Journalism of Courage
While it is well-known that tuberculosis (TB) leads to weight loss,many TB patients in India are undernourished even before they develop the disease. A study by a team from Jan Swasthya Sahyog (Peoples Health Support Group) in central India,and McGill University in Montreal,Canada,published in the journal PLOS ONE in October this year,found high prevalence of under-nutrition and that it hits women harder and more often than men. The study looked at under-nutrition in patients with tuberculosis of the lungs at the beginning and end of treatment,and its impact on treatment outcomes in 1,695 adult patients who were treated at Jan Swasthya Sahyogs rural hospital over a period of six years.
Nearly a half of the men weighed less than 42 kg,with a body mass index (BMI) below 16; while almost half of the women weighed less than 34 kg,with BMI below 15. Some patients had BMI of 13 or less; a level that is considered to pose an immediate threat to life. Only 2 per cent of the patients had body weight equal to or greater than the reference weights of 60 and 55 kg respectively for men and women,as published in a paper by Indian Council of Medical Research (ICMR).
Such severe under-nutrition at the time of diagnosis was associated with two to four times higher odds of death in these patients despite effective treatment. What is intriguing is that the low body weight persisted even at the end of treatment, said Bhargava. Nearly a half of the men and women who completed treatment successfully,had weight below 48 kg and 39 kg respectively,which was still a far cry from the reference weight of 60 kg and 55 kg,he added.
The World Health Organisation recommends that adults with BMI less than 16 need nutritional support,regardless of the presence of any associated disease. However,current international guidelines for TB care,despite the emphasis on patient-centric care do not consider under-nutrition an important co-morbidity in TB patients,or suggest nutritional support during treatment, said Bhargava.
In Focus
India has the highest incidence of TB in the world,according to the World Health Organisations Global Tuberculosis Report 2013,with as many as 2.4 million cases. The Post Graduate Institute of Medical Education and Research,Chandigarh,has estimated that one person in India dies of TB every minute. The report reveals that India also has the most missed TB cases of any country 31 per cent of the global total of missed cases. In view of the facts,India is a real focus of Battention at the 44th Union World Conference on Lung Health at Paris that got underway on October 31.
