ABSTRACT

Bangladesh is a country of about 180 million people. Among which, 2 million people are identified  as Tribal people. Approximately 58 tribe groups are living in Bangladesh. It is a country with a lot  of cultural diversities like marital customs, social organizations, and rituals, and rights. Society  and norms were developed due to the crucial role played by various ethnicities and economical  determinants of this country. The tribal population of Bangladesh are faced with several  socioeconomic issues. However, the access to the basic health and medical facilities are of the  major problems which directly affect the wellbeing of this group of population. In ordered to  identify the solution to reduce such problem, it is important to understand the contributing factors  of health-related issue of tribal population along with the extent of such issue identified. Therefore,  the major focus of this study is to conduct a detailed literature review to document the different  health related issues faced by the tribal population of Bangladesh

CHAPTER 1: INTRODUCTION

The existence of humankind is unique, but today’s reality is very far from its original existence. In  today’s world, humankind is often divided by inequity. One of the major reasons for disparity and  inequity of humankind is racial discrimination. Indigenous/tribal population is an example of the  victim of racial profiling and racial discrepancy. About 203 countries, around the world, have

burgeoning disparity in the socioeconomic context of the tribal population. Bangladesh is no  exception. The tribal population, a thousand years ago, made this uncultivated land cultivatable.  But in today’s world, they are often deprived of the basic civic rights and they often have less access to fundamental facilities than their counterparts. 

Distinctive ethnic gathering in Bangladesh and their brilliant ways of life have fundamentally  advanced the whole culture of Bangladesh. Bangladesh has many assortments of indigenous  networks living in different pieces of the nation. Even though the aggregate indigenous populace  is around 1,000,000, or under 1% of the complete populace, it comprises of 45 indigenous  networks covering around 26 distinct dialects. Truth be told, 45 littler gatherings of indigenous  individuals covering around two percent of the aggregate populace have been living in various  pockets of the sloping zones and a few territories of the plane grounds of the nation (McIntyre,  2005). The ancestral populace comprised of 897,828 people, at the hour of the 1981 registration.  The extent of the ancestral populace in the 64 regions fluctuates from under 1% in dominant part  of the regions to 56% in Rangamati, 48.9% in Kagrachari and 48% in Bandarban in the Chittagong  Hill Tracts (Islam & Odland, 2011). Unfortunately, tribal people of Bangladesh are often reported  to suffer from poverty, malnutrition, starvation, access to basic health support and many other

problems. They are deprived of the necessities of life. Their issues and problems as a valuable  citizen of the country are often neglected because of the lack of accurate information to find the  solutions related to these issues (Hossain, 2013).

1.1 Problem Statement 

The tribal population of Bangladesh are faced with several socioeconomic issues. However, the  access to the fundamental health and medical facilities are of the main problems which directly  affect the wellbeing of this group of population. In ordered to spot the answer to scale back such  problem, it’s important to know the contributing factors of health-related issue of tribal population  together with the extent of such issue identified. Therefore, the foremost focus of this study is to  conduct an in-depth literature review to document the various health related issues faced by the  tribal population of Bangladesh.

1.2 Research Objectives

The specific objectives of this research effort are to study the socio-economic and health status of  the tribal people of Bangladesh.

Further, some specific objectives are:

∙ To conduct a literature review focusing on the socioeconomic and health related contexts  of tribal population of Bangladesh.

∙ To discuss the findings from the literature review.

∙ To compare the results with already present details and provides a conclusion. ∙ To provide recommendations base on the study findings.

1.3 Limitations of the Study

The study is not without limitations. Collecting the info on health status of tribal population would  are expected in identifying the most important issues around this subject. However, thanks to the  COVID-19 pandemic outbreak, it had been impossible to conduct in-person questionnaire survey.  Because of pandemic COVID-19, it had been unsafe and against the principles of health,  regulations to gather primary data so we used the secondary data for this research. Moreover, the  study identified and reviewed during this try is not representative of entire tribal group of  Bangladesh and hence the finding cannot be generalized. Therefore, conducting an in-depth  questionnaire survey that specialize in the health status of tribal population of Bangladesh could a  future research avenue.

