Minute of the meeting of ICMR Tribal health forum held at The Nation= al Institute of Nutrition on 4th March, 2012

Minutes of the meeting of ‘ICMR Tribal Health Research Forum’ held at the

National I= nstitute of Nutrition, Hyderabad on 4^th March, 2012=

&nb= sp;

A meeting on ‘Tribal Health Rese= arch Forum’ (THRF) was organized by NIN in association with the ICMR at the NIN Confere= nce Hall on 4^th Match, 2012. The meeting was chaired by Dr. V.M. Kat= och, Secretary DHR and DG, ICMR, Ne= w Delhi. The following members attended the meeting:

1. Dr= .V.M.Katoch &= nbsp; &nbs= p; … &= nbsp; Chairperson

&= nbsp; Director-General, ICMR and DHR,

Government= of India

2. Shri Sanjiv Datta &= nbsp; &nbs= p; &= nbsp; &nbs= p; Chief guest

&= nbsp; Financial Advisor, ICMR

3. Dr= . Neeru Singh &n= bsp; = ; &n= bsp; = ; Coordinator

&= nbsp; Director, RMRC(T), J= abalpur, MP

<= span lang=3DFR style=3D'color:#FF6600;mso-ansi-language:FR'>4. Dr. B. Sesikeran &= nbsp; = &nb= sp; = &nb= sp; = &nb= sp; =

&= nbsp; Director, NIN, Hyderabad, AP

5. Dr= .G.S.Toteja

&= nbsp; Scientist ‘F’ & Head

&= nbsp; Nutrition, ICMR. =

6. Scientists from different RMRC Centers and other ICMR institutes also attended the meeting (please see annexure). =

= Dr. G.M. Subba Rao, Scientist ‘CR= 17;, NIN welcomed the Secretary, DHR and DG, ICMR, Dr. V.M. Katoch, Mr. Sanjiv Datta, Jt. Secretary, DHR and FA, ICMR and other participants for the ‘Tribal Health Forum’ meeting and requested Dr.V.M.Katoch to ch= air the meeting and conduct the proceedings.

= In his opening remarks Secretary, DHR and DG, ICMR Dr. V.M. Katoch h= as given a brief account about the current scenario of double burden of disease in t= he country (under nutrition and over nutrition). In this context, he quoted th= at there is a rise in the prevalence of diabetes among Indian population as so= me of the National programmes were not dynamic to control these NCDs at the community level. Further, he stressed that the research activities carried = out by ICMR institutes/centers are not active in the area of tribal health as it was quite evident from the recent reports on the prevalence of hypertension among the tribal population. He addressed the scientists of ICMR who are involved in the tribal health research to be proactive to monitor the chang= es occurring during the transition in socio-economic, diet and nutrition in re= lation to the cultural habits of the community in particular with tribal populatio= n. This would help in identifying risk factors of NCDs among the tribal population. Further, he suggested to rope in medical colleges as active partners to take up this area of research in collaboration with ICMR. Also = DG suggested that there should be more focus on malaria in tribal dominant are= as and stressed that to create a special website for ‘tribal health forum’ and link may be given to ICMR website.

= Mr. Sanjiv Datta, Financial Advisor, ICMR suggested to all the membe= rs of the participating centres should submit an action taken report= based on the minutes generated in in every meeting of the ‘tribal health forum’. Further he advised the scientists to disseminate the outcome = of the studies to the beneficiaries. In addition, an institutional mechanism should be built up for accountability and responsibility for the projects t= hat are being under taken by the scientists.

= Dr. Neeru Singh, Director, RMRCT, Jabalpur, Chief Coordinator of the ‘Tribal Health Research Forum’ (THRF) reviewed the outcome of previous meetings on tribal health forum held at different Institutions. She informed that Dr. Toteja has taken a lead in forming a ‘special task force forum on ‘Tribal hypertensionR= 17;. She also informed the formation of task force for Fluorosis to adopt the Nutritional model based on studies conducted by RMRCT, Jabalpur. Further NIIH, Mumbai has unde= rtaken multicentre studies on hemoglobinopathies relating to prenatal diagnosis for thalassemia and sickle cell diseases and new born screening have been submi= tted and awaiting funding.

At this juncture Dr. Katoch has sug= gested to Dr. Toteja to develop a ‘nutrition intervention (risk reduction) model’ in association with NIN which can go as a national programme f= or tribal population.

= Dr. S.K. Kar, Director, RMRC, Bhubaneswar, indicated that future proposals on tribal population should be need-based a= nd the action taken report should provide the information how these programmes have helped in utilization of health care system in tribal areas.

