The Influence of Dietary Practice and

Nutritional Status on Pulmonary Tuberculosis

(TB) Children (10-12 years)
(A Report submitted to IGNOU in partial fulfilment of the requirement
for the degree of Master’s of Science in Dietetics and Food Service
Management)

Submitted By :
Jyoti Gupta
Enrolment No. 135607014

Department of Nutrition Science

(School of Continuing Education)

INDIRA GANDHI NATIONAL OPEN UNIVERSITY

MAIDAN GARHI, NEW DELHI- 110068
 STUDENT CERTIFICATE

The work embodied in this dissertation entitled “The Influence of Dietary Practice
and Nutritional Status on Pulmonary Tuberculosis (TB) Children (10-12 Years)”
has been carried out by me under the supervision of Prof. Deeksha Kapur. This
work is original and has not been submitted by me for the award of any other
degree to this or any other university.

Date:

Place: New Delhi

Jyoti Gupta
M.Sc DFSM (IGNOU)
Enrolment No- 135607014

CERTIFICATE OF DISSERTATION COUNCELOR

I certify that the candidate Mrs. Jyoti Gupta has planned and counted the research
study entitled “The Influence of Dietary Practice and Nutritional Status on
Pulmonary Tuberculosis (TB) Children (10-12 Years)” under my guidance and
supervision and that the report submitted here is a bonafide work done by the
candidate in Delhi.

Date:

Place: New Delhi Prof. Deeksha Kapur

Discipline of Nutritional Sciences

School of Continuing Education,
IGNOU, Maidan Garhi,
New Delhi - 110068

1
 ACKNOWLEDGEMENT

As I begin to think of all the people to whom I would like to express my gratitude
and appreciation for their support and suggestions in making this dissertation
possible, the list continues to grow.
First of all, I owe it all to GOD for granting me the wisdom, health, strength and
helping me throughout this research task and enabling me to complete it by
various mediums.
I wish to express my sincere gratitude to my supervisor Prof. Deeksha Kapur who
was abundantly helpful and offered her invaluable guidance and support. I cannot
express how much helpful she was to me in developing an idea and making it a
reality. Your valuable inputs, timely help and healthy criticism has made possible
the successful completion of the dissertation.
I wish to express a huge thanks to my mother Mrs. Prema Devi, my husband Mr.
Shiv Dutt, my family and my friends for providing me moral support throughout
my study.
Last but not the least I am deeply indebted to all those people who participated in
the study, which was very essential for the completion of the study.

Jyoti Gupta

2
 TABLE OF CONTENTS

STATEMENT PAGE NO.

LIST OF TABLES
LIST OF FIGURES
LIST OF ABBREVIATIONS
ABSTRACT 09
INTRODUCTION 10-12
IMPORTANCE OF STUDY 12
OBJECTIVES 12
CHAPTER 1: REVIEW OF LITERATURE 13-29
1.1 Tuberculosis 13
1.2 Types of Tuberculosis 14
1.2.1 Latent TB Infection 14
1.2.2 Active TB Disease 14
1.3 Signs and Symptoms 15
1.3.1 Pulmonary Tuberculosis 15
1.3.2 Extra-Pulmonary Tuberculosis 15
1.4 Diagnosis 16
1.4.1 TB Culture Test 16
1.4.2 The TB Skin Test 16
1.4.3 TB Interferon Gamma Release Assays 16
1.4.4 Sputum Smear Microscopy as a Test for TB 16
1.4.5 Fluorescent Microscopy 17
1.4.6 Chest X-Ray as a TB Test 17
1.4.7 Serological Test for TB 17
1.4.8 TB Molecular Tests 17
1.5 Complications of tuberculosis 17
1.6 Nutrition in tuberculosis 18
1.7 Studies on tuberculosis 18
1.7.1 Nutritional Assessment of Tuberculosis Children 18

3
 1.7.2 Investigate the Nutrient Intake 21
In relation to their Eating Habits
1.7.3 Knowledge, Attitude and Practice of TB patients 24

CHAPTER 2: METHODOLOGY 30-35

2.1 Study Design 30
2.2 Locale of the Study 30
2.3 Samples, Sample Size and Sampling Techniques 30
2.3.1 Sample 30
2.3.2 Sample size 30
2.3.3 Sampling technique 30
2.4 Development of Tools and Collection of Data 31
2.4.1 Socio- demographic design questionnaire 31
2.4.2 Assessment of nutritional anthropometry 31
2.5 Assessment of Food and Nutrients Intake 33
2.6 To access the Nutrition KAP of Children in Relation to TB 34
2.6.1 Knowledge questionnaire 34
2.6.2 Attitude questionnaire 34
2.6.3 Practice questionnaire 35
2.7 Statistical Analysis 35

CHAPTER 3: RESULTS 36-49

3.1 Demographic Characteristics 36
3.2 Nutritional Status Assessment 38
3.2.1 Anthropometry Assessment 39
3.3 Food and Nutrient intake of the subjects 40
3.3.1 Food Intake 40
3.3.2 Nutrient Intake 41
3.4. Nutritional KAP of the Children in Relation to Tuberculosis 43
3.4.1 Nutritional Knowledge Assessment 43
3.4.2 Knowledge of Parents Regarding Overweight, 45
Normal Weight and Underweight of Patients

4
 3.4.3 Nutritional Attitude Assessment 45
3.4.4 Nutritional Practice Assessment 47

CHAPTER 4: DISCUSSION 50-52

CHAPTER 5: SUMMARY AND CONCLUSION 53-54
CHAPTER 6: RECOMMENDATIONS 55
BIBLIOGRAPHY 56-61
ANNEXURES 62-72
A. Socio -Demographic Profile Questionnaire 62-65
B. Knowledge Questionnaire 66-68
C. Attitude Questionnaire 69
D. Practice Questionnaire 70-71
E. Dietary assessment 72

5
 LIST OF TABLES

Title
Table no. Page no.

1.1 Summary of studies on nutritional status of TB patients 19

Summary of studies on nutrient intake in relation to eating habits of

1.2 22
TB patients

1.3 Summary of studies on KAP in relation to their dietary practice. 25

2.1 Percentile cut off BMI for age for children by WHO 33

3.1 Socio economic and demographic characteristic of study population 36

3.2 Mean ± SD anthropometric parameter of subjects 39

3.3 BMI for age classification of the subjects. 39

3.4 Mean ± SD of food intake by the children. 40

3.5 Mean ± SD values of daily intake of the nutrients of the children 42

3.6 Distribution of study population according to knowledge score 43

Frequency distribution of correct response of knowledge towards

3.7 44
TB

3.8 Mean±SD of nutritional knowledge score of parents 45

3.9 Frequency distribution of correct response of attitude towards TB 46

3.10 Frequency distribution of correct response of practice towards TB 47

6
 LIST OF FIGURES

FIGURE NO. TITLE PAGE NO

3.1 Comparative graphical presentation of percentage food 41

adequacy of the children.

42
3.2 Comparative graphical presentation of percentage
nutrient intake of the children.

7
 LIST OF ABBREVIATIONS

BMI : Body Mass Index

CDC : Centre for Disease Control
CMR : Indian Council of Medical Research
G : Gram
KAP : Knowledge Attitude Practice
Kcal : Kilo calories
Mg : Milligram
MTB : Mycobacterium Tuberculosis
MUAC : Mid Upper Arm Circumference
NCD : Non Communicable Disease
NFHS : National Family Health Survey
NTP : National Tuberculosis Program
RDA : Recommended Dietary Allowances
RDI : Recommended Dietary Intake
TAI : Tuberculosis Association of India
TB : Tuberculosis
TBc : Childhood Tuberculosis
WHO : World Health Organization
WHR : Waist to Hip Ratio
β : Beta
SAM : Severe Acute Malnutrition
MAM : Moderate Acute Malnutrition
DOTS : Directly Observed Treatment Short Course

8
 ABSTRACT

Dietary intake, nutritional status and knowledge about tuberculosis are considered
key in the prevention, treatment and management of tuberculosis. The aim of this
study was to assess the influence of dietary practice and nutritional status on
pulmonary tuberculosis children (10-12 years).

The present study is a descriptive cross sectional study that involved 100
tuberculosis children attending OPD at two different tuberculosis centers in Delhi
region. The height and weight of subjects were taken and BMI was determined.
Food and nutrient intake of the subjects was assessed using 24 hour dietary recall
method. A questionnaire was designed, administered to collect information
regarding socio-demographic status, knowledge, attitude and dietary practices of
the subjects regarding tuberculosis and nutrition.

