Under-nutrition makes children susceptible to tuberculosis: doctors

New Delhi: Emergence of multi drug resistant TB and complications aggravated by high rates of co-infection with HIV-AIDS has renewed the threat of TB epidemic in India. With widespread prevalence of the infection, children experience a serious risk of contracting Tuberculosis, especially if they are under-nourished.

As we observe World TB day, doctors at Venkateshwar Hospital, Dwarka say under nutrition in children (especially below 5 years of age) is a significant risk factor for the disease. Contrary to perception, not just children living in slums and unhygienic conditions, even those from relatively affluent backgrounds are diagnosed with Tuberculosis.

Tuberculosis (TB) is one of the top 10 causes of death globally. The World Health Organization (WHO) estimates that worldwide, approximately 5,00,000 children each year are diagnosed with tuberculosis. One million children (below 14 years of age) fell ill with TB, and 170 000 children died from the disease in 2015. There is dire need to understand the complex interrelationship between TB in children and malnutrition, believe experts across the world.

"On one hand under-nutrition lowers the body's immunity, making it easier for the bacteria to attack an individual. On the other, under-nutrition makes the fight against tuberculosis more difficult. Chronic under nutrition usually leads to reduction in appetite which further reduces the absorption of nutrients in the body leading to muscle atrophy and weakness. TB patients require higher levels of energy and metabolic immunity to cope with the infection, and understandably this need is higher in children during to their growth phase. Cases of childhood cases continue to be reported, not just among economically weaker populations but also among relatively well-off urban dwellers," says Dr. Sunil Kumar Mehendiratta, Sr. Consultant & HOD, Paediatric, Venkateshwar Hospital, Dwarka.

In India, 70% of all the TB patients are aged between 15-54 years. According to national report titled 'TB in India', as many as 81482 cases of children TB were detected in 2012, accounting for seven percent of all TB cases in the country. Many children fail to receive appropriate care and hence remain undiagnosed for a long time, which adds to the problem.

With over two lakh deaths attributable to TB annually across the nation, it is a major health burden in India which needs to be controlled imminently and more impactfully in children. Again, malnutrition or under nutrition is associated with approximately one-third of all childhood deaths in our country. Given the fact that 37% children under age 5 in India have reported stunted growth over the last decade, as highlighted by the recently conducted NFHS, the resultant health burden has become a matter of concern.

"Tuberculosis is caused by Mycobacterium tuberculosis bacterium that most often begins with affecting the lungs, and can spread to other parts or organs of the body later on. While tuberculosis mostly affects adults during their productive years, almost all age groups are at risk. Particularly, students living in hostels sharing space with others, travelling daily in crowded public transport, living in houses with inadequate ventilation and congested cities are all highly prone to catch the TB infection. On and average, 10-15% of all TB patients are under 14 years. In fact, infants and children under-five is probably the most vulnerable age group, who are at increased risk for developing both the infection and disease. Children possessing latent infection are at the risk of disease re-activation of TB in the adulthood years," informs Dr Sunil.

Malnutrition adversely affects Cell Medicated Immunity (CMI) individuals. With lower levels of immunity and resistance mechanisms, children are already at high risk. Most of the times, common symptoms such as mild fever (in the evening time), heavy breath, persistent cough are ignored, and hence TB remains undetected in children. Many a times, pneumonia, anemia and other illness are also likely to give rise to TB in children, say doctors.

"TB, once known to be the poor man's disease, is now also found in cities like Delhi-NCR. Parents must encourage children to adapt healthy lifestyle that can help in staying protected from the potentially dangerous bacteria. Since TB bacillus is widely prevalent in India, children may be highly exposed to the bacteria everywhere. If they are weak, and their nutrition levels are poor, they can become an easy prey to it. Eating a balanced diet rich in fats, vitamins, minerals, and proteins can indeed go a long way in preventing childhood TB," adds Dr. Sunil.

Venkateshwar Hospital, Dwarka advocates integrated patient-centric care and prevention strategies for the eradication of TB, aligned to the 'End TB Strategy' adopted by the WHO, and encourages children and people at large to adhere to healthy lifestyles, to keep immune system healthy, your body may even fight off the disease.