 

CHAPTER 2: LITERATURE REVIEW

The major focus of this research effort is to review a number of relevant papers to develop a  comprehensive understanding on the socioeconomic and health status of tribal population in  Bangladesh. The selected studies for literature review are summarized and presented in Table 1.  The information presented in Table 1 includes focus of the study, data source and a brief summary  of findings. The findings from these studies are summarized below.

Mannan (2013) argued that despite significant success in health sector of Bangladesh, there are  still challenges in several areas of health sector including system losses, access to health service  along with quality of health service provisions. The authors argued that there is disparity with  regards to access in health service which are often favored by social class, wealth and social status.  As is evident from a recent study (Mannan et al. 2003), in Bangladesh, households spend at least  8.8 per cent of their monthly income for treatments and health services. However, alarmingly, the  poorest households carry the biggest burden as it is found that they have to spend 38% of their  income to meet the treatment cost of illness episodes. The study also pointed out that the cost of  medicine, various charges associated with tests/investigations and the cost of hospitalization are  some of the most important barriers for the utilizations of health services. Specifically, distance  travelled, travel time and travel cost to visit the facilities are identified to be the major three  elements of physical accessibility to medical services.

Islam and Sheikh (2010) pointed out that most of the indigenous communities in Bangladesh are  located in extremely remote locations. These locations are located far from cities and are less  accessible to formal labor market and other commercial opportunities. Such remoteness has direct  impact on the health status of these tribal population rising from the hardship in accessing modern  or effective health system. Moreover, poor housing, low educational attainment, unemployment,  inadequate incomes are likely to have amplified effect on their health problems.

Abdullah (2014) discussed that the economic status of the indigenous population of Bangladesh  are overall poor relative to non-indigenous population. Most of the tribal population in Bangladesh  live below the poverty line and barely earn enough to spend on health care. Moreover, the health  status of this groups of population generally goes underreported while 45% of them defecates  without a roof and 33% lacks access to clean drinking water. Among 70 indigenous groups of  Bangladesh, Santals are identified to be most disadvantaged and vulnerable communities.  Alarmingly, their existence is reported to be at stake resulting from land-grabbing, threats,  evictions and killings.

Ahmad (2015) pointed out that most of the tribal people in Bangladesh lives primarily in the hilly  areas of the Southern Region. Being isolated from the mainstream land, these groups are suffering from high level of poverty and lacks accessibility to existing health facilities which resulted a  vulnerable condition for them in terms of access to health facilities. One of the major reasons for  health issues among trial population is identified to be smoking and alcoholism. Both males and females populations are identified to be equally exposed to such unhealthy habits of lifestyle which  often results in serious illness among these population.

Toppo et al (2016) discussed that the livelihood of tribal population in Bangladesh is largely  associated with the surrounding natural environment and the resources. In recent years, their  livelihood has been damaged by market economy and food insecurity. 

Hossain (2013) also identified that the tribal population of Bangladesh are in a disadvantageous  position in several aspects and access to health service of the major ones. Being a minority  community, they often do not have strong voice regarding their rights. Because of their uniqueness,  they are often the victim of racial disparity which often is an obstacle for their economic prosperity.  Given their geographical locations, they are often deprived of the facilities provided by the  Government.

