Understanding the role of nutrition in Tuberculosis

(Mains GS 2 : Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources.)

Context:

• India TB Report 2022 noted a 19% increase in 2021 from the previous year in TB patients’ notification as the number of incident TB patients notified during 2021 was 19,33,381 against the 16,28,161 in 2020.
• However, Health Minister Mansukh Mandaviya reaffirmed the government’s commitment to making India tuberculosis–free by 2025 and said this will be achieved by ensuring access to quality healthcare and advanced treatment.

Pathways to ingenious solutions:

• Report said the 18 States have committed to ending TB by 2025 by formally implementing State–specific Strategic Plans and have gone a step ahead to devise a district–specific strategic plan, which shall serve as a guiding tool for the programme managers and staff at the district and sub-district level towards the elimination of Tuberculosis.
• It said while the world was still reeling under the unsparing effects of the pandemic in 2020 ravaging lives, uprooting livelihoods, crippling national economies and debilitating health infrastructure, the pandemic continued wreaking its havoc in 2021.
• Despite setbacks in decades of gains, the pandemic also forged pathways to ingenious solutions, health–system strengthening and the ever–expanding reach of the public health programme delivery.

Historical perspective:

• There were no drugs for TB till the discovery of streptomycin in 1943 but with improved wages, better living standards and the accompanying 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. 
• After the Second World War, in 1946 G.B. Leyton reported a 92% reduction in the incidence of TB among British soldiers who 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. 
• This historical importance of good nutrition was ignored by the modern therapist who tried to control TB initially with streptomycin injection, isoniazid and para-aminosalisylic acid. 
• In the ecstasy of finding antibiotics killing the germs, the social determinants of disease were ignored.

Not patient-centric:

• With more drug arsenals such as rifampicin, ethambutol, pyrazinamide, the fight against TB bacteria continued, which became multidrug resistant. 
• The regimes and the mode of delivery of drugs were changed to plug the loopholes of alleged “non-compliance of illiterate and irresponsible patients”. 
• But, 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, showing the approach of bacteria targeted, not patient-centric.

Nutrition status and TB risk:

• The nutrition of the individual is the most vital factor in the prevention of tuberculosis.
• It is most unlikely that drugs alone, or drugs supplemented by vaccination, can control TB in the underprivileged countries of the world as long as their nutritional status has not been raised to a reasonable level.
• The fact is that 90% of Indians exposed to TB remain dormant if their nutritional status and thereby the immune system, is good. 
• Tuberculosis is a disease of the poor and the poor are three times less likely to go for treatment and four times less likely to complete their treatment for TB.

Undernutrition and TB are “syndemics”:

• 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.
• Undernutrition and TB are “syndemics” and the intake of adequate balanced food, especially by the poor, can work as a vaccine to prevent TB. 
• This vaccine is “polyvalent, acting against many gastrointestinal and respiratory tract infections; orally active, that can be produced in the country without patent rights; dispensed over the counter, without prescription and without any side-effects; safe for children, pregnant and lactating women, and of guaranteed compliance because it brings satisfaction and happiness”.

Conclusion: 

• The goals of reducing the incidence of TB in India and of reducing TB mortality cannot be reached without addressing undernutrition.