Z Gerontol Geriat 42:53–59 (2009)
DOI 10.1007/s00391-008-0530-2
A. S. Kerketta
G. Bulliyya
B. V. Babu
S. S. S. Mohapatra
R. N. Nayak
Received: 15 July 2007
Accepted: 1 February 2008
Published online: 10 April 2008
Dr. Anna S. Kerketta ())
Regional Medical Research Centre
Indian Council of Medical Research
SE Rly Project Complex (Post)
Bhubaneswar – 751023, India
E-Mail: annas11@rediffmail.com
Gandham Bulliyya, Bontha V. Babu,
Surendra S. S. Mohapatra, Rabi N. Nayak
Regional Medical Research Centre
Indian Council of Medical Research
SE Rly Project Complex (Post)
Bhubaneswar – 751023, India
ORIGINAL CONTRIBUTION
Health status of the elderly population
among four primitive tribes of Orissa, India:
A clinico-epidemiological study
" Abstract Primitive tribal
groups (PTGs) are the most mar-
ginalised and vulnerable commu-
nities in India. Clinico-epidemio-
logical studies on morbidity pat-
terns among the elderly primitive
tribe members are essential to
recommend special intervention
programmes to improve the
health of the elderly in these
communities. A community-based
cross-sectional study was carried
out among the elderly popula-
tions of four different PTGs,
namely Langia Saora (LS), Paudi
Bhuiyan (PB), Kutia Kondh (KK)
and Dongria Kondh (DK) living
in the forests of Orissa, India.
Clinical and anthropometric data
were collected using standard
methods and haemoglobin was
estimated by the cyanomethae-
moglobin method. The average
number of illnesses per person
was 3.0. Common disabilities like
vision and hearing impairment
and mobility-related problems
were found in considerable num-
bers. Gastrointestinal problems
like acid peptic disease were
found among 2.6% to 20% of
cases. Non-specific fever was
marked in 10.2% to 24.2% of in-
dividuals. The iodine deficiency
disorder, namely goitre, was
found among 4.2% to 6.0% of in-
dividuals. Diseases of the respira-
tory tract, like upper and lower
respiratory tract infection, asth-
ma, tuberculosis and leprosy,
were found in small numbers.
The prevalence of hypertension
among males and females was
31.8% and 42.2%, respectively.
The LS had the highest preva-
lence of hypertension (63%
among men and 68% among
women). With regard to anaemia
status, severe anaemia was
marked in 70% of males and
76.7% of females in the LS, while
in other groups the prevalence of
severe anaemia ranged from 15%
to 33%. Although the prevalence
of severe anaemia in other tribal
communities is lower than in the
LS, mild to moderate anaemia
was found to range from 60% to
80%. The present study revealed
a high prevalence of physical dis-
abilities with both non-commu-
nicable as well as communicable
diseases among the elderly primi-
tive tribal members. This war-
rants the implementation of a
special health care strategy to re-
duce suffering at this crucial age
and improve quality of life.
" Key words elderly –
health status – morbidity –
primitive tribe – Orissa – India
Z Gerontol Geriat 1 2009
54
Introduction
The increase in the absolute and relative numbers of
elderly people is one of the major features of demo-
graphic transition in the world [1]. India had 60
million elderly (above 60 years of age), which is
about 6.7% of the total population [2]. The propor-
tion of the aged population in India increased from
about 20 million in 1951 to 60 million in 2001 and
is projected to be 120 million by the year 2031 [3].
The elderly comprise an important vulnerable group
having many physical and mental health problems
and thus social and physical well being of these peo-
ple has become a challenging issue in India [4].
Tribal members constitute more than 8% of In-
dia’s population and their largest concentration is in
the central belt of the country. Of the Indian states,
Madhya Pradesh has the largest tribal population
followed by Orissa with 22.2% of its total population
[2]. Orissa harbours 62 tribal groups, who live in
the remote tribal areas and of which 13 are identi-
fied as primitive tribal groups (PTGs). Due to multi-
dimensional factors, these people face many prob-
lems, including illiteracy, poverty, difficult terrain,
isolation, superstitions and inadequate health facil-
ities [5]. The PTGs of Orissa have relatively little or
no access to even the most elementary forms of
health care and are very limited in the implementa-
tion of even simple health and sanitation issues [6].
Studies on health and nutritional problems of tribal
communities in general and PTGs in particular are
scanty [7]. Therefore, the present study was underta-
ken to assess the health status of the elderly popula-
tion belonging to four PTGs inhabiting four tribally
dominated districts of Orissa, India.
