Co-Authors and Contributors- Sarah Armes, Halima Jama, Ilakkiya Ezhilmaran, Arundhita Bhanjdeo, Harmanpreet Kaur, Debashis Chakraborty, Asim Manna, Wanja Nyaga, Nivedita Narain, Sumantra Ray, Nitya Rao
For centuries, indigenous communities have thrived by maintaining a harmonious relationship with their surroundings and food systems. However, in today's world, indigenous peoples, particularly women and girls, bear the impact of hunger and malnutrition (1). Among them, the Santhal community, the third largest indigenous tribe in India, faces significant challenges in achieving proper nutrition due to extreme poverty and limited nutritional knowledge (2). We, NNEdPro, in association with Charities Aid Foundation (CAF), India, PRADAN and the University of East Anglia’s School of Global Development, explored a transformative intervention that aimed to improve nutrition knowledge, attitudes, and practices (KAP) within the Santhal community in Bihar and Jharkhand, India.
Understanding the Need
Malnutrition among indigenous peoples is often rooted in structural inequalities and the erosion of traditional food systems (3). The Santhal community, like many others, experience both undernourishment and micronutrient deficiencies (4). To combat this complex challenge, contextual, integrated and multidisciplinary interventions are essential, focusing on increasing access to and consumption of a diverse and nutritionally adequate diet.
Empowering the Community through Intervention
Our intervention, adapted from the work of the Mobile Teaching Kitchen International Initative <www.mtki.org> particularly across India, aimed to improve nutritional knowledge, attitudes, and practices (KAP) regarding locally available food and diets in the Santhal tribe of Chakai district in Bihar. It focused on promoting the inclusion of locally available foods, in turn enhancing sustainability and resilience of the Santhal community's food systems. One of the key tools used was the Santhal recipe book, developed through nutritional analysis of locally sourced and collected foods, designed to include recommended menu templates to support dietary diversity, practical application, and the sustainability of food systems. In December 2022, training workshops were conducted with local youth selected to become Change Agents, focusing on these menu templates. They were taught how to collect data from the community, and the knowledge transfer was facilitated using SEE One, DO One, and TEACH One (SODOTO) session. Topics of knowledge transfer included iron-rich foods, traditional cooking methods, meal timing, the importance of preserving traditional food items amidst modernisation, and how shifts in cropping patterns affecting the environment and water. Subsequently, the Change Agents collected pre-intervention data from the field and conducted cooking demonstration workshops disseminating information gained from the SODOTO sessions into the community, particularly women. Post-intervention data was collected one month after the workshops in the specific community. In January 2023, a workshop involving policy makers, stakeholders, and community representatives was held in Dumka, Jharkhand, with the intention of informing local authorities about the project and creating local supportive ecosystem to work on improving community's diet and health.
Pictures from the workshops depicting the SODOTO training in the field and workshop with stakeholders
The Impact
To evaluate the intervention's effectiveness, a KAP questionnaire tailored to reflect local diets and dietary patterns was administered to 293 participants (280 women and 13 men, predominantly farmers, with a mean age of 36 pre- and post-intervention. The results revealed substantial improvements in nutrition related KAP among the participants.
Knowledge: Pre-intervention, the average knowledge score was 12.8 out of 28, indicating varying levels of knowledge among the participants. There was limited awareness of vitamin and mineral content, especially sources of vitamin B12 and calcium, as well as the benefits of local foods. The average post-intervention knowledge score soared to 23.6 out of 28, indicating a substantial increase in participants' understanding. They showcased improved knowledge of diet diversity (93%), regular meal consumption (99%), and the benefits of eggs as a protein source (92%).
Attitudes: Pre-intervention, attitudes were assessed and yielded an average score of 17.6 out of 26. The participants demonstrated positive attitudes towards diverse diets (69%), recognising the harmful effects of excess salt (69%), and acknowledging the importance of vitamins in fruits and vegetables (46%). Post-intervention attitudes experienced positive shifts, with the average score rising to 22.2 out of 26. The participants exhibited stronger agreement on pre-intervention topics, and their recognition of iron-rich foods increased significantly (98%). Additionally, they displayed greater awareness of dietary considerations during pregnancy (68%). The intervention successfully fostered positive attitudes towards healthier dietary choices.
Practices: Pre-intervention, participants' practices received an average score of 13.6 out of 30. The findings revealed infrequent consumption of leafy vegetables (14%) and nuts/seeds (40%), along with high levels of fatigue (68%). However, after the intervention, positive changes were observed. The average score climbed to 18.3 out of 30. The participants showcased improved meal planning (68%) and increased consumption of leafy vegetables (61%) and iodised salt (74%).
Conclusion
This transformative intervention stands as a testament to the power of targeted nutrition education and community empowerment. By focusing on locally available foods and incorporating indigenous knowledge, the intervention improved nutrition related KAP among the Santhal community. The results highlight the importance of bridging knowledge and information gaps, fostering positive attitudes, and promoting healthier dietary practices. It also emphasises the need for sustainable strategies to ensure long-term impact in the Santhal and other indigenous communities.
Moving forward, we plan to analyse the dietary intake data collected from the field to investigate how the KAP intervention has impacted the consumption of indigenous food items within the community. It is also crucial to continue supporting interventions that enhance nutrition literacy, encourage the consumption of locally produced foods, and foster the resilience of indigenous food systems. By empowering communities with knowledge and promoting sustainable practices, we can work together to combat malnutrition and improve health as well as resilience particularly in historically marginalised populations.
References
Lemke S, Delormier T. Indigenous Peoples' food systems, nutrition, and gender: Conceptual and methodological considerations. Maternal & Child Nutrition. 2017 Dec;13:e12499.
Prabhash K Dutta 2022. Who are santhals, the community which Droupadi Murmu belongs to? [Internet]. TOI; [cited 2023 Jul 10]. Available from: https://timesofindia.indiatimes.com/india/who-are-santhals-the-community-which-droupadi-murmu-belongs-to/articleshow/92391524.cms
Health for Indigenous Peoples [Internet]. United Nations. Department of Economic and Social Affairs Indigenous Peoples; [cited 2023 Jul 10]. Available from: https://www.un.org/development/desa/indigenouspeoples/mandated-areas1/health.html
Kumar P, Chauhan S, Patel R, Srivastava S, Bansod DW. Prevalence and factors associated with triple burden of malnutrition among mother-child pairs in India: a study based on National Family Health Survey 2015–16. BMC Public Health. 2021 Dec;21:1-2.