Comorbidities

This section of the guidelines is intended to support programmes in providing people-centred services for TB and undernutrition at all levels of the health system in all WHO Member States.

The specific objectives of the undernutrition section of this document are to:

• reduce the burden of undernutrition among people with TB; and
• reduce the burden of TB among people with undernutrition and in food insecure settings.

The anticipated impacts of the undernutrition section are:

This section of the guidelines consolidates existing recommendations on TB screening among people with undernutrition and in food insecure settings (12) with existing, updated and new recommendations on nutritional interventions for people with TB and their household contacts.

For the updated and new recommendations, three systematic reviews on the following questions worded in the PICO (population, intervention, comparator, outcome) format were conducted:

In 2013, WHO published the Guideline: nutritional care and support for patients with tuberculosis (11). That document included recommendations on nutritional assessment and counselling, management of moderate and severe acute malnutrition, and micronutrient supplementation for people with TB disease. It also contained guidance on nutritional assessment and support for household contacts of people with TB.

Tuberculosis (TB) is a leading cause of ill health and mortality from an infectious disease. In 2023, an estimated 10.8 million people fell ill with TB, among whom 1.25 million died from TB (1). TB incidence is closely related to broader socioeconomic determinants such as poverty and food insecurity (1), and undernutrition is one of the most important risk factors that drive the TB epidemic. A systematic review and meta-analysis estimated a 48% prevalence of undernutrition in people with TB (2).

In 2023, an estimated 10.8 million people fell ill with tuberculosis (TB), among whom 1.25 million died from the disease (1). Undernutrition is a key risk factor that drives the TB epidemic and each year it accounts for an estimated 0.96 million (95% uncertainty interval 0.4–1.1 million) episodes of TB (1). The prevalence of undernutrition in people with TB is estimated to be 48% (2).

Drug-susceptible TB: TB disease with no evidence of infection with a strain of Mycobacterium tuberculosis complex that is resistant to rifampicin or isoniazid (1). This includes people for whom drug susceptibility testing was not done or for whom drug susceptibility testing shows a strain of M. tuberculosis complex that is susceptible to both rifampicin and isoniazid.

These guidelines were developed by Annabel Baddeley (World Health Organization [WHO]) and Anna Carlqvist (consultant, WHO), with inputs from Kerri Viney, Farai Mavhunga and Maria Nieves Garcia Casal (WHO), under the overall direction of Tereza Kasaeva, Director of the WHO Department for HIV, Tuberculosis, Hepatitis and Sexually Transmitted Infections.

Guideline Development Group