Prevalence of hypertension in adults of primitive tribe of east Singhbhum district of Jharkhand: A community-based cross-sectional study

ABSTRACT

Context:

Hypertension is a major cause of premature death globally, with higher prevalence in certain cultural groups. This study aimed to estimate hypertension prevalence in a primitive tribe in East Singhbhum district, investigate associated epidemiological factors, estimate tobacco addiction prevalence, evaluate nutritional status using anthropometric measures, and raise awareness about hypertension and its negative effects from alcohol and tobacco use.

Materials and Methods:

This cross-sectional study was conducted among members of the primitive tribes of the East Singhbhum district block. A total of 397 participants aged ≥18 years were selected for this study. Selected anthropometric measures and blood pressure were obtained using standardized tools and methods. Statistical analyses, including frequency and Chi-squared tests, were used to evaluate the data.

Results:

A low literacy rate was found in a study of 397 adults in Sabar, the majority of whom were female (54.3%) and resided in plateau and sub-hilly areas. Among the Sabar tribes, 4.3% had stage II disease, 15.6% had stage I disease, and 19.9% had hypertension. Age, sex, alcohol consumption, and tobacco use (both smoked and smokeless) were significantly associated with the risk of hypertension.

Conclusion:

The study found that smoking, drinking, and salt consumption are common risk factors for hypertension, affecting 19.9% of participants. Further epidemiological research is needed to understand hypertension causes in tribal populations. Early diagnosis and treatment are crucial due to lack of knowledge and poor health infrastructure. Primary care doctors can help manage hypertension by recommending lifestyle changes and routine checkups.

Introduction

Hypertension, a major cause of premature deaths, affects 8.5 billion people globally, with 1.28 billion adults aged 30–79 living primarily in low- and middle-income countries.[1] High systolic blood pressure is the leading modifiable risk factor globally for premature cardiovascular deaths, accounting for 10.8 million and 11.3 million deaths in 2021. It is associated with deaths from ischemic heart disease and stroke, contributing to 2,770 all-cause disability-adjusted life years in 2021.[2] In 2019, the global prevalence of hypertension in adults aged 30–79 was 34% for males and 32% for females, similar to 1990 levels.[3] Africans and Asians are among the 75% of hypertension cases globally, accounting for 29.2% of the total. This disease is responsible for over one million deaths and affects 1.56 billion adults by 2025.[4]

The prevalence of hypertension in the tribal population was 36.5%.[5] The prevalence varied from 0.44% in Odisha to 68.4% in Nagaland, with 23.7% among men and 23.4% among women.[6] The tribal population makes up 8.6% of the total population in India, making it a significant health concern.[7]

Approximately 24% of the Kattunayakan PVTG smoked tobacco in the past year, while 16% reported alcohol use. Males were 17.71 times more likely to use alcohol than females. Over 45% of participants began drinking between the ages of 18 and 25.[8]

According to the 2011 Census, Jharkhand’s population is 32,988,134, with scheduled tribes making up 26.2% (8,645,043 individuals) of this total. There are 32 scheduled tribes in the state, including eight Primitive Tribe Groups: Asur, Birhor, Birajia, Korwa, Parahiya (Baiga), Sabar, Mal Pahariya, and Souriya Pahariya.[9,10]

Jharkhand Tribal communities (8.3%) face health, poverty, malnutrition, mental illness, and addiction issues, with disparities in health indicators.[11] Among tribal patients with chest discomfort, 40.19% of males and 27.45% of females were found to have prehypertension, while 3.92% of both males and females were hypertensive.[12] The prevalence of hypertension was higher among the Sabar (20.9%) and lower among the Munda (12.8%).[13]

Only a small number of studies have been done in remote villages of Jharkhand, so it is important to share information about factors that increase the risk of heart disease, such as blood pressure, body mass index (BMI), nutrition, and daily habits of the Sabar tribes living in villages of East Singhbhum Block.

