N-TB: A mobile-based application to simplify nutritional assessment, counseling and care of patients with tuberculosis in India

Abstract

Undernutrition is the most prevalent comorbidity in patients with tuberculosis (TB) in India. Undernutrition is often severe and results in higher risk of death, drug toxicity during treatment, poor functional status at end of treatment and a higher risk of relapse after successful treatment. A World Health Organization guideline has recommended nutritional assessment, counseling, and care as integral parts of TB care. The Revised National Tuberculosis Control Programme has recognized undernutrition as a significant comorbidity, released a guidance document for improving nutritional care and support, and launched a scheme for direct bank transfer of monthly cash benefit to TB patients. However, there are gaps at the provider level on nutritional assessment, due to challenges in calculation and interpretation of body mass index (BMI). A mobile based application has been developed for use in the programme, which makes estimation of BMI possible, classifies the severity of undernutrition, suggests triage and clinical actions based on the BMI, indicates desirable body weight corresponding to a BMI of 21 kg/m2, and the daily caloric and protein intake for underweight patients with active TB. The app also provides tips for dietary counseling for TB patients, information on the major food groups, emphasizes an adequate and balanced diet from locally available foods for nutritional recovery of TB patients.