In ancient India, tuberculosis was called Rajrog or the King’s Disease. A benevolent king would dole out gold coins to the poor, which raised their economic status, leading to improvement in their nutritional standards.

That led to a decrease in the number of new infections and better recovery of those already infected. If he was uncaring towards his people, the undernourished poor would find it difficult to avoid the curse and inadvertently become victims of it. So rightly or wrongly, it was thought that the king controlled the disease.

However, one thing is crystal clear—it has always been an accepted fact that an undernourished body is an open invitation to the germs of tuberculosis, as well as other diseases. Authorities agree that TB is a disease of poverty as poor people are more likely to be undernourished. This is especially true for children as poor nourishment weakens their immune systems, making them less equipped to fight off the disease.

One activist rightly points out that right now the general public does not care much about the disease—partly due to stigma, but more due to poverty. In a world where just trying to survive for one day is a big challenge for many, talking to them about managing TB may not make much sense.

Malnourishment remains an important risk factor to contract TB, especially in children. Fifty percent of the children in developing countries go without meals. According to UNICEF, malnutrition is more common in India than in Sub-Saharan Africa, with one in every three malnourished children in the world living in India. In fact, around 46 percent of all children below the age of 3 are small for their age, 47 percent are underweight and at least 16 percent are wasted.

Many of these children are severely malnourished. Hence, addressing their nutrition needs is of utmost importance. According to Dr ST Wali, a consultant pediatrician from India, “Improving nutritional status is an extremely important intervention not only in disease-free population including children but also in patients on Anti TB Treatment.”

Professor Surya Kant, Head of the Pulmonary Medicine Department, Chhatrapati Shahuji Maharaj Medical University, laments that “Malnutrition is the single strongest risk factor for childhood or primary TB in India where about 49 percent of the children between 0-5 years of age are malnourished. Tuberculosis occurs as a result of interaction between Mycobacterium tuberculosis load and the body’s resistance or immunity. Body resistance or immunity is directly related to nutrition. That is why malnutrition is a very important risk factor in development of active TB disease in children.”

However Dr Surya Kant cautions that TB is no longer a disease of only those coming from lower socio-economic backgrounds. Lifestyle changes in food habits are taking a toll on health. The fast food culture of modern urban societies is basically decreasing the body immunity of even well children, and so nowadays it is not uncommon to find TB targeting the children of affluent families who are increasingly opting out for fast food.

He says, “Affluent family members of children with TB often ask me—‘Doctor, I am from a high socio-economic background and no one in our past seven generations had TB, how come my child developed TB?’ The answer is that probably it is because of fast food culture. Fast food or junk food, as it is so aptly called, causes free radical injury and thereby decreases the body’s immunity making the child prone to infections such as TB.”

Alberto Colorado rightly stresses on the need to advocate for Children Rights and Social Protection if we want to have zero deaths and infections related to Childhood TB. Proper food and good health is the right of all children and not a luxury for the chosen few. A balanced diet, which is low on fatty, salted and processed food, is necessary for the health of a child. India (and may be other countries too) is a paradox where pot-bellied children coexist with fat ones, though of course the former are much larger in numbers. It is indeed a pity that despite India’s phenomenal economic and technological progress, the fight against malnutrition has not made as much progress, and we still fail to ensure two square meals for our kids. The country boasted of having 57 billionaires last year but does not have enough money to feed the impoverished masses.

The Hunger and Malnutrition Report, based on a recent survey conducted across 112 rural districts across nine states of India, found that 42 percent percent of Indian children were found to be underweight and the growth of almost 60 percent was stunted, a result of inadequate nutrition for the mother during pregnancy and the child in its early years. These shocking figures prompted Prime Minister Manmohan Singh to call malnourishment among the nation’s children a "national shame".

But mere rhetoric will not do. Governments are to be held accountable for the health and wellbeing of their populations, especially the children. Policy makers and program implementers will have to understand the linkages between education, health, and hygiene, with a view to improve the nutritional status of our children. TB education should be incorporated into post natal care for nursing mothers, and care givers of children below 5 years of age. Maternal and child health programs should be comprehensive and should educate mothers about the importance of exclusive breastfeeding during the first six months for strengthening the immune system, and about what constitutes a healthy diet.

One of the findings of the above mentioned survey was that malnourished children in India were rarely hungry; they were merely badly fed on diets consisting largely of carbohydrates, due to widespread ignorance about nutrition among Indian parents. Nursing mothers often discard colostrum –the high-protein form of milk produced just prior to birth—which is again so vital for the baby’s health.

Dr Lalji Verma points out that, “Apart from medicine driven initiatives, there are many other aspects one needs to consider for prevention of TB. We all know the importance of healthy and nourishing food, and as long as we have millions of impoverished children in the world, it may be difficult to accomplish effective prevention.”

(Shobha Shukla is Managing Editor of Citizen News Service (CNS). Email: shobha@citizen-news.org, website: http://www.citizen-news.org)