Editorial: Eliminating malnutrition holds key

Nikshay Poshan Yojana for those diagnosed with TB is grossly inadequate to take care of the nutritional requirements

Malnutrition is the culprit in many diseases. Tuberculosis, an infectious disease caused by bacteria, is one of them. In a country like India, where undernutrition is rampant, particularly among children, eradicating TB continues to be a major challenge. The link between diet and the fatal disease is well known. The latest Lancet study, covering many patients in Jharkhand, has confirmed this link. The study demonstrated that a good diet not only reduces the incidence of the disease among vulnerable people living with infected people, but it also brings down mortality in TB patients. It was found that early weight gain in people with this bacterial disease lowers the risk of mortality by 60%. The findings have significant policy implications for the TB elimination programme of the country that has the highest burden of the disease in the world. India recorded three million new TB cases and 4.94 lakh deaths in 2021, representing 27% of the global TB incidence and 35% of deaths. The results of the Reducing Activation of Tuberculosis by Improvement of Nutritional Status (RATIONS) trial, published in the Lancet on August 8, show that improved nutrition in family members of lung TB patients reduced the incidence of all forms of TB by 40% and infectious TB by nearly 50%. A recovered patient with a poor diet has a serious chance of a relapse. An international team of researchers enrolled household contacts of 2,800 patients with confirmed pulmonary tuberculosis across 28 TB units of the National Tuberculosis Elimination Programme in four districts of Jharkhand. Experts recommend that eliminating TB requires improving the living conditions of patients and their families.

In India, the National Tuberculosis Elimination Programme (NTEP) recognises the need to improve nutrition and under the ‘Nikshay Poshan Yojana’ an amount of Rs 500 is given every month to those diagnosed with TB. This is grossly inadequate to take care of the nutritional requirements. The NTEP guidelines recommend that a tuberculosis patient consume 2,800 calories every day. The severe form of the disease can often incapacitate a patient for long periods and result in livelihood losses and financial strain to families. Nikshay Poshan is a half-hearted attempt at addressing one of the root causes of the problem. The scheme has also been dogged by systemic challenges. A 2020 study in the Indian Journal of Tuberculosis reported that healthcare providers complained of a lack of training and complex reporting formats as the main hurdles in the implementation of the scheme. Low patient awareness has also affected the nutritional programme’s reach. The government has plans to eliminate TB by 2025, a target considered by experts as too ambitious. The Lancet study offers important cues and underlines the need to make sure that people have a healthy diet of proteins, carbohydrates and micro-nutrients. The findings can have implications at the policy implementation level.

---