Undernutrition Linked to High Number of TB Cases in India
Undernourishment is a major contributing factor to the prevalence of tuberculosis (TB) in India. A study conducted in 2022 revealed that 45% of people in India are undernourished, resulting in nearly 1.2 million TB cases annually. Shockingly, nutrition support programs for TB patients were only introduced in 2018 with the launch of Nikshay Poshan Yojana, a direct benefit transfer scheme providing Rs.500 per month for the duration of treatment.
Efforts to Address Nutritional Needs of TB Patients
In an attempt to combat the problem, India implemented the Ni-kshay Mitra nutrition support program in September 2022. The state of Tamil Nadu has also taken steps to reduce the mortality rate among TB patients by launching the Differentiated TB Care program in 2022. Notably, severe undernutrition is one of the parameters used for triaging TB patients during diagnosis.
High Prevalence of Undernutrition Among TB Patients
Triage data from the Differentiated TB Care program in Tamil Nadu revealed that 52% of notified TB patients in the region suffered from undernutrition, with 25% experiencing severe undernutrition. This suggests that the situation may be even worse in northern states with higher levels of undernutrition in the general population. It is crucial to address the nutrition status of TB patients as it reflects the overall nutrition level of their families.
Importance of Nutrition Support for Family Members
Despite the efforts to provide nutrition support to TB patients, these initiatives currently only focus on reducing mortality among patients and not on preventing TB disease in their family members. The 2017 guidance document on nutritional care and support for TB patients recommended providing family members with a “food basket” to address their food insecurity, chronic energy deficiency, and high risk of contracting TB. However, this recommendation has not been implemented yet.
A trial called RATIONS conducted in Jharkhand emphasized the significance of extending nutrition support to family members to prevent TB disease. The trial showed that nutritional support reduced the incidence of TB disease among household contacts by 39% to 48%.
Challenges and Limitations of Current Nutrition Support Programs
According to the India TB report 2023, out of the 2.4 million notified TB cases, only 1.6 million (66%) received at least one month’s payment under the Ni-kshay Poshan Yojana program in 2022. There has been minimal progress in increasing the number of program beneficiaries over the last three years. In 2021, only 62.1% of the 2.1 million notified cases received any payment, and a similar rate was observed in 2020.
The statistics for Delhi, which has the highest TB burden rate in India, are particularly concerning. In 2022, only 44% of beneficiaries in Delhi received at least one payment. Uttar Pradesh, Madhya Pradesh, and Gujarat, which have high case notification rates, also faced challenges in ensuring payments to program beneficiaries, with only 64%, 82%, and 63% respectively receiving at least one payment.
Barriers to Nutritional Support for the Poorest
A retrospective cohort study conducted in January-September 2019 found that the assistance provided by the Ni-kshay Poshan Yojana program did not reach the poorest individuals who require nutritional support the most due to a lack of basic documents. It was also observed that there was a delay of 56 days in receiving the first installment, and 49% of patients received the last installment after completing their treatment. Some TB patients perceived the assistance provided by the program as insufficient to purchase nutritious food throughout their treatment duration.
Efforts need to be made to ensure that nutrition support programs reach the most vulnerable individuals and that the assistance provided is adequate to meet their nutritional needs. Furthermore, expanding the scope of these programs to include family members can help prevent the spread of TB disease and address the overall well-being of affected individuals and their households.
