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International Journal of Nutrition

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  • Nutritional Status of Reproductive Ethnic Woman Living in Chittagong Hill Tracts of Bangladesh: Influence of Socio-economic and Nutritional Factors

    Sadia Sartaz 1   Mahbuba Kawser 1   Md. Akhtaruzzaman 1   Sheikh Nazrul Islam 1  

    1Institute of Nutrition and Food Science, University of Dhaka, Dhaka-1000, Bangladesh



    This cross-sectional study assessed the nutritional status of ethnic reproductive women aged between 15-40 years, comprising 85 lactating women (LW) and 86 non-pregnant-non-lactating women (NPNLW) who lived in various parts of three hilly districts (Bandarban, Khagrachari and Rangamati) of the Chittagong Hill Tracts (CHTs) of Bangladesh.

    Materials and Method

    Research tool was pretested semi-structured questionnaire for this observational study. Anthropometric indices like weight, height and mid-upper-arm-circumference (MUAC) were used in assessing the nutritional status.


    Most (44.4%) of the ethnic women were Marma, followed by Chakma (39.8%), Bam (8.2%) and Tripura (5.8%). No significant (P>0.05) differences were observed in socio-economic variables between LW and NPNLW. Overall, mean age of the women was 28 (±7.2) years; mean family income was 18,822.2 (±3091) BDT and majority (86%-87%) were reported to be food secured throughout the year. Mean Dietary calorie (2631±798 kcal) intake of both groups were up to the mark according to the recommended dietary allowances (RDAs) and most (80.3%-86%) of them also possessed good nutritional knowledge. However, no significant (P>0.05) differences were observed in dietary calorie intake and nutritional knowledge score between two groups of women. Overall, most (68.4%) of the women had normal body max index (BMI kg/m2), 11.7% were found to be undernourished or thin and 19.9% were overweight. It was noticed that better nutritional status of LW and NPNLW were significantly associated with literacy (P<0.05), occupancy in household chores (P<0.05), better income (P<0.05), food security (P<0.05), recommended calorie intake level (P<0.05) and better nutritional knowledge score (P<0.05).


    This study showed that vast majority of the ethnic reproductive women of CHTs are in better nutritional status with normal BMI (kg/m2) and daily calorie intake according to RDA. Most of them were food secured and their nutritional knowledge score was also up to the mark. Better socio-economic condition, nutritional knowledge and accurate calorie intake play a vital role in achieving healthy nutritional status of the two women groups of CHTs.

    Author Contributions
    Received 20 Mar 2020; Accepted 31 Mar 2020; Published 06 Apr 2020;

    Academic Editor: Ishan Wadi, National Institute of Malaria Research, India.

    Checked for plagiarism: Yes

    Review by: Single-blind

    Copyright ©  2020 Sadia Sartaz, et al.

    Creative Commons License     This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors have no conflicts of interest to declare.


    Sadia Sartaz, Mahbuba Kawser, Md. Akhtaruzzaman, Sheikh Nazrul Islam (2020) Nutritional Status of Reproductive Ethnic Woman Living in Chittagong Hill Tracts of Bangladesh: Influence of Socio-economic and Nutritional Factors. International Journal of Nutrition - 5(3):16-25.

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    DOI 10.14302/issn.2379-7835.ijn-20-3279


    An ethnic group is a socially defined category of population who recognize with one another based on common ancestral, social, cultural or national experience. They tend to segment themselves with a different origin, cultural heritage, history, language, ideology, religion and ritual 1. Bangladesh has been culturally enriched by the colourful lifestyle of different ethnic people. Around 44.4 % of ethnic population lived in three hilly districts of Chittagong Hill Tracts (CHTs) with eleven ethnic multi-lingual minorities (e.g. Bawm, Chak, Chakma, Khyang, Khumi, Lushai, Marma, Mro, Pangkhua, Tangchangya, and Tripura). Ethnic minorities or tribal communities possess distinct culture, language, religion, cuisine, dressing style, physical appearance and even landscape from the main land population 1, 2.

