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"Prevalence of Anemia in Tribal Populations: A Regional Study from
Peth Region"
Niranjan Ramesh Giri
M. J. M. A. ACS. College Karanjali. Tal.Peth. Dist. Nashik. Maharashtra Savitribai Phule Pune
University Pune, Maharashtra
DOI: https://dx.doi.org/10.51244/IJRSI.2025.1210000014
Received: 06 October 2025; Accepted: 12 October 2025; Published: 27 October 2025
Anemia remains a major public-health challenge in India, particularly among tribal adolescents who face
nutritional, social, and cultural disadvantages. This cross-sectional study assessed the prevalence and
determinants of anemia among 200 adolescents (10–19 years) from a remote tribal area of the Peth region,
Nashik District, Maharashtra. Hemoglobin levels were estimated using the cyanmethemoglobin method, and
socio-dietary data were obtained through structured questionnaires. Results revealed that 68 % of girls and 54
% of boys were anemic, mostly of moderate severity. Inadequate dietary diversity, early menarche, poor
sanitation, and limited healthcare access were key contributing factors. Compared with national data from
NFHS-5 (2019–21), anemia prevalence in this tribal cohort was markedly higher. Gender-based disparities and
cultural taboos restricting food intake during menstruation further worsened the problem. The findings
underscore the need for targeted school-based iron supplementation, nutrition education, and culturally
sensitive interventions. Addressing anemia in tribal adolescents is vital for improving health equity,
educational outcomes, and future socioeconomic development.
Keywords: Adolescents, anemia, hemoglobin, tribal health, malnutrition, gender disparity
INTRODUCTION
Background and Significance
Anemia remains one of the most persistent public-health challenges in India and worldwide. According to the
World Health Organization (WHO, 2023), nearly 1.8 billion people—approximately one-quarter of the global
population—suffer from anemia, with the heaviest burden in South Asia and Sub-Saharan Africa. In India, the
National Family Health Survey-5 (2019–21) reports that 57 % of women aged 15–49 years and 25 % of men
are anemic. The prevalence is even higher among children and adolescents, particularly within tribal and rural
populations where poverty, dietary monotony, and limited access to healthcare persist.
The Tribal Health Context in India
Tribal communities constitute about 8.6 % of India’s population, representing a remarkable diversity of
culture, language, and ecology. However, most tribal groups live in geographically isolated areas with
restricted healthcare facilities, poor sanitation, and inadequate infrastructure. These conditions foster a vicious
cycle of malnutrition and infection that contributes significantly to anemia. Several reports from Maharashtra,
Madhya Pradesh, Odisha, and Jharkhand show higher anemia rates among tribal adolescents than among non-
tribal peers (Colah et al., 2017; Pasricha, 2021). Despite national initiatives such as Anemia Mukt Bharat
(AMB), coverage in remote tribal zones remains suboptimal because of logistic difficulties, poor compliance,
and cultural barriers.
Why Adolescence Matters
Adolescence (10–19 years) is a critical developmental period marked by rapid growth and increased nutritional
demands. Iron requirements peak due to accelerated muscle development, red-blood-cell production, and—in
girls—the onset of menstruation. Iron deficiency during adolescence has lasting effects: it impairs cognitive
and physical performance, increases susceptibility to infection, and, in females, raises risks of obstetric
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025
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complications later in life. In tribal regions, these biological vulnerabilities intersect with socioeconomic
deprivation. Diets dominated by cereals and millets, low intake of fruits and animal protein, and limited health
awareness exacerbate iron deficiency. Cultural taboos—such as restrictions on specific foods during
menstruation—further elevate risk among girls.
Existing Knowledge and Research Gaps
While numerous studies have examined anemia among pregnant women and children, comparatively few
focus on tribal adolescents, a group that bridges the transition from childhood to adulthood. Data from the
NFHS-5 emphasize adolescent vulnerability but often aggregate tribal and non-tribal populations, masking
regional differences. Localized field studies are therefore crucial to understand community-specific
determinants such as food practices, sanitation behaviors, education levels, and gender norms. Moreover, prior
research has frequently emphasized biological measures while neglecting social and cultural dimensions that
shape nutritional outcomes. An integrated, interdisciplinary perspective combining biomedical data with
sociocultural insights can provide a more complete understanding.