The study included 34% males and 66% females. Data related to anthropometry
revealed that majority (51%) of participants were underweight followed by
normal weight (39%) and overweight (10%).

Data related to mean food intake revealed that intake of cereal and millets, green
leafy vegetables, fruits, sugar and edible oils was low meeting 31%-45%
adequacy in both the groups. Intake of pulses was almost adequate for both the
groups meeting 88%-96%. Intake of roots and tubers was observed to be more
than adequate, meeting 104%-107%. Intake of milk and milk products and other
vegetables met 57%-71% adequacy in both the groups.

Regarding nutrient intake, subjects were meeting only 44%-46% adequacy of

energy with 18% deriving from fat. Intake of protein, vitamin B6 and vitamin C
was fairly good meeting 75%-103% adequacy in both the groups. Intake of
calcium and zinc met 61%-67% adequacy. Intake of iron and vitamin A was poor
meeting 31%-47% adequacy in both the groups.

Overall Mean±SD knowledge score was 7.98±2.96 which reflects that parents
possessed fair knowledge and positive attitude (mean attitude score 0.79±0.40)
towards nutrition. Level of nutritional practice can be a contributing factor to their
poor dietary intake and food consumption pattern which could lead to poor
growth.

9
INTRODUCTION

Disease surveillance in TB is particularly challenging as there is no single reliable

method. To be most effective, a multi-pronged approach, combining a number of
measures adapted contextually, is required. India is the second-most populous
country in the world one fourth of the global incident TB cases occur in India
annually (RNTCP, 2018).
It is estimated that one third of the world‟s population is infected with
Mycobacterium tuberculosis (the bacterium that causes tuberculosis), and that
each year, about 9 million people develop TB, of whom about 2 million die. Of
the 9 million cases of TB worldwide that occur annually, about 1 million cases
(11%) occur in children <15 years of age. Recent evidence suggests that children
can become infected after only 15-20 min of exposure to M. tuberculosis. After
M. tuberculosis infection, the disease can manifest at any time in life, depending
on the balance between the pathogen and the host immunity (Sandhu, 2011).
It is a serious infectious pulmonary disease that attacks the lungs but can also
affect other parts of the body. When the Mycobacteria attack in lungs is known as
Pulmonary Tuberculosis and when Mycobacteria attack the other parts of the body
is known as Extra Pulmonary Tuberculosis. Pulmonary Tuberculosis has become
a global problem. According to the World Health Organization more than 1/4 of
the World population has been affected by Pulmonary Tuberculosis disease
(Singroul, 2015).
The global burden of tuberculosis (TB) in children remains high. Children
younger than 15 years account for 15%-20% of global TB burden, which is often
associated with severe TB-related morbidity and mortality. 75% of these
childhood cases occur annually in 22 high-burden countries that together account
for 80% of the world‟s estimated incident cases. The reported percentage of all TB
cases occurring in children varies from 3% to more than 25% in different
countries (WHO, 2006).
The risk of developing infection with Mycobacterium tuberculosis is higher for
children living in regions where there is a high prevalence of active tuberculosis,

10
in dwellings with high population density (many people sleeping in the same
room), and in buildings with poor ventilation (Carvalho, et al. 2018).

Most children will develop Active Tuberculosis within a year after becoming
infected. Childhood TB is rarely sputum-smear positive on microscopy. That is
probably the reason for the lower priority traditionally given to children by TB
control programs compared to that of adult disease (Savicevi, et al., 2012).

The diagnosis of tuberculosis in children is quite difficult and seldom confirmed

and is based mainly on clinical signs, symptoms, history of contact with adult and
special investigations. TB in children is paucibacillary in nature (Pamukcu, et al.,
2008).

The rapid growth period of infancy and childhood can only be maintained if a
child‟s nutrient intake is optimal. The provision of adequate energy and nutrients
for a child with TB is very important, since the child has increased requirements
as a result of both growth and TB. In meeting their requirements it should be born
in mind that children have limited stomach capacity and appetites and as such plan
the diet carefully to ensure adequate intake of food (NICUS, 2007).

Childhood TB nevertheless remains neglected, as children are not considered a

public health risk and when resources of control are limited programmes target
and treat only infectious cases. Recent advances in diagnosis of childhood
tuberculosis :- children with tuberculosis usually have paucibacillary disease and
contribute little to disease transmission with in the community. Therefore,
Treatment of children with TB is often not considered a priority by TB control
programmes. However children carry a huge TB disease burden particularly in
endemic area (Saraswati, et al. 2018). According to the most recent estimates,
nearly 1 million children develop TB every year (Jenkins, et al., 2014)

There is increasing attention from clinicians and public health perspectives about
this trend, as new occurrence of TB in children is a sentinel event and an indicator
of ongoing transmission in the community (Ki, et al., 2017). The World Health
Organisation approved The End TB Strategy, which is in alignment with the
United Nations Sustainable Development Goals. The new strategy adopts the

11
vision of “A world free of tuberculosis - zero deaths, disease and suffering due to
tuberculosis” and has the goal of ending the global epidemic and eliminating
tuberculosis in low-incidence countries. The goals, to be met by 2035, are a 90%
reduction in the incidence rate and a 95% reduction in the number of deaths due to
tuberculosis-both in comparison with the rates reported for 2015 (Raviglione,
2007).

IMPORTANCE OF STUDY

The study provides an opportunity to observe the influence of dietary practice and
nutritional status on pulmonary tuberculosis (TB) Children. The study also
promotes awareness about the impact of dietary practices on pulmonary
tuberculosis children and lifestyle followed by children of this age group. From
this study the early diagnosis of tuberculosis in children is possible. This study
will be helpful to provide valuable information to health/nutrition care providers,
policy makers, administrators planning and concerned bodies for health/nutrition
care utilization and for allocating resources efficiently and also planning for
effective preventive and therapeutic education programmes. The future
improvements in nutritional counselling will helpful in reducing progression of
tuberculosis in children.

OBJECTIVES
The overall objectives of this study are:

1. To assess the nutritional status of pulmonary tuberculosis children using

anthropometry.

2. To investigate the food and nutrient intake of the active tuberculosis patients in
relation to their eating habits.

3. To assess the nutritional knowledge, attitude and practice of parents regarding

active tuberculosis in children.

12
 CHAPTER-1
REVIEW OF LITERATURE

Tuberculosis (TB) is an old disease – studies of human skeletons show that it has
affected humans for thousands of years. The cause remained unknown until 24
March 1882, when Dr Robert Koch announced that he had discovered the bacillus
Mycobacterium tuberculosis, an event that is now commemorated every year as
World TB Day. The disease is spread when people who are sick with TB expel
bacteria into the air (WHO, 2018).

1.1 Tuberculosis

Tuberculosis (TB) is one of the most ancient diseases of mankind and has co-
evolved with humans for many thousands of years or perhaps for several million
years. In 1882, the bacillus causing tuberculosis, Mycobacterium tuberculosis,
was discovered by Robert Koch. Tuberculosis is caused by a group of closely
related bacterial species termed Mycobacterium tuberculosis complex (Barberis,
et al., 2017).

Tuberculosis is a major global health problem. The current global picture of

tuberculosis shows continued progress but not fast enough. During the year 2013,
an estimated 9 million people developed tuberculosis, which is equivalent to 126
cases per 100000 populations. High mortality rate due to TB among tribal clearly
suggest the lack of awareness regarding the disease. India is the country with the
highest burden of Tuberculosis (Boralingiah, et al., 2007).

Tuberculosis (TB) has affected humanity for more than 4,000 years. It is a
common infectious disease and in most cases fatal. Tuberculosis (TB) is viewed
in two groupings: Active Tuberculosis and Latent Infection. Active TB is an
ailment whereby the TB bacteria are precipitously burgeoning and plaguing
various organs of the body whereas latent phase goes undetected most the times
(Nthiga, 2017).

In some people, TB bacteria overcome the defenses of the immune system and
begin to multiply, resulting in the progression from latent TB infection to TB

13
disease. Not everyone infected with TB bacteria becomes sick. As a result, two
TB-related conditions exist: latent TB infection and TB disease.

1.2 Types of Tuberculosis

There are two general stages of the tuberculosis. First is called Latent
Tuberculosis and second is Active Tuberculosis.

