The KEM Hospital Research Center and the Swiss Tropical Institute, developed a collaborative project on the study of Malaria. How frequently both P. falciparum and P. vivax co–infect an individual was the basis of the study. The previous data from the State Malariology Department showed a high prevalence of both P. falciparum and P. vivax in some of the PHCs of Thane district. Of these the PHC at Sakharshet in Jawhar Taluka was selected for study. This gave us an opportunity to visit the area and to take notice of the health problems in addition to Malaria. The following gives a summary of our impressions of the health problems of the tribal people.
The specific health problems of the tribal peoples can be summarized as follows:
Alcoholism and other psychic and socio–cultural ramifications of alcoholism constitute the major problem among the tribal peoples. Brewing of alcohol from rice, millets, ‘mohua’ flower and fruits had been practiced traditionally. However, in recent years inroads have been made by businessmen by making inexpensive molasses and ammonium chloride available for making alcoholic drinks for home breweries. Consequently, very large quantities of cheap liquor are brewed. The traditional tribal society was singularly free from crime. However, the increased availability of cheap intoxicating drinks, invasion made by the electronic media into the villages, migration of the tribal people to non tribal areas for work and the treatment they receive from the non tribal people are sure to increase the crime rate. Blood borne diseases like Hepatitis B virus infection is likely to be high in the tribal population because of the common social practice of tattooing. This together with alcoholism may result in increased number of chronic active hepatitis and cirrhosis of liver cases. However, no detailed studies have been undertaken on these aspects in the tribal populations.
- Problems of drinking water and water borne diseases.
As the tribal people live in the hilly terrain, during the rainy season the water flows down very fast. In the dry season, the scarcity of water is very acute in most places. Water borne disease like helminthiasis, amoebiasis, giardiasis and diarrhea diseases are rampant in the tribal population
Even during the height of malaria eradication campaign in India, a number of tribal areas still continued to harbor malaria, primarily because of their inaccessibility and lack of community participation. In certain areas the behaviors of vectors are different and require different strategies for control. Malaria still remains a problem in many tribal areas. However, since 1997–98 due to the aggressive anti–malaria program of Govt. of Maharashtra, malaria has shown a steep decline in this area.
- Genetic disorders
Genetically transmitted disorders like sickle cell anemia, Glucose 6 Phosphate Dehydrogenises deficiency are common in the tribal populations in the country. These diseases have been associated with malaria endemicity. High prevalence of these conditions may point out that the tribal populations have been associated with malaria for a long time. Different forms of thalassaemia and thalassaemia traits are also common in the tribal peoples. These conditions add to the overall anemia situation in the tribal peoples. However, the extent and the prevalence of different genetic disorders in this area is yet to be explored.
- The Traditions
The tribal people have been traditionally permissive in sexual matters. Yaws has been quite common earlier. However, in recent days, interaction with the non–tribal population may increase the sexually transmitted disease load among the tribal population. It is important to understand the situation immediately, particularly with reference to HIV and RTI.
This is a major factor influencing morbidity and mortality among the tribal peoples. Because of the poor agricultural practices among the tribes, food is always scarce. As they are not engaged in any other income generating activity (gathering of forest products gives them very little income) they are under severe exploitation by labor contractors. Not only is protein calorie malnutrition common, deficiency of micronutrients like iron, is also very common. However, iodine deficiency leading to goiter is not seen in this area.
- Snake bites, suicides and accidents
This also inflicts considerable burden on tribal population. The lifestyle of the tribal population in the area of investigation and the forest clad hilly terrain can explain the large number of deaths due to snake bites. However, suicides in the tribal population point to a deeper social malady which needs to be looked into.