= Dr. B. Sesikeran, Director, NIN, Hyderabad suggested that the scientists to follow code of ethics and confidentiality = of the outcome of these projects till completion.

<= /p>

PRESENTATIONS ON THE WORK DONE BY DIFFERENT INSTITUTES, ESPECIALLY ON TRIBALS<= /span>

<= /p>

= The project presentations from the participating institutes and the recommendations are as follows.=

= 1. National <= st1:PlaceType w:st=3D"on">Institute of Nutriti= on, Hyderabad

Dr. B. Sesikeran, Director, presented current diet and nutritional status and time trends of the tribal population carried out by the National Nutrition Monitoring Bureau (NNMB) since 1985-89.

Comments/ Suggestions<= /i>

Dr. V. M. Katoch and other members of the ‘tribal health forum’ appreciated research studies carried out on tribal with regard to their diet and nutritional status and time trends over a period of 3 decades (1985-201= 0).

Dr. B. Sesikeran has informed to the members of the forum that currently, NNMB is = in operation in only 10 states and he stressed the need for expansion of the N= NMB units in non-NNMB states to provide national representative data. He reques= ted Dr. A. Laxmaiah, Scientist E, NIN to present the expansion proposal of NNMB= in Non-NNMB states, where ICMR Institutes are already existed.

Shri Sanjiv Dattta informed that funds will not be a constraint for this.

Dr. A. Laxmaiah presented NNMB expansion proposal to the forum includi= ng its budgetary requirements of Rs.30lakhs for each NNMB unit to be established, = where ICMR Institutes are already existed in Non-NNMB states. DG, ICMR and heads = of various ICMR units have agreed in principle to establish NNMB units in Non-= NNMB states.

He also presented a new initiative project titled ‘Effect of nutrition and health education on blood pressure level amo= ng tribal adult population. He has presented various studies carried out on Tr= ibal population during 2005-10 and the following are few of the observation:

·        Prevalence (%) of= under nutrition (< Median – 2SD) among preschool children was high and D= iet and Nutritional status of Tribal population in ITDA areas of Khammam distri= ct, was also carried out.

·        Diet and Nutritio= nal status of Tsunami affected population in Andman and = Nicobar Islands

·        Distribution (%) = of Adults according to Nutritional Status (BMI grades) by Gender: Nicobarese & Settlers – Pooled

Comments/ Suggestions

The DG, ICMR Dr. V. M. = Katoch and Financial Advisor, ICMR, Mr Sanjiv Datta have agreed in principle to se= t-up NNMB units in ICMR Institutes, where NNMB is not in operation in that particular state and also agreed to sanction the required budget of Rs.30 l= akhs for each unit in the initial year and they suggested Dr. A. Laxmaiah, to su= bmit a detailed proposal in this regards.

2. Division of Non-Communicable of Diseases (NCD), ICMR

Dr. Prashant Mathur, Scientist ‘D’ presented the risk factors of non-communicable diseas= es (NCDs) among tribal population.

The following aspects were discussed during the presentation.

Tribal Health related activities supported by the Division of NCD as Extramural &n= bsp; Funding

= · &nb= sp; Telemedicine proj= ect for RF/RHD/HT in Wyanad, Amrita Institute of Medical Sciences, Kochi

NCD related Tribal Research Activities viz., hypertension, diabetes, cancers, Overweight/obesity, mental ill-health, and addressing chronic care and related health system research.

Comments/ Suggestions

DG has suggested having telemedicine project on a centralized resear= ch project mode. Further he suggested developing a health system project which can add= ress the hypertension, diabetes and other chronic diseases for the tribal population. The Directorate of Health and the State governments should incl= ude as part of the forum and ICMR should coordinate with the Directors of the Public Health in order to transfer the outcome of the Tribal Health Research Forum (THRF) for the benefit of the tribal’s and as well as general public. Representations from Medical colleges functioning around the tribal areas should also be involved in the Tribal Health Research Forum (THRF).

= 3. Division of Epidemiology and Communicable Diseases (ECD), ICMR

Dr. Ayan Jha, Scientist C, and Programme Officer for Tribal Health, represented the Division of ECD. He briefly presented the various projects funded under the Tribal Sub Plan and list of projects approved for funding. Currently, there are 19 ongoing projects, and the funds allocated ( Rs&nbs= p; 1crore 20 lakhs ) to the division under the TSP during the financial year 2011-2012 has been = fully utilized.

It was suggested that Tribal forum = should be appraised of the projects which are approved /funded by ICMR under the h= ead Tribal Sub Plan (TSP).