Table 1: Summary of Studies

Study Focus Data source Findings
Mannan   (2013)	Access to health facilities	Survey	Economic accessibility remains as a major hurdle for access to health facilities
Islam and  Sheikh (2010)	Important factors for indigenous  peoples’ health problems	Systematic literature  review	Indigenous peoples’ health is affected by some  distinctive factors such as indigeneity, colonial and post-colonial experience, rurality, lack of  governments’ recognition etc., which nonindigenous  people face to a much lesser degree
Dey et al.   (2014)	Provide ethno   pharmacological information  of indigenous people in   Bangladesh	Survey	Medicinal plant is significantly used for different disease  such as GIT disorder, skin diseases and sexual  dysfunction respectively
Abdullah  (2014)	Status of health and disease condition of  different tribal community	Survey	High blood pressure, diabetes, disorder of Eye, Oral,  Respiratory, Gastrointestinal, Genitourinary,  Musculoskeletal are diseases identified
Pal et al.   (2017)	Measure the socio-economic  status of the Ethnic   Community in Bangladesh	Survey	Socio-economic status of the Manipuri and Khasia  community was identified using self-developed Socio-Economic Index which was  constructed by the composition of various factors
Ahmad et al.  (2015)	Oral Hygiene by Tribal People (Orao) in Rangpur  Region	Survey	Orao tribal group maintain oral hygiene regularly. Oral  health related behavior identified in the study could be  used to identify planning implementation, and evaluation  of oral health promotion programs.
Toppo et al.  (2016)	Depict socio-economic   condition of tribal population  in Bangladesh	Survey	The village healer is popular among tribal people in  Bangladesh. Only 2% of the tribal people visit trained  MBBS doctor during sickness.
Hossain (2013)	Socioeconomic and political  situation of indigenous people  of Bangladesh	Systematic literature  review	Geographical obstacles often plays a major role in  accessing medical and health services provided by the  government and other NGOs.

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CHAPTER 3: LITERATURE BREAKDOWN AND METHODOLOGY

The contents identified in the selected literature are summarized in the following sections in  developing a detailed understating on socioeconomic and health status of tribal population. 

3.1 General Socioeconomic Context

Ethnic minorities come under the term of tribal groups. About 70 different tribal groups are  residing in Bangladesh in several localities. These people try and maintain different economic,  social, and political institutions. They follow different cultures and institutions, and that they are not assimilated into the country. The mainstream population of Bangladesh faces only a few  problems as compared to those tribal people. Many factors are affecting their health status and that  they face many inequalities further. Some major health problems include diabetes and force per  unit area rates as their rates are significantly higher in tribal groups as compared to the mainstream  population. For a rustic to develop its people must be healthy. Nutrition and health play an  important role within the development process of any country. People with enhanced physical  health and good immunity systems can expect high lifespan which is additionally a vital factor of  development. Another important factors include living standards, healthcare services, quality of  drinkable, sanitary conditions, and economic conditions of Bangladesh. There are different  concepts of fitness, health, and diseases among different tribal groups.

These tribal people live their lives in line with their own customary laws, they follow their own  culture and speak their separate language. These characteristics are very distinct from the  mainstream population of Bangladesh. They need set high boundaries of self-indication. They  came thousand years ago and settled themselves and have become natives. These aboriginals are  distinct from those folks that came after them and settled within the country. They are settled in  several parts of Bangladesh and usually their groups are very small in number (Hossain, 2013).  Majority of the tribal people are farmers and living their livelihood through farming whereas a  number of them are labors (Bashar, et al., 2012). Tibeto-Burman tongues are mostly spoken by  tribal people (Mullah, et al., 2007). In tribal community, most of the women participate in outside  work with males to earn their living (Kamal, 2011). Haque et al. (2015) reported that the most  level of schooling among tribal people is that the age bracket of 20 to 39 years while majority of  the tribal population are reported to be uneducated or not completing the first education. The speed  of malnutrition within the tribal people of Bangladesh is decreasing day by day (Haque, et al.,  2015).

Any locality must have social stability and understanding among the people because it’s a really  important think about development. Different political and social problems are faced by  households of tribal groups. Some varieties of social and political problems include intimidations,  split-up, pressure, property disputes, burglaries and theft, separation, and violence. In terms of the  political context, it had been found that about 61% of households of Bangladesh do not face any  social and political problems whereas about 39% of these households face major social and  political problems. Urban areas have fewer social problems that are about 18 % whereas rural areas  have about 48% social problems. This rate is way beyond the people living in mainstream areas  with different races (Baxter, 1986). Per the study by Samad (2006), tribal people of Santals are

very vulnerable because these people are constantly threatened to be evicted, murdered, and land  grabbing (Samad, 2006). A survey was done to understand about the problems and desires of this  tribal group to supply an answer for improving their lifestyle situation. Not many organizations  are willing to figure with Santals and even these organizations do not seem to be following a  correct progress plan. Government agencies and NGOs also neglect the foremost problems with  these people. In summary, with regards to socioeconomic context:

∙ These tribal people live their lives according to their own customary laws, they follow their  own culture and speak their separate language. These characteristics are very distinct from  the mainstream population of Bangladesh.

