Tuberculosis in Madagascar

In 2022, a nutritional support programme was implemented in the catchment areas of three TB diagnostic and treatment centres in the Atsimo-Andrefana region: Ampanihy-Ouest, Androka, and Bezaha. Nutritional support was provided to eligible people with TB—those with a BMI below 18.5 kg/m² at TB screening (designated as timepoint M0). These individuals received monthly rations of 0.6 L of vegetable oil and 6 kg of enriched soy- and wheat-based flour during follow-up visits at treatment initiation (M1), and at months two through six (M2–M6).

The final sample included 1,310 people with TB, of whom 760 (58.0%) were adults (over 18 years), 420 (32.1%) were aged 5–18, and 130 (9.9%) were children under 5.

Among children under 5, 55.4% (72/130) were malnourished at screening, with 42.3% (55/130) experiencing severe acute malnutrition and 13.1% moderate acute malnutrition. In the 5–18 age group, 71.9% (302/420) were well-nourished, 17.1% (72/420) undernourished, and 10.9% (46/420) moderately undernourished.

In adults, only 18.7% (142/760) were well-nourished at screening. Mild undernutrition was observed in 34.3% (261/760), moderate in 17.7% (135/760), and severe in 29.2% (222/760). The average BMI at treatment-seeking among adults was 17.1 kg/m² (IQR: 15.8–18.3; range: 10.3–22.5). Adults who received nutritional support had a slightly lower average BMI (17.0 kg/m²) than those who did not (17.1 kg/m²).

For individuals not receiving nutritional support, BMI increased from 19.4 kg/m² at M0 to 20.1 kg/m² at M6; however, this change was not statistically significant.

At screening (M0) and treatment initiation (M1), only 15.1% and 8.3% of the sample were well-nourished, respectively. This proportion rose to 38.3% by treatment completion (M6), yet 61.7% remained undernourished. Notably, over 70% of those initially well-nourished at M0 became undernourished by M6.

These findings suggest that the current nutritional support provided to people with TB in the Atsimo-Andrefana region is insufficient. More comprehensive interventions are urgently needed to address malnutrition, particularly among children under 5. This study is the first to analyse nutritional support provided by the World Food Programme in this region and highlights the necessity for greater resource allocation and attention to the nutritional needs of people with TB.

Source: Franke, M.A., Emmrich, J.V., Ranjaharinony, F., Ravololohanitra, O.G., Andriamasy, H.E., Knauss, S. and Muller, N., 2024. A cross-sectional analysis of the effectiveness of a nutritional support programme for people with tuberculosis in Southern Madagascar using secondary data from a non-governmental organisation. Infectious Diseases of Poverty, 13(1), p.13.