    In an women`s life reproductive age is identified as those child bearing years between menarche and menopause, roughly from ages 15 to 44 years. The term is imprecise, since some women can become pregnant and bear children at younger or older ages 3. This is one of the most vulnerable group in term of health and nutrition related issues. Blood loss during periods and delivery, extra nutritional requirements during pregnancy and lactation makes this age group a prime concern of any nation. Nutritional status is the current physical status of a person or a group of people in relation to their state of nourishment. Good nutritional status is considered as a reflection of superior standard of living and both social and nutritional awareness, it is not only a determinant but also an outcome of development. Anthropometry is the measurement of body height, weight and proportions of an individual and an efficient indicator of nutritional status 4.Previous studies 5, 6, 7, 8, 9 on ethnic people of Chittagong Hill Tracts were documented as malnourished, poor, uneducated and underprivileged because of their limited earning and employment opportunities, poverty, unhygienic housing and water sources, limited access to education and other necessary social and health services, most of which are almost two decades earlier. Nutritional status of ethnic reproductive women (15-40 years) in Chittagong Hill Tracts is not properly addressed yet in the context of present uprising economy of Bangladesh. Positive changes in socio-economic status (SES) could influence the nutritional status as well as food security. The aim of this study was to assess the prevalence of nutritional status of lactating (LW) and non-pregnant non-lactating women (NPNLW) of the CHTs and to find out the impact of their present socio-economic condition and different nutritional factors (e.g. food security, dietary calorie intake and nutritional knowledge) on nutritional status of the two groups of reproductive women.

    Materials and Methods

    It was a cross sectional study, conducted among the ethnic communities of both the urban and rural areas of Bandarban, khagrachori and Rangamati of the CHTs between the year 2013-2014. A total of 171 participants (85 lactating and 86 Non-pregnant non-lactating) were selected from 156 households as study sample to determine the nutritional status. Verbal permissions and written consent were taken prior the study. Study was approved by the ethical review board of the Biological Science, University of Dhaka. A well semi-structured questionnaire was developed and documented to record data on socio-demographic variables (e.g. age, educational attainments, occupation, marital status and income etc.) and nutritional variables (e.g. food security, dietary calorie intake and nutritional knowledge). ‘Nutritional status’ was assessed by the anthropometric measurements such as height, weight and mid-upper-arm circumference (MUAC) 10, 11, 12. The weight and height were measured by using digital ‘weight scale’ and manual ‘Height Scale’ respectively. Body Max Index (BMI kg/m2) was computed using the standard equation: BMI =Weight (kg) / height (m2) 11, 12. MUAC tapes were used to measure MUAC to the nearest 0.1 cm. MUAC cut off point (22.4 cm) was applied for evaluating nutritional status 4, 12.

    ‘Food security’ was measured using a set of questions addressing debt situation of the family 13. ‘Calorie intake and dietary patterns’ were assessed using a pretested food frequency questionnaire (FFQ) and one day 24-hour dietary recall. A set of standard measuring cups were used to estimate the quantity of food being consumed (serving size in grams). This method is used widely to compare nutrient intakes with specific dietary recommendations. Food conversion factors 14 were used to convert cooked food weight to raw food weight. Nutrients values were calculated per 100 g of raw food consumed by using the food composition database for Bangladesh 15, 16. Dietary calorie intake was compared with standard RDA value to obtain dietary adequacy 17. ‘Nutritional knowledge’ score was assessed by another set of questionnaire comprising 45 questions about nutrition (food groups, balanced diet, nutrient rich foods, nutritional diseases, food habit etc.) bearing one point for each right answer and zero for each wrong answer.

    Statistical Analysis

    Both statistical software packages (version 21.0 SPSS Inc. Chicago, IL, USA) and Microsoft excel were employed for data entry and analysis. Descriptive statistics and compare means were mainly used to analysis the data. Association of nutritional status of the ethnic reproductive women with socio-economic factors or nutritional factors (all categorical variables) were assessed by chi-square and fisher’s exact test. For quantitative variables the differences were tested using one sample t-test. P-value was set at 5% level of significance.


