Nutritional status and other associated factors of patients with TB in urban areas

Who

• Population: 314 adult (≥18 years) patients with active tuberculosis (pulmonary or extrapulmonary) enrolled in DOTS centers.

• Demographics: Mean age 35.2±15.0 years (range 18–80); 51.3% male. Most were 21–50 years old (65.9%).

• Socioeconomic profile: 12.7% had no schooling; 26.8% primary, 26.4% secondary, 34.1% higher secondary/other education. 32.5% were in service, 38.5% dependent. Over half (52.9%) had monthly family income <20,000 taka; 54.8% lived in concrete houses.

• Clinical profile: 44.9% had pulmonary TB; 55.1% extrapulmonary TB; 91.4% on anti-TB treatment <6 months; 10.8% had diabetes; 17.5% had hypertension.

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What (focus, main findings, conclusions, implications)

• Focus: To determine the prevalence of undernutrition and identify factors associated with nutritional status among adult TB patients in selected urban areas of Bangladesh.

• Nutritional status (primary outcome):

  • Underweight (BMI <18.5): 33.4%

  • Normal BMI (18.5–24.9): 45.5%

  • Overweight/obese (>24.9): 21%
    

• Key bivariate associations with nutritional status (significant):

  • Sociodemographic/clinical factors: age group, educational status, occupational status, housing condition, type of TB, TB treatment duration, and diabetes status (all p<0.05).

  • Dietary/lifestyle factors: frequency of meals per day, daily protein intake, receiving dietary counseling, safe drinking water facilities, and fortified oil intake (all p<0.05).

• Key multivariable (logistic regression) findings (underweight vs normal):

  • Age <20 years vs ≥50 years: higher odds of being underweight (OR 2.494; 95% CI 0.994–6.253; p=0.051 – borderline).

  • TB treatment duration <6 months vs ≥6 months: significantly higher odds of underweight (OR 3.639; 95% CI 1.193–11.085; p=0.023).

  • Having safe drinking water and eating three meals per day were protective against underweight (safe water OR 0.151, p=0.017; three meals/day OR 0.339, p=0.037).

• Authors’ conclusions:

  • About one-third of urban TB patients are underweight, indicating a substantial burden of undernutrition.

  • Nutritional status is closely linked with demographic, clinical, and dietary factors (e.g., age, TB type, occupation, family size, diabetes, diet, water and oil use).

  • TB programs in urban Bangladesh should integrate nutritional assessment and support, including food assistance, nutritional care guidelines, and health education on undernutrition and its consequences.

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When

• Study period/data collection: January–June 2023 (6 months).

• Contextual timeframe: Conducted against ongoing national TB control efforts in Bangladesh and the post-1993 WHO TB emergency era, but no longer-term follow-up was performed.

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Where

• Geographic setting: Selected DOTS centers in three urban city corporations in Bangladesh: Dhaka, Gazipur, and Narayanganj.

• Facilities: 12 DOTS centers in total – six in Dhaka City Corporation, three in Narayanganj, and three in Gazipur.

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Why (purpose/rationale)

• TB and malnutrition are major overlapping public health problems in Bangladesh, and malnutrition impairs cell-mediated immunity, increasing risk of TB disease and poor outcomes.

• Urban settings like Dhaka have high TB burden due to overcrowding, poor hygiene, and poverty, making nutritional problems particularly relevant.

• The study aimed to quantify undernutrition among adult TB patients in urban areas and identify associated factors in order to inform nutritional interventions within the National TB Program.

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How (design, methods, analysis)

• Study design: Descriptive cross-sectional study.

• Sampling and inclusion: Adult (≥18 years) patients with active TB confirmed by sputum microscopy and GeneXpert, enrolled in DOTS at the 12 selected centers and currently receiving anti-TB treatment. Only those present and consenting on data collection days were included.

• Data collection tools:

  • Semi-structured questionnaire (developed from prior literature, drafted in English then translated into Bangla, pretested on 10% of sample).

  • Sections on sociodemographics, lifestyle (water source, sanitation, tobacco, exercise, iodized salt and fortified oil use), health status (type of TB, treatment duration, functional status, comorbidities), dietary patterns (meal frequency, protein intake, appetite, dietary changes, counseling), and nutritional status.

• Anthropometry:

  • Weight measured with bathroom scale; height with measuring tape.

  • BMI (kg/m²) used to classify nutritional status: underweight <18.5; normal 18.5–24.9; overweight/obese >24.9.

• Statistical analysis:

  • Data entry and analysis using SPSS v25.

  • Descriptive statistics: means, standard deviations, frequencies, percentages.

  • Bivariate analysis: chi-square tests to explore associations between nutritional status and explanatory variables (sociodemographic, clinical, dietary, lifestyle).

  • Multivariable analysis: multiple logistic regression to identify independent predictors of underweight vs normal nutritional status; significance level p<0.05. 

Source: Nabi, S.G., Aziz, M.M., Uddin, M.R., Tuhin, R.A., Shuchi, R.R., Nusreen, N., Jahan, R., Afroz, F. and Islam, M.S., 2024. Nutritional status and other associated factors of patients with tuberculosis in selected urban areas of Bangladesh. Well Testing Journal, 33(S2), pp.571-590.