India has a large underweight population with TB – and the Covid-19 crisis is only making it worse

When India announced a lockdown to curb the spread of coronavirus, a concern was echoed throughout the country: how will those who need to step out to earn money every day, sustain themselves?

As Covid-19 grips the headlines, we often forget that India has one of the largest underweight populations in the world. In some states, these statistics are extremely grim. We often forget that while low weight is a classic symptom of poverty, it is also one of tuberculosis, a disease associated with the wasting away of fat and muscle. Being underweight is both a cause and a consequence of TB.

Poverty and resulting hunger and undernutrition increase the chances of active TB and also the severity of the disease. It reduces patients’ speed of recovery and exacerbates suffering side effects from the medicine, and the likelihood of their becoming one of the many Indians that TB claims every year.

Nutrition is crucial

Developing TB also compounds undernutrition and weight loss. First, the disease reduces appetite and hence dietary intake. Second, the fever increases the basal metabolic rate – the rate at which calories are expended and finally TB causes a breakdown of protein and muscle, leading to wasting –low weight-for-height. Further, undernutrition continues to challenge patients, both while treatment and after.

It can delay recovery as measured by the time taken for a patient’s sputum to test negative, and severely undernourished patients are between two and four times more likely to die than adequately nourished patients. After the completion of treatment, under-nutrition increases the chances of a relapse and compromises physical activity due to poor muscle strength.

A brief, titled Fighting TB in times of Covid-19 by Survivors Against TB has highlighted “nutrition” as a key aspect for concern, and detailed how several queries received on the group’s virtual helpdesk pertained to it. What should a TB patient eat, especially on a budget?

The brief also mentions that there have also been numerous instances of the non-receipt of direct benefit transfer under Nikshay Poshan Yojana which gives a monthly sum of Rs 500 to TB-affected individuals to meet their nutrition and food requirements.

This forces those from economically weaker sections back into the workforce, pushes them into poverty and debt and puts them at risk of increased mortality due to TB, and now, even Covid-19. A loss in income will also in all likelihood delay healthy behaviours, early care seeking or diagnosis and increased transmission.

Economic impact

The loss of jobs in an already slowing economy has ensured that patients and families are desperate, and often without sufficient nutrition. Due to lockdowns, consistent migration, and losses in the informal economy, food security and nutritional levels are bound to fall and hunger is likely to increase. This will have a long-term impact on immunity levels and a proposition to consider here is the activation of latent TB disease in otherwise latent cases which would have otherwise not added to India’s TB cases.

It is important to track turnaround time for payments on a regular basis for Nikshay Poshan Yojana, Tribal and Private provider schemes. Also needed is to aggressively pursue procurement of Digital Signature Certificates, train staff via e-trainings and fast track delivery of tokens in lockdowns to deploy digital signature certificates. This will help reduce travel to Banks with the slips to pay out the transfers.

Direct benefit transfers play a crucial role to mitigate the challenges pertaining to nutrition and travel support for patients and incentivise private providers to notify and facilitate treatment completion. India needs to fast track payments and clear the backlog of payments to ensure patients are not left in a lurch.

Deepti Chavan is an MDR TB Survivor Advocate and Fellow Survivors Against TB.

Keyuri Bhanushali is a copywriter, MDR TB Survivor Advocate and Fellow Survivors Against TB.