A social and demographic study of Tibetan refugees in India

The social and demographic characteristics of ~65,000 Tibetan refugees in India were determined from data collected 1994-1996. Approximately 55,000 refugees were living in 37 settlements widely distributed around India. The remaining 10,000 refugees were monks living in monasteries associated with some of the settlements, mostly in the south of India. In the settlements, a community-based surveillance system was established and data were collected by trained community health workers in house to house visits. In the monasteries, data were collected by the community health workers in monthly interviews with a designated liaison monk at each monastery. These data indicated little immigration of new civilian refugees in the past 10 years into the settlements but a steady influx of new monks into the monasteries. The age distribution in the settlements showed a prominent mode in the 15-25 year age range, a declining birth rate, and an increasing proportion of elderly. In general, refugees born in India were educated through secondary school, while refugees born in Tibet were often illiterate. The principle occupations were education involving 27% (including students), farming, 16%, and sweater selling, 6.5%; another 6.5% were too young or too old for employment, and only 2.4% were unemployed. The overall crude birth rate was determined to be relatively low at 16.8/1000, although this may underestimate the true figure. Infant mortality varied from 20 to 35/1000 live births in the different regions. Child vaccination programs cover less than 50% of the population. The burden of illness in this society was mainly characterized by diarrhoea, skin infections, respiratory infections, fevers, and, among the elderly, joint pains and cardiovascular problems. Although calculated death rates were unrealistically low, due to under-reporting, causes of death, derived from ''verbal autopsies'', were mainly cancer, tuberculosis, accidents, cirrhosis and heart disease in order of decreasing frequency. Overall, the sociodemographic and health characteristics of this population appear to be in transition from those typical of the least developed countries to those typical of middle income and more affluent societies.Shushum Bhatiaa, Tsegyal Dranyia and Derrick Rowle

Tuberculosis among Tibetan refugees in India

Shushum Bhatia, Tsegyal Dranyi and Derrick Rowle

Tuberculosis among Tibetan refugees in India

Tuberculosis (TB) is a major public health problem among Tibetan refugees in India. To determine the incidence of and risk factors for TB among Tibetan refugees in India, data on TB were included in the demographic and health surveillance project carried out by the Tibetan government-in-exile in Dharamsala from 1994 to 1996. Risk factor and morbidity data were determined by baseline and monthly follow-up home visits, and reported TB was confirmed by clinic records. The surveillance covered ~90% of the refugees in civilian settlements and ~70% of the monks in monasteries. In the settlement population, TB incidence was extraordinarily high in the settlement population, 10.9/1000 in 1994, but decreased to 7.7/1000 in 1996. Incidence rates varied between regions, age groups, and occupational groups, being highest in the Doon Valley (14.8/1000), in sweater sellers (16.7/1000), and in the unemployed (23/1000). Among monastery monks, incidence rates were even higher than in the settlements, averaging 17.2/1000 over the 3-year period. The proportion of patients without sputum results and variation in the proportion of smear positive cases indicated inadequate use and poor quality of laboratory services. India's Revised National Tuberculosis Control Program, based on WHO-recommendations, has been highly successful in pilot districts and is being extended to the whole country. This program should be adopted promptly by the health care system serving Tibetan refugees and vigorously implemented among the refugee population.Refugees Tibet India Tuberculosis