Socio-cultural Beliefs of Malnutrition among Kabui Tribes of Manipur

Khundongbam Gyanabati Devi

Abstract

Understandings, knowledge and practices are all related with the surrounding and culture where people are born and brought up; with due diverse cultural and social environment set up, different communities have different understandings and perceptions about diseases and illnesses. In order to facilitate successful medical intervention, it is imperative to understand the common health concerns people have, their perception of the causes and the methods employed by them in terms of treatment/cure and prevention. Malnutrition remains one of the most common forms of illness that plague the human population globally. As regards number of children suffering from malnutrition, India is ranked 2^nd in the world according to the World Bank estimate made in 1998, whereas the prevalence of underweight children in India is among the highest in the world. Children belonging to scheduled castes, scheduled tribes, or other backward classes have relatively high levels of under nutrition according to all three measures. Children from tribal communities have the poorest nutritional status on almost every measure. Tribal communities in general and primitive tribal groups in particular are highly disease prone. The study was made to bring out indigenous understandings and perceptions regarding the management of malnutrition of children under 5 among the tribes of Manipur. To a medical anthropologist, integrating the belief system within communities with modern medical knowledge, paves the path for evolving successful health care facilities. Intensive field based study was carried out among the ST population in Manipur, Imphal East District.

Keywords: Socio-cultural, Perceptions, Beliefs, Children, Malnutrition, Kabui Tribes, Imphal East, Manipur

1. Introduction

The wide spread poverty, illiteracy, malnutrition, non-availability of safe-drinking water and unhygienic living conditions and poor maternal and child health services, have been reported in several studies as the possible contributing factors for poor health conditions prevailing among tribal communities in India. The National Family Health Survey-3 reported that tribal children have the poorest nutritional status in the nation. Malnutrition among tribal children remains a major public health problem, which has been the area of focus for the last few decades.

The Government of India has introduced several pro-Scheduled Tribe (ST) policies and programmes to tackle child health issues; although the health and nutritional condition among the members of thetribal communities still remains inferior. Several studies have been undertaken (Pal, 1999; Radhakrishna and Ravi, 2004; Kanjilal et al, 2010) to understand child malnutrition and its proximate determinants in India. But in such comprehensive studies, the specific issues of various small communities are not properly and adequately addressed, and this is so true for the STs. The social epidemiology of malnutrition, makes it essential to understand the socio-cultural and behavioral factors influencing the nutritional status in a particular setting (Nyaruhucha et al, 2006; Khundongbam, 2010, Landu, 1977)..

Among the tribes, the concept of health, disease, treatment, life and death varies with their cultures (Chaudhuri, 1986). The tribal society is often guided by the traditional customs and practices; and often attributes certain explanatory models to illnesses and diseases as they try to explain them, with special reference to the underlying systems of beliefs in different cultures. (Weiss, 1988, Joshi, 2004, Khundongbam et al., 2012). They usually bring out certain beliefs and perceptions for interference of supernatural agencies in the understanding of health and diseases. (Oinam H.,et al. 2004). The present study tries to explore such attributes that evolved around the understandings of malnutrition specially undernutrition, as a disease among children.

2. Materials and Methods

This study is based on information collected during the period of intensive fieldwork among the Kabui tribes of Imphal East district, Manipur. Kabui tribe is also known as Rongmei, and is one of the 33 recognized scheduled tribes of Manipur. The focus of the study is to highlight the knowledge, beliefs, and perceptions revolving around malnutrition among children so that a range of socio-cultural factors associated with malnutrition especially under nutrition can be brought out. One hundred twenty-five Kabui mothers of children of age under five, from Sawombung kabui khul village and Keikhu khul village, Imphal East District, were interviewed according to a detailed structured interview schedule.

The interview schedule used was drawn on the performa prescribed by the international and national organizations such as World Health Organisation (WHO) and Ministry of Health and Family Welfare (MOHFW). The schedule aimed at gathering socio-demographic information on the family size, and type of family (nuclear or extended), number, age and gender of children in the household, mother's age, education and occupation, father's occupation, household income per month; knowledge of the causes, prevention and treatment of malnutrition. Before conducting the final study, a pilot testing of the schedule was made, to make more relevant and reliable with the set of the field area.

3. Results

There are many factors that directly or indirectly cause malnutrition among children. Researchers have found child malnutrition as due to a combination of inadequate or inappropriate food intake, gastrointestinal parasites and other childhood diseases, and improper care during illness. However, people, as they try to explain illnesses and diseases, often give vent to certain perceptions and understandings that have been caused due to their social and cultural milieu. The present study is an attempt to bring out indigenous and explanatory understanding and perceptions about the causes and health care practices of malnutrition.