Regional Context: Peth Region, Nashik District
The Peth taluka of Nashik District in northern Maharashtra is predominantly inhabited by the Kokana and
Warli tribes, who depend largely on subsistence agriculture and seasonal labor. The terrain is hilly, rainfall-
dependent, and often cut off from urban centers during monsoon months. Access to healthcare is limited to a
few primary health sub-centers with irregular outreach. Nutritional programs such as school mid-day meals
and iron supplementation often face logistical gaps, irregular supply, and cultural resistance. Preliminary
observations from local health workers indicate widespread fatigue, pallor, and poor scholastic performance
among adolescents—symptoms suggestive of chronic anemia. However, systematic documentation for this
area has been lacking.
Policy Deficiencies and Implementation Barriers
The Anemia Mukt Bharat (AMB) strategy launched in 2018 by the Ministry of Health and Family Welfare
aims to reduce anemia prevalence among children, adolescents, and women by 3 percentage points per year
through a six-pronged approach: (1) prophylactic iron–folic acid supplementation, (2) testing and treatment,
(3) deworming, (4) behavioral change communication, (5) strengthening of institutional delivery mechanisms,
and (6) inter-sectoral convergence. Despite these measures, NFHS-5 data show limited progress in tribal belts.
Gaps in health education, mistrust of biomedical interventions, and logistical hurdles (e.g., irregular
supplement supply, lack of trained staff) continue to constrain program effectiveness.
The Need for a Focused Regional Study
Given the interplay of biological, social, and environmental factors, anemia among tribal adolescents in Peth
region demands detailed investigation. A community-based, mixed-methods approach can elucidate not only
the prevalence but also the determinants of anemia—dietary inadequacies, cultural restrictions, gender
norms, and health-service barriers. Understanding these local dynamics will provide evidence to refine existing
public-health strategies and guide culturally responsive interventions. Furthermore, regional data can feed into
national monitoring frameworks to ensure that tribal voices are represented in policy formulation.
Research Objectives
The present study aims to:
Assess the prevalence and severity of anemia among tribal adolescents aged 10–19 years in the Peth region of
Nashik District, Maharashtra.
Identify key socio-demographic, nutritional, and cultural factors associated with anemia.
Compare local prevalence with national and state-level trends (NFHS-5).
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
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Recommend targeted, gender-sensitive, and culturally acceptable interventions for effective anemia control.
Conceptual Framework
The study is grounded in a biopsychosocial model that recognizes anemia as a product of interacting
determinants—biological (iron deficiency, infections), behavioral (dietary habits, hygiene), and structural
(poverty, education, healthcare access). Such a framework moves beyond purely medical explanations and
emphasizes the importance of social context in shaping health outcomes.
CONCLUSION OF INTRODUCTION
Anemia among tribal adolescents is more than a medical condition—it reflects deep-rooted inequities in
nutrition, education, and opportunity. By documenting prevalence and underlying causes in one of
Maharashtra’s remote tribal belts, this study contributes valuable evidence toward national efforts such as
Anemia Mukt Bharat and the National Nutrition Mission. The findings are expected to inform both local-
level interventions and broader policy deliberations aimed at reducing anemia-related disparities.
Materials and Methods
Study Design
A cross-sectional, community-based study was conducted to assess the prevalence and determinants of
anemia among tribal adolescents residing in the Peth region of Nashik District, Maharashtra. The design
combined biomedical assessment with socio-demographic and dietary surveys, providing both quantitative and
qualitative insights.
Study Area and Population
Peth taluka lies in the northern tribal belt of Maharashtra and is primarily inhabited by the Kokana and Warli
tribes. The region is characterized by hilly terrain, seasonal agriculture, limited healthcare access, and
dependence on government welfare schemes. The adolescent population (10–19 years) forms nearly 18 % of
the total community.
The study focused on three purposively selected villages—Karanjali, Dongarpada, and Ambegaon—chosen
for their accessibility and representation of typical tribal living conditions.
Study Sample and Justification
A total of 200 adolescents (100 boys and 100 girls) were enrolled using stratified random sampling to
ensure proportional representation of both genders and different age groups (10–14 years and 15–19 years).
Sample size estimation was based on the formula:
n=Z2×P(1−P)/d2n = Z^2 \times P(1 - P) / d^2n=Z2×P(1−P)/d2
where Z = 1.96 (95 % confidence), P = expected prevalence = 0.60 (60 %, from NFHS-5 rural Maharashtra
data), and d = 0.07 (7 % margin of error).
The calculated minimum sample was 189, which was rounded to 200 to compensate for potential non-
response. This sample size ensures adequate statistical power for subgroup comparisons.
Inclusion and Exclusion Criteria
INCLUSION
Adolescents aged 10–19 years residing in the selected villages for at least one year.
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
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Participants who provided informed consent (and assent for those <18 years) along with parental approval.
Exclusion:
Individuals with known chronic diseases (renal, hepatic, hematologic disorders).