    In socio-demographic profile (table 1), Most (44.4%) of the tribal women were Marma, followed by Chakma (39.8%), Bam (8.2%) and Tripura (5.8%). Mean age of lactating women (LW) and non-pregnant-non- lactating women (NPNLW) was 26 y and 28 y respectively (P=.567) and vast majority of women of both groups were between 18-40 years old. It was also observed that most of LW (76.5%) and NPNLW (66.3%) were literate, married (91.3%), mainly involved in household chores (78.4%). Maximum families (87.0% -89.5%) of the two women groups (P=.530) earned more than 6000 BDT per month, and majority (86%-87%) were reported to be food secured throughout the year. Mean Dietary calorie intake (2631±798) of both groups were up to the mark according to the recommended dietary allowances (RDAs) and vast majority (80.3%-86%) of them also possessed good nutritional knowledge. However, no significant (P>0.05) differences were observed in dietary calorie intake (2731 vs. 2531 kcal) and nutritional knowledge score (33.8 vs. 35.4) between two women groups.

    Table 1. Socio-economic and Nutritional Variables of the Reproductive Ethnic Women
    Socio-economic variables Total % (N) Lactating women (n=85) % (n)  Mean± SD NPNL Women (n=86) % (n)  Mean± SD  P-value
    Tribe/ethnicity types           
    Marma 44.4 (76) 52.9 (45)   36.0 (31)    
    Chakma 39.8 (68) 41.2 (35)   38.4 (33)    
    Bam 8.2 (14) 0.0 (00)   16.3 (14)    
    Tripura 5.8 (10) 4.7 (04)   6.9 (06)    
    Tonchaonga 0.6 (1) 0 (00)   1.2 (01)    
    Others 1.2 (2) 1.2 (01)   1.2 (01)    
    Age group            
    15- 17 years  6.0 (10)  0.0(0)  26.40 ±4.8  11.6 (10)  28.40±9.0 t=-575
    18-40 years 94.0 (161) 100 (85) 88.4 (76) P=0.567
    Illiterate  28.6 (49)  23.5 (20)    33.7 (29)     χ2= 0.102
    Literate 71.5 (122) 76.5 (65)   66.3 (57)   P= 0.749
    Agriculture  7.0 (12)  4.7 (4)    9.3 (8)    χ2= 2.334
    House hold chores 78.4 (134) 90.6 (77)   66.3 (57)   P= 0.969
    Non-Agriculture 14.6 (25) 4.7 (4)   24.4 (21)    
    Marital status
    Unmarried  8.7 (15)  0.0 (0)    17.4 (15)     _
    Ever Married 91.3 (156) 100 (85)   82.6 (71)   -
    Family Income (BDT)
    <6000 11.7 (20) 13.0 (11) 17986.6 ±5768.9 10.5 (9) 18679.9±1901.7 t = -0.631
    ≥ 6000 88.3 (151) 87.0 (74) 89.5 (77) p = 0.530
    Nutritional variables            
    Food insecurity
    Never  86.5 (148)  87.0 (74)    86.0 (74)    χ2= 2.077
    Occasionally 13.5 (23) 13.0 (11)   14.0 (12)   P= 0.150
    aDietary Calorie Intake (kcal)       
    <RDA  20.5 (35) 18.8 (16) 2731.0 ±803.2 22.0 (19) 2531.0±790 t = 0.590
    ≥RDA 79.5 (136) 81.2 (69) 78.0 (67) p = 0.532
    Nutrition Knowledge Score           
    14-29 17.0 (29) 14.0 (12) 33.8 ±8.2 19.7(17) 35.4 ±6.0 t = -1.664
    30-45 83.0 (142) 86.0 (73) 80.3 (69) p = 0.100

    aRDA for dietary energy of lactating women17
    In 0-6 months of lactation, Sedentary worker – 1875 +550 kcal, Moderate worker- 2225+550 kcal
    In 6-12 months of lactation, sedentary worker – 1875 +400 kcal, Moderate worker- 2225+400 kcal
    aNPNL women, sedentary worker – 1875 kcal, Moderate worker- 2225 kcal

    Table 2 compared the anthropometric indices of the two women groups, no significant differences (P>0.05) were observed between mean BMI (22.1 vs. 22.6 Kg/m2) of the two groups. Overall, majority (68.4%) of women were in normal status (BMI 22.3±3.9 Kg/m2), 11.7% found to be underweight (BMI<18.5 Kg/m2) and 19.9% were overweight (BMI ≥25.0 Kg/m2). According to MUAC measurements, 87.2% participants had the MUAC ≥22.4 cm and were considered to have normal weight.

