title: Relationship between Nutritional Support and Tuberculosis Treatment Outcomes in West Bengal, India.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: World Vision India, New Delhi, India.
authors.forename: Blesson
authors.initials: B
authors.lastname: Samuel
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, USA.
authors.forename: Tyson
authors.initials: T
authors.lastname: Volkmann
authors.affiliation: World Vision India, New Delhi, India.
authors.forename: Sushma
authors.initials: S
authors.lastname: Cornelius
authors.affiliation: World Vision India, New Delhi, India.
authors.forename: Sugata
authors.initials: S
authors.lastname: Mukhopadhay
authors.affiliation: World Vision India, New Delhi, India.
authors.lastname: MejoJose
authors.affiliation: Burdwan Medical College, West Bengal, India.
authors.forename: Kaushik
authors.initials: K
authors.lastname: Mitra
authors.affiliation: International Union against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India.
authors.forename: Ajay M V
authors.initials: AM
authors.lastname: Kumar
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Oeltmann
authors.affiliation: Southern Health Improvement Samity, West Bengal, India.
authors.forename: Sidhajyoti
authors.initials: S
authors.lastname: Parija
authors.affiliation: Department of Community Medicine, Academy of Medical Sciences, Pariyaram, India.
authors.forename: Aslesh Ottapura
authors.initials: AO
authors.lastname: Prabhakaran
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, USA.
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Moonan
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India.
authors.forename: Vineet K
authors.initials: VK
authors.lastname: Chadha
keywords: India; Nutritional Support; Poverty; Pulmonary Tuberculosis