1.2.1 Latent TB infection

Persons with latent TB infection do not feel sick and do not have any symptoms.
They are infected with M. tuberculosis, but do not have TB disease. Persons with
latent TB infection are not infectious and cannot spread TB infection to others.
Overall, without treatment, about 5 to 10% of infected persons will develop TB
disease at some time in their lives. About half of those people who develop TB
will do so within the first two years of infection. For persons whose immune
systems are weak, especially those with HIV infection, the risk of developing TB
disease is considerably higher than for persons with normal immune systems
(CDC, 2014).

1.2.2 Active TB disease

If the person is unable to control the initial infection, active disease or

“progressive primary disease” can result, especially in children, and can give rise
to extensive disease in the lung of meningitis. In another scenario, the latent foci
of TB infection in the body can undergo “reactivation” months, years or decades
later to result in Active TB or “post primary disease”. This process of reactivation
occurs with the weakening of the immune response and active uncontrol
replication of micro bacteria with resultant disease in the lungs or the other
organs. This “reactivation” type of tuberculosis is usually seen within 2-5 years
post infection. Due to factors still poorly understood, the clinical presentation of
tuberculosis differ according to age. Young children have a higher likelihood and
faster progression of Active TB with more dissemination of disease (Bhargava,
2012).

14
1.3 Signs and Symptoms

Tuberculosis may infect any part of the body, but most commonly occurs in
the lungs (known as pulmonary tuberculosis) Extra- pulmonary TB occurs when
tuberculosis develops outside of the lungs, although extra- pulmonary TB may
coexist with pulmonary TB.

1.3.1 Pulmonary tuberculosis

Active TB is an illness in which the TB bacteria are rapidly multiplying and

invading different organs of the body. Pulmonary TB, a chronic infectious disease
caused by Mycobacterium tuberculosis, is characterized by prolonged cough,
hemoptysis, chest pain and dyspnea. Systemic manifestations of the disease
include fever, malaise, anorexia, weight loss, weakness and night sweats
(Hopewell, 1994).

1.3.2 Extra-pulmonary tuberculosis

Extra -pulmonary TB is a rare form of active disease that occurs when TB bacteria
find their way into the bloodstream. In this form, the bacteria quickly spread all
over the body in tiny nodules and affect multiple organs at once. This form of TB
can be rapidly fatal. Extra pulmonary disease represented 4.5% of all new cases of
active tuberculosis and tended to occur in older patients than in previous reports.
Sites of involvement included lymph nodes, blood, genitourinary tract, bone and
articular sites, the meninges, peritoneum, adrenal glands, pericardium, and
miscellaneous sites, in this order. Diagnosis was confirmed by a variety of
techniques whose relative merits are discussed. Overall, 14 deaths occurred
among the 136 patients. One-half of the deaths resulted from causes other than
tuberculosis and two patients died before diagnosis and initiation of therapy
(Alvarez, et al., 1984).

15
1.4 Diagnosis

Assessment of patients of tuberculosis disease is rather challenging in developed

and developing countries as the latter lack the resources for advanced laboratory
based diagnosis and sophisticated imaging techniques

1.4.1 TB culture test

In the case of the TB culture test the test is to see if the TB bacteria
Mycobacterium tuberculosis, are present. The bacteria are usually contained in a
sputum sample taken from the patient suspected of having TB in their lungs.

1.4.2 The tuberculin skin test

The TB skin test is a widely used test for diagnosing TB. The Mantoux TB test is
the type of TB test most often used. A positive mantoux test at 72 hours indicates
infection with Mycobacterium tuberculosis, tuberculin sensitivity develops 3
weeks to 3 months after inhalation of the bacilli and remains for the child‟s
lifetime.

1.4.3 TB interferon gamma release assays (IGRAs)

The Interferon Gamma Release Assays (IGRAs) are a new type of more accurate
TB test. IGRAs are blood tests that measure a person‟s immune response to the
bacteria that cause TB.

1.4.4 Sputum smear microscopy as a test for TB

Smear microscopy of sputum is often the first TB test to be used in countries with
a high rate of TB infection. A sample of sputum is usually collected by the person
coughing. To test for TB several samples of sputum will normally be collected.

16
1.4.5 Fluorescent microscopy

The use of fluorescent microscopy is a way of making sputum TB tests more

accurate. With a fluorescent microscope the smear is illuminated with a quartz
halogen or high pressure mercury vapour lamp, allowing a much larger area of the
smear to be seen and resulting in more rapid examination of the specimen.

1.4.6 Chest X-ray as a TB test

If a person has had TB bacteria which have caused inflammation in the lungs, an
abnormal shadow may be visible on a chest x-ray.12 Also, acute pulmonary TB
can be easily seen on an X-ray. However, what it shows is not specific. A normal
chest X-ray cannot exclude extra pulmonary TB.

1.4.7 Serological test for TB

Serological tests for TB are tests carried out on samples of blood, and they claim
to be able to diagnose TB by detecting antibodies in the blood.

1.4.8 TB molecular tests

Some new molecular tests such as the Genexpert test and the TrueNat test are now
beginning to be available. They are though too expensive to be widely used in
many countries.

1.5 Complications of Tuberculosis

Delayed diagnosis may result in more extensive disease , more complications and
lead to a higher mortality. It also leads to an increased period of infectivity in the
community without treatment, tuberculosis can be fatal. Untreated active disease
typically affects your lungs, but it can spread to other parts of your body through
your bloodstream.

17
1.6 Nutrition in Tuberculosis

Nutrition status is significantly lower in patients with active pulmonary

tuberculosis compared with healthy controls. Tuberculosis is probably associated
with more severe malnutrition than other chronic illnesses ;in an study, the
nutritional status of patients with tuberculosis was worse than that of those with
leprosy. Malnutrition can lead to secondary immunodeficiency that increases the
host's susceptibility to infection. In patients with tuberculosis, it leads to reduction
in appetite, nutrient malabsorption, micronutrient malabsorption, and altered
metabolism leading to wasting. Both, protein-energy malnutrition and
micronutrients deficiencies increase the risk of tuberculosis. It has been found that
malnourished tuberculosis patients have delayed recovery and higher mortality
rates than well-nourished patients. Nutritional status of patients improves during
tuberculosis chemotherapy. Nutritional supplementation may represent a novel
approach for fast recovery in tuberculosis patients. In addition, raising nutritional
status of population may prove to be an effective measure to control tuberculosis
in underdeveloped areas of world. (Gupta, et al., 2010).

1.7 Studies on Tuberculosis

In the following sections literature review of some previous studies done on the
topic are presented as per the topic in Table 1.1

1.7.1 Nutritional assessment of tuberculosis children

Nutritional assessment is an essential prerequisite to the provision of nutritional

care. An optimal nutritional status contributes to immune- competence.
Nutritional assessment is an important element in the nutritional care of
tuberculosis children, it is important for each patient to have an individualized
nutritional assessment, educational plan, and periodic reassessment pertaining to
nutritional needs. Nutritional assessment should be used to determine the
nutritional requirements for all patients taking into account their nutritional and
status. It should be done so as to monitor the patient's progress and any alteration
in requirements (WHO, 2013).

18
 Summary of some recent studies on nutritional status of TB patients is presented
in Table 1.1.

Table 1.1 Summary of studies related on nutritional status of TB patients.

Serial Author,
Subjects Parameters Findings
number year

1 Bora, et 86 Height, Weight, 44.2% children was

al., 2018 tuberculosis BMI, MUAC MAM, 12.8% has
patients SAM and 43% had
normal nutritional
status.

2. Dieu, et 717 Height, Weight, Tuberculosis incidence

al., 2017 tuberculosis BMI was 8.2%. The
children prevalence of
underweight is 20.8%,
of which 8.4% is
severely malnourished.

3. Mehta, et 255 children. Height, Weight, Significant differences

al., with BMI, MUAC in weight gain were
2011 Tuberculosis. observed among
children.

4. Sidabutar, 279 patients. Height, Weight, 5.8.% patients were

et al., BMI well, 39.8% patients
2004 were underweight and
1.4% patients were
severely malnourished.

5. Karyadi, 82 participants. Height, Weight, BMI in all patients was

2000 BMI. 20% lower than in
controls and the mean
proportion of fat in all
patients (17.7%) was
lower than in controls
(21.9%). The number
of patients with BMI <
18.5 kg/m2(66%) was
more than sixfold that
of the healthy controls
(10%).

