High burden of severe and very severe undernutrition among adults with tuberculosis: findings from a state wide operational research in Chhattisgarh, India.

Background: Undernutrition drives the TB epidemic in India with 4-5 times higher mortality among adults with severe/very severe undernutrition. We assessed proportion of severe/very severe undernutrition among adults with TB and timeliness in receiving monetary support for nutrition (Direct benefit transfer-DBT) and food baskets.

Research design and methods: This analytical cross-sectional study conducted in Chhattisgarh, tribal Indian state, utilized program data of adults with TB notified in public facilities under the National TB Elimination Program from April-June 2024. Body Mass Index (BMI) was categorized for nutritional status and equity in distribution of DBT and foodbaskets was evaluated using frequency, proportions, and Chi-square for trend.

Results: Of 6568 adults with TB, BMI was calculated for 6397 (97%). Proportion of severe and very severe undernutrition was 22% and 13% respectively. First DBT instalment was received by 81%, with 29% receiving it within two months; 21% received foodbaskets, with similar coverage across all undernutrition categories (p > 0.05), reflecting inequity.

Conclusions: There is a high burden of severe/very severe undernutrition among TB patients. Similar DBT and food basket coverage among those with severe/very severe undernutrition and other TB patients indicates inequity in distribution. Undernutrition-basedindicators and linkage of DBT and food baskets should be prioritized.