Without addressing undernutrition, the goal of reducing the incidence of TB cannot be reached

• In past, there was a belief that every ill had a pill and the pill killed the germs that made you ill. That germ could be a bacteria, virus or parasite.
• Factors such as genetic and metabolic causes, hormonal imbalance and altered neurochemical transmitters causing illnesses were less known then.
• But there was a good knowledge of how good air and nutrition reduced consumption illnesses such as tuberculosis (TB).

About:

• Caused by: a bacterium called Mycobacterium tuberculosis, belonging to the Mycobacteriaceae family consisting of about 200 members.
• Some Mycobacteria cause diseases like TB and Leprosy in humans and others infect a wide range of animals.
• In humans, TB most commonly affects the lungs (pulmonary TB), but it can also affect other organs (extra-pulmonary TB).
• It is a very ancient disease and has been documented to have existed in Egypt as early as 3000 BC.
• It is a treatable and curable disease.

History and a perspective

• In search of a cure for TB, sanatoriums were set up in mountain terrain, with fresh air, pure water and good food
• There were no drugs for TB till the discovery of streptomycin in 1943.
• With improved wages, better living standards and 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 WWII 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-aminosalicylic acid.
• In finding antibiotics for killing the germs, the social determinants of disease were ignored.

Not patient-centric

• With more drugs such as rifampicin, ethambutol, and pyrazinamide, the fight against TB bacteria continued, which became multidrug-resistant.
• This approach is bacteria targeted, not patient-centric.
• The regimes and the mode of delivery of drugs were changed to plug the loopholes of alleged “non-compliance of illiterate and irresponsible patients”.
• Blister packs of a multi-drug regime were provided at the doorstep, and the directly observed treatment/therapy (DOT) mechanism was set up.
• There was little done to try to understand where patients lived, what work they did, how much they could afford to buy foodetc.
• Many poor discontinued blister-packaged free drugs thinking that these were strong drugs are not suited for the hunger pains they experience every night.
• They coughed up virulent bacteria to infect many around them.
• No wonder TB was never brought under control.

Nutrition status and TB risk

• In 1949, WHO stipulated that nutrition of the individual is the most vital factor in the prevention of tuberculous disease
• It is unlikely that drugs alone, or drugs supplemented by vaccination, can control TB in underprivileged countries as long as their nutritional status has not been raised.
• 90% of Indians exposed to TB remain dormant if their nutritional status and immune system are good.
• When the infected person is immunocompromised, TB as a disease manifests itself in 10% of the infected.
• India has around 2.8 million active cases. It 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, according to WHO.
• In 2014, research showed that undernutrition in the adult population was the major driver of India’s TB epidemic.
• 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”.
• 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.
• A number of organisations began providing eggs, milk powder, dhal, Bengal gram, groundnuts and cooking oil to diagnosed patients along with anti-TB drugs.
• Under the Nikshay Poshan Yojana of the National Health Mission, all States began extending cash support of ₹500 per month to TB patients to buy food.
  • This amount needs to be raised.
  • Without simultaneous nutrition education and counselling support, this cash transfer will not have the desired outcome.

Way forward

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

Exam track

Prelims take away

• Tuberculosis (TB)
• Other bacterial diseases
• Nikshay Poshan Yojana
• Global TB report
• Drugs to treat TB

Mains track

Q. “In spite of various efforts and policies, Tuberculosis is still a big problem in India.” Discuss the various reasons for this. Give some solutions to prevent Tuberculosis.