19
Bora, et al., (2018) was conducted a descriptive, cross sectional study to assess the
nutritional status tuberculosis children in rural population. The study was done in
department of paediatrics in which patient attending outdoor facility at the
institute. The result showed that 86 children were included out of which 65.3%
females had MAM and 13% had SAM. While of 20 male TB contact children
infected with TB, 55% had MAM and 25% had SAM. There was statistically no
significant difference of the nutritional status of the nutritional status of the TB
infected contact children in their gender.

Dieu, et al., (2017) conducted a cross sectional study at 22 different Tuberculosis

Diagnosis and Treatment Centers. It involved 717 tuberculosis children less than
15 years of age. Nutritional status was assessed on the basis of the values of the Z-
score Weight for age according to the NCHS curves. Results showed that the
prevalence of underweight was 20.8%, which is more common for boys with
23.6% than girls 17.6%. 12.4% of the children were moderate malnutrition, which
is more common in boys (13.3%) than girls (11.5%). 8.4% of the children were
severely malnourished which is more prevalent in boys (10.3%) than girls (6.2%).

Mehta, et al., (2011) worked on a study to determine the effect of multivitamin

supplementation on their weight. 255 children were studied during this study
attending an outdoor facility. Tuberculosis were randomized to receive either a
daily multivitamin supplement or a placebo in the first eight weeks of anti-
tuberculous therapy. A significant differences in weight gain were observed
among children (n = 22; 1.08 kg, compared to 0.46 kg in the placebo group; 95%
CI = 0.12, 1.10). At the end of follow-up, there is improvement in the
haemoglobin level in children receiving multivitamin of all age groups. The
median increase in children receiving multivitamins was 1.0 g/dL, compared to
0.4 g/dL in children receiving placebo. HIV-infected children between six months
and three years of age had a significantly higher gain in height if they received
multivitamins (n = 48; 2 cm, compared to 1 cm in the placebo group; 95% CI =
0.20, 1.70).

20
Sidabutar, et al., (2004) conducted a retrospective study at the Directly Observed
Treatment Short-course (DOTS) of Cipto Mangunkusumo (hospital) through a
structured interview of 279 patients attending outdoor facility at the hospital. The
result showed the nutritional status of the subjects was 1 well nourished child
changed to overweight , 67 undernourished children changed to well nourished, 4
severe malnourished children undernourished. 202 children were stayed in their
former nutritional status (97 were well nourished 101 were undernourished and 4
were severe malnourished) before and after six months therapy.

Karyadi, (2000) conducted a case-control study. During this study nutritional

status of patients with active TB compared with that of healthy controls. 41 out-
patients untreated active pulmonary TB were compared with 41 healthy controls.
The mean BMI in all patients was 20% lower than in controls, and the mean
proportion of fat in all patients (17.7%) was lower than in controls (21.9%). The
patients with BMI < 18.5 kg/m2(66%) was more than sixfold that of the healthy
controls (10%) . The mean body weight, BMI, skinfold thickness, mid-upper arm
circumference, proportion of fat, fat mass and fat free mass in male patients were
significantly lower than in male controls, whereas all of these variables except
biceps and suprailiac skinfold thickness were significantly different between
female patients and controls. Serum albumin concentration was 10% lower in TB
patients than in controls. Serum albumin concentration was lower in malnourished
TB patients than in well-nourished healthy controls, malnourished healthy
controls and well-nourished TB patients.

1.7.2 Investigate the nutrient intake in relation to their eating habits

The rapid growth periods of infancy and childhood can only be maintained if
a child's nutrient intake is optimal. Insufficient intake can cause impaired
growth and result in diseases such as malnutrition. Because of the previously
described link between malnutrition and TB, all children presenting with
malnutrition or with failure to gain adequately in weight must be evaluated
for possible TB. The provision of adequate energy and nutrients for a child

21
with TB is very important, since the child has increased requirements as a
result of both growth and TB. In meeting their requirements, it should be
born in mind that children have limited stomach capacity and appetites and as
such meeting nutrient requirements presents a difficult challenge. It is
therefore necessary to modify and plan the diet carefully to ensure adequate
intake of food (Anigbo, et al., 2000).

Summary of some recent studies on nutrient intake in relation to the eating habits
of TB patients is presented in Table 1.2.

Table 1.2 -Summary of studies related on nutrient intake in relation to the

eating habits of TB patients.

Serial Author, Subjects Parameters Findings

number year

1 Gurung, 133 patients Food and 78.2% of the participants

et al., calorie consumed a sufficient
2018 intake. amount of calories,
whereas 21.8% did not.

2. Nthiga, 242 patients. Nutrient Male and females were

et al., intake. found to have consumed
2017 53% and 56% of the RDA
for TB patients.

3. Swart 86 patients Food and The 24 hour dietary recall

and nutrient method was used to obtain
Visser, intake. dietary information.
2016

4. Fox, et 200 Food and New infection was

al., 2015 participants. nutrient associated with inadequate
intake. intake of fruit and
vegetables, carbohydrates
and certain vitamins and
minerals.

22
Gurung, et al., (2018) conducted a cross-sectional descriptive study which was
carried out among 133 TB patients taking anti-tubercular drug. More than half of
the patients had Pulmonary TB. 57.9% TB patients started medication in less than
1 month after diagnosis. The majority (78.2%) of the participants consumed a
sufficient amount of calories, whereas 21.8% did not. Factors which are associated
with calorie intake were Working conditions and food intake frequency were
significantly associated with calorie intake. Socio-demographic factors and
disease-related factors were not found to be associated with calorie intake. Factors
that are associated with recent nutritional status of TB patients were food
frequency, calorie intake, TB types, and nutritional status at the time of
registration were significantly associated with the recent nutritional status of the
participants. The nutritional status among TB patients was the Mean weight and
height were 51.98 kg and 1.57 m, respectively. Relatively, a higher percent were
underweight (21.8%) than overweight (17.3%).

Nthiga, et al., (2017) conducted a cross sectional analytical study. The study was
done in Lodwar County and Referral Hospital. 242 subjects was chosen using the
systematic sampling method. The dietary practices analysis involved a 24-hour
recall, food frequency questionnaire, and dietary diversity score. The mean energy
intake for the study population was 2228 kcal/day and 1870 Kcal/day for males
and females, respectively. The energy intake of TB patients meeting 85% for males
and 81% for females of the RDA. Males consumed 86% and females taking 83%
carbohydrate of the recommended dietary intake. The protein was not consumed
as per recommended dietary allowances. The mean protein intake was 37±22g/day
where males and females were found to have consumed 39% and 46% of the RDA
for TB patients respectively. Micronutrients in TB management including
Vitamins A, D, B1, B2, B6, C, zinc, selenium and folate were consumed at levels
lower than the RDA.

Swart and Visser, (2016) conducted a case- control study in which 43 newly
diagnosed patients (cases)with tuberculosis and 43 tuberculosis- free control were
matched according to age, gender and race. Each participant was interviewed and
completed a structured questionnaire to provide demographic information.

23
Weight, height, Mid-upper-arm circumference and skinfold thickness were also
measured. The 24-hour dietary recall method was used to obtain dietary
information and analysed in the nutrition database of the Medical Research
Council in order to translate foods into nutrients. Biochemical analyses were
carried out to measure concentrations of transferrin, albumin, C-reactive protein
(CRP), ferritin, zinc, copper and vitamins A and E. Means (± standard deviation)
and confidence intervals were used to describe serum micronutrient and
biochemical levels. A significant difference in weight and MUAC was seen.
between groups. Albumin , serum zinc, and serum vitamin A were lower in cases.
Newly diagnosed patients with tuberculosis have a poorer nutritional status than
their tuberculosis-free counterparts.

Fox, et al., (2015) conducted a study in which total of 200 residents of a village
in Northern Quebec were investigated during a tuberculosis outbreak and
identified to have active tuberculosis, the median daily nutrient intake and the
proportion of subjects with inadequate intake of each nutrient and food group.
Energy intake was poor (Only 11%) which was derived from traditional sources
study participants with new infection ( in case–control study 1) were more likely
to report an inadequate intake of fruit and vegetables. Intake of carbohydrate,
vitamin A, thiamin, niacin, folate, magnesium, iron, and selenium was low.
There was no association between active disease (in case–control study 2) and
the reported dietary intake of diet groupings, or individual nutrients after
adjustment for age, sex, personal income, smoking status, and prior infection.
Food insecurity was reported by 76 of 105 (72.4%) subjects and 149 of 197
(75.6%) subjects in the whole study population.