= 4. ICMR, New Delhi

&nbs= p; Dr. Toteja, Scientist ‘F’ & Head, Nutrition, ICMR, <= span style=3D'color:blue'>presented the formation of Task Force on ‘Tribal Hypertension’ and also informed about the invitation of proposal on <= i>“Role of diet and lifestyle on hypertension”. The Effect of nutrition and health education on blood pressure level among tribal adult population under Dr.B.Sesikeran/Dr. A. Laxmaiah, Director, NIN, Hyderabad.=

<= span style=3D'font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-fa= mily: Symbol;mso-bidi-font-style:italic'>·= = Impact of communi= ty based dietary salt restriction in the reduction of blood pressure among tea garden workers of As= sam- under Dr. P.K.Borah, Scientist- ‘C’, RMRC, Dibrugarh

<= span style=3D'font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-fa= mily: Symbol'>· Assessment of uri= ne sodium output in relation to hypertension among tribals of Madhya Pradesh – Dr. Tapas Chakma, Scientist- ‘F’, RMRCT, Jabalpur=

· Prevention of hypertension towards control in tribal population- Dr. S.K.Kar, RMRC, Bhubaneswar.<= o:p>

· Further Dr. Toteja enumerated the preparation of “A compendium on research carried out by ICMR on tribals”. The o= utline of the compendium presented was accepted and is expected to be completed by Aug= ust 2012. All institutes will be required to provide information on the work done in 11th Five year plan alo= ng with proposed activities/vision for 12th plan. Various Divisions at ICMR HQ= RS will provide information on extramural research supported by them. The prof= orma for information will be provided to institutes by 15th March 2012 and are returnable by 15th May 2012. =

· Lastly he also mentioned that Dr Pradeep Das will prepare and submit a study protocol on Hypertension in collaboration with Ranchi Medical College. The study is expected to be carrie= d out in a tribal district of Jharkhand and it will be on the lines of common protocol developed for a multisite study.

Comments/ Suggestions

&nb= sp; DG, ICMR suggested that the project should be sanctioned within a given timefra= me and suggested for a common national protocol so as to get the project propo= sals in uniform to tackle the similar health problem in various regions of the country. All the projects should be developed with an aim to give a solutio= n to the problem as an outcome of the study.&nb= sp; In addition, set the deadline of May 15, 2012 for preparation of com= pendium on Tribal proposed by Dr. Toteja.

5. <= b>National Institute of Immunohaematology, (NIIH)

= Dr. Ghosh, Director presented the following aspects: <= o:p>

Newborn Screening and Natural history of sickle cell disorders
Prenatal Diagnosis of Thalassemia and Sickle Cell Disorders

The following two project propos= als were presented for funding :
Newborn screening and comprehensive care for sickle cell disorders in different regions
Establi= shment of Prenatal Diagnosis of Hemoglobinopathies at RMRC, Jabalpur and RMRC, Bhubaneshwar

6. Regio= nal Medical Research Centre (RMRC), Jabalpur &= nbsp;

&nbs= p; Dr. Chakma, Scientist ‘F’ pre= sented on major health problems of Tribal in Madhya Pradesh. Further, he also presented new initiatives to tackle the problems sickle cell disease and related disorders. He presented the following aspects:

· = Hemoglobinopathies screening in Central India

· = Management of sic= kle cell disease and related disorders in MP

· = Status of Filaria= sis in Madhya Pradesh and need for proper evaluation

· = Multiple Dengue v= irus serotypes and malaria in a sickle cell disease patient

· = Drug resistance s= urveys in Sahariya’s of Guna and Gwalior districts

· = Prevalence of mal= aria with special reference to cerebral malaria and severe malaria in Chhattisga= rh

· = Assessment of the effectiveness of intensive intervention measures on malaria control program= me in tribal district, Balaghat, Madhya Pradesh

· = Time for shift fr= om LLIN to Durable Lining for better results

Comments/ Suggestions

&nbs= p; DG suggested carrying out studies to find out the causes for high prevalence o= f Mf rate despite several rounds of MDA. Dr. Kar suggested developing different methods involved in Information Education and Communication (IEC) in order = to educate the community. DG also suggested looking into the quality of bed ne= ts supplied in the area.

7. Rajen= dra Memorial Research Institute of Medical Sciences (RMRIMS), Patna

Dr.Prad= eep Das, Director, RMRC, Patna presented the following new project proposals for funding. =

a. Study of Abnormal Hemoglobin in tribal population

b. Prevalence of hypertension and associated risk factors among tribal of Bihar/Jharkhand

c. Study on nutritio= nal status involved with the severity of vector and water borne disease<= o:p>

d. Exploration and experimental validation of ethno-medicine used to cure infectious diseases = by tribal population

e. Research component based on the habitat of tribal community in Bihar

f. Study of Haemoglobinopathies and anaemia of Kala-Azar in Bihar.

