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ORIGINAL RESEARCH

A Cross-sectional Study on the Magnitude of

undernutrition in Tuberculosis Patients in the
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Oromia Region of Ethiopia

Bedru Hussien 1 Purpose: To estimate the magnitude of undernutrition in tuberculosis (TB) patients and
Gobena Ameni 2–4 evaluate its association with selected sociodemographic and clinical characteristics of the
1
patients.
Department of Public Health, Madda
Walabu University, Goba Referral Patients and Methods: A health facility-based cross-sectional design was used. Four
For personal use only.

Hospital, Robe Bale, Oromia, Ethiopia; hundred and fifty pulmonary TB (PTB) patients were recruited between September 2017
2
Aklilu Lemma Institute of Pathobiology,
and August 2018. Data were collected by structured questionnaire and anthropometric
Addis Ababa University, Addis Ababa,
Ethiopia; 3Department of Veterinary measurements. Data were analyzed using SPSS 20. Descriptive statistics was used for the
Medicine, College of Agriculture and analysis and expression of the data. Regression model was used to determine the association
Veterinary Medicine, United Arab
Emirates University, Al Ain, United Arab
between undernutrition and selected factors.
Emirates; 4Department of Health Studies, Results: The magnitude of underweight was 51.6%, (95%CI: 47.15–56.2). Binary logistic
University of South Africa, Pretoria, regression indicated that previous treatment with anti-TB (crude odds ratio, COR=1.68, 95%
South Africa
CI: 1.08–2.63; p<0.023), duration of illness greater than two months (COR=2.11, 95%CI:
1.26–3.55, p<0.005), positive HIV serum status (COR=3.83, 95%CI: 1.63–9.02, p<0.002)
and history of resistance to any anti TB drug (COR=2.76, 95%CI: 1.29–5.91, p<0.009) were
associated with underweight. Multiple logistic regression analysis of the association of the
aforementioned variables with undernutrition indicated that HIV positivity (adjusted odds
ratio, AOR=0.26, 95%CI: 0.104–0.65, p<0.004) and resistance to any anti-TB drug
(AOR=0.39, 95%CI: 0.173–0.90, p<0.026) were the associated factors.
Conclusion: A significant proportion of TB patients in the Oromia Region were malnour­
ished. Therefore, nutritional counseling and nutritional supplementation are required for the
effective treatment of TB patients in the Region.
Keywords: body mass index, undernutrition, tuberculosis, Oromia Region of Ethiopia

Introduction
The association between TB and undernutrition has long been known. TB and
undernutrition interrelate in such a way that TB negatively affects the nutritional
status of somebody and undernutrition exposes someone to active TB.1–3 Most
individuals with active TB are in a consumed state worsening undernutrition and
making them weak in defending against infections or allowing them to sustain
easily the progression of subclinical cases to clinically apparent cases like latent TB
to active TB.4,5 The patient may have poor appetite to eat perhaps as a result of
fatigue or may not get enough to eat if they have few resources.4,6 It has also been
Correspondence: Bedru Hussien found that malnourished TB patients have poor bioavailability (low proportion of
Tel +251911997287
Email bedruplos1964@gmail.com a drug that can reach its target) of essential drugs like rifampicin. This can