∙ They have set high boundaries of self-indication. They came thousand years ago and settled  themselves and became natives. These aboriginals are distinct from those people who came  after them and settled in the country.

∙ These tribal groups do not have political and economic powers of Bangladesh because they  aren’t a dominant group. 

∙ They are settled in different parts of Bangladesh and generally their groups are very small  in number (Hossain, 2013).

3.2 Health Context

In general, if someone is unable to perform tasks in tribal areas, they are considered ill, therefore  the concept of diseases, fitness, and health is diverted from the clinical point of view. Generally,

the health status of tribal people of Bangladesh is incredibly poor thanks to poor sanitary and living  conditions, absence of potable, illiteracy, mass poverty, and malnutrition (Rahman, et al., 2012).  Islam and Sheikh (2010) examined the health and prevention services that are full of social,  economic, and cultural factors for tribal people. The study shows that the dearth of presidency  recognition, colonial and postcolonial experience, indigeneity are major factors apart from  commonplace factors that affect people’s health. These factors are faced by the mainstream  population of Bangladesh but it on a way lesser degree. This paper shows the importance of the  incorporation of mental, cultural, socio-cultural, physical, and spiritual factors in life. The health  status of those tribes can improve after the incorporation of such factors. Discriminations and  inequalities are affecting the psychological state tribal people of Bangladesh. The net research also  shows that there’s the next rate of health-related problems in such groups as compared to the  mainstream population of Bangladesh (Islam & Sheikh, 2010).

‘SHIREE’ is a company that studied how the livelihood of poor Adivasi in Bangladesh is affected  thanks to pathological state in 2013. It showed the acute vulnerability of these poor Adivasi and  provides samples of other ways through which this can be happening. Although within the research  area there have been only a few Adivasi as compared to the mainstream population still the speed  of illness was extremely high especially the rates of general and infectious diseases. Various  factors lead to such a high rate including lack of education, low level of income, bad living  conditions, poor nutrition, lack of health awareness campaigns, and avoiding treatments. These  people also do not have access to government health services. These poor Adivasi should move  out of their properties, take advances and loans, and sell their assets to stay providing for the family  (SHIREE, 2013).

The status of oral hygiene and basic practices were studied by Ahmad et al. (2015). The world  they specialize in was the northern region of Bangladesh. The study indicated that children either  brush regularly once or twice out of which 32.6% children brush twice on a daily basis and about  52.8% children brush their teeth just the once. The young group brush their teeth during the early  morning whereas the remainder brush while taking a shower. Biswas et al. (2014) reported that, in  Santals someone appears to be weak, dull and their skin complexions turn dark, they face lack of  appetite and are continuously sleepy, they generally also lose their ability to run and their ability  to speak, sometimes they get startled because of small movements, their eyes are sunken in, dry  and pale, they feel Drowsy and also complained about the pains in their body. When the center  rate increases and therefore the color of urine changes to a dark yellow or completely transparent  these also are the symptoms of an individual being ill. Children when ill are frequently crying,  they lose their appetite of food likewise, they’re sleepy and that they lose their interest in fidgeting  with their friends, their vital sign also rises up and that they are very inactive. There have been  many cases of edema, jaundice, and anemia. 34% of respondents also had hyper-bilirubinemia  (Biswas, et al., 2011)

