Providing nutritional support to half of the families with people receiving TB treatment might avert about 2.2 per cent of disease episodes and 4.5 per cent of TB-related fatalities by 2035, a study has revealed.
According to the study, which was published in The Lancet Global Health journal, such an intervention could prevent over 8.8 lakh TB infections and nearly 3.6 lakh fatalities.
Typically, about 24 households would need to be treated of tuberculosis to prevent one death, while 10 would need to be treated to prevent one case, researchers, including those from the Indian Council of Medical Research (ICMR)-National Institute for Research in Tuberculosis (NIRT), Chennai, estimated.
According to researchers, including those from the Indian Council of Medical Research (ICMR)-National Institute for Research in Tuberculosis (NIRT), Chennai, about 24 households would normally need to receive TB treatment in order to prevent one death, and 10 households would need to receive treatment in order to prevent one case.
The nutritional intervention could have an additional cost of about USD 1,349 million on the health system, with potential benefits of USD 167 for every disability-adjusted life-year averted, they projected.
'Disability-adjusted life-year' is a metric that helps measure overall burden of disease.
The researchers said about a fifth of the world's tuberculosis incidence is attributable to undernutrition, with the ratio increasing to more than a third in India.
A 2023 study, published in The Lancet journal, by the same research team had enrolled household contacts of 2,800 patients with tuberculosis across 28 units of the National Tuberculosis Elimination Programme in four districts of Jharkhand.
The patients received food rations of 1,200 kilocalories (52 grams of protein per day with micronutrients) for six months, with their household contacts receiving monthly food rations and micronutrients having 750 kilocalories (23 grams of protein per day with micronutrients).
Results showed that over a two-year follow up period, tuberculosis incidence in a household dropped by 39-48 per cent, simply by extending nutritional support to household contacts of the infected.
In this study, the researchers used the 2023 study's model to inform estimates of the impact and costs of nutritional support.
"We found that if India can deliver a nutritional intervention to 50 per cent of households in which individuals are receiving tuberculosis treatment, nearly 9,00,000 episodes of tuberculosis would be averted, and nearly 4,00,000 deaths, at a cost of USD 167 per disability-adjusted life-year averted," the authors wrote.
Providing nutritional support is likely to have substantial health and economic benefits among the households willing to pay, even at the national level, they said.
A higher fraction of the tuberculosis burden could be averted by focussing on states having high levels of undernutrition, further improving the value for money, the authors added.
"Considering the equity and health benefits beyond tuberculosis, our study likely underestimates both impact and cost-effectiveness," the authors wrote.
A December 2024 study, published in the journal PLoS Medicine, estimated over 62 million cases of tuberculosis and eight million deaths in the two decades up to 2040, along with a Gross Domestic Product (GDP) loss of more than USD 146 billion.
However, improving case detection rates and meeting the World Health Organization's End-TB target of 90 per cent could reduce disease burden by 75-90 per cent, and macroeconomic burden by USD 120.2 billion, the study projected.
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