Nutritional security is vital in the fight against TB

Two silent epidemics, of tuberculosis (TB) and malnutritionthey have been working together and devastating India for decades. The approach to address TB in India and worldwide it has been mainly clinical. Not surprisingly, health systems, programs, and policies have focused primarily on the control of tuberculosis bacteria.

What is overlooked, however, is that the latent tuberculosis bacteria they are still present in the millions, especially in high load countries like India. However, TB does not show up in everyone who carries the bacteria. Why did this happened?

This is because the mere presence of the bacteria may not trigger active TB disease. But other ‘risk factors’ and ‘comorbidities’, including malnutrition, can increase the chance that latent bacteria will manifest as TB disease.

In India, both tuberculosis and malnutrition exist on a large scale. So when they work together, the results are devastating. COVID-19 brought India and the rest of the world to a standstill, dominating the headlines. In the chaos, we forget that India has a long-standing malnutrition problem that could be made worse by the pandemic. We also overlook the possible impact it could have on TB.

disease severity

How do tuberculosis and malnutrition work together? Poverty and the resulting malnutrition increase the chances of active TB in someone who carries the bacteria, and also the severity of the disease. It reduces the speed of recovery of patients, exacerbates the side effects of the drug and increases the probability of death.

Also read: Comment | How to combat malnutrition

So while TB treatment in India may have increased substantially, it is unlikely that we will be able to control the TB epidemic if we ignore the causal relationship between malnutrition and TB. Despite India’s economic progress, even today a growing number of people remain undernourished and food insecure, particularly children, women, tribal people and other economically marginalized populations. By some estimates, malnutrition accounts for nearly 55% of annual TB cases in India.

When malnutrition is combined with other causes, the overall incidence of diseases such as tuberculosis can increase. As employment opportunities remain limited in India and people migrate to other states in search of work, these challenges are sure to increase. Not only that, low nutritional levels can often lead to worsening of various side effects faced by TB patients. Survivors and patients reported vision loss, severe limb weakness that led to prolonged bed rest, constant fatigue, and body pain as effects they experienced.

Role of governments

So what can we get governments to do? A few years ago, India launched Nikshay Poshan Yojana (NPY), a nutritional support program for tuberculosis patients who cannot afford enough nutritious food. This well-intentioned outline is a case study of why good intentions are insufficient. The design and conceptualization of the scheme were finalized without consulting the survivors. Furthermore, its implementation is fraught with challenges, including delays or non-receipt of payments, and excessive documentation demands. There is no doubt that the amount under NPY, Rs. 500, is insufficient and should be increased for all patients to at least Rs. 2,000. Whenever possible, state-specific ration assistance plans for patients are also warranted.

Why is this urgently needed? Even with government assistance, 50% of TB patient families suffer financially devastating expenses as they struggle to meet their nutritional and medical needs, pushing them further into poverty and the disease trap. We must also recognize the rural, local and regional shortcomings of this scheme. In the end, if the goal of the NPY is to benefit the most vulnerable, we are failing. We need to ensure that people affected by TB follow a balanced and adapted diet.

Also read: Comment | Nearly 18 lakh children in India severely malnourished: Center

Eliminating tuberculosis

India has made bold claims about eliminating TB by 2025. While the COVID-19 pandemic has clearly displaced this goal, it is unlikely that we will be able to control TB if we do not address malnutrition as a preventive and curative tool. Ensuring that the nutritional needs of India’s populations are met is critical, and the path to achieving this is through food security. We need to focus on making our populations food secure and healthier, not just providing diagnosis and treatment. If we continue to neglect the nutritional needs of our populations, we may be creating a longer-term disaster than we can handle in the future.

Deepti Chavan is a member of Survivors Against TB; Chapal Mehra is a specialist in public health.