    Table 2. Anthropometric Indices and Nutritional Status of the Ethnic women
     Parameters Lactating Woman (n=85) NPNL Woman (n=86) P-value All (n=171)
    % (n) Mean± SD   % (n) Mean± SD % (n)  Mean± SD 
    Height (cm)              
    126-150 46.0 (39) 147.7±2.4 48.0 (41) 145.2±7.4 t=-1.259 p=0.211  151.5 ± 6.7
    151-180 54.0 (46) 156.4±4.3 52.0 (45) 155.4±3.0 p=0.211 53.2 (91)
    Total  100 (85) 151.6±5.7 100 (86) 150.5±7.5     100 (171)
    Weight (kg)              
    31-50  55.0 (47)  44.5±4.2  52.0 (45)  45.4±3.7  t =0.288  53.8 (92)  
    51-75 45.0 (38) 58.7±6.4 48.0 (41) 57.5±5.6 p=0.774 46.2 (79) 51.1 ± 8.3
    Total 100 (85) 50.9±8.7 100 (86) 51.1±7.7   100 (171)
    MUAC (cm)              
    <22.4 cm  13.0 (11)  21.5±0.5  13.0 (11) 21.2±0.4  t =0.824  12.8 (22)   25.4± 2.6
    ≥22.4 cm 87.0 (74) 25.7±2.5 87.0 (75) 26.3±2.1 p=0.412 87.2 (149)
    Total 100 (85) 25.4±2.75 100 (86) 25.6±2.6   100 (171)
    BMI (kg/m 2 )           t =1.249     22.3 ± 3.9
    <18.5  11.0 (9)  16.5±1.2  13.0(11)  17.3±1.7  11.7 (20)
    18.5-24.99 71.0 (60) 21.2±1.8 66.0 (57) 21.9±1.8 68.4 (117)
    ≥25.0 18.0 (16) 27.4±2.4 21.0 (18) 28.1±51 p=0.215 19.9 (34)
    Total 100 (85) 22.12±3.4 100 (86) 22.6±4.3 100 (171)

    Significant: p<0.05, Descriptive statistics, Compare mean: One sample t-test

      Table 3 demonstrates the relationship of nutritional status (categories of BMI Kg/m2) of ethnic people with their socio-economic variables, food security, dietary calorie intakes and nutritional knowledge. It was noticed that better nutritional status of lactating and NPNL women were significantly associated with literacy (P<0.05), occupancy in household chores (P<0.05), better income (P<0.05), food security (P<0.05), recommended calorie intake level (P<0.05) and better nutritional knowledge score (P<0.05). Association of nutritional status with age and marital status of LW could not be established as cell values of both ‘15-17 age group’ and ‘unmarried status’ were zero. However, no significant association of Age and marital status with nutritional status of NPNL women was found (P>0.05).

    Table 3. Association of the Nutritional Status of Ethnic Women groups with their Socio-economic and Nutritional Factors
    Socio-economic status BMI (Kg/m 2 )
    Lactating Woman (n=85) P-value (Fisher’s exact test) NPNL Woman (n=86)     P-value (Fisher’s exact test)
    Low (<18.5) Normal (18.5-25) overweight (≥25) Low (<18.5) Normal (18.5-25) overweight (≥25)
    Age in years       constant        
    15-17 years - - - 3 6 1 χ2=2.982
    18-40 years 90 60 16 8 51 17 p=0.227
    Illiterate 6 10 4 χ2=9.343 8 17 4 χ2=8.176
    Literate Literate 3 50 12 p=0.00 3 10 14 p=0.02
    Agriculture 3 1 0 χ2=10.146 5 2 1  
    Household chores 6 56 15 p=0.02 4 41 12 χ2=13.084
    Non-Agriculture 0 3 1   2 14 5 p=0.00
    Marital status       constant        
    Unmarried - - - 4 9 2 χ2=3.064
    Ever married 9 60 16 7 48 16 p=0.222
    Income (BDT)                
    <6000 4 7 0 χ2=8.236 4 5 0 χ2=7.798
    ≥ 6000 5 53 16 p=0.01 7 52 18 p=0.01
    Nutritional factors              
    Food insecurity                
    Never 5 55 14 χ2=7.178 7 49 18 χ2=6.959
    Occasionally 4 5 2 p=0.02 4 8 0 p=0.02
    Calorie intake                
    <RDA 6 8 2 χ2=11.502 2 9 8 χ2=6.027
    ≥RDA 3 52 14 p=0.00 9 48 10 p=0.049
    Nutrition Knowledge Score                
    14-29 4 7 1 χ2=6.182 5 11 1 χ2 =6.247
    30-45 5 53 15 p=0.03 6 46 17 p=0.04

