|Year : 2018 | Volume
| Issue : 3 | Page : 159-163
Prevalence and co-relates of hypertension among Gaddi (Agro Pastoralist) tribal's at high altitude in North-West India
Sunil Kumar Raina1, Mitasha Singh1, Vishav Chander1, Sujeet Raina2
1 Department of Community Medicine, Dr. RPGMC, Kangra, Himachal Pradesh, India
2 Department of Medicine, Dr. RPGMC, Kangra, Himachal Pradesh, India
|Date of Web Publication||24-Sep-2018|
Sunil Kumar Raina
Department of Community Medicine, Dr. RPGMC, Tanda, Kangra, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: An extensive search on PubMed reveals the paucity of data on hypertension among agro-pastoralist (Nomadic) tribal population in India. Studies among nomadic tribal's living at high altitudes provide an interesting epidemiological window to study human adaptation to changing living conditions. Materials and Methods: A total of 420 agro-pastoralist participants above the age of 20 years were evaluated for blood pressure using a stratified simple random technique in agro-pastoralist villages located at high altitude. Results: Out of a total of 420 individuals studied, 44 (males: 28; females: 16) were identified as hypertensive yielding a crude prevalence of 10.5%. The prevalence was higher in males (28/261; 10.7%) as compared to females (16/159; 10.1%). The proportion of hypertension was observed to be significantly higher among 51–60 years of age group (18.2%) as compared to other age groups (P = 0.03). Conclusions: The Gaddi (agro-pastoralist) tribal's diet-style may be the probable reason for a lower prevalence of hypertension among them.
Keywords: Co-relates, Gaddi tribal's, high altitude, hypertension, the prevalence
|How to cite this article:|
Raina SK, Singh M, Chander V, Raina S. Prevalence and co-relates of hypertension among Gaddi (Agro Pastoralist) tribal's at high altitude in North-West India. Adv Hum Biol 2018;8:159-63
|How to cite this URL:|
Raina SK, Singh M, Chander V, Raina S. Prevalence and co-relates of hypertension among Gaddi (Agro Pastoralist) tribal's at high altitude in North-West India. Adv Hum Biol [serial online] 2018 [cited 2020 Apr 7];8:159-63. Available from: http://www.aihbonline.com/text.asp?2018/8/3/159/241935
| Introduction|| |
An extensive PubMed search reveals the paucity of data on prevalence and correlates of hypertension in nomadic (agro-pastoralist) tribal population at high altitude. Studies conducted in an otherwise non-nomadic tribal population at high altitude reveal contradictory views on the prevalence and correlates of hypertension. Earlier, we reported on the prevalence of hypertension in a non-nomadic tribal population of Chamba district while the current study was planned in a nomadic tribal population from the same district.
In research focussing on health and diseases, tribal populations living at high altitude provide an interesting epidemiological opportunity to identify the role of various health and disease correlates. This because the tribal populations living at high altitude (civilisations with the longest history of ancestry) are likely to be genetically more adapted than ones with a shorter history of ancestry to natural stressors. On the other hand in populations with lesser adaptation many of the human physiological processes may have been modified, blood pressure being one of them.
The study on nomadic tribal's at high altitude offers us an additional advantage to study diseases and its co-relate because nomadic tribal populations continue to live in cultural isolation with their traditional customs, beliefs and myths intact.
| Materials and Methods|| |
Background: Study area
Bharmour, a notified tribal area located in the Chamba district of the North-Western part of Himachal Pradesh state India is spread over an area of approximately 1818 km2. The area is situated at an altitude of 7000 feet in the Budhil valley (32.26°N 76.32°E) about 60 km to the South-East of Chamba. Bharmour has an unfavourable climate (peculiarly cold and dry), poor geographical accessibility and lack of basic infrastructural facilities. The area is mainly inhabited by the transhumant agro-pastoralists community 'Gaddis'. Gaddis combine the seasonal movement of livestock with seasonal cultivation. The details are available elsewhere.
The study population for this study was a population base of 12,003 individuals spread over five panchayats (Local Governments) of tribal Bharmour. With an expected frequency of 10% and the target population of 12,000 and a design effect of one the required sample size calculated was 380 at 99.9% of confidence level with each panchayat contributing a minimum of 76 individuals. However, while recruiting for the study a slightly higher number (450) of individuals were planned for recruitment to account for non-response with each panchayat contributing a maximum of 90 individuals aged 20 years and above.
