Nutritional support for adult patients with microbiologically confirmed pulmonary tuberculosis: outcomes in a programmatic cohort nested within the RATIONS trial in Jharkhand, India

Bhargava, Anurag; Bhargava, Madhavi; Meher, Ajay; Teja, G Sai; Velayutham, Banurekha; Watson, Basilea; Benedetti, Andrea; Barik, Ganesh; Singh, Vivek; Singh, Dhananjay; Madhukeshwar, Adarsh Kibballi; Prasad, Ranjit; Pathak, Rajeev Ranjan; Chadha, V. K.; Joshi, Rajendra

doi:10.1016/s2214-109x(23)00324-8

Cited by 44 publications

(13 citation statements)

References 17 publications

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“…[59] Recent studies have shown that social protection in the form of a nutritional intervention reduces TB mortality and averts TB diseases by 40-50%. [60], [61] Secondly, this study highlights the importance of multidimensional measures to adequately capture income and non-income impacts of TB, including the effect of TB on schooling and ownership of assets, for programmatic action. [10], [62]…”

Section: Discussionmentioning

confidence: 99%

Higher loss of livelihood and impoverishment in households affected by tuberculosis compared to non-tuberculosis affected households in Zimbabwe: a cross-sectional study

Timire,

Houben,

Pedrazzoli

et al. 2023

Preprint

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IntroductionTuberculosis (TB) disproportionally affects poor people, leading to income and non-income losses. Measures of socioeconomic impact of TB, e.g. impoverishment and patient costs are inadequate to capture non-income losses. We applied impoverishment and a multidimensional measure on TB and non-TB affected households in Zimbabwe.MethodsWe conducted a cross-sectional study in 270 households: 90 non-TB; 90 drug-susceptible TB (DS-TB), 90 drug-resistant TB (DR-TB) during the COVID-19 pandemic (2020-2021). Household data included ownership of assets, number of household members, income and indicators on five capital assets: financial, human, social, natural and physical. We determined proportions of impoverished households for periods 12 months prior and at the time of the interview. Households with incomes below US$1.90/day were considered to be impoverished. We used principal component analysis on five capital asset indicators to create a binary outcome variable indicating loss of livelihood. Log-binomial regression was used to determine associations between loss of livelihood and type of household.ResultsTB-affected households reported higher previous episodes of TB and household members requiring care than non-TB households. Households that were impoverished 12 months prior to the study were: 21 non-TB (23%); 40 DS-TB (45%); 37 DR-TB (41%). The proportions increased to 81%, 88% and 94%, respectively by the time of interview. Overall, 56% (152/270) of households sold assets: 44% (40/90) non-TB, 58% (52/90) DS-TB and 67% (60/90) DR-TB. Children’s education was affected in 31% (56/180) of TB-affected compared to 13% (12/90) non-TB households. Overall, 133(50%) households experienced loss of livelihood, with TB-affected households twice as likely to experience loss of livelihood; adjusted prevalence ratio (aPR=2.02 (95%CI:1.35-3.03)). The effect of TB on livelihood was most pronounced in poorest households (aPR=2.64, (95%CI:1.29-5.41)).ConclusionsTB-affected households experienced greater socioeconomic losses compared to non-TB households. Multidimensional measures of TB are crucial to inform multisectoral approaches to mitigate impacts of TB and other shocks.

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Section: Discussionmentioning

confidence: 99%

Higher loss of livelihood and impoverishment in households affected by tuberculosis compared to non-tuberculosis affected households in Zimbabwe: a cross-sectional study

Timire,

Houben,

Pedrazzoli

et al. 2023

Preprint

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“…We assumed that PWTB who receive nutritional support have reduced TB-related mortality based on a comparison of outcomes of PWTB in the RATIONS study to an NTEP cohort, operationalized as a risk ratio of 0·65 (95% CI: 0·49, 0·85) applied between TB incidence and cure. (6, 11)…”

Section: Methodsmentioning

confidence: 99%

In-kind nutritional supplementation for household contacts of persons with tuberculosis would be cost-effective for reducing tuberculosis incidence and mortality in India: a modeling study