A total of 125 female respondents within the age range of 20 to40 years and, having children of age under 5, were interviewed. All of them were married and most of them were living in joint families. A majority of the respondents (93) were literate and amongst them nine were graduates, twenty-one were above high school level, thirty two had intermediate level education, twenty-six were educated up to the primary level, whereas thirty-two were illiterate. Occupation-wise, 46.4% mothers were engaged in brewing alcohol, 17.6% were engaged in agriculture, 7.2% in private jobs, 24% were self employed (including embroidery and weaving) and 4.8% were govt. employees.

In biomedical science, malnutrition is generally categorized under two broad headings; over nutrition and under nutrition. From the present study, it emerges that among the tribal community, over nutrition has never been considered as a disease, on the contrary some of them considered it as healthy and an indication of a well nourished child. Unless, a child is inactive, unable to perform daily activities and keeps on lying and crying, the child is not considered as being afflicted by any disease or is having any problem. Likewise, undernutrition is not considered as a serious problem that needs care and attention, if not symptoms like crying without tears, having dry eyes, being lethargy, unable to walk, being very lean and thin, extreme weakness, etc. are visible.

From the time immemorial, tribals have maintained association with plants and animals either for various reasons such as, for ritual practices, for healing diseases and illness, for well being of the whole or of individual. (Chaudhuri, 1986) When children reach the third month and begin biting with teeth, weaning period is observed on some auspicious day. At the weaning period, the first thing fed to child is a beautiful and colorful bird locally known as “jaipu” ; the belief is that it will make the child healthy, well bodied and beautiful as the bird itself.

The study also reveals that according to the mothers the factors like lack of food, breast milk, lack of care, lack of massage, and some other factors inclusive of evil eye, symptom of other diseases etc., contribute to the malnutrition specifically under nutrition. But to these factors the responses of mothers have been different (Table-1). While maximum number of mothers (75.2%) holds lack of food due to poverty as the cause of malnutrition, only 8% mothers hold lack of massage is the cause. In between, lack of breast milk, lack of strength in breast milk,lack of food during pregnancy, lack of quality food, mother’s poor health, lack of immunization, lack of care, frequent infections, diarrhea, fever, premature birth, unhygienic condition, evil eye and symptoms of other illness are respectively held by 70.4%, 60%, 42.4%, 32%,65.6%, 55.2%,36%,18.4%,28.8%,9.6%, 27.2%,13.6%, 16.8%, 12% of mothers as causes of malnutrition.

While explaining the factors of malnutrition of children, interestingly some mothers opined that child’s nutritional conditions have close association with mother’s conditions both physical and psychological. Poor health, diets, medication, feeding breast milk of conceived mother, early and frequency of pregnancy, etc are some of the factors that affect children’s health and nutritional status. Conceived mother’s milk are considered to be hot and difficult to digest and hence harmful for the children, while frequent pregnancies result in lessening of the quantity of breast milk and its nutritional content.

Table 1: Concepts of Causes of Malnutrition among Kabui tribes of Imphal East, India.

Note: Total percentage exceeds 100%, because of multiple responses.

On how to prevent the childhood malnutrition, 65.6% of the respondent mothers articulated certain restrictions on mothers such as avoidance of early and frequent pregnancy, hard medication, consumption of spicy food, sour fruit, egg etc. On the other hand 73.6% of mothers opined that the child should be fed to his/her heart’s content as this, they felt is the demand of child’s soul. In the Table-2, below, are given what other factors should be, according to the respondent mothers in different proportions, tackled to prevent the childhood malnutrition.

Table 2: Concepts related to Prevention of Malnutrition Kabui tribes, Imphal East, India

Note: Total percentage exceeds 100%, because of multiple responses.

4. Discussion

The present study reveals that malnutrition among children is perceived as caused by several factors including environmental, socio- cultural and religious and unhygienic conditions. It has been the case in other studies too. In the studies by Khundongbam et al (2012) and Tabashir et al (2015) it has been shown that the social and cultural norms of the community influence the mothers’ understanding and perception of child’s weight and nutritional status. Nitcher (1988) concluded that environmental, cultural and economic factors interact in determining the prevalence, transmission and severity of nutritional status. Besides, poor hygiene and improper sanitation also results in the high incidence of undernutrition (Gascon et al 2000). The respondent mothers in the present study holding infection and diarrhea as the causes of malnutrition agrees with what Bantley (1988) found in his study in North India: that diarrhea contributes to undernutrition among the young children. The present study reveals an association that exists between the health of breastfeeding infant, nutritional conditions and mother’s conditions. This is similar to the study of Nitcher (1988) among the Sinhalese, where mother’s health behaviour (diet, medication, bathing, etc.) and emotional state were held to be responsible for causing diarrhea among the breastfed infants. The intestinal worms causing malnutrition, as the present study reveals is found to be in agreement with the observation of Joshi (1995). As regards the belief about evil eye as the cause of malnutrition, the observation in the present study is consistent with that of Lozoff et al. (1978) and Nations, (1986). Lozoff et al. (1978) which mention that in South India, if a mother feeds her infants after seeing a woman, who has miscarriage, her child may become sick with weak, lean and thin. In Northern Brazil, Nations, (1986) found that intrusion of a dead person’s spirit and evil eye into child’s body result in unhealthy, lack of appetite and weakness.

