About 35 lakh identified tuberculosis patients across the country will soon get ₹500 every month from the Centre as social support.
Sunil D Khaparde, Deputy Director General (TB) and Head of the Central TB Division, told The Hindu that although the earlier proposal was to provide this cash benefit only to tribal and BPL patients, all the 35 lakh identified patients would be covered now.
“We will start providing the cash benefit for social support that will cover loss of wages, travel and mainly nutrition, soon. All hurdles have been cleared and we are waiting for the finance department’s approval,” he said.
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“Some states are already providing financial support. Similar support will be extended to all TB patients and their families which can be covered under the ambit of direct benefit transfer using Aadhaar,” he said.
Guidance document
The guidance document, based on which this decision was taken, was prepared by a team including Anurag Bhargava, Professor, Department of Medicine, Yenepoya (Deemed to be Univeristy) Manguluru, Anura V Kurpad, Head of the Department of Physiology and Nutrition in St John’s Medical College and Research Institute and other experts in TB and nutrition. It pointed out that under-nutrition is an established risk factor for progression of latent TB infection to active TB.
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According to the guidance document, under-nutrition is a serious co-morbidity in patients with active TB in India, and increases the risk of severe disease, death, drug toxicity, drug malabsorption and relapse after cure. “In the absence of nutritional support, undernourished patients with TB do get enmeshed in a vicious cycle of worsening disease and under-nutrition, which can be detrimental and even fatal. Food insecurity in household contacts of TB patients in India increases their risk of developing active TB. This has serious implications, especially for contacts of patients with multidrug-resistant TB,” the document said.
“Nutritional assessment, counselling and support are now considered integral aspects of care of TB patient. Therefore these elements need to be integrated into the overall management of patients with active TB in India,” Dr Bhargava told The Hindu . “TB is inextricably linked to determinants of health such as malnutrition and low immunity due to social deprivation and marginalisation. Poor nutrition is increasing the risk by three-fold. Nutritional support will help reduced TB deaths, which is currently at an estimated 4.8 lakh per year,” he said.
Take-home ration
Welcoming the Centre’s move to provide social support, Dr Bhargava said apart from this patients should also get nutritional assistance. “The state governments should take it upon themselves and provide this. Rather than processed food, take home rations will be better. Some states like Kerala and Tamil Nadu are already doing this,” he said, adding that this will also help in early case detection and treatment compliance.
“Under-nutrition at the population level contributes to an estimated over one million new cases of annual TB incidence in India. Under-nutrition and tuberculosis (TB) have a bidirectional relationship and studies on nutritional status of TB patients in India have shown high levels of moderate to severe under-nutrition in both women and men,” Dr Bhargava said.
Quoting former Indian Council of Medical Research (ICMR) Director General Sowmya Swaminathan’s paper, Dr Bhargava said: “Ultimately reduction of TB burden in India and its elimination will require improving the nutritional status of the community as a whole.”
What the guidance document has
- Guidelines on nutritional assessment, counselling and support
- A simplified field chart for doctors and health workers to make patient-specific assessment of required nutrition
- Recommendation that patients should also be screened for anaemia
- Recommends extra care for management of severely undernourished patients
- Severely undernourished patients should be hospitalised
Why is nutrition important ?
- Weights in TB patients are among the lowest in the world
- 50% of adult men weigh below 43 kg
- 50% of adult women weigh below 38 kg