Undernutrition and the incidence of tuberculosis in India: National and subnational estimates of the population-attributable fraction related to undernutrition.
Loading...
Date
2014-05
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background. India has the largest global burden of
tuberculosis (TB)-related morbidity and mortality as well as
undernutrition. Undernutrition impairs cell-mediated
immunity, is a risk factor for the development of TB, and has
the largest potential impact on the incidence of TB in countries
with a high burden of TB.
Methods. We refined the national estimate of the
population-attributable fraction (PAF) for undernutrition in
India to report the first subnational estimates, and stratified
these further for age, gender, residence, caste and
socioeconomic status. We also compared the PAF related to
undernutrition in India with that in 15 other countries with a
high burden of TB. We used data on body mass index (BMI)
from the National Family Health Survey-3 (NFHS-3), as well
as risk estimates for a low BMI from a recently published
population-based study which had controlled for several
confounders.
Results. The overall prevalence of undernutrition in the
age group of 15–49 years was 35.6% among women and
34.2% among men. About half (55.4%; 95% CI 27.4–
75.9) of all cases of active TB among women and 54.4%
(95% CI 26.5–75.2) of all cases among men were attributable
to undernutrition. In the age group of 15–19 years, the PAFs
for undernutrition were 62% and 67% among women and
men, respectively. The PAF of undernutrition was higher in
rural areas, in scheduled castes, scheduled tribes and other
backward classes, and in the lower quintiles of the wealth
index. The PAF of undernutrition exceeded 50% in most
states, and the largest PAFs were seen among women of scheduled tribes in central India. Among countries with a high
burden of TB, India had the highest PAF related to
undernutrition.
Conclusion. Addressing the problem of endemic
undernutrition among adolescents and adults in India could
complement the current TB control strategy based on case
management, and help reduce the incidence of TB in India in
line with global targets.
Description
Keywords
Citation
BHARGAVA ANURAG, BENEDETTI ANDREA, OXLADE OLIVIA, PAI MADHUKAR, MENZIES DICK. Undernutrition and the incidence of tuberculosis in India: National and subnational estimates of the population-attributable fraction related to undernutrition. National Medical Journal of India. 2014 May-Jun ; 27 (3): 128-133.