    Significant p<0.05


    This study postulates that overall 68.4% ethnic reproductive women had normal BMI (18.5-24.99 kg/m2), 11.7% were thin or having Chronic Energy Deficiency (CED) (BMI <18.5 kg/m2) and 19.9% were overweight (BMI ≥ 25 kg/m2). The average dietary calorie intake (2631 kcal) and normal BMI (22.3 ± 3.9 kg/m2) of ethnic LW and NPNLW of this study indicate better socio-economic profile, food security and quality dietary, educational attainment of ethnic participants than previous records 6, 7, 8, 9 which collectively upgrade the nutritional status of these women groups. This results are somewhat similar with other studies 18, 19. Study 18 conducted by Haque and Akhter(2014)among both the male and female members of ethnic communities in CHTs showed better nutritional status of ethnic minorities where prevalence of underweight, normal weight and overweight was 4.7%, 78%, and 17.3% respectively, while previous ‘Nutrition and Health Surveillance in the Chittagong Hill Tracts, 2000’ conducted by Helen Keller International (HKI) 5 observed that chronic energy deficiency among Non-pregnant women was 27%. Other dietary factors (data were not shown) those contribute for better nutritional status of these women groups could be their more intake (56.0-63.7%) of green leafy vegetables (GLVs) and non-leafy vegetables (50.3% -59.1%) especially at lunch and milk consumption (17-21.1%) than Bengalese. However, their meat (1.8-8.8%) and fruit (0.6-3.5%) consumption was poor and their rice consumption patterns are similar to Bengalese. Prevalence of common non-communicable diseases was very low in CHTs ethnic community than Bengalese.

    This study showed mean family income was 18,822.2 BDT and majority (86%-87%) were reported to be food secured throughout the year and only 13.5% were food insecure occasionally which are also reflected in Nutrition, Health, Demographic Survey, Bangladesh (2013)19 where higher mean family income documented for CHTs that exceeded the national average household income and expenditure. This is also indicating a major alleviation of living standards of the ethnic people in the CHTs. However, two decades earlier study 6 indicated that 77.25% ethnic households were not food secured and Barakat et al (2009) 7 showed monthly family income and expenditure of ethnic people were 5,200 and 4,750 BDT respectively.

    Globally a large number of studies 20, 21, 22, 23, 24, 25, 26 addressed tribal community, asserted that they are at the lowest stratum of the society due to geographical and cultural isolation, low levels of literacy, multiplicity of the language, high levels of poverty etc. Neighbouring country India where almost half of the world’s tribal population (called scheduled tribe) resided 20 and majority of the studies 20, 21, 22, 23, 24, 25, 26 conducted in India reported that the socioeconomic and nutritional status (both anthropometric and dietary) of these ethnic minorities were not up to the mark and worse nutritional situation prevails than ours. Nutritional knowledge of the tribes was reported also unsatisfactory than ours 20.

    Over many years, the ethnic people of Chittagong Hill Tracts had suffered from a lot of political (25 years of civil war, which formally ended in 1997 with the signing of a peace accord with Government of Bangladesh), economic and social problems. Post war, area’s remoteness, poor communication and unique socio-economic characteristics, multiplicity of languages have made it difficult to provide basic social services to inhabitants of the CHTs. Thus, CHTs had largely been excluded from mainstream development programmes in Bangladesh. Access to the CHTs was especially challenging for international staff 27. Earlier studies 5, 6, 7, 8, 9 on ethnic people of Chittagong Hill Tracts were documented as poor, malnourished, underprivileged, neglected, food unsecured, deprived from basic needs, no health services and job opportunities, and mostly (64%) lived in lower socio economic standards by Jhum cultivation (primitive techniques by burning the trees which made lands infertile and imbalanced the eco-system and created huge environmental damages) followed by agriculture labor (12.5 %).

