In fight against TB, poor nutrition a silent killer

Adequate nutrition doesn’t just complement the treatment of tuberculosis; it is a key component of recovery. Yet government schemes for nutritional support are failing to meet this basic need

MUMBAI: A 32-year-old woman from a Worli slum is battling tuberculosis (TB) for the second time. A few months ago, she was diagnosed with drug-resistant TB—a more severe and harder-to-treat version of the disease.

A patient suffering from Tuberculosis takes his medicines. (HT Archives)

The woman lacks a crucial component in her treatment regimen – one no doctor can provide. The truth is, adequate nutrition alone would greatly raise her chances of recovery. Studies have shown that malnutrition fuels deaths and drug resistance in TB patients, undermining efforts to treat patients with all forms of the disease. On the other hand, a nutrient-rich diet significantly enhances positive outcomes.

Part of the reason the woman is malnourished is that, for the last four months, she has not received the ₹1,000 monthly nutritional support under the government’s Nikshay Poshan Yojana. The sum, recently doubled, is meant to help TB patients afford the bare essentials of a recovery-friendly diet. “My monthly food expenses are around ₹2,000. So I skip the ₹700 protein powder prescribed by my doctor,” she told HT.

A grim reality

Vatsala was one of 2,800 people diagnosed with drug-resistant TB in Mumbai in 2024. That year, Mumbai recorded 60,051 TB cases—averaging 164 new cases diagnosed each day.

In Maharashtra, TB detection rose marginally, by 2% in 2024 – 2,28,877 cases were reported, or 627 cases a day.

In 2024, Mumbai alone witnessed 2,264 TB-related deaths—averaging over six deaths a day. Parel recorded the highest toll – 377 deaths, according to data obtained through the Right to Information Act, 2005.

Nutritional support

Health activists say the government should consider food a medical necessity for TB patients. Ganesh Acharya, a health activist working with TB patients in Mumbai, said, “The ₹1,000 support should be raised to at least ₹2,500 if we want patients to recover. Nutrition is not a luxury—it is the core of TB treatment.”

His concerns are reflected in the findings of the RATIONS trial—a landmark study (conducted between 2019 and 20-22, and published in The Lancet in 2023) in tribal Jharkhand, where TB-affected families were provided macronutrient-rich food baskets (1,200 kcal for patients and 750 kcal for household contacts). The trial showed significantly improved treatment outcomes and a reduction in TB incidence among contacts (family members). Based on this, a modelling study published in The Lancet Global Health (March 2025) estimated that providing food and supplements to just 50% of India’s TB-affected households could prevent 361,200 deaths and 880,700 new TB cases between 2023 and 2035.

Dr Finn McQuaid, one of the RATIONS researchers, told Hindustan Times, “My understanding is that ( ₹1,000) is a big step in the right direction but it’s not quite there yet. Another issue is that the composition of food baskets is important (they must contain sufficient proteins and micronutrients), which cash support alone may not address.”

Dr Pranay Sinha, assistant professor at the Boston University School of Medicine, said implementation, not just policy design, is the bigger challenge. “Lack of access to banking and other logistical delays prevent persons with TB from receiving the money at the most critical juncture of their treatment. We need some operational innovations to ensure that PWTB get the money as soon as possible post-diagnosis.”

Role of Body Mass Index

BMI is a key clinical indicator in TB outcomes—lower BMI increases mortality risk. However, McQuaid cautions against targeting support based on BMI. The RATIONS trial showed benefits even in patients with normal BMI, he underscores.

On the flipside, Dr Pranay Sinha points out, even TB patients with normal BMI may suffer micronutrient deficiencies, noting studies linking Vitamin A deficiency to a ten-fold TB risk and citing 25% mortality in patients with BMI below 14 in Tamil Nadu, where he advocates early inpatient nutritional care.

Sponsor a patient

Experts feel it is not wise to lean too heavily on government schemes for nutritional support, an issue the Ni-kshay Mitra scheme hopes to address. A government scheme, it aims to enhance community involvement in the fight against TB by linking patients with supporters, or ‘mitras’, who provide assistance.

Pulmonologist Dr Vikas Oswal said, “The ₹1,000 is not meant to cover an entire diet, but it’s a helpful supplement. The Ni-kshay Mitra initiative enables individuals and organisations to sponsor patients and provide regular food baskets.”

However, patients from high-burden areas such as Govandi and Dharavi told HT that this support too is inconsistent. A 44-year-old autorickshaw driver from Dharavi, who is undergoing treatment for bone tuberculosis, said he last received the food basket in November 2024. “The local politician who was distributing it stopped. The basket had apples, pomegranates, and grains—it helped us survive for seven months. I can’t work due to my health, and my wife supports the household. TB medicines kill my appetite, but getting good food encourages me to eat better than just dry roti at home,” he said.

According to the Ni-kshay Mitra dashboard, Maharashtra currently has 1,50,579 people undergoing TB treatment. While 14,194 donors have registered under the scheme—and 83.2% committed to providing food baskets for at least six months—coverage remains patchy. In Dadar, of the 3,041 patients under treatment, only 1,569 received food baskets. In another ward, just 1,646 out of 2,133 got assistance—barely 60%.

“There’s a system,” said Acharya, “but it’s breaking where it’s needed the most.”

Dr Sandeep Sangale, Joint Director (TB and Leprosy), Maharashtra, dismissed claims that some TB patients are still receiving ₹500 instead of the revised ₹1,000 nutrition support. “All patient accounts are centrally linked and payments are generated alphabetically through the system. There is no possibility of anyone receiving ₹500 now. The disbursal is done every three months, so patients in earlier payment cycles may have received a lump sum for three months. The next instalment will be credited once their cycle resumes,” he said.