This tribal and mainstream population was highly hooked into tea. In step with the survey about  48.9% of respondents what tea addicts. This is often also adding like them to the addiction of  smoking and alcohol with the proportion of 43.2 in smoking and 39.8 percent alcoholism  (Abdullah, 2014). A survey was conducted to grasp about the right percentage of vaccinated people  in Bangladesh. They speak about 229 participants out of which 120 those that is about 52.4 you  look after people were vaccinated. 39.3 percent of individuals were vaccinated quite once on the  opposite hand 13.1 percent of individuals vaccinated just the once (Abdullah, 2014). The study

also reported that he health status of the people like them to possess a high force per unit area of  about 73.7 %. There are many factors like ok and Healthy lifestyle and food habit that increases  the speed of vital sign participants within the country. It is also reported that the mainstream  population has fewer diabetic patients as compared to the tribal folks that face a high rate of  diabetes that’s about 34.1 %. The speed of respiratory diseases within the people of Bangladesh  was about 24.1 percent out of which 53% of participants face single RD symptoms while 47%  participant faced multiple RD systems. A singular study has performed on alcohol consumption  and its effects on grouping communities (Sachdev, 2011). The analysis cluster showed that among  all the cases each regular and irregular drinker were enclosed.

CHAPTER 4: METHODOLOGY

The data collection and analysis methodologies adopted in the selected literature are summarized  in the following sections in developing a detailed understating on socioeconomic and health status  of tribal population. 

Mannan (2013) collected data from the field survey of BIDS conducted during 2012. The overall  study was designed based on primary data collection and interviews. In collecting the data, three  different data instruments have been administered: (i) Key informant interview (KII) of program  managers (ii) Key informant interview (KII) with service providers; and (iii) Exit interview of  patients (both in-and-out) attending health service locations. In terms of the patients, total 1820  patients (both in and- out patients) from the sample health facilities were interviewed. The  collected data was analyzed based on descriptive stat analysis employing both univariate and  multivariate analysis. 

Islam and Sheikh (2010) has conducted the study based on extensive literature review sourced  from Pubmed, Medline, Google scholar, and Google book searches. For the extensive literature  review, the key words they have employed are indigenous people and health, socio-economic and  cultural factors of indigenous health, history of indigenous peoples’ health, Australian indigenous  peoples’ health, Latin American indigenous peoples’ health, Canadian indigenous peoples’ health,

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South Asian indigenous peoples’ health, and African indigenous peoples’ health. Dey et al (2014)  collected the data from three districts of Chittagong division. For the study, the ethnobotanical  survey was conducted between ‘August 2013 to March 2014’ including a sample size of 80 people.  Other than the sociodemographic information, the participants were asked to collect the plants they  used for the treatment of different diseases. The plant specimens collected from the survey  participants were further pressed, preserved and later identified by the Bangladesh National  Herbarium, Dhaka. The collected data were analyzed by employing exposure rate methods. 

The study conducted by Abdullah (2014) was focused on data collected from Rajshahi Division.  For the study, data were collected by employing a pre-planned questionnaire including  sociodemographic and health relevant topics. The collected data were analyzed by employing  descriptive stat analysis approaches in uncovering the health-related issues of the tribal population.

Pal et al. (2017) have collected the data from Sylhet division. The data was collected from 113  ethnic married females by employing direct interview with structured questioner method during  the period from January to May 2016.The study have adopted the self-developed indexing  approach for carrying out several analyses such as frequency distribution, descriptive statistics. 

Ahmad et al. (2015) collected the data based on a cross-sectional study while the respondents for  the questionnaire survey was 159 tribal (Orao) people from Rangpur District. The sample was  collected and compiled by purposive random sampling technique through a structured  questionnaire the questionnaire was designed focusing on the socio-economic status, knowledge,

and practice about oral hygiene. Data analysis was done by employing descriptive stat analysis

approaches. Toppo et al. (2016) conducted an explorative analysis by adopting a mixed with  qualitative and quantitative data collection design while collecting data from both secondary and  primary data sources. The primary data was collected employing a structured questionnaire,  interviews, focus group discussion and observations design. The secondary data was collected  from different sources identified for the research design. The data was collected from 384  respondents. Hossain (2013) collected data on socio-economic situation of the indigenous people  of the Chittagong Hill Tracts area. The study has focused on identifying relevant literature on  indigenous population of Chittagong hill Tracts.

From the above discussion, it can be argued that the predominant approach of data collection on  indigenous population health status is pre-defined survey design including health status,  sociodemographic and economic status. Major focuses of these studies were:

∙ Major health related issues of tribal people in Bangladesh.

∙ Critical factors contributing to health related issues of tribal people.