The study aims to find out how common hypertension is among adults in a primitive tribe in the East Singhbhum district, look at related health factors, measure how many people use tobacco and non-tobacco products, assess nutritional health using body measurements, and share information about hypertension and the dangers of using tobacco and alcohol.

The outcome of this study will help primary care physicians gain a clear understanding of the prevalence of hypertension among tribal populations and the associated risk factors. Consequently, they will be able to guide the tribal population on necessary lifestyle modifications to manage their hypertension, emphasizing the importance of regular follow-up.

Materials and Methods

Study design

We conducted this community-based cross-sectional study in the various community blocks of the East Singhbhum district of Jharkhand.

The study population consists of men or women from the Sabar Tribes, aged ≥18 years and residing in East Singhbhum, Jharkhand.

Ethical approval

The Institutional Ethics Committee of the MGM Medical College, Jamshedpur, Jharkhand, approved the study and conducted it in accordance with the Declaration of Helsinki. IEC approval no: IEC/01/21, Dated: 23/06/2021.

Seating and places

The East Singhbhum district consists of eleven blocks. There were 231 Panchayats and about 1,810 revenue villages [Figure 1]. The sampling process involved randomly selecting four blocks, each from two subdivisions, from a total of 11 blocks. We randomly selected nine villages from each of these selected blocks using the lottery method, based on the list of primitive tribal villages obtained from the district administration. We conducted a house-to-house survey in a selected village. All the household members present on the interview day were Sabar tribal men and women, aged more than 18 years. The study included individuals who gave their consent to participate. The study excluded pregnant women who were terminally ill.

Figure 1.

Jharkhand political map showing east Singhbhum district

Sample size

From the study by Kaustav Das et al.,[14] “Co-existence of High Levels of Undernutrition and Hypertension among Sabar Males of Purulia, West Bengal, India.” We considered the prevalence of hypertension in the Sabar tribe, which is 37.7%, P = 37.7%, CI: 95%, margin of error: 5%, and N = 360. The study included a total of 397 participants.

The study period spanned from November 2021 to October 2023.

Data collection

The World Health Organization (WHO) laid down standard guidelines for recording anthropometric measurements, such as height, weight, and waist circumference.[15] We followed JNCVII criteria for the diagnosis of hypertension.[16] We considered patients with a blood pressure of 120/80 normal. We classified patients as pre-hypertensive if their blood pressure ranged from 120 to 139 systolic and 80–89 diastolic mm of mercury. We classified patients with systolic pressure ranging from 140 to 159 and diastolic pressure ranging from 90 to 99 as having stage I hypertension and those with blood pressure greater than 160/100 as having stage II hypertension.

We assessed the subjects’ physical activity, considering both occupational and non-occupational physical activity. The category of tobacco users included users of all types of tobacco products. A current user of tobacco was defined as a person who was consuming tobacco in any form (smoking, chewing, or snuff) within the past year. We estimated alcohol consumption by considering anyone who consumed alcohol in any form within the last 12 months as having exposure to alcohol. We recorded the individual’s daily dietary salt intake. We recorded the extra salt intake by asking probing questions about whether they added extra salt to their food while eating, excluding salt added during meal preparation, and whether they consumed any salty food, such as salted dried fish or pickles. We considered consumption of any extra salt in raw form to be more than 5 gm per day.

Statistical analysis

We used the statistical software, EpiInfo 7, to analyze the data. We summarized the baseline characteristics of the study subjects using descriptive statistics such as percentage, mean, standard deviation, and range. We used the Chi-square test to determine the relationship between two categorical variables. A P-value less than 0.05 were considered significant.

Results

We examined 397 adults. Sabars across nine villages revealed a higher proportion of female participants (55.9%) compared to males (44.1%). The average age was 37.71 years, with a BMI distribution showing 53.4% normal weight, 12.3% overweight, 22.9% underweight, and 8.1% severely underweight. Most participants lived in plateau and sub-hilly regions, with a low literacy rate of 75.3% being illiterate. The majority were unskilled agricultural laborers (55.9%), and many utilized Antyodaya ration cards. Housing conditions included 65.7% living in semi-pukka houses, while sanitation practices showed 40.8% using open defecation [Table 1].