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contribute to treatment failure and development of multi­ health coverage of the region in terms of health centers
drug resistance. There could also be higher risk of hepa­ and health posts were 93% and 94% in 2019,
totoxicity (which is a major side effect of TB therapy), respectively.14 Data were collected during the period
poor adherence to medical treatment, delayed recovery and between September 2017 and August 2018.
hence increased transmission rate, and higher mortality
rates than well-nourished patients.7–9 Study Population and Subjects
Food and nutritional support as an incentive and Pulmonary TB (PTB) patients who are permanent resi­
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enabler are employed by national TB control programs dents of the Oromia Region, and individuals visiting
worldwide to make a difference in adherence to anti-TB health centers and hospitals located in the selected zones
drug treatment and sputum conversion period, cure and for ill health and were not on drug treatment for the
treatment completion rates, gain in body weight and body current episode of TB were the study population.
composition as well as performance status, or to modify
associated risk factors for a better TB control program.10– Sampling and Sample Size
12 For sampling, the study zones and particular HFs were
Closer nutritional monitoring and earlier initiation of
nutrition support (before the first two months of treatment selected on the basis of convenience in terms of geographi­
are completed) should be considered particularly if the cal accessibility and logistic capacity and patients were
nutritional indicator is approaching the cutoff value for enrolled according to their presence for clinical consultation
a diagnosis of severe-acute malnutrition.13 until the proportional numbers of people are obtained from
For personal use only.

For appropriate intervention regarding undernutrition each HF to totally recruit the estimated sample size of 450.
in TB patients for effective control program it is important The criteria for recruitment of the study participates were,
to have updated information on the magnitude of the being a case of PTB diagnosed by a clinician according to
problem as well as associated factors. Although previous the National TB and Leprosy Control Program Guideline15
studies have shown the association between TB and under­ and a permanent resident of the region.
nutrition, additional studies can help in generating scien­
tific information on the extent of undernutrition in TB Data Collection Tool and Process
patients in different geographic settings so that appropriate A structured questionnaire was prepared in English and
correction measures are taken in order to improve the administered by the interviewer for data collection. Data
outcome of TB treatment. The Oromia Region is one of were collected on sociodemographic characteristics and
the regional states of Ethiopia with the largest human clinical history of the patient. The questionnaires were
population. Furthermore, similar to the other regions of pretested on 25 TB patients outside the catchment areas
the country, TB is prevalent in the Oromia Region. But of selected HFs and not included in the analysis.
little information is available on the extent of undernutri­ Modifications were made as necessary.
tion in TB patients in the Oromia Region. The present After informed consent, questionnaires were adminis­
study was formulated with the objective of investigating tered by trained data collectors in local languages. The
the magnitude of undernutrition in TB patients and asso­ data collectors were skilled laboratory technicians, nurses,
ciated risk factors in the Oromia Region and it forms part and public health workers who can fluently speak, read
of a thesis that was done through the University of South and write local languages, Afan Oromo and Amharic.
Africa. Anthropometric measurements were taken. Weights
were recorded using regularly calibrated beam balance
(±100 g precision), with the patient wearing light clothing.
Materials and Methods Heights were recorded to the nearest centimeter with
Study Design and Setting a stadiometer using standard procedures. Body mass
A health facility (HF)-based cross-sectional design was index (BMI) was calculated as weight in
used to conduct this study in the Oromia Region. This kilograms divided by squared height in meters (Wt (kg)/
region is the largest state of the Federal Republic of Ht (m2)). For those who were under the age of 18 years,
Ethiopia with a population of about 40 million. With the BMI-for-age percentiles were used for assessing nutri­
regard to health facilities, the region has a total of 108 tional status of boys and girls differently from BMI of
hospitals, 1405 health centers and 7090 health posts. The adults.

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Statistical Analysis Association Between Undernutrition and