Sinha,

Dauphinais,

Carwile

et al. 2024

Preprint

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Background: Undernutrition is the leading cause of tuberculosis (TB) globally, but nutritional interventions are often considered cost prohibitive. The RATIONS study demonstrated that nutritional support provided to household contacts of persons with TB can reduce TB incidence. However, the long-term cost-effectiveness of this intervention is unclear. Methods: We assessed the cost-effectiveness of a RATIONS-style intervention (daily 750 kcal dietary supplementation and multi-micronutrient tablet). Using a Markov state transition model we simulated TB incidence, treatment, and TB-attributable mortality among household contacts receiving the RATIONS intervention, as compared to no nutritional support. We calculated health outcomes (TB cases, TB deaths, and disability-adjusted life years [DALYs]) over the lifetime of intervention recipients and assessed costs from government and societal perspectives. We tested the robustness of results to parameter changes via deterministic and probabilistic sensitivity analysis. Findings: Over two years, household contacts receiving the RATIONS intervention would experience 39% (95% uncertainty interval (UI): 23, 52) fewer TB cases and 59% (95% UI: 44, 69) fewer TB deaths. The intervention was estimated to avert 13,775 (95% UI: 9036, 20,199) TB DALYs over the lifetime of the study cohort comprising 100,000 household contacts and was cost-effective from both government (incremental cost-effectiveness ratio: $229 per DALY averted [95% UI: 133, 387]) and societal perspectives ($184 per DALY averted [95% UI: 83, 344]). The results were most sensitive to the cost of the nutritional supplement. Interpretation Prompt nutritional support for household contacts of persons with TB disease would be cost-effective in reducing TB incidence and mortality in India.

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“…6 The prior mentioned study by Bhargava et al also found that weight gain was associated with a considerably lower risk for tuberculosis mortality. 5 A nutritional intervention study conducted in central India by Singh et al found that the mean weight for TB patients increased significantly during each food distribution episode. 7 This corresponds with our study finding of a moderately positive correlation between the number of nutritional kits received and weight-BMI gain.…”

Section: Analysis Of Weight Changes During Tb Treatmentmentioning

confidence: 99%

“…4 There are evidence available on impact of nutritional support in improving weight and BMI among TB patients and reducing TB mortality in research settings. 5 Study aims to understand impact of nutritional support in improving weight and BMI among TB patients in programmatic settings.…”

Section: Introductionmentioning

confidence: 99%

Does nutritional support under programmatic settings result in weight and body mass index changes among tuberculosis patients? Evidence on the impact of nutritional support through Pradhan Mantri Tuberculosis Mukt Bharat Abhiyan under national tuberculosis elimination programme from Ramgarh district of Jharkhand

T.,

Priyadarshini,

Sinha

et al. 2024

Int J Community Med Public Health

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Background: To increase community participation in tuberculosis (TB) elimination efforts, the government of India has launched ‘Pradhan Mantri TB Mukt Bharath Abhiyan’ (PMTBMBA) under the national TB elimination programme. The scheme allows interested parties (Ni-kshay mitras) to offer nutritional support to TB patients. This study aims to understand the impact of such a support in improving weight and body mass index (BMI) among TB patients as most available evidence comes from research settings. Methods: This is a retrospective cross-sectional study carried out in Ramgarh district of Jharkhand, India, for the period first quarter 2023. Relevant data was extracted from Ni-kshay web portal and TB treatment cards. The data is analyzed using excel 365. Results: Of the 114 participants, 69 received nutritional support during the entire duration of treatment and 45 received support partially. Single factor ANOVA on weight and BMI gain revealed statistically significant difference in mean weight/BMI between the two groups with F (1, 110)=35.4660, p=3.16×10-08 and F (1, 110)=22.9994, p=5.12×10-06. Correlation analysis showed a moderate correlation between the number of nutritional kits received and the weight/BMI gain with correlation coefficients r=0.5, p=1.07×10-07 and r=0.4, p=1.65×10-05 respectively. Conclusions: The study concludes that the impact of nutritional supplementation in programmatic setting is comparable with that of implementation research study settings.

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Nutritional support for adult patients with microbiologically confirmed pulmonary tuberculosis: outcomes in a programmatic cohort nested within the RATIONS trial in Jharkhand, India

Cited by 44 publications

References 17 publications

Higher loss of livelihood and impoverishment in households affected by tuberculosis compared to non-tuberculosis affected households in Zimbabwe: a cross-sectional study

Higher loss of livelihood and impoverishment in households affected by tuberculosis compared to non-tuberculosis affected households in Zimbabwe: a cross-sectional study

In-kind nutritional supplementation for household contacts of persons with tuberculosis would be cost-effective for reducing tuberculosis incidence and mortality in India: a modeling study

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