Search

Tuberculosis is the leading cause of deaths from an infectious disease worldwide. WHO's End TB Strategy is falling short of several 2020 targets. Undernutrition is the leading population-level risk factor for tuberculosis. Studies have consistently found that undernutrition is associated with increased tuberculosis incidence, increased severity, worse treatment outcomes, and increased mortality. Modelling studies support implementing nutritional interventions for people living with tuberculosis and those at risk of tuberculosis disease to ensure the success of the End TB Strategy. In this Personal View, we highlight nutrition-related immunocompromisation, implications of undernutrition for tuberculosis treatment and prevention, the role of nutritional supplementation, pharmacokinetics and pharmacodynamics of antimycobacterial medications in undernourished people with tuberculosis, and the role of social protection interventions in addressing undernutrition as a tuberculosis risk factor. To catalyse action on this insufficiently addressed accelerant of the global tuberculosis epidemic, research should be prioritised to understand the immunological pathways that are impaired by nutrient deficiencies, develop tools to diagnose clinical and subclinical tuberculosis in people who are undernourished, and understand how nutritional status affects the efficacy of tuberculosis vaccine and therapy. Through primary research, modelling, and implementation research, policy change should also be accelerated, particularly in countries with a high burden of tuberculosis.

Background. Scalable interventions are needed to support adolescents thrive. Since 2003, the Ethiopian Government’s Health Extension Programme (HEP) has reached millions of households. We evaluated the relationship between household support from HEP and eleven indicators of adolescent health and wellbeing. Methods. We used Young Lives Ethiopia cohort data between 2002 and 2013. Outcomes were: not underweight, self-reported very good health, education enrolment, domestic tasks, paid work, fertility knowledge, sexually transmitted infection knowledge, no child marriage, no early pregnancy, literacy, and numeracy. We evaluated associations between household support from HEP at age 15 and study outcomes at age 19 using propensity score weighted regression, stratifying by sex, and adjusting for receipt of the Productive Safety Net Programme, and economic shocks. Adjusted probability differences (APDs) and adjusted mean differences (AMDs) were used to contrast exposure to HEP vs. no exposure. Findings. Of 775 adolescents with complete follow-up, 46% were female, with baseline mean age 7.87 years (SD: 0.29). Sixty-six percent of adolescents reported household support from HEP. Baseline predictors of support included lower household wealth, lower caregiver education, rural location, and residence in Tigray. Propensity score weighting yielded good balance. In boys, HEP was positively associated with education enrolment (APD: +17ppts, 95% CIs: +6ppts; +27ppts), and negatively associated with paid work (APD: -16ppts, 95% CIs: -27ppts; -4ppts). In girls, HEP was positively associated with fertility knowledge (APD: +14ppts, 95% CIs: 2ppts; 25ppts), no child marriage (APD: +19ppts, 95% CIs: +9ppts; +29ppts), no early pregnancy (APD: +18ppts, 95% CIs: +9ppts; +28ppts), education enrolment (APD: +23ppts, 95% CIs: +11ppts; +34ppts), literacy (AMD: +7ppts, 95% CIs: +2; +11), and numeracy (AMD: +10ppts, 95% CIs: +5; +14). Interpretation. Policies promoting HEP will substantially support multiple areas of adolescent health and wellbeing, and help their transition to adulthood.