- Mention the facts of TB disease in India.
- Discuss the relation b/w poor nutrition and TB.
- Measures to be taken to address the issue.
India reported a 19% jump in the TB cases in 2021 over the previous year. Simultaneously, there is an increase in the mortality rate due to all forms of TB by 11% (2019-2020). According to Global TB Report 2021, the estimated incidence of all forms of TB in India stands at 188/1 lakh population.
Despite several medicinal intervention, TB cannot be controlled. It is in this context, that the words of American Medical Association holds relevant – “it is most unlikely that drugs alone or drugs supplemented by vaccine can control TB, unless their nutritional status has not been raised to a reasonable level”.
The 2019 global TB report identified malnutrition as the single-most risk factor for the development of TB. TB mainly affects the poor, who are not only malnourished but are also less likely to go for treatment and even less likely to continue treatment. Few research pointed that out of 1,695 pulmonary TB patients, men had an average body weight of 42.1 kg and BMI of 16; while for women, average body weight is 34.1 kg with BMI of 15. With such levels of under nutrition, there has been 2-4 fold rise in mortality associated with TB.
The fact is 90% Indians exposed to TB can remain dormant if their nutritional status and immune system are good. In immunocompromised people, TB manifest in 10% of the infected. India has around 2.8 million active cases now.
“Undernutrition” and TB are “syndemics”. Intake of adequate balanced food is a sine qua-non in preventing TB. Protein rich diet consisting of eggs, milk, dal, grams, etc. must be included. In this respect, the directives given in the Health Ministry’s “Guidance Document – Nutritional Care and Support for Patients with Tuberculosis in India” should be strictly adhered to. The outreach of nutritional support, especially to the poor, must be extended by coupling it with various government schemes. E.g. Chhattisgarh has initiated supplying ground-nut, moong dal, soya oil under the Nikshay Poshan Yojana of the National Health Mission. All states are extending cash support of Rs. 500/month to TB patients to buy food. However, this amount needs to be raised. Without nutrition education & counselling support, cash transfer alone will not give the desired outcome.
India aims to eliminate TB by 2025 according to National Strategic Plan for Elimination of Tuberculosis (2017-25) and 18 states have committed to ending TB by 2025. Although the targets seem stark, yet, the goals of reducing TB incidence & TB mortality cannot be reached without addressing undernutrition.