Those under medication that could affect hemoglobin levels (iron therapy, steroids, etc.).
Pregnant girls were excluded to avoid confounding due to gestational anemia.
Data Collection Tools and Techniques
Data collection was carried out between January and March 2025 through household and school visits.
(a) Hemoglobin Estimation
Capillary blood samples (20 µL) were obtained under aseptic precautions using sterile lancets. Hemoglobin
concentration was measured using the cyanmethemoglobin method with a portable photo-colorimeter,
following WHO (2011) standards.
Anemia was classified according to WHO cut-offs for adolescents:
Mild: 11.0–11.9 g/dL
Moderate: 8.0–10.9 g/dL
Severe: < 8.0 g/dL
Dietary Assessment
A 24-hour dietary recall and food-frequency questionnaire were administered to estimate iron-rich food
intake, dietary diversity, and consumption of inhibitors (tea, phytates). Respondents were also asked about
deworming frequency and supplementation compliance.
Socio-Demographic and Cultural Survey
Structured questionnaires captured information on age, education, parental occupation, family income,
sanitation, and menstrual practices among girls. Interviews were conducted in the local Marathi and Kokana
dialects by trained field investigators to ensure accurate responses.
Data Analysis
Data were compiled and analyzed using SPSS v.26.
Descriptive statistics (mean, SD, percentages) summarized demographic variables.
The Chi-square test examined associations between categorical variables (gender, anemia severity, dietary
habits).
t-tests compared mean hemoglobin between subgroups.
Statistical significance was considered at p < 0.05.
Ethical Considerations
Ethical clearance was obtained from the Institutional Ethics Committee of M.J.M. Arts, Commerce &
Science College, Karanjali. Informed consent was obtained from all participants or their guardians. Privacy
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue X October 2025
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and confidentiality were maintained throughout the study. Participants identified as severely anemic were
referred to the nearest Primary Health Centre for medical management.
Quality Control
All equipment was calibrated daily, and 10 % of samples were cross-checked at the PHC laboratory for
validation. Questionnaires were pre-tested in a pilot group of 20 adolescents to refine language and cultural
appropriateness.
RESULTS
Demographic Profile
A total of 200 tribal adolescents (100 boys and 100 girls) from three villages—Karanjali, Dongarpada, and
Ambegaon—participated in the study.
The mean age of respondents was 14.8 ± 2.6 years.
Most belonged to nuclear families (63 %) and relied on agriculture or daily wage labor as their primary
livelihood.
Nearly 78 % of parents had not completed secondary education, and 69 % of households reported monthly
incomes below ₹8,000.
Access to safe drinking water was limited (58 %), and only 46 % had sanitary latrines.
Prevalence and Severity of Anemia
Out of 200 participants, 122 (61 %) were found to be anemic according to WHO criteria.
Gender-wise prevalence showed that 68 % of girls and 54 % of boys were anemic.
Moderate anemia was the most common category in both sexes (girls 42 %; boys 38 %), followed by mild
anemia (girls 21 %; boys 13 %).
Severe anemia was observed in 5 % of girls and 3 % of boys.
The difference in prevalence between genders was statistically significant (χ² = 4.72; p < 0.05).
Table 1. Prevalence and Severity of Anemia by Gender
Gender
Mild (%)
Moderate (%)
Severe (%)
Boys (n = 100)
13
38
3
Girls (n = 100)
21
42
5
Nutritional and Dietary Patterns
Dietary assessment revealed that 87 % of adolescents consumed cereal-based meals three times a day, but
intake of iron-rich foods such as green leafy vegetables (29 %), pulses (46 %), and animal protein (18 %) was
low.
Consumption of tea immediately after meals—known to inhibit iron absorption—was reported by 72 % of
respondents.
Only 22 % had ever received iron–folic acid (IFA) tablets through school programs.
Figure 1. Dietary diversity score among tribal adolescents (Bar chart)
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Socio-Cultural Determinants
Among girls, 63 % reported food restrictions during menstruation, mainly avoidance of leafy vegetables and
eggs.
Low parental literacy and poor sanitation were significantly associated with higher anemia prevalence (p <
0.05).
Adolescents who had deworming in the past six months showed higher mean hemoglobin levels (11.6 ± 1.2
g/dL) compared with those who had not (10.8 ± 1.4 g/dL).
Comparison with National Data
The overall anemia prevalence of 61 % in this tribal cohort exceeds the national adolescent average of 41 %
(NFHS-5, 2019–21).
This disparity underscores the disproportionate burden faced by marginalized tribal populations despite
ongoing interventions under the Anemia Mukt Bharat programme.
