Health and Nutrition in the Tarahumara of Northern Mexico Studies among Women and Children

Abstract: Belonging to an indigenous group in Mexico is usually associated with poor health, mainly as the result of social isolation from the mainstream society. The Tarahumara are no exception. They constitute the largest indigenous group in northern Mexico and one of the most marginalized ethnic minorities in North America. Health conditions are precarious, yet very little data are available to facilitate the design and implementation of programs to prevent and manage the main public health problems affecting this people. This thesis aims at overcoming part of this information gap. It presents and discusses the results from studies focusing on the nutrition of women and children carried out between 1997 and 2002.A survey in a representative district sample of Tarahumara women of reproductive age found the highest prevalence of anemia among pregnant women in their third trimester (38.5%) and those lactating during the first 6 months after delivery (42.9%), along with a high prevalence of iron deficiency. In this study a technique was developed to collect capillary serum samples spotted onto filter paper to measure serum ferritin in remote settings. In the same study, 52.5% of adult women were overweight, suggesting a process of ‘de-Indianization’ of their traditional diet and activity patterns. This issue was followed-up in a later study based on perceptions of food and body shape using cognitive anthropological methods. Speaking Spanish emerged as a clear indication of acculturation that could be associated with an increase in the prevalence of obesity and its consequences. A nutrition survey among Tarahumara children at boarding schools found evidence of zinc, vitamin B12, iron, and iodine deficiencies but found similar anthropometric status to other rural Mexicans. Finally, a qualitative assessment was carried out to identify culturally accepted foods to redesign a food aid basket aimed at alleviating malnutrition among young Tarahumara children.The results from this thesis provide relevant data for an improved design of interventions to combat and prevent some of the nutritional problems that affect the Tarahumara. These data could also constitute a baseline to which future changes can be compared if similar sampling strategies are used. Overall, the findings highlight the importance and challenge of achieving modernization in a way that not only improves health but at the same time supports, maintains and encourages traditional cultural values. These are not only the foundations of the Tarahumara society, but in some cases also contribute to a better diet and health.