5. Conclusion

The aim of this study was to determine the community perceptions and understandings that have built up from their cultural and social surroundings toward malnutrition of children. Despite the biomedical context, understanding behavioural attitudes such as how and why people act and perceive the way they do, will help in successful intervention. Thus learning about community perception and its understanding of the disease becomes very vital for any programme directed towards combating any health problem. Information about malnutrition showed that many caregivers followed faulty understanding and practices, and lacked awareness. The present study will be helpful in formulating the interventional programs according to the needs and desire of the Kabui tribes and implementing them with care and sensitivity towards their socio-cultural beliefs.

References

• Bentley M. D. (1988). The Household Management of Childhood Diarrhea in rural North India. Soc. Sci. Med. 27(1): 75-85
• Chaudhuri Buddhadeb (ed). (1986). Tribal Health: Socio Cultural Dimensions, Inter-India Publication, New Delhi
• Gascon J., Vargas M., Schellenberg D., Urassa H., Casals C., Kahigwa E., Aponte J.J., and Vila J. (2000). Diarrhea in children under 5 years of age from Ifakara, Tanzania: A Case -Control Study. Journal of Clinical Microbiology. 38(12): 4459- 4462.
• Khundongbam Gyanabati, P. C. Joshi and M. M. Singh.(2012) Perception of Childhood Diarrhea in Langmeidong Village, Manipur, South Asian Anthropologist. 12(2), 135-140.
•  ________. (2010). “Perception and Management of Childhood Diarrhea in Langmeidong Village, Manipur”, unpublished M.Phil Dissertation, Department of Anthropology, Delhi University, Delhi.
• Joshi P. C. (2004). Issues in Tribal Health and Medicines, In A. K. Kalla and P. C. Joshi (edt) Tribal Health and Medicines, Concept Publishing Company, 403-407. New Delhi.
• Joshi P. C.(1995). Don’t Let Me Down: Place of Worms in Culture and Reflections on Ethnophysiology in a Central Himalayan Tribe, Journey of Indian Anthropological Society, 30: 253-258.
• Kanjilal B, Mazumdar PG, Mukherjee M (2010). Nutritional status of children in India: household socio-economic condition as the contextual determinant. Int J Equity Health 9:1–22.
• Landu, David. (1977). Culture, Disease and Healing – Studies in Medical Anthropology, New York, Macmillan.
• Lozoff B, Kamath K. R. and Feldman R. A.(1978). Infection and Disease in South Indian Families: Beliefs about Childhood Diarrhea. Hum. Org. 34, 353-358.
• Nations M. K. (1986). Epidemiological research on infectious disease: quantitative rigor or rigormortis? Insights from ethnomedicine. In Anthropology and Epidemiology: Interdisciplinary Approaches to the Study of Health and Disease (Edited by James C. R. Stall R. and Gifford S. M.) 97-123. D. Reidel Dordrecht
• Nitcher Mark. (1988). From Aralu To ORS: Sinhalese Perception Of Digestion, Diarrhea, and Dehydration. Soc. Sci. Med., 27: 39-52.
• Nyaruhucha C.N. M., Mamir P.S., Keengi A.J. & Shayo N.B. (2006), Nutritional status of under five children in a pastoral community in Simanjiro District, Tanzania Tanzania Health Research Bulletin Vol. 8, No. 1
• Oinam H., Pebam K. (2004). Heaalth Care Practices among Tribes of Manipur, In A. K. Kalla and P. C. Joshi (edt) Tribal Health and Medicines, Concept Publishing Company, 277-282. New Delhi.
• Pal S. (1999). An analysis of childhood malnutrition in rural India: role of gender, income and other household characteristics. World Dev 27: 1151–71.
• Radhakrishna R, Ravi C. (2004). Malnutrition in India: trends and determinants. Econ Polit Wkly 39: 671–76.
• Tabashir Z.; Nabari May; Choo Wang. (2015). Asian American Mother’s Perception of their Children’s Weight: A Comparison with Other Racial/ Ethnic Groups in Los Angels. Ethnicity and Disease Vol.25 No.1.
• Weiss M. G. (1988). Cultural models of diarrheal illness. Soc. Sci. Med. 27: 4-16.

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