Table 1.

General characteristics of study population

Variables	n (%)
Gender
Male	175 (44.1%)
Female	222 (55.9%)
Total	397 (100%)
Age groups
18–27	118 (29.7%)
28–37	101 (25.4%)
38–47	74 (18.7%)
48–57	64 (16.1%)
58–67	31 (7.8%)
68–80	9 (2.3%)
Total	397 (100%)
Body Mass Index
8.89–15.9 Severe Underweight	32 (8.1%)
16.0–18.4 Underweight	91 (22.9%)
18.5–24.9 Normal Weight	212 (53.4%)
25.0–29.9 Overweight	49 (12.3%)
30.0–34.9 Moderately Obese	8 (2.0%)
35.0–39.9 Severally Obese	2 (0.5%)
40.0–69.44 Morbidity Obese	3 (0.8%)
Total	397 (100%)
Educational Status
No Education	299 (75.3%)
Attended formal education	84 (21.2%)
Home schooled	14 (3.5%)
Total	397 (100%)
Marital Status
Never Married	31 (7.8%)
Living in/cohabiting/currently married	335 (84.3%)
Non cohabiting	1 (0.3%)
Widowed	30 (7.6%)
Total	397 (100%)
Occupation
Professional	9 (2.2%)
Medium or large business	1 (0.2%)
Organization	1 (.3%)
Agricultural Land owner	8 (2.0%)
Self-employed and small business	3 (0.8%)
Skilled manual labourer	1 (0.3%)
Unskilled manual agricultural labourer	222 (55.9%)
student	3 (0.8%)
Homemaker	94 (23.7)
Unemployed (able to work)	39 (9.8%)
Unemployed (unable to work)	12 (3.0%)
No response	4 (1.0%)
Total	397 (100%)
Type of house
Pucca	93 (23.4%)
Semi Pucca	261 (65.7)
Kachha	43 (10.9%)
Total	397 (100%)
Type of toilet
Own Flush Toilet	49 (12.3%)
Shared flush toilet	23 (5.8%)
Own Pit toilet	157 (39.5)
Shared pit toilet	5 (1.3%)
Open defecation	162 (40.8%)
Do not Know	1 (0.3%)
Total	397 (100%)

252 participants (63.5%) used public tap water, while 138 (34.8%) relied on piped water. A significant majority, 389 (98%), cooked with firewood, and all participants used mustard oil for cooking and eating. Most participants consumed seasonal fruits locally because of limited access, while only a few purchased them from markets. A notable 370 participants (93.2%) consumed ≤5 grams of salt, while others consumed high-salt foods. Additionally, 342 participants (86.1%) added extra salt to their meals. Most participants avoided chips, achar, and fast food. [Table 2] details the distribution of water sources.

Table 2.

Distribution of source of drinking water, fuel used, and salt intake

Variables	n (%)
Main source of drinking water
Piped supply/hand pump	138 (34.8%)
Public tap	252 (63.5%)
others facility	7 (1.7%)
Total	397 (100%)
Main fuel type used for cooking
Electricity	3 (0.7%)
LPG/Natural Gas	5 (1.3%)
Wood	389 (98.0%)
Total	397 (100%)
Servings of fruits, vegetables and fruit and/or vegetable juices consumed per day
Serving of fruits	9 (2.3%)
Serving of vegetables	204 (51.4)
Serving of fresh fruits and/or vegetables juice	8 (2.0%)
Not answered	176 (44.3%)
Total	397 (100%)
Salt intake
<5 gm	370 (93.2%)
>5 gm	27 (6.8%)
Total	397 (100%)
Extra added salt to food
Never	43 (10.8%)
Always	342 (86.1%)
Some times	11 (2.8%)
Rarely	1 (0.3%)
Total	397 (100%)

109 (27.5%) of the population smoke tobacco, 90 (22.7%) use bidi, and 100% share it. 187 (45.8%) use smokeless tobacco. Under this, 161 (40.6%) use chewing tobacco, and 387 (98%) of participants consume alcohol daily. 387 (98%) consume >3 standard drinks. 135 (33.7%) obtain alcohol from unauthorized sources, while 299 (57.7%) produce it at home [Table 3].

