In 2022, approximately 199 in every one lakh people in India were infected with Tuberculosis (TB), with 23 in every one lakh people dying because of this disease. To put this in perspective, with India's population, this translates to roughly 3,22,000 TB deaths annually.
This is approximately equivalent to 285 Vande Bharat Express trains crashing. Unlike such a hypothetical catastrophic event, TB deaths are largely invisible to the public eye. They occur slowly and persistently, hidden by social disadvantage, in communities already marginalized by poverty, poor housing, and food insecurity.
TB and Malnutrition: The Vicious Cycle
A complex determinant often left unaddressed in the fight for the elimination of tuberculosis is undernutrition. Undernutrition is attributed to a whopping 55 % of the TB incidence in India, putting it ahead of other comorbidities like HIV(5%) and diabetes(9%). Affecting almost a third of the children under 5 years of age and 12% of the Indian population overall, TB and undernutrition are co-epidemics sharing a bidirectional relationship.
The incidence of TB is much higher in patients with chronic undernutrition, and TB itself leads to worsening nutritional status in patients with low baseline weights. Undernutrition impairs cell-mediated immunity, the first line of defense against tubercular pathogens, while the increased BMR and inflammation from the disease in turn exacerbate the anorexia and muscle breakdown. This vicious cycle leads to increased severity of disease, delayed sputum conversion, increased risk of drug-induced hepatotoxicity, and higher mortality rates.
Microview: The role of Healthcare Providers
When a malnourished child from a slum or a migrant worker arrives at the hospital, this is a critical point where the right decisions taken can lead to full recovery. However, many factors lead to a large gap between what should ideally happen and what happens. However, if every single link in the care pathway, from patients to various healthcare workers work in unison, this gap can be reduced.
Patients face various barriers to proper nutritional intake and assessment. Stigma is a major factor that could lead to a decrease in nutritional intake. Many patients avoid eating in a communal setting or hide their diagnosis from family members who might be responsible for household food distribution. Economic barriers are perhaps the most tangible factors that directly affect the quality and quantity of food received.
A recommendation of a protein-rich meal seems a distant dream when basic cereals are in short supply. Additionally, access to healthcare facilities and follow-up is compromised by distance to healthcare facilities, opportunity costs for daily wage workers, and inadequate transport infrastructure in remote areas.
