Back in 2020, when India announced a lockdown in March to curb the spread of Covid-19, a concern that was echoed was how will those who need to step out to earn money everyday sustain themselves?
At the same time, a deeper challenge brewing was that of possible undernutrition and its impact on diseases such as tuberculosis, or TB. Most policymakers are unaware that poverty and resulting hunger and undernutrition increase the chances of active TB and also the severity of disease.
Insufficient nutrition reduces patients’ speed of recovery, exacerbates suffering side effects from treatment and increases the likelihood of them becoming one of the many Indian lives that TB claims every year.
Also, India has one of the largest underweight populations in the world. In some states, these statistics are grim and Covid-19 lockdowns and losses of income have worsened them.
Nutrition and tuberculosis have a complex and far-reaching relationship. A recent research led by professors at Yenepoya University in Mangaluru estimated that undernutrition contributes to 902,000 of India’s 2.64 million annual TB cases, which is 40% higher than earlier estimates.
Globally as well the World Health Organization had in 2020 estimated that undernourishment accounts for 19% of annual new TB cases worldwide. With millions grappling with undernutrition in India, how can growth in TB be far behind?
Developing TB also compounds undernutrition and weight loss. First, the disease reduces appetite and thus dietary intake. Second, the fever increases the basal metabolic rate – the rate at which calories are expended, and finally, TB causes wasting, which is low weight-for-height.
Under-nutrition continues to challenge patients during treatment and after. It can also delay recovery and severely undernourished patients face a two to four times higher risk of mortality. After the completion of treatment, under-nutrition increases the chances of a relapse and compromises physical activity due to poor muscle strength.
In light of these statistics, the pertinent question is how to tackle tuberculosis and nutrition together. Providing proper nutritional support can help prevent TB yet, the health departments ignore it as it is seen as a welfare tool rather than a “preventive tool”.
Most budgetary outlays focus primarily on treatment, neglecting issues of nutrition uptake of a protein-rich diet which remains unaffordable for many. This insular approach is unlikely to address India’s TB crisis.
In India, the government has acted on this issue but only halfheartedly. The Nikshay Poshan Yojana scheme gives a mere Rs 500 a month to those diagnosed with TB. In these times of rising inflation, this would not even provide nutritional support to a person for a week, leave alone a month.
A brief titled “Fighting TB in times of COVID-19” by Survivors Against TB has also highlighted nutrition as a key concern during the pandemic, and detailed how food insecurity and nutritional queries were widely received on the group’s virtual helpdesk. The brief also mentions numerous instances of TB patients not receiving their monthly Rs 500 under the Nikshay Poshan Yojana. This amount needs to be increased to at least Rs 2,000 per month.
Focussing on nutrition helps the National TB Elimination Program goals as well. Consider this, continuing economic challenges will force those who are financially weaker to return to the workforce, or will push them into poverty and debt and put them at greater risk of increased mortality due to TB. Some may even give up on treatment.
A loss in income due to TB will also in all likelihood delay healthy behaviours such as seeking care or diagnosis, and lead to increased transmission. Hence expanding and increasing nutritional support is a critical and urgent need.
As India’s economy recovers, it must be ensured that TB-affected individuals and families are not desperate and without sufficient nutrition. If not, it will have a long-term impact on immunity levels and affect the TB burden.
The direct benefit transfer of funds under Nikshay Poshan Yojana plays a crucial role in mitigating the challenges pertaining to nutrition and travel support for patients. Thus, the scheme is a solution that can work if implemented well. It can facilitate better recovery and treatment completion. Here, efficiency is key and it is important to track the turnaround time for payments on a regular basis under the scheme..
India’s fight against TB has to go beyond slogans. Hunger and undernutrition are real threats to the intent to defeat TB. Until they are addressed, India is unlikely to even control, forget eliminate, the scourge of TB.
Ritu Khattar is a consultant and a TB advocate and survivor. Himanshu Patel is an manager in an MNC, a marathoner, TB advocate and an MDR TB survivor