Feed the cure: On paying TB patients 

Feed the cure: On paying TB patients 

Context

Giving TB patients money for an enhanced diet is a good step — but oversight is crucial

What

The Central TB Division has said the government would hand over a sum of ₹500 a month to each of India’s 35 lakh diagnosed TB patients in order to strengthen the fight against the disease.

Why

The funds are intended to offset the loss of wages due to TB, and to help with travel and nutrition.

Malnutrition and TB

An early study from a prisoner-of-war camp in Germany in the 1940s showed that Soviet inmates, who didn’t receive extra rations from the Red Cross as their British counterparts did, were around 16 times more likely to develop the disease.

Loss of Appetite

It is a vicious cycle, because TB itself triggers malnutrition by hurting the patient’s appetite. One calculation suggests that half of all adult Indian TB patients get the disease due to malnutrition.

Lack of Data

• Sadly, despite the evidence on the TB-diet link, it is still not clear how best to fix the problem, given the lack of research into interventions that can speed up recovery
• A few small-scale studies have looked at cure rates among those patients consuming cereal-lentil powders or micronutrients such as Vitamin A and zinc, with mixed results.

But lack of data isn’t a justification for inaction.

Guidance document recommendations

In a guidance document this March, the Central TB Division proposed extensive interventions to tackle the problem

• Double the Rations

One recommendation was to double the rations under the public distribution system to families of TB patients, so that they are less likely to contract the disease

• Supplements

Because TB patients also need a high protein intake, the document recommends a second set of supplements, such as oilseeds and dried milk powder, which they wouldn’t have to share with the family

Rs. 500 is not enough

Given these recommendations and the scale of India’s malnutrition problem, the proposed assistance of ₹500 may not make any dent, especially if patients are not counselled on their ideal diet.

Questions Raised

India needs to fine-tune these interventions with further evidence so that policy can be more precisely targeted. Do pre-packaged protein powders work better than rations of cereals and pulses? Do TB patients need more of certain vitamins and minerals than healthy people do? These are difficult questions to answer.

Recent Study might offer some insight

A recently announced 2000-subject study by the Indian Council of Medical Research in Jharkhand may go some way in plugging this knowledge gap, but more research is required.

Conclusion

A better diet is a no-brainer for an illness like this, historically called “Consumption” because of how it ate away at patients. But understanding what constitutes such a diet, and making sure that patients get it, isn’t as straightforward.