Table 3.

Distribution of patterns and types of smoked, smokeless tobacco and alcohol uses

Variables	n (%)
Types of Smoked tobacco uses
Bidi	90 (22.7%)
Manufactured cigarettes	2 (0.5%)
Hand rolled cigarettes	7 (1.8%)
Others (Ganja)	10 (2.5%)
Never use	288 (72.5%)
Total	397 (100%)
Types of Smokeless tobacco uses
Chewing tobacco	161 (40.6%)
Paan with tobacco	7 (1.8%)
Tobacco snuff by mouth	17 (4.3%)
Tobacco snuff by nose	2 (0.5%)
Never use	210 (52.9%)
Total	397 (100%)
Alcohol Use
Not consumed	10 (2.5%)
Ever consumed	254 (64.0%)
Consumed in past 12 hours	21 (5.3%)
Consumed in past 30 days	112 (28.2%)
Total	397 (100%)
Maximum number of standard drinks consumed
>3 Standard Drink	324 (81.6%)
3–5 standard drink	54 (13.6%)
>6 standard drinks	9 (2.3%)
Alcohol not consumed	10 (2.5%)
Total	397 (100%)
Source of consumption of alcohol
Unauthorized sources	135 (33.7%)
Smuggled	5 (1.3%)
Home barewed	229 (57.7%)
Other untaxed alcohol	19 (4.8%)
Alcohol not consumed	10 (2.5 %)
Total	397 (100%)

94 (23.7%) are busy with household work. 394 (99.2%) of participants do not know about the increase or decrease in blood pressure or its other aspects. Only 93 (23.9%) of the participants seek assistance from government facilities, such as health and wellness centers, primary health centers (PHCs), and community health centers (CHCs) [Table 4].

Table 4.

Awareness, treatment, and control of blood pressure

Variables	n (%)
Awareness, treatment, and control of blood pressure
Awareness of raised blood pressure	3 (0.8 %)
Do not know	394 (99.2%)
Total	397 (100%)
Source of current consultation and treatment
Currently consulting allopathic practitioner in public sector.	4 (1.0 %)
ANM and Government medical facility	95 (23.9 %)
Do not know	298 (75.1%)
Total	397 (100%)

Prevalence of hypertension

Our findings showed that 79 (19.9%) of Sabar tribes had hypertension, 40 (18%) of women and 39 (22.3%) of men. Out of the total study participants, 62 (15.6%) had stage I hypertension and 17 (4.3%) had stage II hypertension. Prevalence of hypertension is shown in Table 5 and Figure 2.

Table 5.

Prevalence of hypertension as per JNC VII criteria

JNC VII Criteria	n (%)
Normal Blood Pressure	306 (77.1 %)
Pre Hypertension	12 (3.0 %)
Stage 1 Hypertension	62 (15.6 %)
Stage 2 Hypertension	17 (4.3 %)
Total	397 (100%)
Gender wise distribution of Hypertension
Male	39 (22.3%)
Female	40 (18%)

Figure 2.

Prevalence of hypertension as per JNC VII criteria

Significant associations were found between hypertension levels and different types of smoked tobacco, smokeless tobacco, alcohol, patterns of alcohol consumption, salt intake, and awareness about blood pressure control [Table 6 and Figures 3–7].

Table 6.