1.7.3 Knowledge, attitude and practice of TB patients

A good knowledge , attitude and practice helps in preventing and delaying the
onset of tuberculosis related complications Assessment of knowledge, attitude,
and practice (KAP) of community toward TB, is very essential to collect
information for planning public health programs, problem cognition and planning
intervention based on the gaps. Knowledge, attitude, and health-seeking practice

24
and associated factors toward tuberculosis and it transmission (Hibstu, et al.,
2016).Summary on some recent studies on knowledge, Attitude and Practice in
relation to their dietary practices is presented in Table 1.3.

Table 1.3 Summary of studies on knowledge, Attitude and Practice in

relation to their dietary practices:-

Serial Author,
Subjects Parameters Findings
number year

1. Ayed, 2019 544 parents. KAP. Parent‟s attitude and

practices on
antibiotics for their
children are poor.

2. Hussein, et 407 KAP. 53% of participants

al., 2018 subjects. had Low level of
knowledge, and
favourable attitude
regarding TB by
63%.

3. Boralingiah, 126 cases Knowledge. 6.3% of patients

et al., 2017 per 100000 knew TB was caused
populations. by bacteria.
88% knew the
symptoms of TB.
More than half
(66%) had
unsatisfactory
knowledge on TB

4. Chinnasami, 491 KAP. Majority of

et al., 2016 participants. participant‟s
knowledge as well as
attitude towards
rational antibiotic
usage is less.

25
 5. Babu, et al., 113 KAP. 53, 59, 1 patients
2015 subjects. were found to have
poor medium and
high KAP,
respectively.

6. Jani, et al., 151 Knowledge 45% caregivers had

2015 participants. and knowledge of mode
awareness. of spread of TB.
89% knew about
curability of disease.
68.9% had
knowledge regarding
DOTS.

7. Esmael, et 422 Height, Mean and median

al., 2013 tuberculosis Weight, knowledge score
patients BMI about Pulmonary TB
was 6.81 and 7,
respectively.

8. Haasnoot, et 105 Height, Sixty-seven percent

al., 2010 participants. Weight, of the population
BMI. knows about TB,
80% knows the
symptoms, and
67% knows it is
treatable.

Ayed, (2019) conducted a cross- sectional study. The study was carried out by a
questionnaire. Parents of children aged ≤14 years, were contacted and requested to
participate in the study. 544 parents were participated in the study. During 6
months of the study, 431 parents had taken their children to physicians. Only 7.2%
reported not being prescribed any antibiotics, whereas 66.8% were prescribed an
oral antibiotic one or two times and 26% were more than three times. 373 of the
parents (68.6%) purchased antibiotics without a prescription, whereas 171
(31.4%) purchased it only after obtaining a prescription. However, only seven

26
(1.3%) followed instructions regarding antibiotic usage, whereas 50% did not
receive any advice from their doctor regarding use.

Hussein et al. (2018) carried out a study based on KAP were assessed by a piloted
questionnaire. Convenience sampling was performed, Knowledge and attitudes
were assessed by creating composite scores. Associations between socio
demographic characteristics and knowledge and attitudes were investigated using
logistic regression to compute odds ratios and 95% confidence intervals. A total of
407 participants took part; 49% were males and 51% were females. 53% of
participants had low level of knowledge whereas, 63% patients had favourable
attitude regarding TB. Female participants were twice more likely to have a
favourable attitude than males. Those with high knowledge are twice more likely
to have a favourable attitude towards TB.

Boralingiah, et al., (2017) conducted a retrospective and prospective follow up

study. A pretested structured questionnaire was used for data collection.6.3% of
study subjects knew TB was caused by bacteria or some germs. Majority
responded that TB was caused due to smoking, alcohol consumption, not taking
food or sins of the past. 88% knew the symptoms of TB. 16% of the study subjects
knew the organs affected by TB. More than half (66%) had unsatisfactory
knowledge on TB on using a Knowledge score.

Chinnasami, et al., 2016 carried out a cross- sectional quantitative study. 491
respondents of age 20-50 were participated in the study. A standard questionnaire
was prepared for the respondents. Majority of participants were young and
educated parents. 17% of the parents agreeing that antibiotics have no role against
viruses. only 20% accepted that antibiotics are not necessary for short duration
fever and common cold. Around 60% of the parents agreed about the full course
of antibiotics should be completed. Participants had 18 times better knowledge
about antibiotics with prior medical training as compared to general public.

27
Babu, et al., (2015) conducted a Prospective-Educational Interventional study on
113 patients, receiving DOTS therapy was conducted on DOT's centres in
Hoskote region for a period of six months. Patient's level of knowledge attitude
and practice were assessed using suitable KAP questionnaire. Out of 113 patients
studied, 46.9 % were found to have poor KAP, 52.2% were found to have medium
KAP and only 0.88% were found to have high KAP during the baseline interview.
Only sixteen percent of the respondent's family had acceptable attitude whereas
eighty two percent of the respondents had non-acceptable attitude. From the study
it was clear that there is still a need to strengthen the educational activities on TB
through mass media; they are excellent venues for information-dissemination and
pharmacist assisted care/counseling.

Jani, et al., (2015) conducted a cross- sectional observational, descriptive

epidemiological study in north Gujrat. 151 pediatric caregivers were participated
during the study. A pre- designed questionnaire was prepared to collect
information regarding socio- demographic profile, knowledge and awareness
regarding tuberculosis. 45.0 % caregivers of patients had knowledge regarding
mode of spread of TB infection to others. 58.9% caregivers of patients knew
about curability of the disease. 68.9% caregivers of patients had knowledge
regarding DOTS (Directly Observed Treatment Short course chemotherapy)
centre.

Esmael, et al., (2013) conducted a cross sectional descriptive study among

suspected pulmonary TB cases at the out-patient department and retreatment cases
at DOTS (age ≥ 18 years). A total of 422 respondents were enrolled in this study.
Of these, 221 (52.4%) were male and 201(47.6%) were female, respectively.
Inhaled droplets through coughing and sneezing were recognized as the common
source of TB infection that was recognized by 79.9% of respondents, but exposure
to dust (65.4%), exposure to cold (62.6%), and drinking raw milk (44.8%) were
also mentioned as important modes of transmission. The four most commonly
recognized symptoms of TB mentioned by respondents were coughing (65.6%),
weight loss (33.2%), cough for 2 weeks and above (32.7%), and shortness of

28
breath (29.4%). The majority of respondents, 76.8% (324) believed that TB is a
curable disease and 60.4% (255) of anybody were at risk of acquiring the disease.
Similarly, 278 (65.9%) respondents stated that the disease is curable with modern
therapy but 22.5% (95) of respondents did not know how it is cured. Only 43.1%
of respondents knew the current free service of diagnosis and treatment of TB and
50.5% did not know its service. The mean and median knowledge score of
respondents toward pulmonary tuberculosis was 6.81 and 7, respectively. In
studying the attitudes and practices of respondents, 36.5% (153) of the study
subjects thought PTB as very serious. About 45.3% (191) of the respondents
pursued a self-treatment option as a choice for primary health care; however, only
13.7% (58) of respondents visited a governmental clinic/hospital two or more
times per year.

Haasnoot, et al., (2010) study to determine knowledge, attitudes, and practice

among Maasai concerning tuberculosis (TB), and to gain insight into the role of
traditional healers in diagnosis and treatment. The patients have insufficient
understanding concerning TB. The patients are aware of the severity of TB. 67%
of the population knows about TB, 80% knows the symptoms, and 67% knows it
is treatable. The \questionnaire outlined major gaps in their knowledge. Less than
half of the population answered questions in the aforementioned categories
correctly. Education has a significant positive effect on knowledge. School
children are more aware of TB and its etiology.

29
 CHAPTER-2

METHODOLGY

This study was designed to see the influence of dietary practice and nutritional
status on pulmonary tuberculosis patients. This chapter compiles the detailed
information related to different methods and materials used to achieve the
objectives of the study.

2.1 Study Design

This was a descriptive cross sectional study conducted on tuberculosis subjects.

2.2 Locale of the Study

The study was conducted in the following region:
1. Delhi Commonwealth Women‟s Association (Kailash Colony).
2. Delhi Government Dispensary (Budh Nagar).

2.3 Samples, Sample Size and Sampling Technique

2.3.1 Sample
Subjects suffering from pulmonary tuberculosis, both male and female in age
group 10-12 years were included in the study.

