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- Title
Nutritional Supplementation to Prevent Infection in Household Contacts of Tuberculosis Patients.
- Authors
Mathew, Joseph L.; Indumathi, C. K.; Mohan, Pavitra
- Abstract
Summary: This was a field-based, open-label, cluster-randomized controlled trial, in which household contacts of 2800 patients with microbiologically confirmed pulmonary tuberculosis across 28 tuberculosis units of the National Tuberculosis Elimination Programme across four districts of Jharkhand, India, were enrolled. The tuberculosis units were randomly allocated 1:1 by block randomization to the control group or the intervention group. Although microbiologically confirmed pulmonary tuberculosis patients in both groups received food rations (1200 kcal, 52 grams of protein per day with micronutrients) for 6 months, only household contacts in the intervention group received monthly food rations and micronutrients (750 kcal, 23 grams of protein per day with micronutrients). After screening all household contacts for co-prevalent tuberculosis at baseline, all participants were followed-up actively, for the primary outcome of incident tuberculosis (all forms). There were 10,345 household contacts, of whom 5328 (94·8%) of 5621 household contacts in the intervention group and 4283 (90·7%) of 4724 household contacts in the control group completed the primary outcome assessment. The authors detected 31 (0·3%) of 10,345 household contact patients with co-prevalent tuberculosis disease in both groups at baseline and 218 (2·1%) people were diagnosed with incident tuberculosis (all forms) over 21,869 person-years of follow-up, with 122 of 218 incident cases in the control group [2·6% (122 of 4712 contacts at risk), 95% CI 22–3·1; incidence rate 1·27 per 100 person-years] and 96 incident cases in the intervention group [1·7% (96 of 5602), 1·4–21; 0·78 per 100 person-years], of whom 152 (69·7%) of 218 were patients with microbiologically confirmed pulmonary tuberculosis. Tuberculosis incidence (all forms) in the intervention group had an adjusted IRR of 0·61 [95% CI 0·43–0·85; aHR 0·59 (0·42–0·83)], with an even greater decline in incidence of microbiologically confirmed pulmonary tuberculosis [0·52 (0·35–0·79); 0·51 (0·34–0·78)]. This translates into a relative reduction of tuberculosis incidence of 39% (all forms) to 48% (microbiologically confirmed pulmonary tuberculosis) in the intervention group. An estimated 30 households (111 household contacts) would need to be provided nutritional supplementation to prevent one incident tuberculosis. The authors conclude that nutritional intervention was associated with substantial (39–48%) reduction in tuberculosis incidence in the household during the two years of follow-up.
- Subjects
JHARKHAND (India); INDIA; TUBERCULOSIS patients; TUBERCULOSIS; HOUSEHOLDS; DIETARY supplements; INFECTION
- Publication
Indian Pediatrics, 2023, Vol 60, Issue 11, p941
- ISSN
0019-6061
- Publication type
Article
- DOI
10.1007/s13312-023-3042-7