Context

Historical importance of good nutrition was ignored by the modern therapist who tried to control TB initially with streptomycin injection, isoniazid and para-aminosalisylic acid. In the ecstasy of finding antibiotics killing the germs, the social determinants of disease were ignored.

Lack of patient-centric TB treatment

• With more drug arsenals such as rifampicin, ethambutol, pyrazinamide, the fight against TB bacteria continued, which became multidrug resistant.
• The regimes and the mode of delivery of drugs were changed to plug the loopholes of non-compliance of patients.
• Blister packs of a multi-drug regime were provided at the doorstep, and the directly observed treatment/therapy (DOT) mechanism set up.
• Many of the poor discontinued blister-packaged free drugs thinking that these were “hot and strong” drugs not suited for the hunger pains they experienced every night.

Role of nutrition in dealing with TB

• India has around 2.8 million active cases. It is a disease of the poor.
• And the poor are three times less likely to go for treatment and four times less likely to complete their treatment for TB, according to WHO, in 2002.
• The fact is that 90% of Indians exposed to TB remain dormant if their nutritional status and thereby the immune system, is good. 
• When the infected person is immunocompromised, TB as a disease manifests itself in 10% of the infected.
• The 2019 Global TB report identified malnutrition as the single-most associated risk factor for the development of TB, accounting for more cases than four other risks, i.e., smoking, the harmful use of alcohol, diabetes and HIV.
• The work and the findings of a team at the Jan Swasthya Sahayog hospital at Ganiyari, Bilaspur in Chhattisgarh established the association of poor nutritional status with a higher risk of TB.

Way forward

• Chhattisgarh initiated the supply of groundnut, moong dhal and soya oil, and from April 2018, under the Nikshay Poshan Yojana of the National Health Mission.
• All States began extending cash support of ₹500 per month to TB patients to buy food. This amount needs to be raised.
• Nutrition education and counselling support: Without simultaneous nutrition education and counselling support, this cash transfer will not have the desired outcome.

Conclusion

Food is a guaranteed right for life under the Constitution for all citizens, more so for TB patients. Thus, the goals of reducing the incidence of TB in India and of reducing TB mortality cannot be reached without addressing undernutrition.

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