Food Baskets Can Reduce Tuberculosis Cases in India by 50%

Highlights:

Food baskets, containing rice and lentils, reduced new TB cases by nearly half among high-risk individuals
Undernutrition contributes to 40% of TB cases in India
Nikshay Mitra, a crowd-sourced initiative, aims to provide nutritional support to TB patients

A food basket comprising 5 kg rice and 1.5 kg lentils per adult per month will reduce new tuberculosis diagnoses by nearly half among TB patients' household contacts, according to a landmark study in India. The study in Jharkhand has been touted as the world's first to directly establish the efficacy of rice, split pigeon pea, and multivitamins in preventing tuberculosis cases among persons at high risk of infection.

According to the study, the incidence of lung TB among members of households with TB patients who received these food baskets was 48% lower than among members of households with TB patients who did not receive the baskets.

Drug-Resistant Tuberculosis
Drug-resistant tuberculosis (TB) is a globally serious infectious disease caused by the bacterium Mycobacterium tuberculosis. It occurs as multidrug-resistant or MDR TB or in its more severe form, extensively drug-resistant or XDR TB.

‘A groundbreaking Jharkhand study shows that a simple food basket can significantly reduce new TB cases. Could this be the game-changer India needs? #TBFight #HealthAndNutrition’

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Does Nutrition Play a Role in Tuberculosis?

“We’ve known that undernutrition is a major risk factor for TB and that about 40 per cent of TB in India can be attributed to undernutrition,” said Soumya Swaminathan, former head of the Indian Council of Medical Research and chief scientist at the World Health Organisation, now at the MS Swaminathan Research Foundation in Chennai. “But we had no proof - until now.”

The findings, she said, add to the evidence supporting policies that include nutrition as an intervention to prevent new TB cases at a time when the number of new cases is not reducing as quickly as it needs to for India to eliminate TB by 2025.

Extra Pulmonary Tuberculosis
Extra pulmonary tuberculosis is infection of tissues and organs other than the lungs by mycobacterium tuberculosis and related organisms.

Combat TB with Rs 325 Spend for Nutrition

As per, Anurag Bhargava and Madhavi Bhargava of Yenepoya University near Mangalore, as well as their collaborators at the National Institute for Research in Tuberculosis in Chennai and other institutions, the food basket would cost Rs 325 per household contact per month, including delivery, at 2019 prices.

“We expect that the food basket will not only lower the risk of TB infections among the household contacts but also protect them from other infections by raising general nutrition levels,” Anurag Bhargava said.

Since April 2018, the Narendra Modi government, which established the 2025 elimination target, has provided nutritional support to TB patients in the form of a monthly payment of Rs 500 during treatment, which normally lasts six months in uncomplicated TB.

Renal Tuberculosis
Renal tuberculosis or tuberculosis of the kidney is a type of genitourinary tuberculosis that can be treated with anti-tubercular medications.

Nikshay Mitra Initiative: Extending Nutritional Support Beyond the Patient

Last year, the Union Health Ministry also launched a crowd-sourced system called Nikshay Mitra, which allows individuals, corporate organizations, and other entities to provide nutritional support to tuberculosis patients. “If nutritional support were to be extended to the families of TB patients, it could potentially drive down TB cases in the community,” said Swaminathan, who was a member of the team that conducted the Jharkhand study.

Screening Tests for Tuberculosis
Tuberculin skin test and Interferon – Release Assays are tests used to screen for tuberculosis.

Chasing the TB Elimination Target

A health ministry assessment issued earlier this year anticipated that TB incidence (new cases) in 2022 would be 196 per 100,000 people, far exceeding the elimination plan's objective of 77 by 2023 and 44 by 2025 ().

The Bhargavas and their collaborators followed 10,345 household contacts of 2,800 TB patients in four Jharkhand districts - Ranchi, Seraikela Kharsawan, East Singhbhum, and West Singhbhum - for three years.

They documented 218 new TB cases among the contacts. “But our study suggests a 48% reduction in new lung TB cases over the three years in households that got the food baskets,” said Madhavi Bhargava. The study was published The Lancet.

Nutrition as Medicine: The Protective Power of a Meal Basket

While family contacts at high risk of contracting tuberculosis may also be offered anti-TB drugs, the researchers found that a meal basket containing rice, lentils, and multivitamins provided comparable protection.

Every month, each of the 2,800 TB patients received 5kg rice, 1.5kg milk powder, 3kg roasted chickpea flour, 500 ml oil, and multivitamins. The study found a lower risk of death with weight gain, as expected. A 5% weight gain after two months of treatment lowered the risk of mortality by 60%.

The death rate among TB patients was 3.9%, which was much lower than the 6% death rate seen among TB patients from six states who received no nutritional care.

Reference:

Leading the Way India TB Report 2023 - (https://tbcindia.gov.in/WriteReadData/l892s/5646719104TB%20AR-2023_23-%2003-2023_LRP.pdf)

Source-Medindia