Samuel Blesson, Volkmann Tyson, Cornelius Sushma, Mukhopadhay Sugata, Mitra Kaushik, Kumar Ajay M V, Oeltmann John E, Parija Sidhajyoti, Prabhakaran Aslesh Ottapura, Moonan Patrick K, Chadha Vineet K
World Vision India, New Delhi, India.
Centers for Disease Control and Prevention, Atlanta, USA.
J Tuberc Res. 2016 Dec;4(4):213-219. doi: 10.4236/jtr.2016.44023. Epub 2016 Dec 21.
Poverty and poor nutrition are associated with the risk of developing tuberculosis (TB). Socioeconomic factors may interfere with anti-tuberculosis treatment compliance and its outcome. We examined whether providing nutritional support (monthly supply of rice and lentil beans) to TB patients who live below the poverty line was associated with TB treatment outcome.
This was a retrospective cohort study of sputum smear-positive pulmonary TB patients living below the poverty line (income of <$1.25 per day) registered for anti-tuberculosis treatment in two rural districts of West Bengal, India during 2012 to 2013. We compared treatment outcomes among patients who received nutritional support with those who did not. A log-binomial regression model was used to assess the relation between nutritional support and unsuccessful treatment outcome (loss-to-follow-up, treatment failure and death).
Of 173 TB patients provided nutritional support, 15 (9%) had unsuccessful treatment outcomes, while 84 (21%) of the 400 not provided nutrition support had unsuccessful treatment outcomes (p < 0.001). After adjusting for age, sex and previous treatment, those who received nutritional support had a 50% reduced risk of unsuccessful treatment outcome than those who did not receive nutritional support (Relative Risk: 0.51; 95% Confidence Intervals: 0.30 - 0.86).
Under programmatic conditions, monthly rations of rice and lentils were associated with lower risk of unsuccessful treatment outcome among impoverished TB patients. Given the relatively small financial commitment needed per patient ($10 per patient per month), the national TB programme should consider scaling up nutritional support among TB patients living below the poverty line.
贫困和营养不良与患结核病（TB）的风险相关。社会经济因素可能会干扰抗结核治疗的依从性及其治疗效果。我们研究了向生活在贫困线以下的结核病患者提供营养支持（每月供应大米和扁豆）是否与结核病治疗效果相关。
这是一项回顾性队列研究，研究对象为2012年至2013年期间在印度西孟加拉邦两个农村地区登记接受抗结核治疗的痰涂片阳性肺结核患者，他们生活在贫困线以下（每日收入低于1.25美元）。我们比较了接受营养支持的患者与未接受营养支持的患者的治疗效果。采用对数二项回归模型评估营养支持与治疗失败结局（失访、治疗失败和死亡）之间的关系。
在173名接受营养支持的结核病患者中，15名（9%）治疗结局不佳，而在400名未接受营养支持的患者中，84名（21%）治疗结局不佳（p<0.001）。在调整年龄、性别和既往治疗情况后，接受营养支持的患者治疗失败结局的风险比未接受营养支持的患者降低了50%（相对风险：0.51；95%置信区间：0.30 - 0.86）。
在项目实施条件下，每月定量供应大米和扁豆与贫困结核病患者治疗失败结局风险较低相关。鉴于每位患者所需的资金投入相对较少（每位患者每月10美元），国家结核病项目应考虑扩大对生活在贫困线以下的结核病患者的营养支持。