Methods
n People
This community-based cross-sectional study was
conducted among the elderly population belonging
to four PTGs, i.e. Langia Saora (LS), Paudi Bhuiyan
(PB), Kutia Kondh (KK) and Dongria Kondh (DK)
in Gajapati, Sundergarh, Pulbhani and Rayagada dis-
tricts, respectively. All of these districts are tribal
dominated districts in the state of Orissa, India. The
study area is hilly with forest and is situated in diffi-
cult terrain. The PTGs are characterized by having
socio-cultural isolation, an extremely low literacy
rate, primitive techno-economy, and stagnant or di-
minishing population [8]. The tribal communities
pose a wide range of variations, which are manifest
in their socio-cultural milieu. Based on the varia-
Z Gerontol Geriat 1 2009
A. S. Kerketta et al.
tions and considering the primitiveness, the Govern-
ment of India has designed these tribal communities
as PTGs. Since the Fifth Year Plan period, the Govern-
ment of India has adopted four criteria for determin-
ing the primitiveness of a tribal group. They have 1)
pre-agricultural level technology and economy, 2)
very low rates of literacy, 3) declining or near stagnant
population and 4) general simpleness due to seclusion
and consequential archaic modes of living.
" Langia Saora (LS) They are the most ancient com-
munity frequently referred to in Hindu mythology
and classics. Saora appear to be derived from Sa-
gories the scythian’s word for ‘axe’ and Saba Roye
the Sanskrit term for ‘carrying a dead body’ (hunted
animal). They always carry an axe on their shoulder
since hunting is one of their primary occupations.
They belong to the cultural type of ‘primitive hill
cultivation’. In appearance they look like pre-Dravi-
dian tribes. The word Langia refers to the dress of a
Saora man, which consists of a loincloth about 6 feet
long and 10 inches wide tied around the hips, which
hangs down in two strips the one in the rear being
longer. The women wear a waistcloth that hardly
reaches the knees. During the winter they cover the
upper part of the body with another piece of cloth.
The villages are situated in inaccessible areas, hid-
den in the forest-clad hills, making it difficult to
reach them except by zigzag steep hill paths. The
area is situated 3000 ft above sea level. The settle-
ments are located in undulating terrain and houses
are scattered. They build their houses on slope or
foot hills, which are free from water logging. The
primary source of economy comes from shifting cul-
tivation of mainly terraced and to some extent wet
cultivation. They are excellent terrace cultivators.
The terraces are built along the beds of the hill
streams and extend many hundreds of feet from the
depth of the valley to the hill slopes. Rice is culti-
vated on the terraces. No manure is applied in the
field in the upper terrace areas where ragi (millet) is
transplanted. They also collect forest products year
round. The principle food of the Saora is gruel pre-
pared from rice or ragi. They also eat vegetables
grown in the kitchen garden, fruits, tubers, roots,
leaves, and honey collected from the forest. Through
the consumption is less, they relish non-vegetarian
food. They enjoy alcoholic drinks and smoke tobac-
co. They have very little knowledge about environ-
mental sanitation, thus do not keep their village
clean, rather throw the cow dung, animal excreta
and other wastes into the street. The aesthetic life of
the LS is reflected through their colourful dance,
typical music and wall paintings. The women use or-
naments to adorn their ears, nose, waist and ankles.
Health status of elderly among four primitive tribes in India
" Paudi Bhuiyan (PB) The word ‘Bhuinyan’ is de-
rived from the Sanskrit word ‘Bhumi’ and means
land or earth. The main concentrated pocket of
Bhuinyan is Bhuinyan-Pirh, which lies roughly be-
tween 218 and 228 North latitude and 8.58 and 8.68
East longitude. The block of hills and elevated val-
leys stretching from the Keonjhar district to Sundar-
garh district constitute the homeland of this primi-
tive tribe. The Paudi (those living in the hills) Bhu-
inya hamlets or villages are generally small in size
and homogenous in nature. The economic life of this
group is mainly centred around shifting cultivation,
which is the primary source of their livelihood. To a
large extent it is supported by collection of forest
products and to the same extent by wet and dry cul-
tivation, hunting, fishing and wage earning. Rice is
the main crop grown in the wet land in the valley.
In the elevated plane land, they cultivate pulses and
minor millets and in the area near their residence