The statistical analysis was performed using SPSS version Different Factors
20. Descriptive statistics were used to depict the socio­ Bivariate regression model analysis has shown that age
demographic characteristics, clinical history, and nutri­ group <18 years of age compared to age group 29–39;
tional status. The heights and weights measured were educational status of below secondary school compared to
used to calculate the BMI (BMI=weight in kg/height secondary school complete; and family size >4 compared
in m2) at registration. A BMI of ≥18.5 and ≤24.99 kg/m2 to those with family size ≤4 are associated with under­
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was classified as normal, and undernutrition as BMI nutrition (p<0.25) as shown in Table 3. Multiple logistic
<18.5 kg/m2, overweight as BMI ≥25 kg/m2. Different regression analysis indicated that age group <18 was asso­
classes of malnutrition were also defined as follows: mild ciated (AOR= 0.028, 95%CI: 0.006–0.125) with
malnutrition, BMI=17.0–18.4 kg/m2; moderate malnutri­ undernutrition.
tion, BMI=16.0–16.9 kg/m2; severe malnutrition, BMI In addition, the selected clinical parameters were sta­
<16.0 kg/m2.16–18 Bivariate and multiple logistic regres­ tistically (p<0.05) associated with undernutrition as com­
sion model analysis were used to test the statistical asso­ puted by binary logistic regression model. Further analysis
ciation between nutritional status and sociodemographic of the association of these risk factors with undernutrition
characteristics as well as clinical parameters. A p-value using multiple logistic regression indicated that positive
<0.05 was taken as statistically significant. HIV serum status (adjusted odds ratio, AOR=0.259, 95%
CI: 0.104–0.647) and history of resistance to anti-TB drug
For personal use only.

Results (AOR=0.394, 95%CI: 0.173–0.897) were statistically

Sociodemographic and Clinical associated with subnormal nutritional status (Table 4).
Characteristics of the Study Participants
Of the 450 patients who were recruited into the study, 364 Discussion
(80.9%) of the study participants were within the age The study involved 450 PTB patients in Oromia region of
group of 18–45 years with the age range of 4–81 years Ethiopia with the intention to determine the magnitude of
and median age was 26. Male to female ratio was almost undernutrition and the association of undernutrition with
one to one and 180 (40%) were from Arsi and East Shewa selected socio-demographic characteristics and clinical
zones. About one-third of the patients were illiterate with history.
very few first degree graduates. The clinical history of the The prevalence of undernutrition recorded by the pre­
patients revealed that nearly a quarter of them were pre­ sent study was 51.6% and was a bit less than that reported
viously treated as PTB patients for at least four weeks. from the Amhara Region of Ethiopia (57.17%),19 but
There was delay in seeking medical treatment from mod­ similarly in the beginning 50s with that reported from
ern HFs as concluded from the fact that about 70% sought the Adama Town of Ethiopia (53%).20 The finding of
modern treatment after four weeks of symptoms. One systematic review and meta-analysis on the prevalence of
hundred and forty-eight (32.9%) of them were users of undernutrition in TB patients in Ethiopia also reported
khat or cigarette or alcohol beverages or combinations of a pooled prevalence of 50.8% (95%CI: 43.97–57.63)21
these at least in the last one year prior to the interview. The and the report from Kenya, a neighboring country, as the
TB-HIV co-infection rate was below 10%. History of institution-based study done in Turkana, showed the pro­
resistance to anti-TB drug was reported in 23 (7.8%) of portion of TB patients with undernutrition of 50.12%22
previously treated patients (Table 1). which are also in agreement with the report of the present
study. However, lower prevalence (35.8%) of undernutri­
Estimation of Body Mass Index tion was reported from Burkina Faso23 while
Two hundred and thirty-two (51.6%, 95%CI: 47.15–56.2) a significantly higher prevalence (85%) was reported
of all the subjects had fallen under the undernutrition from central rural India.24 This could possibly be due to
range of BMI, and very few were found to be overweight differences in socioeconomic standards among others
(Table 2). The maximum, average, and minimum BMI of between the populations.
the patients were 27.11 kg/m2, 18.27 kg/m2, and 12.5 kg/ According to this study, those previously treated and
m2, respectively. who had duration of illness >1 month before starting

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Table 1 Sociodemographic and Clinical Characteristics of the Study Participants, Oromia, 2020
Characteristics N (%)

Age (years) <18 52 (11.6)

18–28 203 (45.1)
29–39 106 (23.6)
40–45 55 (12.2)
>45 34 (7.6)
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Sex Male 240 (53.3)

Female 210 (46.7)

Address (zones) North Shewa 37 (8.2)

