South Africa is grappling with one of the highest burdens of tuberculosis (TB) in the world. Every year, the country sees a high number of TB infections, resulting in the loss of tens of thousands of lives.
This issue is further compounded by the prevalence of HIV-TB co-infection and the emergence of drug-resistant TB strains, making treatments longer and expensive.
"It's hard to believe that a curable disease that has been around for over 2000 years is still a major health challenge in 2023," said Janke Draper, a registered dietitian and spokesperson for the Association for Dietetics in South Africa (ADSA).
Unfortunately, TB disproportionately affects people living in poverty and, as unemployment rates rise and income inequality persists, poverty becomes an increasingly significant problem.
Those facing economic hardships are the least likely to access TB diagnosis and treatment, highlighting the urgent need to improve TB health services in underserved communities.
TB is an infectious disease caused by Mycobacterium tuberculosis, primarily affecting the lungs. It spreads through airborne bacteria released when an infectious person with active TB disease coughs or sneezes.
Close and prolonged contact with an infectious person is usually necessary for transmission, and not everyone exposed to the bacteria develops active TB disease.
The immune system can often keep the TB infection dormant, but individuals with weakened immune systems, such as those living with HIV, are more susceptible to developing active TB disease.
Poverty, malnutrition, and TB intersect, creating a vicious cycle. Malnutrition weakens the immune system and increases the risk of developing TB disease.
Food insecurity and chronic substance abuse contribute to malnutrition in South Africa, with underweight individuals being particularly vulnerable.
Faaizah Laher, another ADSA spokesperson and registered dietitian, explains: "Malnutrition, poverty, overcrowding, stress, alcoholism, and drug addiction are all factors that contribute to TB.“
Unfortunately, malnutrition is often severe by the time of diagnosis due to limited access to healthcare. The body requires extra energy, protein and nutrients to fight off infection.
“Maintaining a healthy weight is crucial for the effectiveness of TB drug regimens. However, both HIV and TB interfere with the body's ability to absorb nutrients, making weight gain and maintaining body mass challenging.”
During TB treatment, patients must prioritise their daily nutrition. Loss of appetite and digestive complaints are common symptoms, making it difficult to consume sufficient nutrients.
It's important to remember that TB is a curable disease, but strict adherence to antibiotic treatment for several months is crucial to prevent recurrence and drug-resistant infections.
TB patients have increased protein and energy requirements, as well as specific needs for vitamins and minerals. They often experience deficiencies in vitamins A, E, and D, as well as minerals like calcium, iron, zinc and selenium.
Draper stresses the significance of these deficiencies, stating: “Micronutrients play a complex role in immune function. When the immune system is compromised, successful TB treatment is at risk.
“Nutrition deficiencies are associated with an increased risk and severity of TB disease, delayed recovery, and more frequent hospital visits.”
Laher shares some top tips for improving nutrition for those with TB:
Focus on a varied, healthy diet and avoid unhealthy habits like smoking, drinking alcohol, and consuming sugary drinks.
Stay hydrated by drinking plenty of clean water throughout the day.
Aim for a minimum of three mixed meals per day, as this allows for optimal nutrient absorption.
Engage in physical activity or light exercise to rebuild muscles.
If experiencing a loss of appetite, try eating five to six smaller meals throughout the day.
She explains that mixed meals mean ensure that we use a combination of foods from the four basic food groups in one meal:
Starches such as cereals, rice, maize meal, wholewheat bread, potatoes and butternut.
Vegetables and fruit provide our body with all the vitamins and minerals it needs to support the immune system.
Protein-rich foods such as milk, eggs, yoghurt, maas, beans, lentils, chicken, meat, and fish.
Oils and fats as well as nuts and seeds.
Here are some of Laher’s examples of mixed meals containing all four food groups:
Chicken stew with onion and carrots served with green beans and maize porridge.
Beans and samp with beetroot, cooked cabbage and onion.
Peanut butter and bread with a banana.
An orange with a cheese sandwich.
Maize porridge with milk or maas, a little margarine and sugar with an apple or fruit of your choice.
Oats porridge with yoghurt, a banana and a little sugar.
Pilchards with rice, cabbage salad and chakalaka.
Beef stew with tomatoes, green beans and carrots served with rice or lentils.
Mielie pap, morogo, beetroot and lamb.
Chicken sandwich and an apple.
Amabumbe with pilchards and stewed vegetables.
Mielie pap with tomato and onion stew, beans and mixed vegetables.
Bean stew with rice and steamed frozen vegetables.
Pilchards on bread with salad.
Beans and bread with cooked spinach and tomato.
Beef mince with tomato, spinach and onion served with pasta.
Bread with a boiled egg and a banana.
Soy mince with mixed vegetables and rice or pap.
High protein cereal with milk and margarine, and a banana.
Vegetable soup with chickpeas or barley and a slice of bread.
And that’s why it’s important to remember that nutrition plays a vital role in the recovery and well-being of TB patients.