they grow tobacco, vegetables, mustard and maize.
Bullock driven ploughs are used to till the lands.
Very simple agricultural techniques are used with
the help of hoes, axes, spades, sickles, wooden poles,
crowbars, yokes and ploughs. Rice is the staple food;
in addition they eat millet and other cereals. On fes-
tive occasions they eat pulses. During lean seasons,
root tubers, flowers and fruits are also eaten. They
are known for their chewing and smoking of tobac-
co. They consume alcoholic drinks prepared from
mahua flower, rice, and palm extraction. Their poor
economic status is illustrated by the household arti-
cles, which consist of earthen vessels, jars, gourd
containers, palm leaf mats, leaf umbrellas and rain
coats, broom sticks, bamboo baskets, stone mortar
and pestles, ploughs, bow and arrows, kerosene
lamps and straw-made grain bins.
" Kutia Kondh (KK) Kutia Kondh is one of the most
primitive sub-tribes of Kondh tribe. The term Kutia
means “Big hole in earth”. They relate closely to the
Proto-Australoid stock with considerable Mongoloid
admixture. They live in small settlements on the
slopes of the hills. The area lies between 19845' and
20850' North latitude and between 8.3830' and
8.3845' East longitude. The houses are built in two
rows separated by a street facing east-west. The
thatch of the adjacent houses merge in such a way
as to give the impression of a single, long roof
stretched from one end of the village to the other.
Sources of living basically centre around agriculture,
forestry and wage earning. They are generally shift-
ing cultivators. Their lands are divided into back
yard land, up land, low land and swidden land. They
grow rice in the up and low lands and minor millets
and cereals in the swiddens. They also produce crops
like turmeric, ginger, mustard, black gram, arrow-
55
root, niger, etc. In lineament season they work as la-
bourers. A barter economy is prevalent among them.
They eat gruel prepared from millet or rice for
breakfast. The same is eaten during lunch in the
fields, swiddens or forest. The evening meal is con-
sidered the best meal with rice and some leafy vege-
tables. They eat non-vegetarian food cooked with
turmeric and chilli as the only condiments. They are
fond of dry fish. Liquor both distilled and fermented
is used in their social-religious affairs. Everybody, ir-
respective of sex and age, consumes liquor as a so-
cial necessity. Tobacco is very commonly used,
mostly as a powder. The men wear only a loincloth.
The women have tattoos over their whole face and
hands. Household articles include gourds (bottles
made from the dried shell of a bottle gourd), wood,
bamboo, stone articles, baskets, earthen pots and
iron implements. The family structure consists of
husband, wife and their children who live in a two-
roomed domicile.
" Dongria Kondh (DK) They are another subgroup of
Kondh. They belong to the Dravidian linguistic
group. The name “Dongria” signifies that they are
hill dwellers since the word donger means hill land.
The area is situated 2000 ft to 5000 ft above sea lev-
el. They practice both shifting cultivation and horti-
culture. They are expert horticulturists, producing
fruits like bananas, pineapples, oranges, jackfruit,
etc. on the hill slopes. They also raise livestock. The
food pattern is similar to that of the Dongria Kondh.
A barter system is still the traditional method for
exchanging goods. The Dongria man wears a cloth
six feet in length and one foot wide. The women
beautify themselves with hairpins, earrings, nose
rings and necklaces. But they do not have tattoos.
Both females and males grow their hair long, which
is tied in a knot at the nape of their neck in a tradi-
tional fashion. The composition of the family is nu-
clear type. Clanship is one of the basic determinants
of identity in the Kondh, which guide their day to
day socio-cultural and politico-economic lives.
Kutia Kondh Development Agency, Belghar of
Phulbani district, Dongria Kondh Development
Agency, Chatikona of Rayagada district, Langia
Saora Development Agency, Seranga of Gajapati dis-
trict and Paudi Bhuiyan Development Agency, Khun-
tagaon of Sundargarh district are responsible for the
development of these PTGs. A total of 5 to 7 villages
were covered for each tribal group. The list of all el-
derly persons in the area was obtained from the mi-
croproject office, and the study sample was selected
using a simple random method. Thus, a sample of
312 respondents (135 male and 177 female) over 60
years of age were included in this study. During the
selection of respondents, ascertaining their age was
Z Gerontol Geriat 1 2009
56 A. S. Kerketta et al.

