INDIA: Nutrition and TB: An Essential but Ignored relationship

Prashant Kumar Dubey

Nutrition and TB are two entities which need to be considered together, not separately. It is unfortunate that our country has not taken any initiative in this area resulting in a disregard for this relationship. If we really want to overcome TB, we need to talk through a package system similar to what the market does. For TB to be controlled, we need to make sure that nutrition is an essential part of the treatment as a basic means to fight against this disease.

The Shahbad region in Baran District of Rajasthan State is infamous for deaths due to malnutrition. It has 294 severely malnourished children, 1% out of a total population of 22,935. Indicators of development may find it an ideal situation where only one percent of children are severely mal-nourished. This is a true picture and there is no lie behind it. 
When we talk about the whole State, data shows that 40 percent of children of their total population are malnourished including those 5 percent who are severely malnourished living in Rajasthan. How is this possible? It is no less than a miracle. In his statement, Project Officer Ravi Mittal says no one has any idea how this wonder happened. There must be some error which needs to be examined. But official data confirms it. He was overjoyed at seeing that the Region has less rate of malnutrition than the national average.

It should be mentioned here that Shabad is the stronghold of the Sahariya tribe who are labeled as a most backward tribe. The people of this community once depended on forests with a rich nutritional base. Their need of development deprived them of the forests and new policies deprived them of rights to remaining forests. Within 4-5 decades traditional knowledge and skills died off, triggering deaths due to hunger. In 2001, the region had so many deaths due to hunger that it set off discussions on Right to Food on a huge scale. It should be mentioned that the Sahariya tribe is not only weak on nutritional grounds but in their woeful financial situation. They supplement each other. This is the feature that makes the people prone and susceptible to tuberculosis.

TB targets mostly poor people, a disease of the poor in society. The reason behind it is not that it targets people in lower financial circumstances. But, lacking adequate finances, most poor families cannot afford good nutritious food. Over time, being underfed, their immune systems become too weak to fight off disease. Most of the people are not aware of the fact that they are under siege, by infectious bacteria, which eventually causes TB to attack their bodies.

Half the population of adults in India walk around with an inactive TB infection. The bacteria wait for the right time to strike. They become active when the immune system of a person’s body is weakened mainly by under-nutrition, HIV infection, diabetes or old age.

Malnutrition is an important factor which plays a vital role in activating the latent TB bacteria. It targets malnourished children with weak immune systems. India is the only country in the world where 42 percent of children below 5 years of age are malnourished. Malnourished children are the most vulnerable, having the highest rate of being targeted by TB. Every malnourished child may be a victim of TB. Considering these factors, it makes more sense in putting more efforts into identifying and diagnosing TB in children.

A research report was published in the health magazine, PLASWAN, in October 2013. This research was based on ‘nutritional levels and its relationship with death’ in adult patients with pulmonary TB in rural areas of Central India. Anurag Bhargava, Associate Professor at the Himalaya Institute for Medical Science, Dehradun and Adhukar Pai, Assistant Professors found that in most cases of TB there was a lack of adequate nutrition. In other research, carried out on 1695 patients from 2004 to 2009, in Public Health Help of Bilaspur, 85 percent were found to be malnourished.

Yogesh Jain, co-author of the research mentioned above, says that the sole TB control programme of India, which doesn’t consider malnourishment and TB together, should take this research seriously. Bhargav says, in 56 countries where most cases of TB and mal-nourishment have been detected, have introduced nutrition as a compulsory component in their TB control programmes but not in India. The same thing was found in other research, carried out in the Tiruvallur district. Half of these TB patients were severely enmeshed in the throes of food insecurity. The World Health Organization is developing guide lines on nutritional needs and support for TB patients. WHO considers nutrition an essential part of treatment. 

After considering all the evidence and research available, the government now has an opportunity to foster a strong will to work on nutrition and TB together. The government has a Food Security Law under which TB affected families can be given priority and provided with nutritional security. Madhya Pradesh State has taken the initiative to give TB families priority status. Central Minister Harsh Vardhan has said that India has geared up against TB and measures are underway to provide free food for TB patients.

This is a critical task as 70 percent of the total population survives on below 20 rupees a day. A balanced diet for all is a far cry off. And in the absence of a balanced diet, overcoming TB would be an impossible task. Insufficient food has been shown as the main reason behind half of TB infections. The situation gets worst with malnourished children. Field squads working at the grass roots level, have neither appropriate guide lines nor a capacity to understand this fundamental relationship of bad nutrition and TB. 

It is incumbent on the government to clearly define for the public, the relationship between TB and malnutrition. Programmes need to be speeded up so that the present generation of children can be safeguarded and their futures ensured. It is an issue that should be addressed as soon as possible.

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About The Author: 
Mr. Dubey is a NFI-Save the children child media survival fellow. He can be contacted at