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

Abstract

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...

Nutritional Supplementation Is a Necessary Complement to Dietary Counseling among Tuberculosis and Tuberculosis-HIV Patients

“…The discussion of nutritional status before, during and after tuberculosis treatment in patients treated in Brazil is particularly intriguing, as the brazilian health care system provides free access to tuberculosis and HIV treatments. This is a unique situation, and it is not expected that findings from studies conducted in other countries [ 3 , 4 , 11 , 18 , 19 ] could be extrapolated to brazilian patients.…”

Gender difference in mortality among pulmonary tuberculosis HIV co-infected adults aged 15-49 years in Kenya

“…Our data indicate that more men compared to women were older and had a lower BMI than the women. Older age at presentation, more co-morbidity, limited access to health services and poor adherence are associated with mortality among older men [ 17 , 18 , 22 – 25 ]. Findings from this study are consistent with previous research which showed that patients with a higher BMI had a lower risk of death [ 23 , 26 – 28 ].…”

Predictors of Low Body Mass Index Among Patients with Smear Positive Pulmonary Tuberculosis in Kenya

“…This finding is not surprising because low BMI means inadequate dietary intake, which is a common occurrence in impoverished communities, WHO lack employment, hence lack a means to buy food [8]. Poverty is a product of lack of employment which is associated with poor nutrition status and has a dose response relationship with incidence of TB disease [12,13]. The role of diet in patients with TB disease has been studied for decades [14].…”

“…The role of diet in patients with TB disease has been studied for decades [14]. Poor nutrition has been found to be a strong risk factor for TB reactivation and mortality; food supplementation has been shown to accelerate therapeutic benefits [13]. A HIV infected cohort in Tanzania, showed that low BMI or falling BMI is associated with a higher risk of developing HIV associated TB [15].…”

“…This study underscores the need for nutrition support in TB cases that have low BMI and lack employment. In Bangladesh, there is evidence that half the patients WHO were underweight at the start of TB treatment remained so till the end [17,18]. This shows a need for identifying those with or at risk of low BMI for nutrition support over and beyond TB drug treatment which is the first line intervention.…”