Comments/ Suggestions

= DG appreciated the presentations of on-going studies and the new pro= ject proposals presented by NIIH and RMRIMS and also suggested to develop a multi centric study on sickle cell anaemia, haemoglobinopathies etc.. However he pointed out that assessment of the clinical situations/nutritional status of the population will not help until and unless a solution can be worked out = to solve the problem of the community.

8. = Regional Medical Research Centre, Orissa

&nbs= p; Dr.Bullaya, Scientist ‘D’ discussed o= n the progress made in tribal health. The following aspects were presented:<= /o:p>

· = Improved regimen = for control of anaemia in adolescent tribal girls

· = Efficacy of nutri= tion education modules with IFA+B12+Albendazole

· = Anaemia amongst haemoglobinopathy disorders Vs normal tribal adolescent girls

· = Severity of undernutrition vs Vit.A & Vit.E deficiencies in preschool children

· = Assessment of reproductive and sexual health among tribal adolescents in Kalahandi distri= ct

· = Etiology of severe diarrhoea among tribals

Dr. Kar, Director, RMRC, Bhubaneswar presented the following new initiatives:

1) Oral cholera vacc= ine- Community application by State Health Department in tribal areas & Feasibility assessment.

2) Strategy for Hypertension Control

3) Development of a situation specific vector control strategy in Tribal district of Odisha (Kalahandi).

4) Community-based management of severe acute malnutrition among childr= en under-five years in Kalahandi district, Orissa <= /p>

5) Protein-energy malnutrition and micronutrient deficiencies in relation to malaria among preschool children in Kalahandi district.

6) G-6 PD deficiency status in tribal population: multi-centric study (NIIH)

7) Neonatal screenin= g for Sickle cell disease and morbidity follow up

Comments/ Suggestions

&= nbsp; DG appreciated the progress made by the institute and suggested that a protocol need to be developed to investigate tribal fever. Further he suggested buil= ding up a health system which can empower the local system through the state government so that the strategies can sustain at the community level to tac= kle the problems related to health in the tribal population. =

9.&n= bsp; Regional M= edical Research Centre (RMRC), Port Blair &n= bsp;

Dr.A N Shriram, Scientist “B” presented the data for the following=

Risk factors of chronic non-communicable diseases-reanalysis of NCD risk factor data with current reference val= ues and intervention of risk reduction jointly with Directorate of Health Services,A&N administration
Nutritional status preschool children of Nicobare= se
Hepatitis B infection-Seroprotection among vaccine recipients 10 years after vaccination and infection with mutant strain= s of hepatitis B
Tuberculosis- culture and drug sensitivity testing services under DOTs plus
Vector Borne Diseases- Prevalence of Aedes spp in= Car Nicobar, Situation Analysis-Current status of DspWB in Nancowry Islan= ds
Traditional knowledge of healing and community biodiversity registers-preparation of CBDRs for Nicobar (Nicobarese) and Mayabunder (Karens) and compilation of traditional knowledge of healing of tribal communities of A & N islands
Trachoma among Nicobarese-Detection and Treatment=
Cardiomyopathies among Nicobarese

Comments/ Suggestions

DG suggested monitoring emer= gence of hepatits infection with vaccine escape mutants, which may be helpful for overall assessment of the hepatitis vaccination programme. In general, DG further suggested that a national proto= col should be developed for addressing various health issues related to tribal population and also solution based projects should be encouraged so that the solutions derived as an outcome of the project would be utilized by the community. <= /o:p>

<= b>10. National <= st1:PlaceType w:st=3D"on">Institute of Malaria= Research (NIMR), New Delhi

Dr. Neelima pres= ented Drug Resistance Monitoring and discussed the following aspects:<= /span>

Progress since last ICMR Tribal Health Research Forum held on 6th December 2011
Multivariate predictors = of P. falciparum treatment failure and delayed parasite clearance <= /o:p>
Effective and safe interventions for prevention of malaria in pregnancy in India
Effective and safe treatment for mal= aria in pregnancy in India: a randomised Controlled trial

New initiatives

Epidemiology of malaria in India: Impact of new con= trol tools and changing patterns
Comparison of different regimens of primaquine as antirelapse therapy in vivax malaria
Comprehensive Case Management pilot in Orissa

<= span style=3D'mso-spacerun:yes'> Molecular Marker= s for drug resistance at study sites (2010-11)

Comments/ Suggestions<= /i>

The presentation was appreciated by the members of the= forum and there were no major suggestions with regard to the presentation. However Dr.V.M.Katoch suggested for development of studies for mapping all etiologi= cal factors causing fever/ pyroxia and further suggested that RMRC, Bhubaneshwa= r to build a composite programme and = to prepare a format to resolve this issue.

