Letter: A Pilot Health and Nutritional Assessment of Tribes Living in a High Altitude District of Himachal Pradesh,India

Dear Editor,

Understanding the morbidity profile and nutritional status of communities residing in inaccessible areas is central to achieving universal health coverage (UHC) under the Sustainable Development Goal (SDG) initiative of the United Nations. This can only be achieved if tribal communities residing in high altitude with less connectivity to health care delivery systems can be taken into consideration. Therefore, health and nutritional assessments in tribes will pave the way to fulfill the health needs in these communities and UHC. The Bodh and Swangla tribes living in the Lahaul and Spiti district of India (∼3,000–4,000 m) face challenges in health care delivery due to low population density and extreme weather conditions; and their health outcomes remain poorly known. Therefore, this cross-sectional study was conducted in the Bodh and Swangla tribal communities residing in 20 different villages of Lahaul and Spiti district of Himachal Pradesh, India.

A total of 352 adults (>15 years old) residing in the Lahaul and Spiti district of Himachal Pradesh were randomly selected for this study. Detail methodologies for accessing health and nutritional status are provided in the Supplementary Data and Supplementary Table S1. Among the 352 participants, 160 (45.5%) were women. Twenty-five percent of the participants were obese (body mass index [BMI] >25 kg/m²). A high prevalence of anemia (94.9%), hypertension (41.5%), gastroesophageal reflux disease (GERD) (51.4%), musculoskeletal pain (58%), and visual refractive errors (RE) (49.1%) were the hallmark findings of this study (Supplementary Table S2).

Interestingly, the occurrence of musculoskeletal pain was statistically significantly higher in patients with high BMI (χ² = 4.73; df = 1; p = 0.030) (Supplementary Table S3). Furthermore, 13.5% of the populations were found to be prediabetic and 10.5% had hearing loss. Other chronic illnesses, such as cardiovascular disease and hypothyroidism, were also observed, but in negligible frequencies (Fig. 1). Despite a high prevalence of anemia in the community, not a single case of any inherited hemoglobin disorder was found. Similarly, no cases of malaria could be detected.

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FIG. 1.

Distribution of different morbidities among study population of Lahaul and Spiti 2019–2020.

These findings, however, differ from populations living at low altitudes. Several aspects of health parameters in these tribal communities living in high altitude (e.g., the high prevalence of anemia, GERD, musculoskeletal pain, and hypertension) differ from peoples living at low altitude. For example, high prevalence (51.4%) of GERD is clearly in contrast to studies conducted in southern Indian populations living at low altitudes, where GERD prevalence was found to be 5%–22.2% (Wang et al., 2016; Chowdhury et al., 2019). Similarly, finding on more than half of the population to have reported musculoskeletal pain was very similar to high altitude Peruvian populations (50.23%) (Vega-Hinojosa et al., 2018). Such parallel results suggest a high prevalence of musculoskeletal pain, possibly as a consequence of physical activity, such as walking in steep terrain.

This finding on high prevalence of hypertension, however, is in contrast to a study conducted a decade earlier, reporting fairly low prevalence of hypertension in the Spiti valley (Negi et al., 2012). It is possible that these particular communities might have recently adapted to a more sedentary lifestyle, which is a known risk factor for obesity (Park et al., 2020). Since obesity is a risk factor for development of hypertension (Natis et al., 2020), current prevalence of a comparatively higher hypertension in comparison with that of the earlier study (Negi et al., 2012) might be attributed to this fact.

In high altitude regions, where the ultraviolet index is higher, a higher prevalence of visual RE could be expected. This finding on high RE is a confirmation of the similar results of 49.1% by earlier workers (Sheeladevi et al., 2019).

In conclusion, this pilot health and nutritional assessment study in two high altitude tribal communities in Himachal Pradesh, India, demonstrated several unique findings in health and nutritional profiles. Similar studies in other tribal communities living in inaccessible and high altitude settings with in-depth laboratory and clinical investigations will contribute in achieving UHC under the SDG in India.