Estimating the impact of reducing under-nutrition on the tuberculosis epidemic in the Central Eastern states of India: a dynamic modeling study
Abstract
Background
Tuberculosis (TB) and
under-nutrition are widespread in many low and middle-income
countries. Momentum to prioritize under-nutrition has been
growing at an international level, as demonstrated by the
"Scaling Up Nutrition" movement. Low body mass index is an
important risk factor for developing TB disease. The objective
of this study was to project future trends in TB related
outcomes under different scenarios for reducing under-nutrition
in the adult population in the Central Eastern states of India.
Methods
A compartmental TB
transmission model stratified by body mass index was
parameterized using national and regional data from India. We
compared TB related mortality and incidence under several
scenarios that represented a range of policies and programs
designed to reduce the prevalence of under-nutrition, based on
the experience and observed trends in similar countries.
Results
The modeled nutrition
intervention scenarios brought about reductions in TB incidence
and TB related mortality in the Central Eastern Indian states
ranging from 43% to 71% and 40% to 68% respectively, relative to
the scenario of no nutritional intervention. Modest reductions
in under-nutrition averted 4.8 (95% UR 0.5, 17.1) million TB
cases and 1.6 (95% UR 0.5, 5.2) million TB related deaths over a
period of 20 years of intervention, relative to the scenario of
no nutritional intervention. Complete elimination of
under-nutrition in the Central Eastern states averted 9.4 (95%
UR 1.5, 30.6) million TB cases and 3.2 (95% UR 0.7-, 10.1)
million TB related deaths, relative to the scenario of no
nutritional intervention.
Conclusion
Our study suggests that
intervening on under-nutrition could have a substantial impact
on TB incidence and mortality in areas with high prevalence of
under-nutrition, even if only small gains in under-nutrition can
be achieved. Focusing on under-nutrition may be an effective way
to reduce both rates of TB and other diseases associated with
under-nutrition.
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Source:
PLOS ONE