South West Shewa 28 (6.2)
East Shewa 92 (20.4)
Arsi 88 (19.6)
West Arsi 24 (5.3)
Bale 64 (14.2)
Guji 60 (13.3)
Borena 25 (5.6)
West Harerge 32 (7.1)
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Education Cannot read and write 169 (37.6)

Read and write 88 (19.6)
Elementary 146 (32.4)
Secondary 31 (6.9)
College and above 16 (3.6)

Family size Lives alone 10 (2.2)

1–4 298 (66.2)
>4 142 (31.6)

Category of tuberculosis treatment history New 343 (76.2)

Previously treated 107 (23.8)

History of anti-TB drug resistance (N=107) No 58 (54.2)

Yes 23 (21.5)
Unknown 26 (24.3)

Duration of illness before medical treatment <1 month 137 (30.4)

1–2 months 225 (50.0)
>2 months 88 (19.6)

Currently smoking No 421 (93.6)

Yes 29 (6.4)

Currently chewing khat No 382 (84.9)

Yes 68 (15.1)

Drink alcohol beverages No 399 (88.7)

Yes 51 (11.3)

HIV serum status Negative 404 (89.8)

Positive 34 (7.6)
Unknown 12 (2.6)

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Table 2 Distribution of Body Mass Index of the Study Participants, Oromia, 2020
Category of BMI (kg/m2) N (%) 95% Confidence Interval

<16.0 Severe undernutrition 40 (8.9) 6.4–11.6

16.0–16.99 Moderate undernutrition 52 (11.6) 8.9–14.9

17.0–18.49 Mild undernutrition 140 (31.1) 26.9–35.3

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18.5–24.99 Normal 213 (47.3) 42.9–51.8

>25 Overweight 5 (1.1) 0.2–2.0

Total 450

treatment have shown a tendency to become undernour­ in Beira (Mozambique) had shown that low BMI, among
ished probably because of the longstanding and recurrent other social determinants including: being male, low socio­
existence of infection that negatively affects dietary intake, economic status (education and income), and HIV serum
and overall metabolism whereby lipolysis and proteolysis positivity increases the likelihood of therapy failure in
may cause surplus anabolic activities.25 Patients with posi­
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newly diagnosed PTB patients.30 Studies have also indicated

tive HIV serum status have also shown greater tendency to that undernutrition may affect responses to BCG vaccination
become undernourished; this could be due to additional
which is an important approach in the prevention of active
stress of infection and also possibility of opportunistic
TB in addition to impairment of innate and adaptive immune
diseases on top of the underlying common factors with
responses needed to control Mycobacterium tuberculosis
HIV negative TB cases.
infection.31 It is also possible to extrapolate that malnutrition
In general, it is an established fact that undernutrition has
been found to be associated with adverse TB treatment out­ could have a role in the development of drug resistance
comes and its presence at the initial diagnosis of active TB which could be due to impaired immunity as a result of
has been reported to be a predictor of increased risk of death poor nutrition that may allow organisms of M. tuberculosis
and TB relapse.5,26–29 In support of this fact, the study done to stand against the effect of a drug or drugs.

Table 3 Association of Sociodemographic Characteristics of TB Patients with Undernutrition in TB Patients, Oromia, 2020 (N=445)
Characteristics Nutritional Status COR (95% CI) p-value AOR(95% CI) p-value

<N N

Age group <18 50 2 0.032 (0.007–0.140) 0.000 0.028 (0.006 −0.125) 0.000
18–28 92 108 0.951 (0.952–0.529) 0.837 0.893 (0.547–1.468) 0.651
29–39 47 58 1 1
40–50 24 31 1.047 (0.542–2.020) 0.892 1.031 (0.530–2.007) 0.928
>50 19 14 0.597 (0.271–1.316) 0.201 0.624 (0.280–1.388) 0.247