Association of hypertension with various risk factors

Variable	Normal	Pre Hypertension	Stage 1 Hypertension	Stage 2 Hypertension	χ 2	P
Gender distribution
Male	128 (73.1%)	8 (4.6%)	26 (14.9%)	13 (7.4%)	10.463	.015
Female	178 (80.2%)	4 (1.8%)	36 (16.2%)	4 (1.8%)
Age groups
18–27	101 (85.6%)	2(1.7%)	11(9.3%)	4(3.4%)	37.04	.001
28–37	79 (78.2%)	6 (5.9%)	16 (15.8%)	0 (0.0%)
38–47	53 (71.6%)	3 (4.1%)	15 (20.3%)	3 (4.1%)
48–57	51 (79.7%)	1 (1.6%)	6 (9.4%)	6 (9.4%)
58–67	18 (58.1%)	0 (0.0%)	10 (32.3%)	3 (9.7%)
68–80	4 (44.4%)	0 (0.0%)	4 (44.4%)	1 (11.1%)
Occupation wise distribution of Hypertension
Professional	7 (77.8%)	0 (0.0%)	2 (22.2%)	0 (0.0%)	54.03	.012
Medium or large business	1 (100.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Organization	1 (100.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Agricultural Land owner	7 (87.5%)	0 (0.0%)	0 (0.0%)	1 (12.5%)
Self-employed and small business	2 (66.7%)	0 (0.0%)	1 (33.3%)	0 (0.0%)
Skilled manual labourer	0 (0.0%)	1 (100.0%)	0 (0.0%)	0 (0.0%)
Unskilled manual agricultural labourer	174 (78.4%)	6 (2.7%)	30 (13.5%)	12 (5.4%)
student	2 (66.7%)	0 (0.0%)	1 (33.3%)	0 (0.0%)
Homemaker	68 (72.3%)	4 (4.3%)	20 (21.3%)	2 (2.1%)
Unemployed (able to work)	34 (87.2%)	1 (2.6%)	3 (7.7%)	1 (2.6%)
Unemployed (unable to work)	6 (50.0%)	0 (0.0%)	5(41.7%)	1 (8.3%)
No response	4 (100.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Body Mass Index
8.89–15.9 Severe Underweight	26 (81.3%)	0 (0.0%)	5 (15.6%)	1 (3.1%)	22.58	.207
16.0–18.4 Underweight	77 (84.6%)	2 (2.2%)	9 (9.9%)	3 (3.3%)
18.5–24.9 Normal Weight	157 (74.1%)	7 (3.3%)	37 (17.5%)	11 (5.2%)
25.0–29.9 Overweight	38 (77.6%)	1 (2.0%)	9 (18.4%)	1 (2.0%)
30.0–34.9 Moderately Obese	4 (50.0%)	2 (25.0%)	1 (12.5%)	1 (12.5%)
35.0–39.9 Severally Obese	2 (100.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
40.0–69.44 Morbidity Obese	2 (66.7%)	0 (0.0%)	1 (33.3%)	0 (0.0%)
Consumption of variety of Smoked tobacco
Bidi	66 (73.3%)	4 (4.4%)	16 (17.8%)	4 (4.4%)	8.17	.771
Manufactured cigarettes	2 (100.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
Hand rolled cigarettes	5 (71.4%)	1 (14.3%)	1 (14.3%)	0 (0.0%)
Others	7 (70.0%)	1 (10.0%)	2 (20.0%)	0 (0.0%)
Never use	226 (78.5%)	6 (2.1%)	43 (14.9%)	13 (4.5%)
Types of Smokeless tobacco
Chewing tobacco	123 (76.4%)	7 (4.3%)	24 (14.9%)	7 (4.3%)	32.95	.001
Paan with tobacco	4 (57.1%)	0 (0.0%)	3 (42.9%)	0 (0.0%)
Tobacco snuff by mouth	7 (41.2%)	1 (5.9%)	6 (35.3%)	3 (17.6%)
Tobacco snuff by nose	1 (50.0%)	0 (0.0%)	0 (0.0%)	1 (50.0%)
Never use	171 (81.4%)	4 (1.9%)	29 (13.8%)	6 (2.9%)
Use of Alcohol
Alcohol not consumed	8 (80.0%)	0 (0.0%)	1 (10.0%)	1 (10.0%)	19.48	<0.05
Ever consumed	210 (82.7%)	8 (3.1%)	31 (12.2%)	5 (2.0%)
Consumed in past 12 hours	14 (66.7%)	1 (4.8%)	5 (23.8%)	1 (4.8%)
Consumed in past 30 days	74 (66.1%)	3 (2.7%)	25 (22.3%)	10 (8.9%)
Patterns of alcohol use daily
Unable to stop drinking once started	132 (72.1%)	8 (4.4%)	33 (18.0%)	10 (5.5%)	16.69	<0.05
Failed to do routine activities due to drinking	18 (75.0%)	1 (4.2%)	4 (16.7%)	1 (4.2%)
Needed drink in the Morning	149 (82.8%)	1 (0.6%)	24 (13.3%)	6 (3.3%)
Alcohol not consumed	7 (70.0%)	2 (20.0%)	1 (10.0%)	0 (0.0%)
Maximum number of standard drinks consumed
>3 Standard Drink	257 (79.3%)	6 (1.9%)	49 (15.1%)	12 (3.7%)	24.50	.004
3–5 standard drink	38 (70.4%)	4 (7.4%)	8 (14.8%)	4 (7.4%)
>6 standard drinks	4 (44.4%)	0 (0.0%)	4 (44.4%)	1 (11.1%)
Alcohol not consumed	7 (70.0%)	2 (20.0%)	1 (10.0%)	0 (0.0%)
Salt intake
<5 gm	293 (79.2%)	12 (3.2%)	51 (13.8%)	14 (3.8%)	18.88	.000
>5 gm	13 (48.1%)	0 (0.0%)	11 (40.7%)	3 (11.1%)
Time spent in Physical activity per day
Vigorous activity	2 (100.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	9.30	.430
Moderate activity	26 (72.2%)	0 (0.0%)	8 (22.2%)	2 (5.6%)
Leisure time activity	1 (33.3%)	0 (0.0%)	2 (66.7%)	0 (0.0%)
work related activity at home/work place	277 (77.8%)	12 (3.4%)	52 (14.6%)	15 (4.2%)
Awareness, treatment, and control of blood pressure
Awareness of raised blood pressure	2 (66.7%)	1 (33.3%)	0 (0.0%)	0 (0.0%)	9.83	.020
Do not know	304 (77.2%)	11 (2.8%)	62 (15.7%)	17 (4.3%)

