Sustainable Development Goals (target 3.3) envision that by 2030, we shall have ended epidemics like tuberculosis. However, this will remain a mirage if the social determinants fuelling the infection are not circumvented.
The 2022 Global TB Report indicates that 10.6 million people were infected with TB while 1.6 million died from the disease in 2021.
With a death rate of 7.1 per cent, Kenya is among countries that contributed 77,854 cases to the global TB burden.
Science has shown that undernutrition is one of the strong risk factors for the ballooning cases of TB. The 2021 National TB Report cemented this evidence when it recorded a whopping 49 per cent and 56 per cent malnutrition rate among drug-susceptible and drug-resistant TB patients respectively at the time of diagnosis.
The situation is dire in the drought-stricken penumbra counties. Turkana tops the list of TB patients with a malnutrition rate of 69.1 per cent. In other words, out of 100 TB patients, 69 of them are malnourished. Turkana is closely followed by Samburu County (68.1 per cent), Baringo (65 per cent), West Pokot (64 per cent), Marsabit (62.8 per cent) and Elgeyo Marakwet at 59.1 per cent.
The figures are alarming, but that is the dispiriting reality on the ground. Due to this devastating state, scholars have termed under-nutrition as Nutritional Acquired Immunodeficiency Syndrome (N-AIDS).
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An immunonutritionist will tell you that undernutrition weakens the body's defence mechanism against infections and can undermine good treatment outcomes at national and individual levels. Therefore, a person with TB should aim to have three meals and three snacks daily.
There is increasing evidence that undernutrition in TB patients is associated with increased frequency and severity of disease and, indeed, a two-fold increase in mortality. In the same vein, a five-fold risk of drug-induced liver damage and malabsorption of key anti-TB drugs has been recorded.
It is clear that there is a problem which can only be ameliorated through a multi-sectoral approach that aims at the entire spectrum of external factors hampering TB prevention, control and management strategies.
Due to poor TB treatment outcomes occasioned by malnutrition, the National Tuberculosis Programme has judiciously ensured continuous nutrition assessment and appropriate interventions for all eligible TB patients throughout the treatment, targeting patients with severe acute malnutrition or moderate acute malnutrition.
This meagre support targets patients those enrolled for TB treatment. What about those not benefitting from this initiative? Nutrition should be addressed at the household level to obviate predisposing communities to TB.
The Ministry of Agriculture, the National Treasury, county governments, partners, the corporate world, Kenya National Bureau of Statistics and other stakeholders should collaborate with the Ministry of Health to alleviate the under-nutrition crisis by galvanising and catalysing sustainable, impactful, cost-effective and community-led interventions, which have been mathematically modelled to prevent TB reactivation, increase treatment success rates, improve recovery and reduce TB deaths. Equally, implementation research will help to unravel this crisis.
Mr Marcomic and Mr Karani are Field Epidemiology and Laboratory Training Programme Residents-Nairobi. mjmaragia@@gmail.com and vallerian08@gmail.com