Education Illiterate 86 81 0.680 (0.313–1.477) 0.330 0.730 (0.327–1.630) 0.442

Read and write 46 42 0.659 (0.288–1.508) 0.324 0.786 (0.337–1.835) 0.578
Elementary 81 63 0.562 (0.256–1.232) 0.150 0.910 (0.404–2.051) 0.821
Secondary 13 18 1 1
College + 6 9 1.083 (0.309–3.802) 0.901 1.230 (0.334–4.533) 0.756

Family size Lives alone 6 4 0.653 (0.181–2.363) 0.516 0.531 (0.142–1.983) 0.347
1–4 145 148 1 1
>4 81 61 0.738 (0.493–1.105) 0.140 1.125 (0.717–1.767) 0.608
Abbreviations: <N, undernutrition; CI, confidence interval.

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Table 4 Association of Clinical History with Undernutrition in TB Patients, Oromia, 2020

Characteristics Nutritional Status COR (95%CI) p-value AOR (95%CI) p-value

<N Normal

Treat. Cat New 167 173 1

Repeat 65 40 1.683 (1.076–2.634) 0.023 1.41 (0.628–2.075) 0.665

DoI <1 month 68 69 1

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1–2 months 108 115 1.994 (1.141–3.487) 0.015 1.042 (0.648–1.675) 0.865
>2 months 57 29 2.112 (1.257–3.549) 0.005 0.579 (0.291–1.155) 0.121

HIV status Negative 200 199 1

Positive 27 7 3.838 (1.634–9.017) 0.002 0.259 (0.104–0.647) 0.004

Khat No 200 179 1

Yes 32 34 0.842 (0.499–1.421) 0.520 1.229 (0.618–2.444) 0.556

Alcohol No 207 188 1

Yes 25 25 0.908 (0.504–1.636) 0.748 1.255 (0.612–2.57) 0.535

Cigarette No 217 199 1

Yes 15 14 0.983 (0.463–2.087) 0.963 1.073 (0.397–2.897) 0.889
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History of DR NR 166 183 1

R 25 10 2.756 (1.285–5.910) 0.009 0.394[0.173–0.897) 0.026
Abbreviations: DoI, Duration of illness; DR, Drug Resistance; NR, No resistance; R, Resistance.

It is not only the socioeconomic support that is Supplementary feeding in food insecure and vulnerable
observed to be in deficit, but also the nutritional assess­ people is proven to be associated with reduced number of
ment and counseling were not as they are supposed to be patients dropping out, increased recovery rate, increased treat­
as manifested by missing information regarding nutritional ment completion and sputum conversion rate during active TB.
status of previous TB patients and absences of nutritional Food and nutritional support optimize the nutritional value and
counseling for newly presenting patients during data col­ adequacy of the diet, improve quality of life and improve
lection. In support of this fact, the qualitative study done in various health parameters of disadvantaged families.10,36–40
Tigray Region (a preprint of manuscript) has indicated the The socioeconomic situation of TB patients demands
existence of related problems and that factors associated multisectoral action to address the social and economic
with these inappropriate conditions in regard to nutrition determinants including material support. This can be food
include: lack of supportive supervision, shortage of staff, or financial support like meals, food baskets, food supple­
phasing out of supporting partners; lack of commitment ments, food vouchers, transport subsidies, living allow­
from health workers; and very low economic status of ance, housing incentives, or financial bonus as
patients, sharing and selling of provided supplies, and recommended by the WHO in order to access health
defaulting from treatment.32 services and, possibly, to mitigate consequences of income
In line with the socioeconomic aspect of TB, people with loss related to the disease and consequences of TB as part
TB commonly face reduction of income in two ways. That of the strategies of ending TB.13,41
is, they can become too sick to work and get income; or, they
or their families have to cover other expenses related to the Conclusion
treatment even if diagnosis and drug treatment is free. Quite a significant proportion of TB patients in Oromia region
Therefore, they economically go downhill.8,33–35 Out of is undernourished. Medical treatment alone is not adequate for
the 450 TB patients participated in the study only 30 effective TB control program. Therefore, nutritional assess­
(7.8%) could possibly benefit from the existing nutritional ment, counseling and need based socioeconomic support for
support system because of their positive HIV status. TB patients demand attention of the program holders.