2.3.2 Sample size

Total 100 pulmonary tuberculosis subjects were included in the study. The
inclusion and exclusion criteria is presented next.

2.3.3 Sampling technique

Simple Random Technique in which Lottery Method is used to select
Tuberculosis children.
Inclusion criteria
 Children of pulmonary Tuberculosis will be select.
 Children of age between 10-12 years will be select.
 Both male and female children will be select.

30
 Exclusion criteria
 Child who have Extra -Pulmonary Tuberculosis.
 Child not willing to participate.
 Not complete follow up.

2.4 Development of Tools and Collection of Data

A detailed interview schedule was prepared for the collection of data. The
questions were asked to the patients keeping in mind their feasibility and comfort,
after assuring that their data won‟t get leaked out. The following methods were
used for gathering information.

 Socio- demographic design questionnaire.

 Assessment of nutritional anthropometry.
 Assessment of food and nutrients.
 Access the nutrition knowledge, practices & attitude of the children in
relation to tuberculosis.

2.4.1 Socio- demographic design questionnaire

The Demographic profile of the subjects were assessed on the basis of following
parameters- age, gender, education qualification and occupation of parents, socio-
economic status, family type, type of houses and facilities, number of children,
duration and family history of TB by means of self- reported general information
questionnaire attached at Annexure A.

The socio- economic status was assessed by means of Kuppuswamy‟s socio-

economic scale 2017.

2.4.2 Assessment of nutritional anthropometry

Nutritional status of the children can be assessed by Nutritional Anthropometry
which is based on the appropriate body measurement. Here, Anthropometry was
taken where height and weight was measured.

31
1. Height
The height of the patient was measured using the following procedure
1. Patient was asked to remove shoes, heavy outer clothing, hair clips and undo
braids etc.
2. Patient was stood straight with his/her back and feet against the wall, heels
Close together, legs straight, arms at sides and shoulders relaxed.
3. Then, the patient was asked to stand in straight position on a non- carpeted
floor.
4. After that, Patient must inhale deeply and stand fully erect without altering
heel position or allowing heels to rise off the floor.
5. Patient was asked to look straight ahead with head erect.
6. After that, we noted down the measurement.

2. Weight
The weight of the patient was measured using the following procedure
1. We must see the scale which should be on zero, before the patient steps on the
weighing machine.
2. Patient was asked to remove shoes and bulky clothing (no jackets). Patient
was asked to empty his/her pockets.
3. Then, Patient stood with back facing the sliding beam or other readout, both
feet on the centre of the platform, and not touch other objects or persons.
4. After that, we recorded the weight of the child.

After recording the height and weight of the children, BMI (Body Mass Index) of
the children were calculated.

Formula for calculating BMI was used:-

BMI - Weight (kg)/ Height (m2)

Calculated BMI was used to determine the BMI for AGE (percentiles) given by
WHO (2007). Highlighted in the Table 2.1

32
Table 2.1-Percentile cut off-BMI-for-Age for children by WHO (2007)

S.No. Percentile Classification

(BMI Kg/m²)

1. >95th percentile Obese

2. 85th to <95th percentile Overweight

3. 5th to <85th percentile Normal weight

4. <5th percentile Underweight

2.5 Assessment of Food and Nutrient Intake

Diet is a vital determinant of health and nutritional status of people. The dietary
habits of individuals/families/communities vary according to socio-economic
factors, regional customs and traditions.

The food and nutrient assessment of all the tuberculosis patients was done by
using 24 recall method. This helped to get an idea of the amount of different raw
ingredients used in the preparations consumed by the respondents. At least a 3
days 24-hour recall including 2 weekdays (i.e. Monday and Thursday) and one
week end that was Saturday were conducted.
Prior to collection of the actual data the respondents were explained in detail
about the survey to ensure that they furnish the required information correctly.

The nutrients that are energy, protein, carbohydrates, fats, vitamin A, vitamin C,
iron, calcium and zinc values for these amounts were then calculated using
ICMR‟s “Nutrition Composition Table.” The day‟s total intake of different
nutrients assessed and compared with the RDA (ICMR, 2010) and the nutrient
adequacy ratio was calculated as follow
Nutrient adequacy ratio = Mean intake X 100
Recommended intake

33
Intake of various foods consumed by the children was estimated and food
adequacy ratio was calculated then compared with that of the balanced diet as by
ICMR (2010) for children (10-12 years old) to access the consumptions of the
food intake of the children.

Food adequacy intake = Mean intake X 100

Recommended intake

2.6 To Access the Nutrition Knowledge, Attitude and Practices of the

Children’s Parent in Relation to Tuberculosis
Questionnaire consisting of questions covering topics related to tuberculosis and
its effects were designed specially for the study. A questionnaire was formed for
interviewing the parent to enquire their knowledge, attitude and practice about
tuberculosis.

2.6.1 Knowledge questionnaire

A 14 item questionnaire was designed to collect data regarding knowledge of
parents. The questionnaire was close ended and consisted of Multiple Choice
Questions with only one correct answer. The knowledge covered major parts;
tuberculosis - symptoms, causes, effects, severity, nutrient sources. The multiple
choice questions were framed on the basis of above topics and the correct
response was given a score equal to one and all incorrect responses were marked
zero. The data was analysed by calculating the frequency of various responses of
all the questions individually and also the frequency of number of total correct
responses overall to find out the general awareness status of the samples. The
mean knowledge score was calculated thereafter. The practice questionnaire has
been attached at appendix B.

2.6.2 Attitude questionnaire

The attitude questionnaire comprised of 14 questions related to attitude of parents
towards balance diet, HFSS food, protein, calcium and iron sources, precautions
during TB, regular check-ups. This was done with Likert scale. All the statements

34
on the scale were positive. Respondents rated their degree of agreement with the
statement. Their responses showed both the direction (for or against) and intensity
(strength) of their attitude. After the attitude questionnaire was filled, the scoring
was done in the following manner:-2= Strongly Disagree, -1= Disgree, 0=
Undecided, 1=Agree, 2= Strongly Agree. Since the statements were positive, a
high overall score reflected a positive attitude and al low overall score indicated a
negative attitude. The attitude questionnaire has been attached at appendix C.

2.6.3 Practice questionnaire

The practice questionnaire comprised of nine multiple choice questions covering
the flowing topics: HFSS foods duration and frequency, eating practices, regular
breakfast practices, routine visit to doctor and dietician, and regular check-ups.
Here the frequency of the various practices followed by the subjects regarding a
particular issue was calculated. Also, it was found out how many subjects were
following the correct practices. The practice questionnaire has been attached at
appendix D.

2.7 Statistical Analysis

The information collected from subjects was consolidated and transferred

scientifically into master coding sheet. Then the data was subjected to qualitative
and quantitative analysis using statistical formulae such as Mean, Standard
Deviation, Frequency, Percentage Adequacy, P-value. Prior to analysis the data as
screened and errors if any were corrected. All the statistical analysis was done
using the SPSS version 22.

35
 CHAPTER-3

RESULTS
Presented in this chapter are the study findings as per the objectives: Demographic
characteristics of the study population, their nutritional status, knowledge about
tuberculosis, food & nutrient intake.

3.1 Demographic Characteristics

The socio economic and demographic characteristics of the participants are

presented in Table 3.1.