Summary of Key Findings
Anemia is highly prevalent (61 %), particularly among girls.
Dietary monotony, poor hygiene, and low education levels are major contributors.
Gender-specific socio-cultural taboos further increase female vulnerability.
Program coverage (IFA supplementation, deworming) remains inadequate in remote tribal regions.
DISCUSSION
Overview of Findings
The present study reveals a high prevalence of anemia (61%) among tribal adolescents in the Peth region of
Nashik District, Maharashtra. The burden is notably greater among girls (68%) than boys (54%), consistent
with patterns observed across tribal and rural populations in India. These results emphasize that despite
national programs such as Anemia Mukt Bharat (AMB), anemia remains a deeply rooted public-health issue
influenced by nutritional, cultural, and socio-economic determinants.
Comparison with National and Regional Data
The overall prevalence recorded in this study is substantially higher than the national average for
adolescents reported in the NFHS-5 (2019–21), which indicated 59.1% among girls and 31% among boys.
Regional studies from tribal belts of Odisha (60%), Jharkhand (64%), and Madhya Pradesh (57%)
(Pasricha, 2021; Colah et al., 2017) also echo similar trends, confirming that tribal adolescents continue to
experience disproportionate vulnerability.
Such findings highlight persistent regional inequities and suggest that program reach and compliance in remote
tribal areas remain limited. Moreover, the higher prevalence among girls reinforces the intersection of gender
and culture in shaping nutritional outcomes.
Nutritional Determinants and Dietary Patterns
Dietary assessment identified poor diversity and low consumption of iron-rich foods as major contributing
factors. Most adolescents relied on cereal-based diets with minimal fruits, pulses, and animal protein—patterns
similar to those observed in rural Maharashtra and Madhya Pradesh (Balasubramanian et al., 2023).
The widespread consumption of tea after meals (72%), which inhibits iron absorption due to tannins, further
exacerbates the problem. This pattern reflects both habit and lack of nutrition education.
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Iron deficiency is the dominant cause of anemia globally, accounting for nearly 50% of cases (WHO, 2020),
but in tribal populations, multifactorial etiologies are evident—dietary insufficiency combined with chronic
parasitic infections, repeated malaria, and poor hygiene practices. These determinants collectively reduce iron
bioavailability and increase loss through intestinal bleeding.
Gender Disparities and Cultural Taboos
The significant difference between boys and girls (p < 0.05) is biologically and culturally mediated. Menstrual
blood loss, when compounded by low dietary intake and early menarche, leads to higher susceptibility among
girls.
In this study, 63% of girls reported dietary restrictions during menstruation, mainly avoidance of leafy
vegetables and eggs—foods rich in iron and folate. Similar findings were reported in tribal studies from
Dahanu (Maharashtra) and Sundargarh (Odisha), where cultural taboos limited girls’ nutritional intake
during menstruation (Kalaivani, 2009).
Such practices, rooted in traditional beliefs about impurity, perpetuate nutritional deprivation and reinforce
gender inequity. Addressing these barriers requires culturally sensitive communication and the involvement of
community elders, women’s groups, and schoolteachers.
Socio-Economic and Environmental Factors
The study establishes a clear link between parental education, household income, and anemia prevalence.
Over two-thirds of participants belonged to families earning less than ₹8,000 per month, and 78% of parents
lacked secondary education.
Low literacy reduces understanding of dietary needs and healthcare utilization. Moreover, poor sanitation and
limited access to clean water facilitate parasitic infections, further aggravating anemia.
These findings are consistent with reports from NFHS-5, which show that districts with lower education and
sanitation coverage have higher anemia rates. This multidimensional interplay of poverty, hygiene, and
awareness aligns with the social determinants of health model.
Comparison with Global Evidence
Globally, South Asia continues to bear the highest anemia burden, with prevalence rates of 45–60% among
adolescents (Stevens et al., 2013). Studies in Bangladesh and Nepal report similar figures and highlight dietary
inadequacies as central causes.
However, the tribal context of India adds an additional layer of cultural complexity. In African and Latin
American regions, community-driven health promotion and food fortification programs have demonstrated
success (WHO, 2014). India can draw lessons from these examples to tailor interventions that combine
biomedical and cultural approaches.
Effectiveness of Current Programs
The Government of India’s Anemia Mukt Bharat (AMB) initiative aims to reduce anemia prevalence by 3
percentage points annually through six interventions, including iron–folic acid supplementation, deworming,
and behavioral change communication.
However, the present study reveals low program penetration—only 22% of adolescents had ever received
IFA tablets. Implementation barriers such as irregular supply, limited school outreach, and lack of local
awareness restrict impact. Moreover, community skepticism about “western medicine” and supplement side
effects reduces compliance.