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Abbreviations 6. Grobler L, Nagpal S, Sudarsanam TD, Sinclair D. Nutritional supple­

ments for people being treated for active tuberculosis. Cochrane
BMI, body mass index; HF, health facility; PTB, pulmon­ Database Syst Rev. 2016;6:CD006086. doi:10.1002/14651858.
ary tuberculosis; TB, tuberculosis. CD006086.pub4/abstract
7. Lutge E, Wiysonge C, Knight S, Sinclair D, Volmink J. Incentives
and enablers to improve adherence in tuberculosis. Cochrane
Data Sharing Statement Database Syst Rev. 2015;2015(9): CD007952. doi:10.1002/
14651858.CD007952.pub3
The datasets used and/or analyzed during the current study
8. Pande JN, Singh SP, Khilnani GC, Khilnani S, Tandon RK. Risk
Journal of Multidisciplinary Healthcare downloaded from https://www.dovepress.com/ by 54.70.40.11 on 23-Oct-2021

are available from the corresponding author on reasonable factors for hepatotoxicity from antituberculosis drugs: a case-control
request. study. Thorax. 1996;51(2):132–136. doi:10.1136/thx.51.2.132
9. Ramachandran G, Kumar AKH, Bhavani PK, et al. Age, nutritional
status and INH acetylator status affect pharmacokinetics of
Ethics Approval and Consent to anti-tuberculosis drugs in children. Int J Tuberc Lung Dis.
2013;17:800–806. doi:10.5588/ijtld.12.0628
Participate 10. Chua AP, Lim LK, Ng H, Chee CB, Wang YT. Outcome of a grocery
Ethical clearance was obtained from Health Studies voucher incentive scheme for low-income tuberculosis patients on
directly observed therapy in Singapore. Singapore Med J. 2015;56
Higher Degree Committee of University of South Africa (5):274–279. doi:10.11622/smedj.2015054
(Ref No: REC-012714-039, HSHDC/454/2015). The 11. Gupta KB, Gupta R, Atreja A, Verma M, Vishvkarma S. Tuberculosis
Oromia Regional Health Bureau gave permission and has and nutrition. Lung India. 2009;26(1):9–16. doi:10.4103/0970-
2113.45198
written a letter of support to respective Health 12. Oliver M. What’s the link between TB and nutrition? Results UK;
Departments. The purpose of the study was explained to 2013. Available from: http://blog.results.org.uk/. Accessed February
For personal use only.