χ²=Chi-Square. P=P<0.05 was considered statistically significant

Figure 3.

Distribution of hypertension with age group

Figure 7.

Distribution of hypertension with salt intake

Figure 4.

Distribution of hypertension with smokeless tobacco

Figure 5.

Distribution of hypertension with alcohol use

Figure 6.

Distribution of hypertension with pattern of alcohol use daily

Discussion

Since the 19^th century, hypertension’s health risks have been acknowledged, with research in India starting in the late 1940s. Before 2000, tribal hypertension received little focus, despite low incidence rates in these populations. Community-based studies are essential due to tribal diversity. This investigation specifically studied the Sabar tribe in East Singhbhum, Jharkhand, highlighting the need for tailored research.

The Sabar tribal tribe indicated a hypertension prevalence of 19.9%, comparable to findings from several tribal populations across India (16-26%). The study by Shriraam V et al.[5] found that the prevalence of hypertension in south India was 36.5%. Mangal et al.[17] found that the prevalence of hypertention in the tribal community in Southern Rajasthan was 23.33%.

The study indicated that the prevalence of hypertension among the Kani tribal people in Kerala was 48.3%. The rate was 43.4% among the Rang Bhotias tribal population in Uttarakhand, India.[18]

According to C.R. Hazarika’s and Babu[6] study, the rate of high blood pressure varies a lot among Indian tribal groups. The Mokokchung tribes in Nagaland had one of the highest rates, at 68.4%. This information makes people worry that the rate of high blood pressure is rising among these groups. Majgi SM et al.[19] reported that the pooled hypertension prevalence (25.1%) from this meta-analysis was lower than the prevalence of hypertension in the general population.

