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Context: The nutrition of the individual is the most vital factor, in the prevention of tuberculosis, along with drugs. It is most unlikely that drugs alone can control TB with low nutritional status in a person.
What are the learnings from History?
There were no drugs for TB till the discovery of streptomycin in 1943. With improved wages and the higher purchasing power for food, the TB mortality rate came down from 300 people per 1,00,000 population to 60 in England and Wales.
TB disappeared from socio-economically developed countries long before the advent of chemotherapy. After the Second World War, in 1946 G.B. Leyton reported a 92% reduction in the incidence of TB among British soldiers. They were fed an additional Red Cross diet of 1,000 calories plus 30 grams of protein when compared to Russian soldiers who were fed only a camp diet.
What is the current approach for tackling T.B?
The modern therapist tried to control TB initially with streptomycin injection, isoniazid, and para-aminosalicylic acid. In the ecstasy of finding antibiotics killing the germs, the social determinants of disease were ignored.
With the use of more drugs, TB bacteria become multidrug-resistant.
There was little done to try to understand where patients lived, what work they did for a living, how much they could afford to buy food, and how much they ate.
Why should we focus on improving the nutritional intake of individuals?
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.
Various studies have shown a positive relationship between nutrition intake and TB reduction. For instance,
1.) The findings of a team at the Jan Swasthya Sahayog (JSS) hospital at Ganiyari, Bilaspur in Chhattisgarh established the association of poor nutritional status with a higher risk of TB. In the period 2004-09, among the 1,695 pulmonary TB patients they treated, men had an average body weight of 42.1 kg and a body mass index (BMI) of 16.
2.) 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.
3.) Many experts like Dr. Anurag Bhargava (professor of medicine) have deduced that “undernutrition and TB” are “syndemics”. Therefore, the intake of adequate balanced food, especially by the poor, can work as a vaccine to prevent TB.
Note: A syndemic is a situation in which two or more interrelated biological factors work together to make a disease or health crisis worse.
What are some steps taken to improve nutritional status?
The central TB division of the Ministry of Health came up with a “Guidance Document – Nutritional Care and Support for Patients with Tuberculosis in India” in 2016.
A number of organizations began providing eggs, milk powder, dhal, Bengal gram, groundnuts, and cooking oil to diagnosed patients along with anti-TB drugs.
From April 2018, under the Nikshay Poshan Yojana of the National Health Mission, all States began extending cash support of Rs. 500 per month to TB patients to buy food.
Conclusion
The food vaccine 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.
Source: This post is created based on the article “The food vaccine as right, more so for TB patients”, published in The Hindu on 16th April 2022.