1, 2017.
the study participants and written consent was obtained
13. World Health Organization. Nutritional Care and Support for
from each. For those aged less than 18 years as well, Patients with Tuberculosis. E-Library of Evidence for Nutrition
written informed consent was obtained from their par­ Actions. Geneva: WHO; 2017.
14. Oromia Health Bureau. Available from:https://orhb.gov.et/index.php.
ents/legal guardians. All in accordance with the Accessed June 10 2021.
Declaration of Helsinki.42 15. Federal Ministry of Health. Tuberculosis, Leprosy, and TB/HIV
Prevention and Control Program Manual. 4th. Addis Ababa,
Ethiopia; 2008:30.
Acknowledgment 16. NHANES. Anthropometric Procedure Manuals. Vol. 1. United State
of America: National Health and Nutrition Examination Survey;
The researchers are indebted to Madda Walabu University
2007.
for its financial support to partially cover personnel costs 17. World Health Organization. Nutritional Landscape Information
and transportation. Oromia Health Bureau and selected System. Geneva: WHO; 2010:1–51.
18. World Health Organization. BMI Classification. Geneva: WHO;
HFs for their permission to use their facilities. We are 2019. Available from http://www.apps.who.int/bmi. Accessed
also grateful to staff members of the health facilities and October 25, 2020.
19. Feleke BE, Feleke TE, Biadglegne F. Nutritional status of tubercu­
study participants for their cooperation.
losis patients, a comparative cross-sectional study. BMC Pulm Med.
2019;19(1:182. doi:10.1186/s12890-019-0953-0
20. Guadie FF, Assaminew B. Assessment of nutritional status and asso­
Disclosure ciated factors among adult TB patients on directly observed treatment
The authors report no conflicts of interest in this work. of short course in health facilities at Adama town, East shewa zone,
Ethiopia. Scholar Pract J. 2016.
21. Wondmieneh A, Gedefaw G, Getie A, Demis A. Prevalence of under­
References nutrition among adult tuberculosis patients in Ethiopia: a systematic
1. Lönnroth K, Williams BG, Cegielski P, Dye C. A consistent loglinear review and meta-analysis. J Clin Tuberc Other Mycobact Dis.
relationship between tuberculosis incidence and body mass index. 2020;22:100211.
Int J Epidemiol. 2010;39:149–155. doi:10.1093/ije/ 22. Nthiga I, Mbithe D, Mugendi BJ, Wambui T. The nutritional status
dyp308pmid:19820104 of pulmonary tuberculosis patients aged 25–44 years attending
2. Kant S, Gupta H, Ahluwalia S. Significance of nutrition in pulmonary tuberculosis clinic at Lodwar County and referral hospital,
tuberculosis. Crit Rev Food Sci Nutr. 2015;55(7):7955–7963. Turkana County, Kenya. Murang’a Univ Technol Inst Repstry.
doi:10.1080/10408398.2012.679500 2017;2(1):119–122.
3. Annabel Kanabus, GHE. Food and TB. TBFACT.ORG information 23. Musuenge BB, Poda GG, Chen PC. Nutritional status of patients
about tuberculosis. [s.a.]. Available from: https://tbfacts.org/food.tb/. with tuberculosis and associated factors in the health centre region
4. Brooks JA. Management of patients with chest and lower respiratory of Burkina Faso. Nutrients. 2020;12(9):2540. doi:10.3390/
disorders, in Bruner and Suddarth‘s textbook of medical-surgical nur­ nu12092540
sing, 12th edn, 1(1), edited by Hilarie Surrena. Lippincott. 24. Bhargava A, Chatterjee M, Jain Y, et al. Nutritional status of adult
2010;551–600. patients with pulmonary tuberculosis in rural central India and its
5. World Health Organization. Guideline: Nutritional Care and Support association with mortality. PLoS One. 2013;8(10):e77979.
for Patients with Tuberculosis. Geneva, Switzerland: WHO; 2013. doi:10.1371/journal.pone.0077979

Journal of Multidisciplinary Healthcare 2021:14 https://doi.org/10.2147/JMDH.S326233

2427
DovePress

Powered by TCPDF (www.tcpdf.org)

 Hussien and Ameni Dovepress

25. Paranandi A, Wanke C. Tuberculosis infection and nutrition. In: de 34. Mauch V, Bonsu F, Gyapong M, et al. Free tuberculosis diagnosis and
Pee S, Taren D, Bloem M. (eds). Nutrition and Health in treatment are not enough: patient cost evidence from three continents.
a Developing World. Nutrition and Health. Humana Press, Cham; Int J Tuberc Lung Dis. 2013;17(3):381–387. doi:10.5588/ijtld.12.0368
2017:437–447. Available from: https://link.springer.com/chapter/10. 35. Tanimura T, Jaramillo E, Weil D, Raviglione M, Lönnroth K.
1007/978-3-319-43739-2_19#citeas. Accessed June 10, 2021 Financial burden for tuberculosis patients in low-and
26. Alam I, Larbi A, Pawelec G. Nutritional status influences peripheral middle-income countries: a systematic review. Eur Respir J.
immune cell phenotypes in healthy men in rural Pakistan. PMC. 2014;43:1763–1775. doi:10.1183/09031936.00193413
2012;9:1–10. PMid: 22863368. doi:10.1186/1742-4933-9-16 36. Koethe JR, Von Reyn CF. Protein-calorie malnutrition, macronutrient
27. Hood ML. A narrative review of recent progress in understanding the supplements, and tuberculosis. Int J Tuberc Lung Dis. 2016;20
Journal of Multidisciplinary Healthcare downloaded from https://www.dovepress.com/ by 54.70.40.11 on 23-Oct-2021