The study found that the prevalence of hypertension was 18% in females and 22.3% in males. Giri PP et al.[13] reported that 1.1% of male Sabar tribe members in Vishakhapatnam, Andhra Pradesh, had stage-I hypertension, and 9.4% of female Sabar tribe members did too. In Cuttak (Orissa), the Sabar, a more educated and acculturated tribe had a prevalence of hypertension of 20.9%. Our study also found a significant association between gender and hypertension.

In our study, 12.7% of the study participants, less than 30 years old, were hypertensive, indicating that lifestyle diseases are no longer confined to the elder population but are also affecting the young adult tribal population. A similar study is found in the study done around that time in Gujand, Madhya, and Prades showed similar results.[20] Giri et al.[13] revealed that 50.5% of the Nicobarese tribe suffers from hypertension, possibly due to the over-representation of older individuals. In the Bhotia region, hypertension prevalence was 43.4%, while high-altitude tribes had a lower prevalence of 10.7%. Hypertension may be more common in young adults, according to research by Ganie MA et al.[21] Our study also found a significant association between young and younger people and hypertension.

Low food intake or poor metabolism causes malnutrition, and various investigation methods can determine its severity. Biological causes include infectious diseases and helminth infections, while behavioral factors include inadequate access to food, insufficient knowledge, and poor hygiene. Social risk factors include political situations, a lack of education, economic inequality, and cultural influences on food habits, religious customs, and social customs. Evaluating nutritional status is important to determine the severity of malnutrition, as proper knowledge is required for clinical signs and symptoms. Anthropometrics is a non-invasive method for assessing nutritional and health status in adults, which provides detailed information about body composition, especially muscle and fat components. BMI is a reliable indicator for assessing chronic energy deficiency in adults, especially in developing countries, as it is highly correlated with fat and fat-free mass.[22] We calculate BMI using the formula BMI = Weight (kg)/Height (m), which serves as the criteria for classifying the nutritional status of Sabar tribes.

Concerningly, hypertension is prevalent among both severely underweight (18.7%) and underweight (13.2%) people with low body mass index. One of the risk factors for CVD, according to numerous studies, is a low body mass index (BMI). Because their bodies are not absorbing enough micronutrients, people with low body mass index may experience elevated blood pressure.[20] Within the Sabar tribes, there was a significant connection between the prevalence of overweight and hypertension, which stood at 20.4%. Those who are overweight are more likely to develop hypertension, a major indicator of cardiovascular diseases. Suman Chakrabarty and Premananda Bharati found that advancing age in Shabar people in Odisha state is linked to increased hypertension, possibly due to factors such as higher BMI, fewer physical activities, and changing habits.[23]

In my study, most of the participants, who suffered from hypertension, were unskilled manual agricultural laborers and homemakers. Most of them did not have any education. Higher socioeconomic status and higher levels of education were associated with lesser prevalence of hypertension. Ganie MA et al.[21] conducted a similar study.

Smokeless tobacco includes various forms like paan, gutka, naswaar, khaini, and others, consumed by chewing or snuffing. Its popularity varies by region, with betel nut prevalent in South Asia. In Pakistan, paan, gutka, and naswaar are common, with paan favored by Hazara and North Punjab migrants, while Pathans prefer naswaar. Many users have consumed smokeless tobacco for over a decade. Chewing tobacco significantly raises the risk of ischemic stroke and cardiovascular disease, as it produces high nicotine levels in the blood, leading to increased blood pressure. Awareness of these health risks is crucial for users.[24]

In this study, those who chew tobacco [19.2%] and use tobacco snuff by mouth showed the most prevalent type of hypertension. Our study also found a significant association between these two behaviors and hypertension.

