TB is a major global health concern, and children are particularly vulnerable to this infectious disease. Out of the 9 million TB cases in the world each year, 11% of such cases are found in children. However, of several causes of morbidity and mortality among children in developing countries, tuberculosis (TB) and malnutrition are the leading ones.

Malnutrition fuels tuberculosis. On the contrary, malnutrition can be caused by chronic inflammatory diseases such as TB. According to the World Health Organization (WHO), malnutrition increases the risk factors for pulmonary TB in children. Malnutrition is a severe problem worldwide. Next to African countries, India stands second in child malnutrition. We know that the combination of malnutrition and tuberculosis is very lethal. Over 33% of under-five deaths were associated with malnutrition, in India.

Causes of Malnutrition and Tuberculosis in Children

Poverty, poor dietary habits, digestive conditions, mental conditions such as depression and anxiety, poor hygiene and chronic disorders are the leading causes of malnutrition. These factors of malnutrition are interconnected factors that contribute to the risk of TB in children. By addressing these factors and promoting optimal child nutrition, we can improve overall health outcomes and reduce the burden of TB in children.

As a rule of thumb, case finding is a crucial step in the care of patients with TB; however, TB in children remains largely underdiagnosed. Of incident cases of TB in children under the age of five, only 31% of the cases are diagnosed. Of children dying due to TB, 96% of deaths are occurring in those who are most likely never diagnosed.

Preventive Measures for Malnutrition and Tuberculosis in Children

To effectively address child nutrition and TB, a multi-faceted approach is needed. Some key strategies and interventions that can be implemented include:

• Promoting exclusive breastfeeding: Encouraging and supporting mothers to exclusively breastfeed their infants for the first six months of life, and continued breastfeeding with appropriate complementary feeding up to two years of age, can provide essential nutrients and antibodies that boost the child’s immune system and protect against TB infection.

• Improving access to nutritious food: Ensuring that children have access to a balanced diet with essential nutrients, including protein, vitamins, and minerals, can strengthen their immune system and reduce the risk of TB infection. This can involve initiatives such as food supplementation programs, school feeding programs, and community-based nutrition interventions.

• Poverty alleviation measures: Implementing poverty alleviation programs that address the socio-economic determinants of child nutrition, such as providing access to clean water, sanitation facilities, and education, can break the cycle of poverty and TB. This can involve social protection measures, economic empowerment programs, and community development initiatives. The burden of Childhood Tuberculosis is huge and needs to be tackled.

• Health education and awareness: Educating caregivers and communities about the importance of child nutrition, breastfeeding, and TB prevention can create awareness and empower them to make informed choices about their child’s nutrition and health. This can involve health promotion campaigns, community-based education programs, and targeted messaging through various media channels.

• Collaboration between health and nutrition sectors: Effective collaboration between health and nutrition sectors is crucial in addressing child nutrition and TB. Integrating nutrition screening, assessment, and interventions into TB programs and vice versa can ensure a holistic approach to managing TB in children.

By prioritising child nutrition as an integral part of TB control programs and implementing a multi-faceted approach, we can work towards reducing the burden of TB in children and improving their overall health and well-being. Investing in child nutrition is not only vital for TB prevention, but also for the overall health and development of children, ensuring a brighter and healthier future for them.

As malnutrition, which causes TB in children has grabbed global attention, it is high time that public health officials and clinicians should understand the unique considerations for the co-prevalence of TB and malnutrition. Society as a whole needs to be aware of these problems in children and come together to fight the menace of TB among children.