinki Declaration of 2000(5). The anthropometric measurements including height and weight of each subject were measured using standard techniques(6) by trained investigators. The nutritional status of Santal children was evaluated using age specific values of height and weight from the National Center for Health Statistics (NCHS) reference data(7). The indices of undernutrition such as stunting, underweight and wasting were calculated by Z-score using the reference values of height-for-age, weight-for-age and weight-for-height of NCHS standards, respectively. The severity of under-nutrition was assessed by Z-score according to the classification of World Health Organization(8). Children with Z-score below –2 of any indices were considered to be undernourished and the children with Z-score below –3 were considered to be severely undernourished. The statistical analyses were performed using Statistical Package for Social Science (SPSS software).

The height and weight of Santal children show increasing pattern with advancement of age. The mean height and weight of Santal boys are comparable to the Santal girls at all age groups. In comparison to the NCHS reference data, the mean height of Santal boys and girls remain above the 25th percentile at earlier ages (5-7 years), but with advancement of age, Santal boys are placed a little above 10th percentile (Fig. 1a) and that of Santal girls are placed around the 10th percentile (Fig.1b). Mean weight of Santal boys (Fig. 2a) and girls (Fig. 2b) remain between 10th and 25th percentile at earlier ages (5-7 years) but at later ages (9-11 years) mean weight is placed below the 5th percentile of NCHS reference data.

(a)	(b)
Fig. 1. Mean height (cm) of Santal boys (a) and girls (b) with NCHS reference data.

(a)	(b)
Fig. 2. Mean weight (kg) of Santal boys (a) and girls (b) with NCHS reference data.

The prevalence of moderate stunting (Z-score between –2 and –3) was found to be higher in girls (15.9%) than boys (9.7%). But the percent values of severe stunting in both the sexes are similar (4.17%) in boys and 5.76% in girls). The prevalence of moderate and severe wasting was higher in girls (23.9% and 11.9%, respectively) than the boys (15.7% and 7.4%, respectively) (Table I). Stunting and wasting (below –2 Z score) were found in 49 (21.7%) and 81 (35.8%) girls, respectively and these percent values were higher than that of boys (13.8% stunting and 22.7% wasting). The prevalence of moderate underweight was higher in boys (29.6%) than the girls (22.1%), but the prevalence of total underweight was found to be similar in both sexes (35.8% boys and 31.5% girls). Overall, 79 (17.88%), 149 (33.72%) and 130 (29.42%) of Santal children were stunted, underweight and wasted, respectively, according to the reference criteria (Z-score below –2) recommended by WHO. Severe (below –3 Z-score) stunting, underweight and wasting were found in 22 (4.98%), 35 (7.92%) and 42 (9.51%) of Santal children respectively.

The prevalence of undernutrition among the tribal children in India has not been investigated sufficiently. Rao, et al.(9) reported widespread undernutrition (60% underweight) among the preschool children of Gond tribe of Madhya Pradesh. In West Bengal, 54% of children (6-12 years of age) of Oraon tribe are suffering from severe malnutrition(10). In the present study, undernutrition among Santal children of Puruliya district is not severe like Gond and Oraon tribes. Rao and Vijay(11) observed similar percent of severe underweight (6%) among the Santal children of Purnia district of Bihar. The stunting among Santal children in the present study is less than Gond tribe, which showed 30.1% of children as severely stunted compared to 4.98% of Santal children of Puruliya district.

Though there is no remarkable difference between boys and girls in severe stunting and underweight, the total stunting appears to be higher in girls compared to boys. The gender difference is also prominent in total wasting of girls. Probably the results indicate that the prevalence of undernutrition is higher in Santal girls than boys.

The specific causes of undernutrition in these children can not be ascertained from this study. A lower socio-economic status of these children indicates that factors such as education, occupation and economic status of parents may be related to the undernutrition.

We would like to acknowledge the authorities of all Primary schools (Dalgiri Primary school, Patharbagan Primary School, Gidighati Primary School and Uludi Primary School) providing permission to carry out the work. We are greatly indebted to Mr. Abani Mohon Sandil for his help in the field work.

Contributors: SDC: data collection and analysis; TC: data collection; TG: data analysis. All authors were involved in manuscript preparation.

Funding: None.

Competing interests: None stated.