difficult since many of them did not remember their Table 1 Details of the sample
date of birth and there were often no reliable birth
records. Hence, the age was ascertained by recollect- Tribe Male Female Mean age Mean weight
n n (in years) (in kg)
ing and correlating life cycle events and important
past events in the area or country. Dongria Kondh 30 20 69.80 40.38
Kutia Kondh 46 66 68.44 40.69
Langia Saora 20 30 65.70 40.68
n Data Paudi Bhuiyan 39 61 71.17 38.99

A pre-tested questionnaire was used to collect the

history of present and past illness. After obtaining
informed consent, all individuals were examined
clinically by the first author (ASK) who is a medical
doctor. Finger prick blood was collected from each
individual for haemoglobin estimation. A sample of
blood (20 ll) was measured accurately by using a
haemoglobin pipette and delivered onto filter paper.
It was labelled after air-drying and brought to the
laboratory, where the portion of filter paper contain-
ing the blood was dipped in 5 ml Drabkin’s solution
in a test tube. After waiting for 30 minutes the con-
tents were mixed thoroughly using a vortex; the hae-
moglobin (Hb) concentration was measured using
the cyanomethaemoglobin method. Anaemia was
graded using the WHO classification [9]. The blood
pressure was measured for 322 persons using a mer-
cury sphygmomanometer [10] and classified into
different categories of hypertension [11]. Height,
weight and other anthropometric measurements
were collected through standard methods [12]. The
data were computerized and analysed with SPSS V.10
(SPSS Inc., Chicago, IL, USA).
Results
The details of age, sex and weight are shown in Ta-
ble 1. The average number of illnesses per person
was 3.0. The tribe-wise prevalence of various general
morbidity conditions are shown in Table 2. Common
disabilities like vision and hearing impairment were
found in 63% of males and 68% of females, and
25% of male and 39% of female respondents, respec-
tively. Mobility related problems like joint pain/stiff-
ness, backache, peripheral neuritis/neuralgia were
found in a considerable proportion of elderly people.
Gastro-intestinal problems, including acid peptic dis-
ease (APD) with complaints of dyspepsia, abdominal
pain and heart burn, were found among 2.6% to
20% of cases. However, no cases of diarrhoea were
encountered during the study period. Non-specific
fever was marked in 10.2% to 24.2% of the popula-
tion. Iodine deficiency disorder, namely, goitre was
found among 4.2% to 6.0% of the study population.
Diseases of the respiratory tract, like upper and low-

Table 2 Prevalence of various morbidity conditions among elderly of different primitive tribal groups

Morbidity condition Dongria Kondh Kutia Kondh Langia Saora Paudi Bhuiyan Total

Male Female Male Female Male Female Male Female Male Female
(n = 30) (n = 20) (n = 46) (n = 66) (n = 20) (n = 30) (n = 39) (n = 61) (n = 135) (n = 179)

Vision impairment 60.00 85.00 63.00 63.60 30.00 63.30 82.00 68.80 62.90 67.80
Chewing problems 30.00 40.00 46.60 48.50 20.00 26.60 66.60 63.90 25.20 38.90
Hearing impairment 10.00 20.00 28.30 25.70 15.00 20.00 38.50 44.30 25.20 38.90
Fever 0.00 15.00 19.50 24.20 0.00 13.30 10.20 18.00 9.60 19.20
Acid peptic disease 20.00 10.00 6.50 12.10 0.00 0.00 2.60 3.80 5.90 7.90
Backache 6.60 15.00 41.30 33.30 60.00 36.60 28.20 29.50 32.60 30.50
Peripheral neuritis 3.30 10.00 8.60 3.00 0.00 3.30 7.70 4.90 5.90 4.50
Joint pain 13.30 25.00 8.60 15.10 15.00 26.60 30.80 26.20 17.00 22.00
Goitre 0.00 0.00 4.20 6.00 0.00 0.00 0.00 4.90 1.50 3.90
Respiratory tract infection 10.00 0.00 2.10 4.50 10.00 3.30 7.70 6.50 6.70 4.50
Asthma 3.30 0.00 0.00 0.00 0.00 0.00 1.60 3.20 1.50 0.50
Hypertension* 13.30 26.30 18.60 26.10 63.20 67.80 19.20 40.00 31.80 42.20
Tuberculosis 30.00 0.00 4.30 1.50 0.00 0.00 5.10 1.60 8.10 0.60
Leprosy 3.30 0.00 2.10 4.50 0.00 0.00 0.00 1.60 1.50 2.20

All figures are percentages.

* Systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg

Z Gerontol Geriat 1 2009

Health status of elderly among four primitive tribes in India 57

Table 3 Prevalence of various degrees of anaemia among elderly of primitive tribe members

Dongria Kondh Kutia Kondh Langia Saora Paudi Bhuiyan Total

Male Female Male Female Male Female Male Female Male Female
(n = 30) (n = 20) (n = 46) (n = 66) (n = 20) (n = 30) (n = 39) (n = 61) (n = 135) (n = 177)

Severe 33.3 20.0 15.2 15.1 70.0 76.7 23.1 19.7 29.6 27.7
Moderate 46.6 15.0 47.8 48.4 15.0 20.0 48.7 54.1 43.0 41.8
Mild 13.3 50.0 34.8 27.3 10.0 3.3 28.2 22.9 24.4 24.3
Normal 6.6 15.0 2.2 9.1 5.0 0.0 0.0 3.3 3.0 6.2
Mean ± SD (g/dl) 9.12± 10.15± 10.45± 9.53± 8.19± 6.67± 9.78± 8.97± 9.57± 8.89±
3.12 3.13 1.39 1.63 2.13 1.57 1.82 1.57 2.22 2.15

er respiratory tract infection or asthma, were found
in more than 5% of respondents. Blood pressure lev-
els indicated a higher prevalence of hypertension in
these groups with the overall prevalence among
males and females being 31.8% and 42.2%, respec-
tively. The LS had the highest prevalence of hyper-
tension (63% among men and 68% among women).
Tuberculosis was found highest in up to 30% of the
male elderly of the DK. Leprosy was found in up to
4.5% of the population.
Table 3 presents the anaemia status of the study
population. Of the four tribal groups, severe anae-
mia was marked in 70% of males and 76.7% of fe-
males in LS. And in other groups the prevalence of
severe anaemia ranged from 15% to 33%. Only 5%
of males were found to have normal levels of haemo-
globin. The mean haemoglobin level in LS was 7.5 g/
dl, where as in other communities it was around 9.5
g/dl. Although the proportion of severe anaemia in
other tribal communities is lower than in the LS,
mild to moderate anaemia was found ranging from
60% to 80%.
Discussion
Old age is a time of multiple illness and general dis-
ability, and elderly are more vulnerable to disease
because of decreased physiological reserves and
compromised defence mechanisms [13]. Diseases in
old age are not always curable, which also imply a
strain on financial conditions. However the feeling
of well-being can still override actual physical dis-
comfort if the surroundings and environment is nur-
turing [1]. Geriatric medicine focuses primarily on
the management of acute and chronic diseases in
frail elderly persons with much less emphasis on the
promotion of health and prevention of disease as in
the health care for children and middle aged adults
[14]. The larger number of elderly female proved
that they are physiologically better equipped than
their male counterparts and therefore enjoy a greater
longevity. The present cross-sectional study on el-
derly primitive persons shows that the average num-
ber of illnesses experienced per person is 3.0. It is
slightly higher than the average number of illnesses
reported in other studies from other parts of India
(2.62 illnesses experienced per person [15] and 2.42
illnesses experienced per person [16]). Cough, cold,
fever and diarrhoea were identified as the common
illnesses in the general population of all age groups
but fever was more prevalent than diarrhoea among
the elderly [17]. In the present study, fever was re-
ported in around 20% of males and 24% of females.
These may be of viral or bacterial origin. However,
since no laboratory investigation had been underta-
ken, the aetiology cannot be established.
Disabilities related to mobility like joint pain/
stiffness were found in up to 30.8% of elderly
males and 26.2% of elderly females. It is less than
the prevalence among elderly from Pondicherry,
India [16]. Backache was also marked among both
males and females up to a maximum of 60%.
Shifting cultivation on the slopes and tops of
hills is the main source of economy and they have to
work hard using primitive agriculture technology.
Physical strain and poor nutrition may also be fac-
tors responsible for both backache and joint pain/
stiffness.
Vision impairment was marked in about 63% of
men and 68% of women, which showed that it is a
common problem in this geriatric age group. An ear-
lier study from Chennai, India showed 56% visual
disability among the general elderly population,
which is reported as the single preventable disability
in this age group [18]. High prevalences of visual
(65%) and locomotor disability (36%) were reported
from a rural community of India [4]. The high prev-
alence of other disabilities like hearing impairment
and chewing problems (toothless/pain in gum and
teeth) were found to range from 44.3% to 66.6%

