Malnutrition and TB Services

• Calorie and protein supplementation consistently improved TB outcomes, such as weight gain, muscle strength, and recovery. These interventions are especially beneficial for malnourished or high-risk TB patients and should be part of routine care.
• Micronutrient supplementation showed mixed or minimal benefits. While vitamin D, zinc, and iron were largely ineffective, vitamin E had conflicting effects, and only vitamin C showed limited potential.
• Malnutrition is highly prevalent in TB patients and significantly increases mortality risk. Nutritional risk scores (CONUT, GNRI, PNI) also enhanced the accuracy of TB mortality prediction models.
• Active TB surveillance faces major implementation barriers, especially in rural areas, due to transport issues, poor coordination, and community distrust. Tailored, location-specific strategies are needed to strengthen surveillance efforts.
• Healthcare workers in Taiwan face higher TB incidence but have better outcomes due to early diagnosis and fewer treatment delays. This supports ongoing occupational health surveillance and rapid-response systems in healthcare settings.
• BCG-Denmark revaccination did not significantly reduce new TB infections among adult healthcare workers in Brazil. This suggests limited benefit of BCG revaccination for TB prevention in already BCG-vaccinated adults.
• TB mortality in Taiwan fell sharply between 1978 and 2022, especially in younger age groups and females, reflecting successful public health policies. However, older adults continue to bear the highest burden, partly due to waning vaccine protection and immunosenescence.
• The decline in TB deaths is linked to Taiwan’s broader socioeconomic progress—better nutrition, healthcare access, universal BCG coverage, and DOTS implementation. Cohort and period effects confirm that public health and social investments have long-term mortality impacts.
• Discrepancies between Joinpoint and age–period–cohort models stem from methodological differences, but both confirm consistent downward trends. Excluding the 85+ group in APC models likely inflated decline estimates slightly, as TB mortality decreases more slowly in the elderly.
• TB case-finding remains a major challenge without strong public health actions (PHAs). Many cases are missed due to weak proactive screening and patients avoiding formal care, especially in high-burden countries.
• PHAs such as community outreach, contact tracing, and social support mechanisms are essential for breaking TB transmission chains. Yet they remain underfunded, relying heavily on donors rather than integrated national health systems.
• Transitioning TB services into national social health insurance and social protection schemes can ensure sustainability and reduce financial burdens on patients. This shift requires coordinated financing, political will, and multisectoral planning.
• Contracting private and NGO actors for TB services improves reach and effectiveness, but sustainability remains a challenge. Countries like Bangladesh and India are showing early success in shifting toward domestically funded contracting frameworks.

References:

1. Ockenga, J., Fuhse, K., Chatterjee, S., Malykh, R., Rippin, H., Pirlich, M., Yedilbayev, A., Wickramasinghe, K. and Barazzoni, R., 2023. Tuberculosis and malnutrition: the European perspective. Clinical Nutrition, 42(4), pp.486-492.
2. Ma, J.J., Guo, Y.J., Li, Z., Chen, Y., He, H. and Li, W.M., 2022. Prevalence and prognostic significance of malnutrition risk in patients with pulmonary tuberculosis: a hospital-based cohort study. Frontiers in Public Health, 10, p.1039661.
3. Ajudua, F.I. and Mash, R.J., 2024. Implementing active surveillance for TB: A descriptive survey of healthcare workers in the Eastern Cape, South Africa. African Journal of Primary Health Care & Family Medicine, 16(1), p.4217.
4. Pan S-C, Chen Y-C, Wang J-Y, Sheng W-H, Lin H-H, Fang C-T, et al. (2015) Tuberculosis in Healthcare Workers: A Matched Cohort Study in Taiwan. PLoS ONE 10(12): e0145047.
5. Dos Santos, P.C.P., Messina, N.L., de Oliveira, R.D., da Silva, P.V., Puga, M.A.M., Dalcolmo, M., Dos Santos, G., de Lacerda, M.V.G., Jardim, B.A., e Val, F.F.D.A. and Curtis, N., 2024. Effect of BCG vaccination against Mycobacterium tuberculosis infection in adult Brazilian health-care workers: a nested clinical trial. The Lancet Infectious Diseases, 24(6), pp.594-601.
6. Chen, S.Y., 2024. Trends and annual percentage changes in tuberculosis mortality estimated by Joinpoint regression and age-period-cohort analyses, Taiwan, 1978–2022. Scientific Reports, 14(1), p.29101.
7. Wells, W.A., Waseem, S. and Scheening, S., 2024. The intersection of TB and health financing: defining needs and opportunities. IJTLD open, 1(9), pp.375-383.

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