    Previously literacy rate in the CHTs was also lower than that national level and seven out of every ten women in the CHTs were illiterate. Earlier survey 7 reported that 54.5% of the ethnic household heads had no formal education and 53.9% of the ethnic people were illiterate. But in the last couple of years this scenario has been changed, which also reflected in this study and showed 71.5% literacy rate, more than half (57.3%) of which completed secondary education. Compared to previous surveys 7, an acceleration of literacy rate is seen in another study 18 among ethnic people of the CHTs that showed 63.3% literacy rate. This increased literacy could be the outcomes of various projects and services like – provision of new schools, mother language based multi lingual pre-primary education and new recruitment and training of teachers provided for ethnic people in the CHTs by local, national and international NGOs.

    For many years various development projects 27, 28, 29, 30, 31, 32, 33 being run by either government or local or international NGOs to accelerate the lifestyle pattern of ethnic communities in the Chittagong Hill Tracts, which also reflected through their current better nutritional status in present study. Different development programmes were running during data collection and every ethnic household in the CHTs is currently under some kind of development project conducted by either local NGOs or international NGOs. Thus the road of progress was slow and difficult for these ethnic people but gradually these developmental projects and programs had helped ethnic communities of CHTs to upgrade their socio-economic status, offered them an improved living standards (quality education, quota facilities both in higher education and government jobs, various job opportunities, better health care facilities, freedom of expression). The improvement in standard of living of the ethnic people of CHTs is more or less evident and obvious. Thus, comparing previous records, a conclusion can be made that there has been an increasing trend in improving the nutritional status of the ethnic reproductive women of CHTs over the decades.


    Ethnic people are in a better nutritional status than reported before. Prevalence of chronic energy deficiency are lower than that of overweight in both groups. Upgraded socio-demographic status in CHTs ensured better nutritional status. Economic stability, high literacy rate, food security, adequate food intakes and proper nutrition knowledge appears to be the important fundamental factors responsible for better nutritional status of the ethnic reproductive women in Chittagong Hill Tracts.


    Authors are grateful to ethnic participants of three districts of Chittagong Hill tracts for their support in data collection on socio-demographic and nutrition related information. They showed much patience while measuring anthropometric indices.


    No funding was received for this study.


