00:00professor of medicine at kasturba medical college mangalore and apart from my other things i've
00:06been doing research on tb particularly its relation to under nutrition or malnutrition
00:12as people call it for the last many years and we have been we had worked in rural areas on this
00:20problem and we have we showed that actually when people with tb are undernourished they have a high
00:26risk of dying we also showed in our work earlier that in all the risk factors for tb in india
00:35major risk factor is under nutrition in adults so diabetes hiv smoking alcohol they are important
00:42but the most of the cases nearly more than one third or half are due to under nutrition and
00:50so in the rations trial we got this opportunity of directly demonstrating the effect of
00:56improving nutrition in patients as well as their household members
01:00on new cases of tb development in the household and on for example death amongst patients so
01:09as you know patients who are in close you know patients with tb who are infectious
01:15their household members are at higher risk of tb so and in places like jharkhand malnutrition is
01:22very common in the general population also particularly amongst tribals so in this trial
01:26we try to show the effect of an intervention in a field trial and maybe i'll tell you more about that
01:37before the trial one more thing which happened in india was that because of our work in tb nutrition we
01:43were given an opportunity by the national tb program to formulate with along with other experts
01:48a guidance document for tb and nutrition so this was released in 2017 and basically it said that
01:56all patients with tb in india should have their weight and height recorded at the time of diagnosis
02:01and during treatment and at that time also because already the data was showing that under nutrition
02:08is very common and severe in tb patients in india that they should be getting a food basket
02:13uh now because of certain logistical difficulties the government implemented a cash transfer scheme
02:19called the nikshya potion yojna so instead of food basket which is was still being given in some states
02:26government was transferring 500 rupees a month to all tb patients uh for a better food for a better diet
02:35now before the rations trial we did not have any evidence of what is the effect of these food baskets on
02:42patients will they improve in terms of you know reduce deaths or will they have more weight gain or
02:48will they have better treatment results and for the first time this intervention whether it can prevent tb
02:56in uh for example household members so no trial in the world had tested that uh possibility of preventing
03:03tb by give improving nutrition status so this rations trial basically uh was answering two questions
03:10which are very relevant to tb in india can food baskets for example improve the results of treatment
03:16and lower the death rates and can food baskets for the household members reduce number of new cases of
03:23tb so this was a three-year trial uh in four districts of jharkhan and we had enrolled 2800 family
03:32families with one person having infectious tb so lung tb patients with their household members were
03:38recruited in the study and the study was conducted between 2019 and 2022 in four districts of jharkhan
03:46and every patient in every of these 2800 families they got a 10 kg food basket
03:52so all patients got food baskets with rice with what is known as chana sattu with milk powder with oil
03:58and multivitamins for six months sometimes prolonged to 12 months and in addition amongst the 2800 families
04:071400 families got extra food rations where they were given five kg rice per head per month for an adult
04:15and one and a half kg tour dal along with multivitamins so this was the intervention in our
04:22trial it was not a drug intervention it was a food intervention
04:25and basically the outcome of the trial was that when we follow these patients for two years
04:31and their families can the number of new cases be reduced in this arm where we got we give extra food
04:381400 families who were not given this extra ration but the family member member with tb got a food basket
04:45so we are happy to say that over a period of you know the two years of follow-up
04:53we saw that compared to the control arm where you know the household members in the intervention
05:04arm had 39 percent reduction of all forms of tb and in the case of lung tb which is the more important
05:12part of tb there was 48 percent reduction so roughly 40 to 50 percent reduction of new cases
05:18happened in the trial when we gave additional food baskets containing rice and most importantly pulses
05:25to the family members and this was seen as a very important finding a new finding and as a result of
05:32this finding there has been a revision of the who guideline also amongst the patients we found
05:37that when we gave them food baskets patients had very very many of them at very low weights to start
05:43with even weights as low as 20 24 kgs as adults but their mortality figure was reduced compared to other
05:51studies by 35 percent and if we take very very severely underweight patients their mortality was the death
05:58rate was decreased by 50 percent also these patients gain better weight compared to other studies
06:06and what we saw was many of them more than uh 75 percent were said that they are able to return to work
06:14after the uh treatment along with the food basket so uh this trial showed that apart from effective
06:20treatment which is the basis for tb treatment if in our country when where patients have a lot of
06:26malnutrition and severe malnutrition if we give them extra food which many poor families cannot afford
06:32because when the patient with tb often he's the bread uh winner of the family he becomes ill then the
06:39family suffers more poverty they do not have enough money for nutritious food so when we give this extra
06:45food basket patients can uh you know there will be lesser deaths people will return to work and uh you
06:52know the overall outcome will improve so both with the national goal that we are trying to do is reduce
06:57tb deaths which should be brought down really because we are still losing too many patients with tb
07:03and of preventing new cases the rations trial has given some new direction so um i think
07:12so it has important findings and the who convened a meeting in 2024 of their guideline development group
07:21to discuss uh you know all the evidence around food support for tb patients and their families
07:26and we were part of the process so dr magmi will probably take you through that
07:32these papers were published in 2023 in the lancet and lancet global health these are respected uh
07:40you know medical journals and they got a very wide coverage both uh you know across the world and i'm
07:46happy to say that the government also uh you know paid attention to these new findings and they tried
07:52to you know improve the uh money uh you know being transferred to patients as well as try to uh have
07:59tried to introduce food baskets for patients through the nikshaya mitra yojana so that's also positive
08:05development and in some states like jharkhand and himachal pradesh uh these are already being rolled out
08:12uh also uh our guidelines have come into textbooks of medicine and uh now the whoo guide
08:28you
Comments