WHO's new TB guidelines calls for food assistance to tackle disease

New Delhi, Oct 13 (PTI) The World Health Organisation has released new guidelines to tackle tuberculosis and undernutrition, recommending that food assistance be provided to households with TB patients while the undernourished or food insecure be screened for the disease.

The shift in the global TB policy is inspired by the pathbreaking Reducing Activation of Tuberculosis by Improvement of Nutritional Status (RATIONS) trial by Indian researchers.

The RATIONS trial, conducted in Jharkhand and published in The Lancet and The Lancet Global, highlighted the vital role nutrition plays in reducing mortality among people living with active TB, as well as in reducing incidence among household contacts of pulmonary tuberculosis patients.

The ICMR-supported RATIONS trials were led by a research team headed by Dr Anurag Bhargava and Dr Madhavi Bhargava from Kasturba Medical College and Yenepoya Medical College, respectively.

The studies showed that weight gain in the first two months was associated with a 60 per cent lower risk of TB mortality, higher treatment success, and a decrease in loss to follow-up.

Significantly, better nutrition in family members of pulmonary tuberculosis patients reduced the incidence of the disease of all forms in household contacts by nearly 40 per cent, and infectious TB by 50 per cent.

Based on this evidence, the Health Ministry last year doubled the nutritional support to TB patients under the Ni-kshay Poshan Yojana from Rs 500 to Rs 1,000, started providing energy-dense nutritional supplementation to patients with a BMI below 18.5, and expanded the coverage of the Ni-Kshay Mitra initiative to include the family members of TB patients.

WHO stated that undernutrition remains one of the most significant drivers of the TB epidemic globally -- contributing to increased vulnerability to the disease, poorer treatment outcomes, and preventable mortality.

Addressing undernutrition and food insecurity among people affected by TB has the potential to improve outcomes and save lives, it said.

The release of the latest guidelines marks a significant step in tackling determinants as part of people-centred care under WHO's End TB Strategy.

"Tuberculosis thrives on inequality, with undernutrition as a major driver," said Dr Tereza Kasaeva, Director of the WHO Department for HIV, Tuberculosis, Hepatitis, and Sexually Transmitted Infections.

"To end TB, we must address undernutrition and food insecurity as part of a comprehensive, household-centred response. Integrating nutrition into comprehensive TB care is essential to breaking the cycle of disease and poverty, and constitutes a critical step towards a world free of TB," Dr Kasaeva added.

Key recommendations in the new guidelines include nutritional assessment and counselling for all people with tuberculosis, as well as their household contacts. This recognises that a significant proportion of people in households with TB may be undernourished.

WHO also recommended provision of nutritional interventions to optimise clinical outcomes in people with TB who have undernutrition, regardless of age, drug resistance, pregnancy status or severity of undernutrition.

It also recommended the provision of food assistance to prevent TB in household contacts of people with the disease in food-insecure settings.

"In settings of food insecurity, food baskets in combination with multiple micronutrient supplements should be offered to all households of people with TB," WHO stated.

It also recommended that nutritional interventions should be offered to individuals with TB who have severe, moderate or mild undernutrition, as part of a comprehensive package of tuberculosis care.

Besides, WHO also suggested that seven Vitamin D supplementation may be provided to people with TB in the context of rigorous research. PTI PLB NSD NSD