A total of 420 participants out of a targeted sample of 450 agreed to complete the study. A house to survey was conducted to identify individuals above 20 years of age. Pregnant females were excluded from the study. The study was approved by the Institutional Ethics Committee.
The study was conducted using a two-stage sampling design. In the first stage, the households were selected by systematic random sampling. The household constituted the primary sampling unit. The whole study area was mapped, and all the main roads were identified. The panchayat house was taken as the starting point for this study. Four directions were identified, and one direction was selected randomly. The main road leading in that direction was approached first, and the first house reached was considered as the first household for the study. After that every 3rd household was selected and visited for the study. Once the boundary of population served by that panchayat in that direction was reached; the adjacent direction starting from panchayat house was approached for the same.
In the second stage, a single eligible participant was chosen from the selected household which formed the secondary sampling unit. An inquiry regarding an eligible participant (age above 20 years and non-pregnant) was made in the selected household. For households with only one eligible participant, that person became the designated participant and was included in the study. In case of more than one eligible participant in the selected household, lottery method was used to select a single participant by simple random sampling. This was done by assigning all the eligible participants from the household unique numbers on identical slips of paper which was then put in a container. Then, one item was drawn at a time and the unit to which the drawn number corresponds was selected to participate in the study.
The study was verbally explained to the participant, and adequate opportunities were given for discussion of any of their questions. If an eligible participant was not available in the selected household on the day of the study, a revisit to the household was made. A maximum of two revisits were conducted. If after two revisits, the eligible participant was not available, immediate next household (not a part of the randomly selected list) was included in the study.
A physical activity questionnaire was used to arrive at the level of activities performed by the study participants. Further inquiry regarding lifestyle and diet was made from each study participant.
Anthropometric measurements including weight and height were obtained using standard techniques. Height was recorded with the help of a stadiometer to the nearest of 5 mm. Weight was measured using a digital weighing machine to the nearest 100 g and was calibrated using standard weight every day.
The Body Mass Index (BMI) was calculated using the formula, weight (kg)/(height [m])2. BMI ≥23 kg/m2 was defined as overweight. Blood pressure was measured using an automatic device (HEM 7000; OMRON Life Science Co. Ltd., Kyoto, Japan).
Blood pressure was measured twice after taking at least a 5 min rest in a sitting position, and the mean of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated. SBP ≥140 mm Hg and/or DBP of ≥90 mm Hg and/or taking current antihypertensive medicine were defined as hypertension.
| Results|| |
The prevalence of hypertension among the study population was 10.5% (8.0–13.0). The sociodemographic profile of the study population shows that the prevalence was marginally higher among males (10.7%) as compared to females (10.1%). The proportion of hypertension was observed to be significantly higher among 51–60 years of age group (18.2%) as compared to other age groups (P = 0.03). A significant proportion of 26.7% of illiterates was hypertensive (P = 0.00). Majority of the study population had attained education up to high school (56.2%; 236/420) and a significant proportion (6.8%) were hypertensive (P = 0.01). Majority of the study population were unemployed (40.7%; 171/420) and a significant proportion of these was diagnosed with hypertension (16.4%; P = 0.00). Marital status of the study population was in the majority currently married (76.7%; 322/420) with 11.2% among them diagnosed with hypertension [Table 1].
The risk factor profile of the population diagnosed with hypertension shows significant proportion (54.5%) of hypertensive consumed alcohol in the past 12 months and smoked tobacco daily (P = 0.01). A higher proportion (72.7%) of hypertensive had normal BMI as compared to 67.1% of the normotensive population. A significant proportion of 36.3% and 45.2% of those diagnosed with hypertension reported 'often' and 'sometimes' intake of processed food, respectively. While none of the participants who were diagnosed with hypertension reported the daily addition of salt before eating; 2.4% of normotensive reported the same. While cooking 72.7% of those diagnosed with hypertension reported the daily addition of salt while cooking [Table 2].
The mean number of days in a week and the servings of fruit consumed by the study population were significantly lower among hypertensive as compared to non-hypertensive (P = 0.00). Similar findings were observed with vegetable consumption also. Mean duration of moderate activity per week performed at work was significantly lower among hypertensive as compared to non-hypertensive (P = 0.00). Mean duration spent in walking or bicycle to and from work was statistically higher among non-hypertensive as compared to hypertensive (P = 0.00). Mean duration in a week performing vigorous and moderate intensity recreational activities was lower among hypertensive as compared to non-hypertensive [Table 3].
| Discussion|| |
Bharmour (home to transhumant agro-pastoralist or the 'Gaddis') is situated at an altitude of 2,134 m in Budhil valley (32.26°N 76.32°E) in the South East of the district Chamba (Himachal Pradesh). The 'Gaddi's' undertake seasonal migration along with their livestock from one agro-ecological zone to the other and back. Bharmour serves as their established permanent home base. The movement from Bharmour enables them to move their livestock at different points in time and explore different agro-ecological zones, thereby efficiently utilising available resources. The staple diet of Gaddi's is Maize along with wheat, barley and phulan.
