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Challenges and Barriers in Implementation of National Tuberculosis Elimination Program Guidelines at Nutrition
Praveen Kumar Anand1, Devanshi Patel2, Ghisaram Dewasi3
1ICMR National Institute for Implementation Research on Non-Communicable Diseases, New Pali Road, Jodhpur, Rajasthan, 342005, India.
Background:
Tuberculosis (TB) remains a significant public health challenge in India. Malnutrition and TB form a vicious cycle, where malnutrition predisposes a child to acquire TB, while TB could exacerbate undernutrition. In India, Nutritional Rehabilitation Centers (NRCs) provide therapeutic nutrition and medical care to address malnutrition in children. The National Tuberculosis Elimination Program (NTEP) was integrated into India's NRCs in 2012 for early detection of TB among malnourished children; however, its implementation remains suboptimal. The present study aims to identify the challenges and barriers in implementing NTEP guidelines at NRCs in India through systematic review of literature.
Methods:
The systematic review was conducted across six databases including PubMed, Scopus, ScienceDirect, WHO Global Index Medicus, Semantic Scholar, and Google Scholar for studies published between 2010 and 2024. The systematic review protocol has been registered in the PROSPERO web portal with Registration ID No. CRD42025644172. The quality of individual studies included in the evidence synthesis was assessed using the Mixed Methods Appraisal Tool (MMAT) - Version 2018. A narrative synthesis approach, following the SWiM (Synthesis Without Meta analysis) guidelines, was employed for data analysis.
Results:
Out of 1,374 records identified through database searches, four studies met the inclusion criteria and were included in the final synthesis. Key challenges and barriers reported in implementation of TB screening and diagnosis were (1) underutilization of diagnostics, (2) human resource constraints, (3) sample collection issues, (4) treatment gaps, and (5) infrastructural limitations. Addressing these barriers with context-specific innovative strategies is essential to improve TB screening and diagnosis among malnourished children admitted in NRCs.
Conclusion:
This systematic review highlights that while NRCs play a crucial role in managing SAM, the underutilization of diagnostic tools, limitations in human resources, difficulties in sample collection, and infrastructural and logistical barriers have resulted in the potential underdiagnosis of TB in this vulnerable population. This systematic review provides valuable insights into the issues that must be addressed to improve TB diagnosis among SAM children admitted at NRCs in India.
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