Z Gerontol Geriat 1 2009

58
which indicates further worsening of the suffering
among this group.
Chronic communicable disease was also marked
among this group. The prevalence of tuberculosis
was up to 30% in the PB community, which shows
the active transmission of infection in this commu-
nity. Earlier, tuberculosis infection was reported to
be about 17.0% among the tribal population of all
age groups from Car Nicobar Island [19]. Leprosy
was also found in 4.5% of the elderly KK and 3.3%
in the elderly DK. However, not a single case of le-
prosy or tuberculosis was found in the LS tribe.
Non-communicable diseases like hypertension
were also observed in these groups. A high preva-
lence of hypertension among the elderly of the LS
community is reported which may be due to accul-
turisation and modernization in this community and
particularly in the study area. More than 80% of LS
have adopted Christianity and the modern way of
living, when compared to other tribes of this region.
A well established phenomenon of increased blood
pressure level with age accompanying the process of
modernization is well-established [20–26]. A recent
study among tribal members from the neighbouring
state of Andhra Pradesh demonstrated the impact of
acculturation/modernization as the predictor of hy-
pertension [21]. The micronutrient deficiency disor-
der goitre indicates lack of iodine in their diet. A
study from the rural district of Orissa reported a
10.8% incidence of goitre which could be related to
low consumption of iodised salt since it is costly.
They, however, receive rock salt by the barter system
[27].
A high prevalence of anaemia was observed
among the study population in the tribal commu-
nity. Among LS, merely 5% of males have normal
haemoglobin levels, i.e. more than 13 g/dl, and none
of the females had normal haemoglobin status.
Around 70% of males and 77% of females are found
to be severely anaemic. It was reported that almost
all individuals in tribal communities irrespective of
their age, sex and physiological status were anaemic
[18]. Some genetic factors like high frequency of
sickle cell haemoglobin may also be responsible for
this situation along with poor nutrition. Although
the prevalence of severe anaemia in KK and DK is
Z Gerontol Geriat 1 2009
A. S. Kerketta et al.
lower than in the LS, 50–80% had mild to moderate
degrees anaemia. A study from South India reported
a high prevalence of anaemia (83%) among the el-
derly population [15]. Anaemia in the elderly may
be multifactorial with aetiology as nutritional, physi-
ological or pathological [28]. This warrants an ur-
gent need for in-depth study to establish the actual
aetiology.
Although the concept of well being and the no-
tion of the disease varies between communities, in
the tribal habitat a person is usually considered to
be ill if he/she is incapable of doing routine work,
which is usually expected to be carried out by the
individual in the society; thus, incapacitation from
work is the universal index of poor health. The
study shows that even if a high prevalence of mor-
bidity exists among the elderly primitive, only
around 7% of them complained of weakness. Symp-
toms such as pain, aches, weakness, scabies, cough,
mild fever and wounds are not taken seriously as the
symptoms of disease [29]. The tribal groups inhabit
widely varying ecological and geo-climatic condi-
tions with different population densities and due to
their remote and isolated living it is difficult to
reach them [30]. The availability of good roads was
identified as a way to reduce the prevalence of mor-
bidity significantly and it was also reported earlier
that as the distance to a doctor increases the num-
ber of days of normal activities being affected also
increases [17]. Since the nearest health facility is
around 8–10 km from the study villages, which are
in inaccessible forest areas, it is difficult for them to
reach and use the health facilities. This may be one
of the reasons for high morbidity among this elderly
group of people. Therefore a better understanding of
the health situations along with implementation of a
special health care strategy and the community-
based delivery system may be the solution to cater
to the health-related needs among these commu-
nities. It will reduce the suffering and improve the
quality of life of the elderly primitive tribe mem-
bers.
" Conflict of interest There is no conflict of interest. The presen-
tation of the topic is impartial and the representation of the con-
tents is product neutral.
Health status of elderly among four primitive tribes in India
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