A study of tuberculosis, malnutrition and gender in Sri Lanka

Ahmed

et al. 2013

public health action

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...

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Beyond drugs: tuberculosis patients in Bangladesh need nutritional support during convalescence

Ahmed

et al. 2013

public health action

“…TB is still continuing to be a major public health problem in Sri Lanka and the incidence of tuberculosis is 0.089% (Trading Economic, 2011). The majority of these patients are significantly malnourished (Metcalfe, 2005 cases of tuberculosis are notified every year, of which around 60% are smear-positive pulmonary TB cases. The incidence of TB differs much within the divisional secretariat (DS) divisions depending on various demographic factors and environmental pollution levels.…”

Section: Introductionmentioning

confidence: 99%

Relative Risk for TB in the Unprotected Small Industrial Environment: a case study

Razmy

2016

J. Mgt.

“…It increases susceptibility to and severity of an infection (Muller and Krawinkel, 2005) and tuberculosis (TB) is a prominent example (Cegielski and McMurray, 2004). Malnutrition as reflected by a low body mass index (BMI) is common among TB patients (Metcalfe, 2005) and it increases mortality from TB (Zachariah et al, 2002). Thus, malnutrition seems to be an important determinant of clinical outcome of TB.…”

Section: Introductionmentioning

confidence: 99%

Vitamin A deficiency and other factors associated with severe tuberculosis in Timor and Rote Islands, East Nusa Tenggara Province, Indonesia

et al. 2009

Background: Plasma zinc and vitamin A concentrations have been reported to be low in tuberculosis (TB) patients in some studies, although it is not clear whether this constitutes a risk for a more severe clinical presentation among TB patients. The acute phase reaction may also deplete zinc and vitamin A in the plasma. Therefore, we further studied these associations. Methods: We carried out a cross-sectional study among newly diagnosed sputum smear-positive TB patients in East Nusa Tenggara. The patients were categorized as either mild TB when Karnofsky Score (KS) X80 or severe TB (KS o80). Body mass index (BMI), mid upper arm circumference (MUAC), chest radiograph, and the results of hemoglobin, erythrocyte sedimentation rate, albumin, C-reactive protein (CRP), zinc and vitamin A in plasma were correlated with TB category. Results: A total of 300 TB patients participated in the study (63% male and 37% female), and were categorized as mild TB (53%) or severe TB (47%). Vitamin A, hemoglobin and plasma albumin were significantly lower, and CRP was significantly higher, in severe TB than in mild TB, and the active lesion area on the chest radiograph was greater among severe TB patients. In a multiple regression analysis, after adjustment for CRP, low vitamin A (b ¼ 3.2, 95%CI (confidence interval) 1.6-4.9, P ¼ 0.000) but not zinc, correlated with the severity of TB. MUAC was better than BMI as a predictor of TB severity (b ¼ 1.3, 95%CI 0.6-6.2, P ¼ 0.000). Conclusions: Severe TB was associated with vitamin A deficiency. MUAC can be applied as a measure of TB severity.