∙ Factors affecting accessibility to health services of tribal people.

∙ Perceptions on health service access and facility of the tribal people.

∙ Barriers in accessing health services provided by the Government and private sector for  the tribal people.

CHAPTER 5: DISCUSSION

Indigenous individuals round the world are reported to be oppressed, withdrew, and separated,  which is unequivocally and verifiably influencing their well-being status too. Studies uncover that  indigenous populace’s experience more wellbeing related issues and disparities when contrasted  with their standard networks. The death rates of newly born children and therefore the date rate of  their mothers is higher as compared to the remainder of the places. Mortality comparative is  experienced highly by these indigenous tribal people with non-indigenous people groups. Even  more explicitly, maternal death rates are essentially higher among weak gatherings, especially  among the indigenous, ethnic, or other minority gatherings. Indigenous people groups’ wellbeing  status and results are installed inside the actual financial, political, and social settings  (Subramanian, et al., 2006). This examination is extensively a trial to feature the wellbeing and  sickness status with regards to Bangladesh. Not many organizations are willing to figure with  Santals and even these organizations do not seem to be following a correct progress plan.  Government agencies and NGOs also neglect the most important problems with these people.

A study found that poor access to health data doesn’t allow an opportunity to debate their health  and safety condition (Sachdev, 2011). The underreported health issues identified are eye puffiness,  jaundice, anemia, pathology, and decrease in weight, disgorgement, and nausea. Disease, chronic  disease (Sayeed, et al., 2004). Some analyses across the world, the prevalence of hereditary  condition within the group population was above that of the nontribal population of the Asian

countries (Thekaekara, 2011). Older age, higher central avoirdupois, and better gain were tested  important risk factors of genetic abnormality. The high prevalence of the congenital disease among  these tribes indicates that the prevalence of polygenic disease and its complications can still  increase. Historical proof suggests that dental malady was rare among social groups within the  first twentieth century. (Islam & Odland, 2011) Today, they have lots of untreated decay and gum  malady than the opposite population cluster, due to socioeconomic standing, changes in diet, lack  of preventive programs, and simply not enough dental professionals to meet the big backlog of  untreated diseases (Toppo, et al., 2016). A correct plan must be form so as to focus on these tribal  communities to grant the knowledge about the health and treatment that’s available within the  country which can make these communities plenty less vulnerable.

5.1 Recommendations

There should be a health advisory body to tackle the health problems with tribal people of  Bangladesh. This advisory body should include representative from tribal those who are visiting  represent their communities. All the funds raised by the advisory group should be directly  transferred to those communities. The Adivasi communities should get effective recognition and  may get proper access to basic needs like healthcare system Moreover, there should be a trial to  gather a comprehensive dataset on the health issues regularly faced by such communities. Their  specific needs should be taken into consideration in health specific laws and policies.

CHAPTER 6: CONCLUSION

The present study throws lightweight on the undiscovered aspects in relevancy habit and lives  hood to date untouched grouping population of Bangladesh. This study has disclosed that the  community of Bangladesh is usually facing changes thanks to many health factors like cultural  values health status and healthy practices. These factors have a robust impact on the general profile  of Bangladesh. Social, habitation, cultural exchange with the nontribal folks brings some  modification in their ideas and views. Matters are even worse among their restored counterpart  international organization agency is incapable to assist their health communities by getting food  and medical plants. Many duct issues are faced by the people because of living in unhealthy  environmental conditions that are combined with excessive alcohol intake and connected  undernutrition. Because of adverse health conditions variety of diseases are spread during this area  like diabetes and high force per unit area along with tuberculosis, viscus parasitic infection,  contractor paint, diarrhea, and other different diseases. The tribal people of Bangladesh are slowly  adapting to the urban that comes together with accepting the facilities available within the country.  However, the mental perception about unhealthiness and healthy practices result in delay in  medical treatments and this unhealthy behavior because of the dearth of health education rest the  lifetime of many. A correct plan must be form to focus on these tribal communities to relinquish  the knowledge about the health and medical care that’s available within the country which can  make these communities lots less vulnerable.

 

 

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