In the 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 bacterium, virus or a parasite. Factors such as genetic and metabolic causes, hormonal imbalance and altered neuro-chemical transmitters causing illnesses were less known then.
But there was fairly good knowledge of how good air and nutrition reduced consumption illnesses such as tuberculosis (TB).
History and a perspective:
This is why sanatoriums/sanatoria were set up in mountain terrain, with fresh air, pure water and good food, in the quest for a cure for TB. There were no drugs for TB till the discovery of streptomycin in 1943.
With improved wages, better living standards and the accompanying 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.
This 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.
About Tuberculosis (TB):
- TB is caused by a bacterium called Mycobacterium tuberculosis, belonging to the Mycobacteriaceae family consisting of about 200 members.
- Some of 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). TB is a treatable and curable disease.
- TB is a very ancient disease and has been documented to have existed in Egypt as early as 3000 BC.
Malnutrition and Tuberculosis:
Malnutrition and tuberculosis are both problems of considerable magnitude in most of the underdeveloped regions of the world.
- These two problems tend to interact with each other. Tuberculosis mortality rates in different economic groups in a community tend to vary inversely with their economic levels.
- Similarly, nutritional status is significantly lower in patients with active tuberculosis compared with healthy controls.
- Malnutrition can lead to secondary immunodeficiency that increases the host’s susceptibility to infection.
- In patients with tuberculosis, it leads to reduction in appetite, nutrient malabsorption, micronutrient malabsorption, and altered metabolism leading to wasting.
- Both, protein-energy malnutrition and micronutrients deficiencies increase the risk of tuberculosis.
- It has been found that malnourished tuberculosis patients have delayed recovery and higher mortality rates than well-nourished patients.
- Nutritional status of patients improves during tuberculosis chemotherapy.
- High prevalence of human immunodeficiency (HIV) infection in the underdeveloped countries further aggravates the problem of malnutrition and tuberculosis.
- Effect of malnutrition on childhood tuberculosis and tuberculin skin test are other important considerations.
- Nutritional supplementation may represent a novel approach for fast recovery in tuberculosis patients.
- In addition, raising nutritional status of population may prove to be an effective measure to control tuberculosis in underdeveloped areas of world.
India TB report 2021:
Global TB Burden:
- Every year, 10 million people fall ill with TB and 1.5 million people die from TB each year, making it the world’s top infectious killer.
- Most of the people who fall ill with TB live in low- and middle-income countries, but TB is present all over the world.
- About half of all people with TB can be found in 8 countries: Bangladesh, China, India, Indonesia, Nigeria, Pakistan, Philippines and South Africa.
- It is the leading cause of death of people with HIV and also a major contributor to antimicrobial resistance. It is one of the top 10 leading causes of deaths worldwide.
India’s TB Burden:
India has 30 percent of the world’s TB cases, which is the highest in the world, followed by Indonesia and China.
- Tuberculosis continues to be one of India’s most critical health challenges, which typically has devastating health, social and financial consequences for patients and communities at large.
- With an estimated 2.64 million tuberculosis patients, India has the largest caseload in absolute numbers, globally.
- The government aims to have a TB-free India by 2025, five years ahead of the global target of 2030.
- Global Tuberculosis Programme and Report, 1+1 initiative & Multisectoral Accountability Framework for TB by WHO.
- Ending the TB epidemic by 2030 under UN SDG target 3.3.
- Moscow Declaration, 2017 to End TB.
- National Tuberculosis Elimination Programme: National Strategic Plan to end TB by 2025 under pillars of Detect-Treat-Prevent-Build (DTPB).
- Universal Immunization Programme.
- Revised National TB Control Programme under the National Health Mission.
- NIKSHAY portal and TB Sample Transport Network.
- Development of National Framework for Gender-Responsive approach to TB.
What is the Theme for World TB Day 2022?
- The theme is “Invest to End TB. Save Lives.”
- The theme emphasizes the critical need to invest resources to accelerate the fight against tuberculosis and meet the commitments made by leaders around the world to end tuberculosis.
With more drug arsenals such as rifampicin, ethambutol, pyrazinamide, the fight against TB bacteria continued, which became multidrug resistant. Sharper bullets were fired into the frail body of patients.
It was 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”.
Nutrition status and TB risk:
- 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.
- The nutrition of the individual, is the most vital factor in the prevention in tuberculous disease.
- 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. 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 2002.
- In the period 2004-09, among the 1,695 pulmonary TB patients they treated, men had an average body weight of 42.1 kg and a body mass index (BMI) of 16.
- For women, the average body weight was 34.1 kg and a BMI of 15. With these levels of undernutrition, there was a two to four-fold rise in the mortality associated with TB.
- Beginning with the JSS, a number of organizations began providing eggs, milk powder, dhal, Bengal gram, groundnuts and cooking oil to diagnosed patients along with anti-TB drugs.
- Chhattisgarh also initiated the supply of groundnut, moong dhal and soya oil, and from April 2018, 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.
‘Syndemics’: Undernutrition and TB:
“Undernutrition and TB” are “syndemics”, and the intake of adequate balanced food, especially by the poor, can work as a vaccine to prevent TB.
This vaccine is “polyvalent, acting against many gastrointestinal and respiratory tract infections; orally active, that can be produced in the country without patent rights; dispensed over the counter, without prescription and without any side-effects; safe for children, pregnant and lactating women, and of guaranteed compliance because it brings satisfaction and happiness”.
The 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.