Although not confined to tribal peoples, the disease is especially common among them occurring widely in Gujurat, Maharastra, Madhya Pradesh, Chhattisgarh and Orissa States in central India and another focus of the gene occurs in the north of Tamil Nadu and Kerala in southern India. The tribal peoples generally live in remote rural communities presenting special challenges in the delivery of education and health care. Associated with the Asian haplotype, high levels of fetal haemoglobin and frequently alpha thalassaemia, mild clinical features might be expected but the pattern of disease in this environment remains largely undocumented.