Prevalence of Tuberculosis in Severely Malnourished Indian Children

This study is funded and conducted under the U.S. National Institutes of Health, Fogarty International Center. PIs are Robert Bollinger, MD, MPH; Dr. Muralidhar Tambe, BJGMC

Severely malnourished children are vulnerable population for communicable and non-communicable disease.  Diagnosis of TB among children especially malnourished children is a challenge.  The TB diagnostic symptoms of weight loss, loss of appetite, low grade fever, cough are also commonly present in SAM children with other infections thus delaying the TB diagnosis among them.  Hence, active TB screening among SAM children is needed to ascertain the correct prevalence of TB among SAM children in NRCs.  Algorithm of Revised National Tuberculosis Control Programme (RNTCP) for diagnosis of TB in children includes investigations like – TST, Chest X-ray, and Gastric aspirate.  Few additional investigations in SAM children such as urinary LAM, USG abdomen, Lymphnode biopsy when indicated may improve the yield of TB diagnosis.

There is scarcity of data on prevalence of tuberculosis in Indian SAM children admitted to Nutritional Rehabilitation Centers who have failed the appetite test which is an admission criteria for SAM children to NRC’s for supervised nutritional management. 

Research question:  What is the prevalence of tuberculosis disease among severe acute malnourished (SAM) children admitted (as per WHO guidelines) to Nutritional Rehabilitation Center.

Primary Objective:

To find out the prevalence of active tuberculosis disease in children with severe acute malnutrition (SAM) admitted to the Nutritional Rehabilitation Center.

Secondary Objective:

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  To assess utility of additional laboratory testing including urinary LAM, Gene-Xpert on gastric aspirate, lymph node biopsy when indicated to ascertain Active TB disease in severely malnourished children.
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  We propose to undertake this study to determine the prevalence of tuberculosis in severely malnourished children by screening all children admitted to NRC from Sassoon General Hospitals (SGH) and to find an optimal approach to determine TB status among severely malnourished children using the Paediatric TB management guideline screen and additional laboratory tests.