Smoking activates the sympathetic nervous system, which increases heart rate and blood pressure. Among the long-term impacts is a higher risk of hypertension, especially for people who smoke heavily. Over five pack-years of nicotine can raise blood pressure by more than 30%. The danger is larger for heavy smokers, who use machine-rolled cigarettes. Combining smoking with alcohol consumption raises the risk of hypertension in the long run. Arterial wall damage, plaque accumulation, heart attacks, and strokes are further potential health problems.[25,26]

In this study, individuals who use Bidi [22.2%] exhibited the most prevalent type of hypertension. Aswin, M.G. et al.[18] reported that the overall prevalence of any tobacco use was 28.2%. Prevalence of any tobacco was reported among Kani tribes in Kerala (81.5%).

According to this study, 97.75% of the participants reported high levels of alcohol consumption, which is higher than the study of Giri PP et al.[13] Our study may reveal higher levels of underreported tobacco and alcohol use compared to previous reports.

In our study, tobacco addiction was found to have a significant association with hypertension (P < 0.05), whereas the association of use of alcohol, patterns of alcohol use daily, and maximum number of standard drinks consumed with the risk of hypertension was statistically significant. Giri PP et al.[13] reported that the tribals of Maharashtra showed a significant association of alcohol and tobacco addiction to the risk of hypertension.

Dietary salt consumption significantly influences blood pressure (BP) independently of other risk factors. In a study, 51.8% of participants used extra salt, establishing it as a hypertension risk factor. Giri PP et al.[13] indicate that individuals consuming over 5 gm of salt daily have a higher prevalence of hypertension, highlighting a positive correlation between salt intake and elevated blood pressure levels.

Most of the participants engaged in work-related activities at home and in the workplace, as well as moderate-level activities. We noted hypertension in 18.10% of these participants. The study by B. Babu et al.[20] also found that a lack of intense physical activity was a predictor of hypertension.

In the present study, we found that awareness, treatment, and control of hypertension, along with its risk factors and perceptions about treatment, are significantly lower compared to other studies conducted both in India and abroad.[13]

Implications

Hypertension and chronic diseases are increasingly prevalent among India’s tribal populations due to lifestyle factors like poor nutrition, smoking, and inactivity. This shift from infectious to chronic disease epidemics highlights the impact of tobacco use, alcohol consumption, and high salt intake as significant risk factors. While obesity is rare due to labor-intensive lifestyles, urban Indigenous populations face higher overweight rates. Effective management of these chronic conditions requires the involvement of primary care doctors and community health workers. The Indian government’s National Health Mission Program emphasizes targeted interventions to help tribal communities prevent and manage hypertension and related health issues.

Conclusions

Research indicates that hypertension prevalence among India’s Sabar tribes is like other indigenous groups, linked to low socioeconomic status, high salt intake, smoking, and alcohol use. Raising awareness about these modifiable risk factors is essential for long-term reduction of hypertension. Further epidemiological studies are needed to understand its causes, alongside regular screenings, and culturally sensitive management strategies. Non-communicable disease surveillance should focus on tribal health, and multicentric cohort studies are necessary to explore hypertension’s prevalence among indigenous populations. The Indian government has committed to supporting marginalized communities through a dedicated ministry and various programs to address their healthcare needs.

Clinical relevance

The need for early diagnosis and treatment of hypertension in tribal populations is crucial due to limited health knowledge and infrastructure. A prevalence study will aid in understanding hypertension distribution patterns, ultimately enhancing mitigation efforts in East Singhbhum district’s tribal communities.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

This research project was approved and funded by the Department of Health Research, Ministry of Health and Family Welfare, and government of India, New Delhi and the Multi-Disciplinary Research Unit, MGM Medical College, Jamshedpur, Jharkhand. The authors are thankful to the Nodal Officer of MRU and staff of MRU, MGM Medical College Jamshedpur for all kinds of support during the study. The authors also thank the Director, Integrated Tribal Development Agency (ITDA) of East Singhbhum, Civil Surgeon of East Singhbhum, Medical Officer in Charge of PHCs and CHCs of all blocks, ANMs, AWWs, Sahiyas and MTS staff of the blocks of East Singhbhum for allowing and cooperating to carry out the research work. We express our heartfelt gratitude to the Deputy Collector and SDM of East Singhbhum for their constant support and guidance during the project work.