Table 3.1: Socio- economic and demographic characteristic of study

population (N=100)

Age Group (Years) Percentage (%)

10 36
11 36
12 28

Sex Percentage (%)

Male 34
Female 66
Education Qualification Of Mother Father
Children’s Parent Percentage (%) Percentage (%)
Post Graduate & above 1 6
Graduate 5 18
Higher Secondary Certificate 31 37
High School Certificate 27 13
Middle School Certificate 16 9
Literate, less than Middle
8 7
School Certificate
Illiterate 12 10

Occupation Of Children’s Mother Father

Parent Percentage (%) Percentage (%)
Semi-Professional 5 2
Arithmetic Skill Jobs 12 3
Skilled Worker 1 51
Semi-Skilled Worker 2 23
Unskilled Worker 6 10
Unemployed 74 1

36
 Socio-Economic Status Percentage (%)
Upper class (I) 0
Upper middle class (II) 14
Lower middle class (III) 37
Upper lower class (IV) 43
Lower (V) 6

Family Type Percentage (%)

Nuclear 57
Joint 43

Types of Houses Percentage (%)

Rented jhuggi 3
Own jhuggi 11
Rented house with 1-2 rooms 54
Own house with 1-2 rooms 20
Own house with 3-4 rooms 9
Own house with 5 rooms or more 5

No. Of Vehicles Percentage (%)

1 car 1
1 bike/scooter 46
2 bike/scooter 9
1 cycle 1
2 Cycle 2
Other 9
None 23

Facilities Percentage (%)

Park/playground 56
Hospital/other health services 87
Electricity 86
Trash box 73
Water connection 69

No. Of Children Percentage (%)

1 26
2 37
3 28
4 8
More than 4 6

Birth Order Of Subject Percentage (%)

1 31
2 36
3 19
4 7
More than 4 2

37
 Duration Of Tuberculosis Percentage (%)
More than 6 months 8
4-6 Months 31
2-4 Months 45
0-2 Months 16

Family History Of Tuberculosis Percentage (%)

Present 29
Absent 71

Food Habits Percentage (%)

Vegetarian 38
Non-Vegetarian 62

As depicted data from Table 3.1, a total 66 (66%) females and 34 (34%) males of
age group 10-12 years were participated in the study. About 31% of mothers and
37% of fathers had higher secondary certificate. Most of the mother (74%) were
housewives and father (51%) were working as skilled worker. The data regarding
socio- economic status revealed that the majority of the population was belongs to
upper lower class (43%) followed by lower middle class (37%) and upper middle
class (14%) and lower class (6%) and no one belongs to upper class. 57% of
subjects stayed in nuclear family followed by 43% in joint family. Most of the
children (54%) live in rented house with 1- 2 rooms. 46% of the parents had 1
bike or scooter as a vehicle. Most of the participants had public facilities like
hospitals/ other health services (87%), electricity (86%), trash box (73%), water
connection (69%) and park/ playground facilities (56%) near their area. About
37% of the parents had 2 children. Maximum children suffering from tuberculosis
were second child of their parents. Majority of subjects (45%) had TB from last 2-
4 months followed by 31% (4-6 months), 16% (0-2 months) and 8% (>6 months).
71% of the subjects didn‟t have family history of TB. 62% subjects were non-
vegetarian.

3.2 Nutritional Status Assessment

In this section the data is presented with regards to anthropometric measurements
of pulmonary tuberculosis subjects.

38
3.2.1. Anthropometric assessment
Anthropometric measurements were recorded and presented in Table 3.2. It shows
the nutritional status of the subjects with respect to their height, weight and BMI.

Table 3.2: Mean ±SD anthropometric parameters of subjects (N=100)

Mean± SD
S.No. Parameters
Female Male

1 Height (cm) 135.82 ± 5.92 134.06 ± 5.86

2 Weight ( kg) 27.45 ± 4.78 27.06 ± 4.79

3 BMI (kg/m2) 14.84 ± 2.12 14.95 ± 1.67

The data was further analysed and classification of subjects into different grades
of malnutrition is presented in Table 3.3.

Table 3.3 BMI for age classification of the subjects (N=100)

Female Male
Total
BMI for (n=66) (n=34)
S. Classifi
Age Percen Perce Percen
No. cation
Percentile No. tage No. ntage No. tage
(%) (%) (%)
85th to 95th Over
1 5 7.3 5 14.7 10 10
Percentile weight
5th to 85th Normal
2 24 36.7 15 44 39 39
Percentile weight
<5th Under
3 37 56 14 41.3 51 51
Percentile weight

As data presented in Table 3.3 revealed that 51% of the children were underweight.
Underweight was more prevalent in females (56%) than males (41.3%). 39% of the
subjects were found to be in normal category, normal weight was more prevalent in
females (56%) than males (51%). Only 10% of the children were found to be in
overweight category (7.6% and 14.7% in females and males, respectively).

39
 3.3 Food and Nutrient Intake of the Subjects

Food and nutrient intake of the subjects were recorded and data presented
herewith.

3.3.1 Food intake

The average food intake was collected and presented in Table 3.4

Table 3.4 : Mean ± SD of food ntake (g) by the children (10-12) Years.

Balanced Diet %age

Mean ± SD intake
(ICMR 2010) adequacy
Food Group
Fema
Female Male Female Male Male
le
Cereals and
240 300 108 ± 26.31 120.58 ± 24.03 45 40
millets (g)
Pulses (g) 60 60 53.26 ± 33.47 58.65 ± 34.59 88 96
Milk and
milk 500 500 315.20 ±103.1 285.98 ±112.7 63 57
products (ml)
Roots and
100 100 107.88 ± 56.70 104.37±39.39 107 104
Tubers (g)
Green leafy
100 100 32.66 ± 40.73 22 ± 58.20 33 22
vegetables(g)
Other
200 200 137.15 ± 66.46 142.74 ± 66.13 68 71
vegetables(g)
Fruit (g) 100 100 31.66 ± 31.08 32.32 ± 23.37 32 32

Sugar (g) 30 30 12.83 ± 7.10 11.75 ± 5.15 42 31

Fat and
Edible oils 35 35 15.09 ± 5.52 14.78 ± 7.30 43 42
(ml)

As data presented in Table 3.4 revealed that, intake of pulses and root and tubers
was adequate meeting 88%-107%. The consumption of other vegetables was close
to adequate among most children, with adequacy 68%-71%. Intake of cereals and
millets, milk and milk products, green leafy vegetables, fruits, sugar and fat was
inadequate in both females and males meeting only 22%-63% adequacy.

40
The comparison between adequacy of food intake of female and male presented in
the figure 3.1.

Fat and Edible oils (ml)

Sugar (g)
Fruit (g)
Other vegetables(g)
Green leafy vegetables(g)
Roots and Tubers (g)
Milk and milk products
Pulses (g)
Cereals and millets (g)

0 20 40 60 80 100 120

Male Female

Figure 3.1 Comparative graphical presentation of percentage food intake of

the children.

3.3.2 Nutrient intake

The average food intake was collected and presented in Table 3.5

As data presented in Table 3.5 revealed that, intake of protein, vitamin-B6,

vitamin-C was adequate in both females and males meeting 75%103% adequacy
range. The consumption of calcium and zinc was inadequate in both groups
meeting only 61% -66% adequacy whereas the intake of vitamin-A, iron was poor
in both groups (31%-47%) not even met 50% of adequacy.

41
 Table 3.5 : Mean ± SD values of daily intake of the nutrients of the
children (10-12 years )

RDA Mean±SD intake %age adequacy

Nutrients
Females Males Females Males Females Males
Energy(kcal/day) 1059.74±127.49 1105.37±140.17
2010 2190 45.87 44.39
Protein(g/day) 36.45±6.71 41.3±10.14
40.4 39.9 86.27 75.18
Total Fat(g/day) 34.62±9.49 37.21±8.79 - -
% calories from fat 15-20 15-20 (17.6) (18.4)
Vitamin A 600 600 46.56 40.78
279.37±120.45 244.70±107.09
(retinol)(mcg/day)
Vitamin B6
1.64±3.21 1.45±3.21
(mg/day) 1.6 1.6 102.75 90.78
Vitamin-C(µg/day) 40 40 688.8±18.11 746.8±23.34 86.12 93.37
Calcium (mg/day) 800 800 494.76±125.29 490.12±133.58 61.84 61.26

Iron(mg/day) 8.44±1.6 8.94±1.9

27 21 31.28 42.59
Zinc (mg/day) 5.57±1.91 6.01±1.18
9 9 61.90 66.88

The comparison between percentage nutrient adequacy of female and male

presented in the figure 3.2.

ZINC (mg)
IRON (mg)
CALCIUM (mg)
VITAMIN_C (mg)
VITAMIN_B6 (mg)
VITAMIN_A…
FAT (g)
PROTEIN (g)
ENERGY (kcal)

0 20 40 60 80 100 120
Female Male

Figure 3.2 Comparative graphical presentation of percentage nutrient intake

of the children.

42
3.4. Nutritional Knowledge, Attitude and Practices of the Children in
Relation to Tuberculosis.

Nutritional knowledge, attitude and practices of the children were assessed and
presented in this section.

3.4.1 Nutritional knowledge assessment

To assess the nutritional knowledge of the parents, certain questions related to

nutritional knowledge were asked and their responses presented in the Table 3.6

Table 3.6 : Distribution of study population according to knowledge score

(N=100)

Total
Mean±SD
Category
Percentage
N
(%)
Good knowledge of
Tuberculosis 24 21.1
(10-14)
Fair knowledge of
Tuberculosis (6-9) 83 72.8
7.98±2.96
Poor knowledge of
Tuberculosis (0-5) 7 6.1

It can be inferred from table 3.6 that 21.1% of parents had good knowledge about
TB. Most of the parent that is 72.8% had fair knowledge about TB. 6.1% parent
scored between 0 to 5 i.e., they had poor knowledge about TB.