The results of the present study revealed that overall prevalence of hypertension in Gaddi population is 10.5%. The prevalence is much lower than the prevalence of hypertension reported (36%) for the non-tribal Himachali population. Importantly, the prevalence is also lower than the one reported by studies conducted among non-Gaddi tribals at high altitude in other parts of Himachal Pradesh. The prevalence reported for Spiti valley in Lahaul and Spiti district was 22.5% while that for Kinnaur district is 19.7%., However, the prevalence is almost similar to the one reported by us among non-agropastorilist (non-Gaddi) tribal's of Chamba district living at a relatively higher altitude than Bharmour (Gaddi) tribal's.
The agro-climatic conditions though hard, there exists wide disparities in the socio-economic status across tribal Himachal. Pangi and Bharmour, the most difficult areas within the tribal belt, are far behind other regions. They are still comparatively inaccessible and therefore present greater challenges regarding accessibility.
With the change in socio-economy and increase in accessibility, the diet style of tribal's in Kinnaur and Lahaul-Spiti has become more urbanised as compared to Pangi and Bharmour in Chamba district. While barley, wheat (grown locally), maize and phulan act as staple foods in tribal area Bharmour, wheat and rice (mostly imported from urban areas) is the staple diet in Kinnaur and Lahaul and Spiti. The Tribals of Kinnaur and Lahaul and Spiti consume non-vegetarian diet frequently while the Tribals of Bharmour and Pangi consume the same on special occasions.
What seems to work in favour of Gaddi's is as compared with the typical diet used in other parts of Himachal Pradesh, the diet of Gaddi's is high on diversity, high on whole grains and fruits and low on red meat, sweets and sugar-containing beverages, the kind of dietary patterns proved to lower blood pressure.,
| Conclusions|| |
The Gaddi (agro-pastoralist) tribal's diet-style may be the probable reason for a lower prevalence of hypertension among them. This may be acting as a protective factor against the rise in blood pressure.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Raina SK, Chander V, Prasher CL, Raina S. Prevalence of hypertension in a tribal land locked population at high altitude. Scientifica (Cairo) 2016;2016:3589720.
HEM 7000. Kyoto, Japan: OMRON Life Science Co. Ltd.
Raina SK, Raina S, Chander V, Grover A, Singh S, Bhardwaj A. Identifying risk for dementia across populations: A study on the prevalence of dementia in tribal elderly population of Himalayan region in Northern India. Ann Indian Acad Neurol 2013;16:640-4.
] [Full text]
Bhardwaj R, Kandori A, Marwah R, Vaidya P, Singh B, Dhiman P, et al.
Prevalence, awareness and control of hypertension in rural communities of Himachal Pradesh. J Assoc Physicians India 2010;58:423-4, 429.
Negi PC, Bhardwaj R, Kandoria A, Asotra S, Ganju N, Marwaha R, et al.
Epidemiological study of hypertension in natives of spiti valley in Himalayas and impact of hypobaric hypoxemia; a cross-sectional study. J Assoc Physicians India 2012;60:21-5.
Negi PC, Chauhan R, Rana V, Vidyasagar, Lal K. Epidemiological study of non-communicable diseases (NCD) risk factors in tribal district of Kinnaur, HP: A cross-sectional study. Indian Heart J 2016;68:655-62.
Sacks FM, Obarzanek E, Windhauser MM, Svetkey LP, Vollmer WM, McCullough M, et al.
Rationale and design of the dietary approaches to stop hypertension trial (DASH). A multicenter controlled-feeding study of dietary patterns to lower blood pressure. Ann Epidemiol 1995;5:108-18.
Swain JF, McCarron PB, Hamilton EF, Sacks FM, Appel LJ. Characteristics of the diet patterns tested in the optimal macronutrient intake trial to prevent heart disease (OmniHeart): Options for a heart-healthy diet. J Am Diet Assoc 2008;108:257-65.
[Table 1], [Table 2], [Table 3]