Mangaluru Doctors’ TB Research Prompts Major Change in WHO Guidelines
Groundbreaking research by a
Mangaluru-based doctor couple has led the World Health Organisation
(WHO) to revise its global tuberculosis (TB) treatment guidelines,
placing new emphasis on food and nutritional support for both patients
and their families.
Dr. Anurag Bhargava of Kasturba Medical
College and Dr. Madhavi Bhargava of Yenepoya Medical College conducted
an Indian Council of Medical Research (ICMR)-supported trial that
demonstrated the critical role of nutrition in reducing TB transmission
and improving survival rates.
Their study, known as the RATIONS
(Reducing Activation of Tuberculosis by Improvement of Nutritional
Status) trial, showed that providing food support to household contacts
of TB patients cut the risk of new TB infections by nearly half.
Simultaneously, nutritional support for patients improved their chances
of recovery and survival significantly.
Earlier this week, the
WHO incorporated these findings into its consolidated guidelines on
tuberculosis and undernutrition, recommending “provision of food
assistance to prevent TB in household contacts of people with TB in food
insecure settings.” The organisation cited five studies by the
Bhargavas and their collaborators as key evidence supporting this policy
change.
The RATIONS trial, involving around 2,800 TB patients
and over 10,000 family members across four districts in Jharkhand,
provided each adult participant with a monthly food basket containing 5
kg of rice, 1.5 kg of lentils, and multivitamin tablets. The
intervention reduced new cases of infectious pulmonary TB among
household members by 48%.
“The risk of TB in family members is
much higher due to shared environments of poverty and food insecurity,”
said Dr. Madhavi Bhargava. “A family-based approach not only improves
treatment outcomes but also helps reduce the overall TB burden in the
long term.”
Following the trial’s success, state governments in
Jharkhand, Tamil Nadu, and Himachal Pradesh have begun distributing food
baskets to families of TB patients. The Union government has also
increased monetary assistance to help patients access better nutrition.
India
has the world’s highest TB burden, with over 28 lakh new cases and more
than 3.2 lakh deaths in 2023 — translating to 37 deaths every hour. In
Karnataka alone, TB claims nearly 5,000 lives annually.
“Malnutrition
remains the leading risk factor for TB in India,” said Dr. Anurag
Bhargava. “Improving nutrition across the population could be a game
changer in ending TB.”
The Bhargavas’ study also found that
improved food availability reduced TB mortality by 35%, while weight
gain during the first two months of food supplementation cut the risk of
death by 60%. Modeling studies suggest that extending such food support
to half of India’s TB-affected families could prevent four lakh deaths
and nine lakh TB episodes between 2023 and 2035.
“This was
field-based evidence, not a hospital or laboratory study,” Dr. Anurag
noted. “It is encouraging that the results, given their real-world
relevance, have been incorporated into WHO guidelines and even medical
textbooks within just two years.”