Prioritizing Nutrition for Enhanced TB Resilience in Tribal Groups

Undernutrition is a serious health condition which tends to contribute to poor treatment outcomes among TB patients. The Global Tuberculosis Report, 2022 estimates that ?undernourishment contributes to the largest fraction of TB patients (7.38 lakh) in India followed by harmful alcohol use (2.57 lakh), smoking (1.09 lakh), diabetes (1.05 lakh), and HIV (0.93 lakh).[1] In a country where undernutrition is pervasive and the number of TB patients is highest in the world, nutritional support is an impending need for implementing patient-centred care as well addressing preventable TB comorbidities.

The prevalence of TB among the tribal population is significantly higher 703 per 100,000 compared to the national average (256 per 100,000).[2] On the nutritional front tribal population are deficient in vitamins, calories and proteins.[3] These enhances their vulnerability to TB.

The National Strategic Plan (NSP) 2017-2025 envisions a TB-free India with zero deaths. It emphasises the need for a patient-centric service delivery approach to address the social determinants such as undernutrition and eliminate out-of-pocket expenditures during the treatment, support the patient’s nutritional needs through financial incentives and create linkages to other social welfare schemes.

The Ministry of Health and Family Welfare, Government of India has initiated a nutrition support scheme of rupees 500/month to all notified TB patients for the duration when patients will be on anti-TB treatment. TB patients are provided financial aid / kind support for improved dietary intake through Nikshay Poshan Yojana.

[1] India TB Report 2023, page 26.

[2] Thomas BE, Adinarayanan S, Manogaran C, Swaminathan S. Pulmonary tuberculosis among tribals in India: A systematic review & meta-analysis.?Indian J Med Res.?2015;141:614–23.

[3] S K Basu, A health profile of tribal India

Nutritional support for tribal TB patients

A majority of TB patients belong to tribal communities in the intervention districts of Jharkhand, which are tribal dominant areas. A key activity of WHP’s TB elimination programme includes assessing nutritional status before/ at the time of treatment initiation. While basic clinical parameters are checked as part of the differentiated care model for risk assessment and initiation of timely referral for reducing TB mortality, giving nutrition a priority consideration enhances the patient’s ability to fight TB. ??

Since the initiation of the TB program in October 2020 till September 2023, World Health Partners (WHP) has provided nutrition support (food baskets consisting of rice, milk powder, roasted chickpea flour, oil, and multivitamins) to 67 tribal TB patients across two intervention districts of Ranchi and East Singhbhum, under Government’s Nikshay Poshan Yojana. Out of these eight TB patients have been adopted by WHP staff, who have come forward to support this cause.

For a meaningful impact and early recovery, WHP’s field staff also counsel and explain the importance of healthy food to TB patients and help them in improving their dietary pattern and nutritional status. Patients are equipped with a tracking form for easy monitoring of changes occurring in their weight. Stories of patients who were able to overcome TB with improved nutrition and weight management, affirms the potential of nutrition in reducing TB mortality risks. ?