Context: The 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.
Mindmap Learning Programme (MLP)
How the existing treatment was not patient-centric?
- With more drug arsenals such as rifampicin, ethambutol, and 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 non-compliance of patients.
- Blister packs of a multi-drug regime were provided at the doorstep, and the directly observed treatment/therapy (DOT) mechanism was set up.
- Many of the poor discontinued blister-packaged free drugs thinking that these were “hot and strong” drugs not suited for the hunger pains they experienced every night.
In short, there was little done to understand where patients lived, what work they did, how much they could afford to buy food, and how much they ate.
Nutrition status and TB risk
- The nutrition of the individual is the most vital factor in the prevention of tuberculous disease.
- 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.
- It is a disease of the poor.
- The poor are three times less likely to go for treatment and four times less likely to complete their treatment for TB.
- 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.
TB cases in India:
- India has around 2.8 million active cases.
- The fact is that 90% of Indians exposed to TB remain dormant if their nutritional status and thereby the immune system, is good.
- When the infected person is immunocompromised, TB as a disease manifests itself in 10% of the infected.
Intake of adequate balanced food:
- “Undernutrition and TB” are “syndemics”, and the intake of adequate balanced food, especially by the poor, can work as a vaccine to prevent TB.
More cash benefits:
- In 2018, under the Nikshay Poshan Yojana of the National Health Mission, all States began extending cash support of Rs. 500 per month to TB patients to buy food. This amount needs to be raised.
Nutrition education and counselling support:
- Without simultaneous nutrition education and counselling support, this cash transfer will not have the desired outcome.
Practice Question for Mains
- Without addressing undernutrition, the goals of reducing the incidence of TB, and mortality, in India, cannot be reached. Discuss. (250 Words, 15 Marks)