Patients seeking care from informal practitioners access care more promptly, but have prolonged delays in initiating treatment. Further investigation on how to involve these practitioners in the programme should be evaluated.

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high TB burden. 2,6,12 The effective management of TB therefore requires a detailed evaluation of nutritional status, as this can help to prevent or modify many complications of the disease.Signifi cant improvement has been achieved in TB control in Bangladesh in the last few years. 13 The government of Bangladesh, in partnership with different non-government organisations, including BRAC, has been implementing a community-based National Tuberculosis Control Programme (NTP) based on the DOTS strategy since 1993. 14 As data on the nutritional status of TB patients are scarce and unreliable in Bangladesh, the BRAC Research and Evaluation Division (RED) initiated a study to explore the nutritional status of TB patients attending peri-urban BRAC sputum microscopy laboratories during the various stages of convalescence before, at 2 months and immediately after completion of DOTS-based treatment.The present study will help fi ll in this gap in knowledge and help design programme interventions for better management of nutrition for TB patients in the country. METHODS Study settingsThe study was conducted among TB patients from peri-urban populations registered for treatment at BRAC TB sputum microscopy laboratories in Dhaka City. Patients with cough of >3 weeks' duration attend the microscopy laboratories for sputum testing free of charge under the NTP. Smear-positive pulmonary TB cases are registered immediately for treatment. Patients with negative microscopy results undergo further investigations and, if found positive, are admitted for treatment at the BRAC laboratory. Study population and sample sizeWe included 1110 new TB patients aged >15 years registered at 10 BRAC sputum microscopy laboratories from May 2010 to December 2011. Of these, 42 were excluded (3.9%) as they were not available for interview, had a previous history of TB, were receiving anti-t uberculosis treatment, were pregnant or currently lactating, had diabetes mellitus or had any form of mental disease, as confi rmed by physicians. Healthy controls (comparison group) were selected from nonfamily neighbours of the patients (same socio-economic status), and were matched by age and sex with TB patients (one for each TB case). Around 12% of the controls did not agree to provide information or participate. A fi nal sample of 1068 TB patients (624 males Results: Two thirds of the patients (67%) had a low BMI (<18.5 kg/m 2 ) before treatment, compared to only 23% among the healthy controls. At the end of treatment, 50% of the patients still had a low BMI, including 12% who had severe malnourishment (BMI ⩽ 16 kg/m 2 ). MUAC < 22.0 cm was higher among patients before (42%), at 2 months (39%) and immediately after completion of treatment (34%) compared to the control group (9%). Conclusions:Malnutrition is a serious problem among TB patients in peri-urban areas of Dhaka City. Under the circumstances, additional nutritional supplements, combined with education on nutrition, are expected to contribute to rapid and sustained recovery during DOTSbased treatmen...