relationship between tuberculosis and protein energy malnutrition. (7):857–863. doi:10.5588/ijtld.15.0936

Eur J Clin Nutr. 2013;67(11):1122–1128. doi:10.1038/ejcn.2013.143 37. Lai -H-H, Lai Y-J, Yen Y-F, Dowdy DW. Association of body mass
28. Wingfield T, Boccia D, Tovar M, et al. Defining catastrophic costs index with timing of death during tuberculosis treatment. PLoS One.
and comparing their importance for adverse tuberculosis outcome 2017;12(1):e0170104. doi:10.1371/journal.pone.0170104
with multi-drug resistance: a prospective cohort study, Peru. PLOS 38. Mansour O, Masini EO, Kim BS, Kamene M, Githiomi MM,
Med. 2014;11(7):e1001675. doi:10.1371/journal.pmed.1001675 Hanson CL. Impact of a national nutritional support programme on
29. Seid G, Ayele M. Undernutrition and mortality among adult tubercu­ loss to follow-up after tuberculosis diagnosis in Kenya. Int J Tuberc
losis patients in Addis Ababa, Ethiopia. Adv Prev Med.
Lung Dis. 2018;22(6):649–654. doi:10.5588/ijtld.17.0537
2020;27:2020.
39. Visser J, McLachlan MH, Maayan N, Garner P. Community-based
30. Pizzol D, Veronese N, Marotta C, et al. Predictors of therapy failure
supplementary feeding for food insecure, vulnerable and malnour­
in newly diagnosed pulmonary tuberculosis cases in Beira,
ished populations–an overview of systematic reviews. Cochrane
Mozambique. BMC Res Notes. 2018;11(1):1–6. doi:10.1186/s13104-
Database Syst Rev. 2018;11.
018-3209-9
40. Rocha C, Montoya R, Zevallos K, et al. The innovative
31. Sinha P, Davis J, Saag L, et al. Undernutrition and tuberculosis:
socio-economic interventions against tuberculosis (ISIAT) project:
public health implications. J Infect Dis. 2019;219(9):1356–1363.
an operational assessment. Int J Tuberc Lung Dis. 2011;15
doi:10.1093/infdis/jiy675
For personal use only.

32. Degefa MG, Bezabih AM, Kahsay ZH, Belachew AB. Barriers and (6):50–57. doi:10.5588/ijtld.10.0447
facilitators of nutrition assessment, counseling and support for 41. World Health Organization. End TB Strategy. Geneva: WHO; 2016.
Tuberculosis patients: a qualitative study. Res Square. Preprint manu­ 42. World Medical Association. World Medical Association declaration
script. doi:10.21203/rs.3.rs-96716/v1 of Helsinki: ethical principles for medical research involving human
33. Lönnroth K, Glaziou P, Weil D, Floyd K, Uplekar M, Raviglione M. subjects. JAMA. 2013;310(20):2191–2194. PMID: 24141714.
Beyond UHC: monitoring health and social protection coverage in doi:10.1001/jama.2013.281053
the context of tuberculosis care and prevention. PLOS Med. 2014;11
(9):e1001693. doi:10.1371/journal.pmed.1001693

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