<= b>11. Vector Con= trol Research Centre (VCRC), Puducheri

Dr. K. Gunasekaran, Scientist ‘F’ presented the results of the study on vector prevalen= ce and bionomics in relation to transmission of malaria and its containment in Southern districts of Odi= sha State. The following aspects were discussed:

Relative density of An. fluviatilis & An. culicifacies and malaria incidence in= the southern districts

Density of the malaria vectors and malaria parasite incidence per 1000 population (MPI) in relation to space and time

Proportion of vector spec= ies obtained from different methods of collection

Indoor resting density of= the malaria vectors and MPI per 1000 population

An. culicifacies a= nd An. fluviatilis response to DDT, malathion and deltamethrin=

In addition, he also presented the results on

Sensitivity and specifici= ty of RDK against microscop= ic results in the southern districts and

Therapeutic efficacy of A= CT in Dasamanthapur PHC of Koraput district

Dr. L. K. Das, Scientist ‘E’ presented the following aspects:

Disease profile among tribes of the two PHCs, Dasamanthapur and Laxmipur of Koraput duistric= t (Odisha State)

Malaria situation in the two PHCs

Types of complications = of malaria cases admitted in the District Head Quarter Hospital, Kora= put.

The proposed malaria st= udy by the VCRC on tolerability and efficacy of ACT in Koraput district of Odisha state as approved by the ICMR Tribal Health Forum for funding.<= span style=3D'mso-spacerun:yes'>

Comments/ Suggestions<= /i>

        = While appreciating the usefulness of the study results on vector bionomics in helping the state government for malaria control, the DG sugge= sted that the three ICMR institutes (NIMR, RMRC & VCRC) working in Odisha st= ate should put their results together and finally it should go in one voice ie ICMR's voice to the state government for necessary action. Pointing out the high mortal= ity due to fever among tribes in Odisha, = the DG suggested undertaking studies on fever causing mortality through syndromic approach including pyrexia of unknown origin. He also suggested to test and monitor the sensitivity and specificity of all types of rapid detection test kits for malaria available in the area.

FA indicated the need for approval of all five y= ear plan projects by the Tribal Health Research Forum.

Finally, next meeting of the forum was decided t= o be held in June, 2012 at RMRC, Port Blair, followed by the annual meeting in August, 2012 to be held at RMRC, Bhubaneswar.

   &nbs= p;

   &nbs= p; Dr. A. Laxmaiah, Scientist E & HOD, Division of Community Studies, NIN prop= osed a vote of thanks. =

Annexure I

LIST OF THE SCIENTISTS ATTENDED THE MEETING<= /span>

<= /b>

1.   &n= bsp; Dr.K.Ghosh, Director, National Institute of Immunology, Mumbai,=

2.      Dr.S.K.Kar, Direc= tor, RMRC, Bhubaneswar<= /st1:City>, Orissa

3.   &n= bsp; Dr.J,Mahanta, Director, RMRC, Dibrugarh, Assam

4.      Dr. Pradeep Das, Director, Rajendra Memorial Research Centre, Patna

5.      Dr.P.Vijayachari, Direc= tor, RMRC, Port Blair, A&N

6.   &n= bsp; Dr.P.K.Mohapatra, Scientist F

7.   &n= bsp; Dr.T.Longvah, Scientist F

8.      Dr.Tapas Chakma, Scientist F

9.   &n= bsp; Dr.K.Gunasekaran, Scientist F

10. Dr. A. Laxmaiah, Scient= ist E

11. Dr.L.K.Das, Scien= tist, E

12. Dr.Neena Varma, S= cientist E

13. Dr.D.Raghunatha R= ao, Scientist E

14. Dr.Balakrishna, S= cientist D

15. Dr.M.Bullaya, Sci= entist D

16. Dr.J.J.Babu, Scie= ntist D

17. Dr.Neena Valecha, Director, NIMR, New Delhi <= /p>
18. Dr.Neelima Mishra, Scie= ntist D

19. Dr. Prasanth Math= ur, Scientist D

20. Dr.Raja Subramani= am, Scientist D

21. Dr.Ayan Jha, Scientist = C

22. Dr. C. S. Lal, Scientist C

23. Dr.Meshram, Scientist C

24. Dr.Subba Rao, Scientist C

25. Dr.A.N.Shriram, S= cientist B