Disclaimer: Copyright infringement not intended

Context: As per Lancet’s India research, Improved nutrition, early weight gain can cut TB cases, mortality.

About the study

• The two studies were conducted between August 2019 and August 2022 in four districts of Jharkhand.
• The study was named Reducing Activation of Tuberculosis by Improvement of Nutritional Status (RATIONS) trial.
• The findings of the studies by the Indian Council of Medical Research (ICMR), in collaboration with the National TB Elimination Programme and National Institute for Research in Tuberculosis, Chennai, have also been published in The Lancet and The Lancet Global Health Journals.

Findings of the study

• Improved nutrition can reduce the incidence of all forms of TB by up to 40 per cent, and of infectious TB by up to 50 per cent among those in contact with patients suffering from infectious lung TB.
• Early weight gain among underweight patients with TB could reduce the risk of mortality by up to 60 per cent, as it ensured higher treatment success.
• According to the study, to prevent a single case of TB, about 30 households (111 household contacts) and about 47 patients would need to be provided nutritional support. The monthly cost of a food basket was Rs 1,100 per patient, and Rs 325 per contact (at 2019 prices).
• The TB patients currently receive a monthly 10 kg food basket (rice, pulses, milk powder, oil) and multivitamins for six months. Among family members, the intervention group received 5 kg rice and 1.5 kg pulses per head per month.
• Jharkhand was chosen as a trial site because it has a high burden of TB (52,179 cases notified in 2021) and the second highest level of multidimensional poverty.

Importance of the finding

• The study is the first of its kind in the world and the question was can nutritional intervention reduce TB incidence.
• These findings, which come at a time when the Centre is seeking to eliminate TB by 2025, can have implications at the policy implementation level.
• The study offers the first evidence of how nutritional support reduces the risk of mortality among TB patients.
• The results of the trial are significant as it shows that improved nutrition in family members has worked at the community level.
• The studies are significant because under-nutrition has now emerged as the leading risk factor for TB globally and simple dietary interventions have been found to be effective.
• The findings shed light on how we can tackle TB in the future.

WHO and government’s initiatives

• The national strategic plan 2017-2025 sets the target of India reporting no more than 44 new TB cases or 65 total cases per lakh population by 2025.
• Under the national programme to eliminate TB by 2025, TB patients are given monthly nutritional support of Rs 500 through direct benefit transfer for the duration of their treatment.
• The programme also aims to reduce the mortality to 3 deaths per lakh population by 2025.
• Under the Ni-Akshay Mitra programme, volunteers can provide monthly nutrition kits to their “adopted” patients.
• More accurate molecular diagnostic tests like CB-NAAT and TureNat have been developed to test and detect TB cases.
• 79 line probe assay laboratories and 96 liquid culture testing laboratories have been set up for the diagnosis of multi and extremely drug-resistant TB.
• World Health Organisation’s End TB strategy calls for an 80% reduction in the number of new cases, a 90% reduction in mortality, and zero catastrophic cost by 2030.

Prevalence of TB in India

• India accounts for 28% of all TB cases in the world, according to the Global TB Report 2022.
• There were 21.3 lakh cases detected in 2021 as compared to 18.05 lakh cases in 2020. The numbers are still lower than the 24.04 lakh cases reported before the pandemic in 2019, according to data from the government’s Ni-kshay portal.
• In India, three million new TB cases and 4,94,000 deaths were reported in 2021, representing 27 per cent of the global TB incidence and 35 per cent of deaths, according to the WHO Global Tuberculosis Report, 2022.

Improvements in treatment protocols

• Newer drugs such as Bedaquiline and Delamanid for the treatment of drug-resistant TB have been included in the government’s basket of drugs provided to free TB patients. These oral drugs can replace the injectable kanamycin that was associated with serious side effects like kidney problems and deafness.
• These new drugs have also been included in the new National List of Essential Medicines that gives the government power to regulate their market price as well.
• Researchers have also been studying shorter three- and four-month courses of anti-tubercular drugs, instead of the existing six-month therapy. Anti-tubercular drugs have to be taken for six months to over two years depending on the susceptibility of the mycobacterium.
• The issue with the current vaccine
• The BCG vaccine, currently in use, uses a weakened form of the TB bacteria to train the immune system.
• It can protect against severe forms of TB like the ones in the brain, but, the protection is not very good against the most common form of TB in the lungs.
• It offers limited protection to adults, it doesn’t prevent people from getting the infection or re-activation of a latent infection.

Newer vaccines in the pipeline

• Trials are underway to test the effectiveness of a vaccine called Immuvac, which was initially developed to prevent leprosy, preventing TB.
• The vaccine developed using Mycobacterium indicus pranii has antigens – the portions of a pathogen against which antibodies are developed – similar to those of leprosy and TB bacteria.
• Researchers are also testing the vaccine candidate called VPM1002, which is a recombinant form of the BCG vaccine modified to express the TB antigens better.

Way ahead

• A good nutritional package that provides a substantive amount of calories, proteins and micronutrients should be given to the household members of TB patients.
• The government needs to take stock of where the bottlenecks are. There is no point in pouring more money into a failing system.
• Any investment in diagnostic treatments is irrelevant if people fighting TB are living on an empty stomach. It affects the poorest populations and almost every family is in financial distress due to medical costs and lost wages.
• This distress can worsen food insecurity. A broader approach is needed to prevent TB, and it should include food support for those in close contact with the patient as they are also at high risk of contracting the disease.

PRACTICE QUESTION Q. “A good nutritional package is a way to tackle the TB challenge in India.” In the light of the above statements Discuss the prevalence of TB cases in India, initiatives taken by the government and Need of newer vaccines for controlling TB cases in India.( 250 words)

https://indianexpress.com/article/lifestyle/health/improved-nutrition-early-weight-gain-can-cut-tb-cases-mortality-lancets-india-research-8883022/