India’s TB Crisis : Nutritional Support and Policy Changes

October 22, 2024

Tuberculosis (TB) is a critical public health issue in India. Each year, approximately three million new TB cases are reported, and around 300,000 deaths occur due to the disease. The Ministry of Health has recently increased the financial support under the Nikshay Poshan Yojana (NPY) from ₹500 to ₹1,000 per month. Additionally, a one-time payment of ₹3,000 will be provided at the time of diagnosis. These initiatives aim to support TB patients throughout their treatment.

The Importance of Nutritional Support

Nutritional support is essential for TB patients, especially those suffering from undernutrition. Many patients enter treatment with an average weight of 43 kg for men and 38 kg for women. Without adequate nutrition, treatment outcomes can worsen. Undernutrition contributes to an important portion of new TB cases in India. Studies indicate that it plays a role in the severity of the disease and the risk of death.

Social Determinants of TB

TB is deeply intertwined with social factors. Overcrowding, poverty, and undernutrition increase the risk of contracting TB. Other risk factors, such as diabetes and substance abuse, are more prevalent among impoverished populations. These issues create a cycle of poor health and economic distress, making it difficult for patients to recover.

Challenges Faced by TB Patients

Patients often experience income loss and food insecurity due to TB. The costs associated with treatment can be overwhelming, leading to further economic hardship. Many patients struggle to return to work, exacerbating their financial situation. These challenges highlight the need for comprehensive support systems.

Evidence Supporting Nutritional Interventions

Research supports the effectiveness of nutritional interventions. For example, the RATIONS trial demonstrated that providing a 10 kg food basket per month reduced the risk of death among TB patients. A low-cost intervention involving food baskets and micronutrient supplements also showed a reduction in new TB cases, akin to vaccination effects.

Evaluation of the Nikshay Poshan Yojana

The National Institute of Epidemiology’s evaluation of the NPY programme revealed critical insights. Staff involved in TB programmes often feel overwhelmed with additional responsibilities. Vulnerable communities may struggle to access benefits due to a lack of identification, bank accounts, or geographical barriers. Non-receipt of benefits correlates with a higher risk of adverse outcomes.

Recommendations for Improvement

To enhance the NPY programme, several recommendations emerge. First, dedicated resources for NPY activities are essential. This will help streamline processes and improve patient support. Second, culturally appropriate counselling materials should be developed to emphasise the importance of nutrition in TB treatment.

Stigma surrounding TB remains an important barrier. Strategies should be implemented to protect the privacy of patients receiving nutritional support. Additionally, the Nikshay Mitra programme requires redesign to ensure vulnerable populations receive adequate coverage.

Integrating Support Initiatives

Nutritional, financial, and social support initiatives should be integrated with other healthcare aspects. This includes ensuring an uninterrupted supply of medications, managing comorbidities effectively, and providing thorough evaluations at diagnosis. Collaborative efforts can lead to better patient outcomes and a more effective TB control strategy.

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