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Nutrition Supplement Improves Treatment Outcome among Adults on the Retreatment Regimen for Tuberculosis; A Two Arm
Reddy Sirasanambati Devarajulu1, Ariarathinam Newtonraj1, Thiruvengadam Kannan1
1Department of Clinical Research, ICMR National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India.
Background:
Loss to follow-up and noncompliance to anti-tuberculosis treatment (ATT) are the main causes of recurrence of tuberculosis (TB). In this study, we aim to investigate the effect of nutritional supplements as a treatment enhancer to help patients with pulmonary TB (PTB) on a retreatment regimen to complete ATT, reduce loss to follow-up, and thus increase favorable outcomes in a programmatic setting.
Methods:
In this prospective community interventional study conducted under NTEP program in the Vellore district of Tamil Nadu during 2017-2019, PTB patients on a retreatment regimen were given a nutritional supplement. The supplement, given fortnightly as a 500 gm pack of enriched flour, was distributed to all the tuberculin units of Vellore in a phased manner. The flour consisted of finger millet (ragi), rice flakes, groundnuts, and roasted Bengal gram with advice to cook and consume 30 gm per day with milk or hot water. ATT was given as per the National Program guidelines. Phased implementation of the supplement was performed in the tuberculosis unit, while the others were considered as control groups.
Results:
We enrolled 415 adult PTB patients on a retreatment regimen. Of them, 284 (68%) patients received the nutritional supplement, and 131 (32%) did not receive the nutritional supplement. There was a 28% significant decrease in unfavorable outcomes among the intervention group (adjusted risk ratio [aRR] -0.72 (0.57-0.90) when compared to the control arm. There was also a significant increase in weight and mid-arm circumference over the follow-up period of 14 months in the intervention arm. There was a significant improvement in social relationships and environmental domains in quality of life among the intervention group.
Conclusion:
In a program setting, nutritional supplement not only increases weight but also act as treatment enhancers. This improves treatment completion and reduces unfavorable outcomes among retreatment patients.
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