'Food Basket Helped Me Fight TB’: Study Says Nutrition Support Could Save Over 1 Lakh Lives A Year In India

When 32-year-old Ratnesh Kumar from rural Bihar was diagnosed with tuberculosis (TB) last year, the medicines were not his only struggle. The daily wage worker had already lost weight rapidly, was too weak to work, and often skipped meals so his children could eat.

“After starting treatment, I still felt tired all the time,” he recalled. “Some days there was only rice and salt at home. I knew I needed nutrition, but we simply could not afford it.”

Things changed when a local health programme linked to the government’s TB services began providing his family with a monthly food basket containing pulses, rice, oil, and protein-rich supplements.

“Within weeks, I felt stronger. I could tolerate the medicines better and slowly started gaining weight,” he says. “The food support helped my whole family survive that period.”

Stories like Ratnesh’s are at the centre of a new international study which has found that providing food baskets to TB patients and their families could emerge as one of India’s most cost-effective public health interventions.

The study, published in BMJ Global Health by researchers from Boston University and Boston Medical Center in collaboration with India’s National Tuberculosis Elimination Programme (NTEP), suggests that scaling up nutritional support nationwide could prevent more than one lakh TB-related deaths every year.

India continues to bear the world’s highest TB burden, with nearly 2.8 million cases reported annually. Experts say undernutrition remains one of the biggest drivers of the disease in the country.

“Undernutrition isn’t just a complication of TB—it’s one of its root causes,” said Urvashi Singh, former Deputy Director General of NTEP.

“While we wait for effective vaccines for TB, food is the vaccine we already have, and providing food baskets to households affected by TB could be one of the most impactful things we do for TB elimination,” she said.

The findings underline a reality doctors across India witness daily: TB and poverty often reinforce each other. Patients who are already malnourished are more vulnerable to infection, while the disease itself leads to further weight loss, weakness, and loss of income.

For many families, even accessing regular nutritious meals during treatment becomes difficult. The researchers found that for every 10,000 TB patients provided with food supplementation, nearly 10,470 years of poor health and premature death could be prevented. The intervention was estimated to cost about USD 141 for each health gain achieved—far below India’s accepted cost-effectiveness benchmark of USD 550.

In nearly 94% of the simulations conducted by researchers, nutritional support emerged as a highly cost-effective intervention.

When projected nationally across India’s annual TB burden, universal food support could avert approximately 120,000 deaths every year.

“What this study shows is that scaling up in-kind nutritional support in India isn’t just the right thing to do—it’s also an excellent investment,” said Pranay Sinha, senior author of the study and assistant professor of medicine at BU Chobanian & Avedisian School of Medicine, Boston Medical Center.

“For less than the cost of many biomedical interventions, we could prevent over 100,000 TB deaths a year,” he added.

Public health experts say the findings strengthen the argument that TB control cannot rely on medicines alone. Addressing social determinants such as nutrition, overcrowding, and poverty remains equally important.

India already runs the Nikshay Poshan Yojana, under which TB patients receive direct cash transfers for nutritional support. However, experts believe in-kind food baskets may ensure more consistent nutritional intake, especially in vulnerable households where cash assistance may be diverted towards other urgent needs.

“This work bridges the gap between clinical evidence and policy,” said Julia Gallini, the study’s first author and doctoral candidate in biostatistics at BU. “We wanted to give NTEP and global health policymakers a clear, quantitative picture of what nutritional support could achieve nationally. The numbers make a compelling case.”

Adding to the discussion while talking to The Health Outlook, Aparna Singh, Assistant Program Lead of Foods and Nutrition at the S.M. Sehgal Foundation—an organisation working for the welfare of the rural sector in the country—stressed the importance of balanced diets and community-level awareness.

“The TB patients should be provided with a balanced diet which contains all the food groups, with a focus on a ‘Food First’ approach,” she said. “This means preferring regular, balanced meals for nutrition instead of relying only on supplements or medicines.”

She advised including whole grains and millets such as jowar, bajra, and ragi as major energy sources, along with adequate protein intake through pulses, milk, eggs, and meat. Seasonal fruits and vegetables should also form a regular part of the diet.

“Patients should avoid alcohol, tobacco, junk food, sugary drinks, and excessive tea, coffee, salt, and spices to support better recovery,” she added.

Aparna Singh also highlighted the importance of information access and awareness, especially in rural communities where myths and stigma surrounding TB remain common.

Doing its bit in that direction, the S.M. Sehgal Foundation-supported community radio is creating awareness through programmes such as "TB Harega and Desh Jeetega" broadcast on CR Connect FM 107.8. She added that these “programmes also allow people to interact directly with doctors and experts, making the information more practical and relatable".

However, challenges remain. Despite India’s goal of eliminating tuberculosis, doctors say the disease continues to be widely reported even in major urban centres, underlining persistent gaps in awareness, early diagnosis, and treatment adherence.

For instance, at Delhi-based Aakash Healthcare alone, around 921 TB cases were reported between 2016 and 2026, reflecting the continuing burden of the disease at the grassroots level.

“TB is more than just a medical condition. Social determinants of TB, social stigma, and delayed diagnosis make it far more challenging to treat,” said Dr. Aashish Chaudhry, Senior Orthopaedic Surgeon and Managing Director of Aakash Healthcare. He stressed that timely diagnosis remains critical, particularly as awareness about the disease continues to remain low in many sections of society.

Dr. Manav Manchanda, Director and Head of Respiratory, Critical Care, and Sleep Medicine at Asian Hospital, agreed. He said many patients often ignore early symptoms such as persistent cough, fever, and unexplained weight loss, mistaking them for seasonal viral infections.

“Patients may delay seeking medical attention until the disease becomes more advanced,” he said, stressing early detection. “Delayed diagnosis not only worsens outcomes for patients but also increases the risk of transmission within communities.”