How Chhattisgarh and Puducherry are cutting TB deaths: Food and cash for the undernourished in the first month itself

Studies have shown that most TB deaths occur during the first two months after diagnosis with under-nutrition being one of the key factors for poor outcome and death. (Photo: Freepik)

In an effort to improve treatment outcomes for patients with tuberculosis, states such as Chhattisgarh and the Union Territory of Puducherry have prioritised early nutritional support for the under-nourished through direct cash transfers of Rs 1,000 and a food basket.

While the national programme for elimination of TB extends this benefit to all patients, it takes months for them to start receiving it. The governments in Puducherry and Chhattisgarh are, therefore, prioritising the under-nourished who are most at risk. Studies have shown that most TB deaths occur during the first two months after diagnosis with under-nutrition being one of the key factors for poor outcome and death. “TB patients with severe and very severe undernutrition have four to five times higher chance of dying due to the disease, necessitating early nutrition support,” says Dr Hemant Shewade, senior scientist, ICMR-National Institute of Epidemiology.

While doctors at the lowest levels of the healthcare system across the country record parameters such as height and weight of the patients, most states do not isolate undernourished patients. “The programme already documents weight and height during the diagnosis on the Ni-kshay platform… Reporting indicators such as BMI (body mass index), percentage of severely and very severely undernourished adults, and those of them who gain 5% of their weight at two months will reinforce the implementation of nutritional support mechanisms,” says Dr Shewade.

In Chhattisgarh, the state health department issued an order in December to recognise and prioritise nutritional support for those severely undernourished (with a BMI of less than 16) and very severely undernourished (with a BMI of less than 14). “After the December order, the districts have started reporting TB patients, categorising them as per their BMI. Every month or every quarter, the effort is to report the number of patients with BMI less than 14 and those under-16, check if these patients received their food basket within the first month of diagnosis and assess how many received their Rs 1,000 nutritional support in the first month,” says Dr Chaitanya Malik, who studied nutritional support provided to TB patients in the state and is currently collaborating with the state government for prioritising it.

Before the rollout, Dr Malik’s study found that less than a third of the TB patients received their direct benefit transfer within the first two months and around a fifth received the nutritional basket. This was the same across all BMI categories.

After the December order, however, the severely and very severely undernourished patients are being prioritised at the block, district and state-level. “While it takes some time for processing the DBT payments, officials at all levels are prioritising the paper-work for the undernourished patients and sending it to the next level within 48 hours. Food baskets, depending on the availability of donations, are also being given to these patients on priority,” he says, hopeful of a discernible impact after a few months.

In Puducherry, with a similar mechanism for recognising undernourished TB patients in place, the UT government has started prioritising the distribution of nutrition baskets. Under the national TB programme, volunteers can adopt TB patients and send in a monthly nutrition basket to them. “We have prioritised three categories of TB patients — those with a BMI less than 18.5, those with drug-resistant TB and those living below poverty line,” says Dr C Venkatesh, TB officer in Puducherry.

The UT has created a buffer stock of donated nutrition baskets. “Now, we are able to give the baskets to prioritised patients on Day 1 of diagnosis from this buffer stock. For others, we try to ensure that they are able to get a nutritional basket, as per availability, within 20-25 days,” says Dr Venkatesh.

This is a marked improvement over the findings of a study conducted in the UT between 2023 and 24. A study by Dr Revadi G from Sri Manakula Vinayagar Medical College and Hospital showed 49% of the patients received at least three food baskets during their treatment period. As the treatment for the non-drug resistant TB lasts for six months, ideally patients should have received six baskets. And the duration between the diagnosis and the receipt of the first food basket was found to be 41 days.

As Dr Venkatesh says: “We have started seeing improvements already. The treatment outcomes have improved, the patients reported feeling better and they returned to work earlier, sometimes as early as 1.5 months after diagnosis.”