NEW DEHLI: Infectious, deadly, and closely associated with poverty, tuberculosis (TB) has long posed a significant health challenge in India. It not only causes severe weight loss but is also exacerbated by poor nutrition. However, a groundbreaking study conducted in India has illuminated a promising path forward, demonstrating that improved nutrition can reduce the risk of death by a remarkable 60% and lower the likelihood of infection within families by approximately 40%.
India bears the heaviest burden of TB and TB-related deaths worldwide and has launched an ambitious plan to slash incidence and death rates by 80% and 90%, respectively, by the year 2025.
The study, aptly named Rations (Reducing Activation of Tuberculosis by Improvement of Nutritional Status), stands as the largest and most compelling evidence to date linking enhanced nutrition to improved TB treatment outcomes and prevention. It received invaluable support from the Indian Council of Medical Research.
Dr. Anurag Bhargava, a physician and epidemiologist at Yenepoya Medical College in Mangalore, underscores the significance of this research. He points out that while previous smaller studies hinted at a connection between better nutrition and reduced mortality, the results were far from conclusive. Rations, however, mark a groundbreaking milestone as the world’s first trial aimed at preventing TB in family members through nutritional supplementation.
This comprehensive three-year study, initiated in 2019 and involving over 10,000 participants, took researchers to remote, hard-to-reach villages in Jharkhand state. Family members of individuals with infectious TB were provided with a monthly food basket containing 5kg of rice, 1.5kg of pulses, and micronutrient pills for six months. Over the next two years, the incidence of TB dropped by an impressive 39% to 48% compared to those not receiving additional nutrition.
Patients with TB received a monthly 10kg food basket, consisting of rice, milk powder, oil, pulses, and multivitamins, in addition to their regular TB medications. This holistic approach led to improved treatment adherence rates. The study revealed that a 5% weight gain resulting from the food basket during the first two months of treatment reduced the risk of death by an astounding 60%.
Perhaps even more encouragingly, around 75% of patients reported their ability to return to work upon completing their treatment. The study also recorded a nearly doubled weight gain among patients who received nutritional supplements compared to those who did not.
Startlingly, at the beginning of the Rations study, more than 80% of patients were underweight, with almost half classified as severely underweight. Remarkably, by the end of the study, nearly 3% of participants had regained the capacity to engage in normal activities.
The Bhargava couple, Dr. Anurag and Dr. Madhavi Bhargava emphasize the critical importance of early intervention in improving nutrition, particularly because many TB patients succumb to the disease within the first two months of infection. Contrary to common assumptions, weight gain during TB treatment may not occur in areas struggling with food insecurity, as demonstrated in a recent study.
This evidence from the Rations trial presents a vital tool in India’s ongoing battle against TB. Since 2018, the government has been providing TB patients with 500 rupees (£4.75) each month to assist them in affording a more nutritious diet. Moreover, a new program was launched in September, urging companies, non-governmental organizations, and the public to “adopt” a TB patient and send them parcels of nutrient-rich food every month.
While these initiatives represent significant strides, the Bhargavas voice their concerns about the sufficiency of donors to cover all TB patients and the regularity of food parcel deliveries. Their experiences underscore the importance of timely nutritional support. Even amidst the disruptions caused by the COVID-19 pandemic in 2020, the field team continued to deliver food baskets to villages.
In some areas, villagers erected barricades to prevent outsiders from entering and potentially spreading the virus. Field workers persevered, ensuring that no family was left without support. Madhavi Bhargava attests that our workers were amazing. Not one delivery was missed, even though the field staff themselves were nervous about the virus.