Therefore, health strategies must move beyond distribution to community engagement and ownership,
incorporating tribal traditions and indigenous foods.
Role of Education and Schools
Schools can act as critical platforms for anemia control. Teachers can monitor IFA consumption, organize
nutrition awareness sessions, and dispel myths surrounding menstruation and diet. Integrating health education
into school curricula has shown positive outcomes in similar rural settings (Horton & Ross, 2003).
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In tribal regions like Peth, schools often serve as the only formal institution accessible to adolescents, making
them ideal centers for integrated health programs, periodic screening, and referral linkages with primary health
centers.
Emerging Solutions and Innovations
Advances in nanotechnology-based iron formulations and fortified staple foods offer promising
alternatives to improve iron absorption and reduce gastrointestinal side effects (Beard et al., 2021).
Community-level food fortification (iron-fortified salt or rice) could provide sustained, population-wide
benefits, especially where dietary change is slow.
Combining these innovations with traditional practices, such as promoting iron-rich indigenous foods (e.g.,
nachni, drumstick leaves, black gram), could improve local acceptability.
Limitations of the Study
While this study provides valuable insights, certain limitations should be acknowledged.
First, its cross-sectional design limits causal inference between anemia and contributing factors.
Second, biochemical parameters other than hemoglobin (e.g., ferritin, folate, vitamin B12) were not
measured due to logistical constraints.
Third, findings are specific to three villages in Peth region and may not be generalizable to all tribal groups.
Nevertheless, the inclusion of both biomedical and socio-cultural dimensions offers a holistic understanding
and a strong base for further longitudinal and intervention-based research.
Policy and Public-Health Implications
Findings underscore the need for multi-sectoral approaches integrating nutrition, education, sanitation, and
gender empowerment.
Recommendations include:
Strengthening school-based IFA distribution and deworming with active teacher participation.
Implementing nutrition education sessions using local language and culturally relatable visuals.
Training Anganwadi and ASHA workers to counsel adolescent girls and parents on dietary diversification.
Encouraging community participation through local leaders and tribal healers to dispel myths about
menstruation and food restrictions.
Expanding food fortification programs using locally consumed staples to ensure sustainability.
Future Research Directions
Future studies should incorporate biochemical profiling (serum ferritin, folate, B12) to distinguish iron
deficiency from other causes of anemia. Qualitative methods such as focus-group discussions could further
explore gender norms and cultural beliefs. Longitudinal intervention trials in collaboration with local schools
and primary health centers can evaluate the effectiveness of community-based anemia control models.
CONCLUDING REMARKS OF DISCUSSION
The persistence of anemia among tribal adolescents reflects a convergence of nutritional deficits, cultural
practices, and socio-economic inequality. Addressing it requires both scientific rigor and cultural sensitivity.
Biomedical interventions alone will not suffice; sustainable change will arise from empowering communities,
respecting traditions, and integrating indigenous knowledge with modern health programs.
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CONCLUSION
This study demonstrates that anemia among tribal adolescents in the Peth region of Nashik District remains a
serious and multifactorial public-health challenge. With an overall prevalence of 61 %, the problem is
significantly higher than national averages, underscoring persistent inequities in nutrition and healthcare
access. Girls are particularly vulnerable because of menstrual blood loss, dietary restrictions, and entrenched
cultural taboos that limit their consumption of nutrient-rich foods.
The findings reveal that poor dietary diversity, low parental literacy, inadequate sanitation, and limited
awareness form a complex web of risk factors. Despite the existence of national programs such as Anemia
Mukt Bharat, field implementation remains weak in remote tribal areas. Effective control of anemia requires a
paradigm shift—from isolated biomedical interventions to community-anchored, culturally informed
strategies.
Key recommendations include:
Strengthening school-based programs for regular iron–folic acid supplementation, deworming, and
hemoglobin screening.
Integrating nutrition and health education into school curricula and community meetings, emphasizing
locally available iron-rich foods such as nachni, drumstick leaves, and pulses.
Empowering adolescent girls and mothers through culturally sensitive counseling that addresses
menstruation-related myths and encourages equitable food distribution.
Collaborating with tribal leaders, teachers, and ASHA workers to improve trust, compliance, and local
ownership of health initiatives.
Expanding food-fortification schemes using regionally consumed staples for sustained impact.
Addressing anemia in tribal adolescents is not only a biomedical necessity but also a moral and
developmental imperative. Ensuring the nutritional well-being of these youth will strengthen educational
attainment, economic productivity, and the overall health equity of India’s tribal communities.
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