    1.Peoples James, Bailey Garrick. (2012) Humanity: an introduction to cultural anthropology [electronic resource] - 9th edition.Belmont,CA Wadsworth,Cengage Learning xvii,476. [accessedMarch,2020]
    2.Haque M M, Islam K. (2018) Socio-economic condition, dietary pattern and nutritional status of pre-school ethnic children in Bandarban district of Bangladesh. , J Nutritional Health & Food Engineering 8(6), 395-402.
    3.US Census Bureau. (2010) census of population and housing [collection of documents] Washington DC: US Census Bureau;. [AccessedJuly19,2019]. [Google Scholar]
    4.Jelliffe D B. (1996) The assessment of the nutritional status of the community (with special reference to field surveys in developing regions of the world; prepared in consultation with twenty-five specialists in various countries).WHO.
    5. (2003) Helen Keller International (HKI). Nutrition and Health Surveillance in the Chittagong Hill Tracts. Nutritional Surveillance Project Bulletin No.13May2003 .
    6.Dutta J P. (2000) . Impact of Development Programmes on Environment and Demographic Phenomena of the Ethnic Minorities of Chittagong Hill Tracts. UNFPA, CPD. .
    7.Barakat A, Halim S, Poddar A, Badiuzzaman M, Osman A et al. (2009) Socio-economic Baseline Survey of Chittagong Hill Tracts, Human Development Research Center. , Dhaka. UNDP, Bangladesh
    8.Roy R D. (2012) Country Technical Notes on Indigenous Peoples’ Issues: People’s Republic of Bangladesh. (AccessedMarch,2020) , IFAD, AIPP
    9.D M Hossain. (2013) Socio-economic Situation of the Indigenous People in the Chittagong Hill Tracts (CHT) of Bangladesh. , Middle East Journal of Business 8(2), 22-30.
    10. (2018) World Health Organization. BMI classification. (Retrieved15February)
    11. (2004) WHO expert consultation (2004). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. The Lancet. 157-163.
    12.Johnston R. (2009) Anthropometry Tools and Use. UNICEF-WCARO. (Accessed2019May)
    13.Bickel G, Nord M, Price C, Hamilton W, Cook J. (2000) Guide to Measuring Household Food Security. USDA, Food and Nutrition Service Office of Analysis, Nutrition, and Evaluation Measuring Food Security in the United States OR
    14.SMK Ali, Praminik M A. Institute of Nutrition and Food Science, University of Dhaka (1991) Conversion Factors and Dietary Calculation. , Bangladesh
    15.Islam S N, MNI Khan, Akhtaruzzaman M. (2010) Food Composition Database for Bangladesh with Special reference to Selected Ethnic Foods.›sites›default›files›Finalreport
    16.Shaheen N, ATMA Rahim, Mohiduzzaman M, Banu C P, Bari M L et al. University of Dhaka (2013) Food Composition Table for Bangladesh. Institute of Nutrition and Food Science and Centre for Advanced Research in Sciences , Dhaka-1000, Bangladesh .
    17. (2009) National Institute of Nutrition,Indian Council of Medical Research.Hyderabad. Nutrient Requirements and Recommended Dietary Allowances for Indians.A report of the expert group of the Indian Council of Medical Research.
    18.Haque M M, Akhter F. (2014) Nutritional Status of Three Ethnic Communities in Hilly Area: anthropometry is the key. , European Academic Research Vol. II, 10.
    19.Akhtaruzzaman M, MNI Khan, Akhter F, SKN Islam. (2013) Nutrition, Health, Demographic Survey. (NHDS, BD-2013). Institute of Nutrition and Food Science,University of Dhaka. , Bangladesh .
    20.Joshi D, Raghav P K. (2019) Food intake of tribes in Rajasthan: A review. , The Pharma Innovation Journal 8(6), 753-756.
    21.MSDP Nayak, Sreegiri S. (2016) A study on nutritional status of tribal women in Visakhapatnam district. , Andhra Pradesh, India. Int J Community Med Public Health 3, 2049-2053.
    22.Lamba A, Garg V. (2018) Nutrition Profile of the Tribal (Bhoksa) Women in Bijnor District, Uttar Pradesh. International Journal of Science and Research (IJSR)Volume7Issue4 DOI: 10.21275/ART20181282 .
    23.Ninama R, Sharma V. (2016) The evaluation of the most important anthropometric variables of tribal women of Banswara district. , Rajasthan (india), Int J Biol Med Res 7(2), 5569-5573.
    24.Dave P H, Mistry J J, Chaudhary M K. (2019) . Nutritional Status and Food Consumption Pattern of Tribal Farm Women of Sabarkantha.Int.J.Curr.Microbiol.App.Sci.8(3): 2239-2245.
    25.Mohandas S, Amritesh K, Vasudevan S LaisH, AjithakumariS. (2019) Nutritional assessment of tribal women in Kainatty, Wayanad: A cross-sectional study. , Indian J Community Med 44(5), 50-53.
    26.Hamid T, Vaida N. (2017) A study on nutritional status of scheduled tribe (Gujjar and Bakerwal) women of Kashmir. , International Journal of Home Science 3(3), 203-205.
    27.Bangladesh UNICEF.. MANY TRACTS ONE COMMUNITY UNICEF’S Work in the Chittagong Hill Tracts. (AccessedMarch,2020) .
    28. (2010) Asian Development Bank, ADB Technical Assistance Consultant’s Report. Second Chittagong Hill Tracts Rural Development Project (CHTRDPII). Chittagong Hill Tracts development facility. (Accessed2019).
    29.The Ministry of Chittagong Hill Tracts Affairs of Bangladesh. chapter-19. Section- 2: Improving Women's Productivity and Participation in Labour Market. Gender Budgeting Report 2018-2019. (Accessed2019) .
    30.Minj A, Khakshi J W. (2015) Mapping BRAC Development Activities Relating To Indigenous Peoples. Integrated Development Programme, BRAC. (AccessedMarch,2019)
    31.UNDP. (2017) Bangladesh. For development of CHT over 31 million US dollars hittagong-hill-tracts-development-facility.html (AccessedMarch,2020).
    32. (2011) The Government of People’s Republic of Bangladesh (2011). Tribal/Ethnic Health Population and Nutrition Plan for the Health, Population and Nutrition Sector Development Program (HPNSDP). to 2016. http:// (AccessedMarch,2020)
    33.ASM Sayem.Best practices & alternative integrated community based model in delivering primary health care service for Chittagong hill tracts of Bangladesh. (AccessedMarch,2020)