To assess the knowledge of the children towards tuberculosis, certain set of

questionnaire was conducted and their responses were recorded and presented in
the Table 3.7.

43
Table 3.7 : Frequency distribution of correct response of knowledge towards TB.

(N=100)

Correct Response
Parameters
Percentage (%)
Balance Diet means 43
Meals taken per day 16
Good source of
29
protein
Good source of iron 30
Function of iron 30
Good source of
14
Vitamin A
Junk Food 20
Importance of
37
weighing during TB
Kind of TB (disease) 25
Severity of TB 22
Symptom of TB 33

Spreading of TB 33
Mostly affected part
35
during TB
Condition in which
31
TB spread more

As data presented in Table 3.7 revealed that, knowledge among parents was fair
29%- 43% correct responses were received regarding balance diet, food and
nutrition items. 25%- 37% correct responses were obtained regarding symptoms,
spreading, kind of disease, mostly affected part and condition in spread more
disease indicating moderate knowledge. Knowledge about meals taken per day
(16%), Vitamin- A source (14%) and HFSS food (20%) was very poor and only
22% of parents aware about severity of TB.

44
3.4.2 Knowledge of parents regarding overweight, normal weight and
underweight of patients

All the parents were assessed for their awareness about various aspects of
underweight during tuberculosis by means of a pre-designed questionnaire. The
mean and standard deviation of knowledge score was found to be (maximum
score of 14) revealing fair knowledge score.

The Mean±SD knowledge score of overweight/underweight and normal patients

represented in Table 3.8

Table 3.8 Mean±SD of nutritional knowledge score of parents

Knowledge Score of P-value

Parents
Classification Mean±SD

Over weight/ Under 7.61±1.92

weight 0.1021
Normal weight 9.09±2.52
T- test significant at 0.05 level

No significant difference was found in the knowledge score of parents of children

who were overweight, normal weight and underweight.

3.4.3 Nutritional attitude assessment

To assess the nutritional knowledge of the parents, certain questions related to

nutritional attitude were asked and their responses presented in the Table 3.9

As data presented in Table 3.9 revealed that, since the statement were positive a
high positive score means positive attitude while a lower to negative score
indicated negative and unfavourable attitude towards the item studied. The data
revealed that overall attitude towards childhood TB was moderately positive
0.79± 0.34.

The attitude towards the balance diet food preferences, nutrient and vitamins,
wearing mask, regular check-ups, continuation of treatment, importance of diet
was favorable (score 0.82- 1.18). However, attitude towards nutritious food, HFSS
food, TB exposure, TB heredity were less favourable (score 0.10-0.54).

45
 Table 3.9 Parents response of attitude towards TB.

(N=100)

Attitude Score N( score) Average

score
Strongly Dis- (Sum of
Unde- Strongly
Disagre agre Agree scores/n)
Parameter cided Agree
e e
Range
-2 -1 0 1 2
-28 to 28
Balance diet is important 8 4 2 56 30 0.96
All food items are not
9 20 5 49 17 0.45
nutritious
I prefer protein rich sources
like milk, pulses, etc. to my 2 2 4 70 22 1.08
child.
All GLV‟s are rich in iron. 2 6 16 46 30 0.96
I think HFSS food is not the
major cause of TB in case of 8 15 9 45 23 0.37
my child
My child likes to eat HFSS
food but I don‟t give it to 16 24 13 28 19 0.10
her/him.
I give milk to my child to
fulfill the protein and 0 0 8 70 22 1.14
calcium requirement.
I do not encourage my child
1 3 11 47 38 1.18
to share food with everyone
My child feels suffocating
while wearing mask but 4 13 3 57 23 0.82
he/she do not removes it
I think regular checkup of TB
2 6 4 72 16 0.94
is necessary
I will still continue the TB
5
treatment of my child once 7 5 54 29 0.95
symptoms are not visible
TB is a hereditary disease 3 26 9 33 23 0.47
According to me, balance
diet as well as medicines are
0 4 2 68 26 1.16
equally important while TB
treatment
I think exposure to a TB
patient leads to infection and 7 12 16 50 15 0.54
infection turns into disease
Mean±SD (Sum of average 0.79±
scores/number of statements) 0.34

46
 3.4.4 Practices adopted by children for tuberculosis

After the assessment of nutrition knowledge and attitude, next step was to know
the practice adopted by parents in children daily life in respect to knowledge they
had. To know the practices, questionnaire was conducted and presented in the
Table 3.10

Table 3.10 Frequency distribution of correct response of practice towards TB

(N=100)
Percentage (%)
Parameter
How often Children eat HFSS food ?
Once a day 28
Twice in a week 39
3 Times in a week 1
Don‟t know 32
Which food your child like to eat when he/she feels hungry ?
Pizza 2
Fruit 46
Khichdi 14
Noodles 22
Biscuit 14
If other, specify 2

Do your child take milk on daily basis ?

Yes 90
Sometimes 10
Never 0
I don‟t take 0
Do your child take breakfast daily ?
Yes 100
No 0
Where does he/she spend pocket money mostly ?
On noodles 14
On juice 58
On biscuits 14
If other, specify 14

47
Do you give medicines to your child on regular basis ?
Yes 96
No 4
Sometimes 0
How many hours in the day do your child play outdoor games ?
Half an hour 18
More than 1 hour 42
More than 2 hour 20
He/she don‟t 20

Where do you get most of the information about how to get and keep your child
healthy?
Percentage (%)
Hardly Ever Sometimes Often Always
School 62 38 0 0
Friends 34 32 22 12
TV 26 30 31 15
Others 29 28 25 18

Where do you get most of the information about how to get and keep your child
healthy?
Percentage (%)
Hardly Ever Sometimes Often Always
School 58 34 8 0
Friends 38 36 16 10
TV 28 54 16 2
Others 38 38 18 6

As data presented in Table 3.7 revealed that, 39% of the children like to have
HFSS food twice a week, 46% of the children eat fruits while they were hungry
followed by Noodles (22%), biscuit and khichdi (14%) and pizza (2%). Majority
of the children that is take Milk (90%), breakfast (100%) as well as medicines
(96%) on the daily basis. Most of the children like to spend most of their pocket
money on buying juices (58%). 42% of the children play outdoor games for more

48
than 1 hour followed by more than 2 hour or he/she don‟t 20% and half an hour
18%. It can inferred that subjects should not take HFSS food.

Most of the parents i.e. 58% of the parents hardly get any information from the
school about how to keep their child healthy and the no. increases to 62% in case
of having information about the nutritious diet to be given to the subjects. Parents
get hardly any information from their parents, 38% in case of information about
how to keep their child healthy followed by 34% in case of nutritious diet to be
given.. Some parents (38%) get information about how to keep their child healthy
and 30% get information about the diet from their friends sometimes. 38% of
people and acquire information about how to keep their child healthy and 29%
acquire information about the diet from TV Ads hardly followed by 34% and 28%
from books respectively. Only 24 people get information from other scores out of
which 50% hardly get any information about way to keep their child healthy. 15
people knew about the diet of the subjects from other sources out of which 40%
hardly get information, 32% sometimes acquire information from other sources.

49
 CHAPTER- 4

DISCUSSION

The overall aim of this study was to gain a deeper understanding of nutritional
status, awareness level about TB, lifestyle and food and nutrient intake of
Pulmonary TB. This chapter presents the discussions regarding the finding. This
chapter presents the discussions regarding the findings of the study.

The highest frequency of TB respondents was observed in females (66%) as

compared to males (34%).

Majority of parents had higher secondary certificate 31% and 37% of mother and
father, respectively. Most of the parents i.e., 74% mother were housewives and
51% father were skilled worker. Most of the parents 43% belong to upper lower
class, the similar findings were documented by previous researchers also who
found that many persons suffering from tuberculosis were more frequently, worst
of the socio economic conditions for all the patients. Education, crowding type of
housing water supply and numbers of consumer articles in the household was
found to be independently and significant associated with a higher risk of
tuberculosis (Gupta, 2004).

The present study revealed that 29% of TB patients have positive family history
of TB and 71% have negative family history of TB. Some similar observation
showed the similar findings where it was found that family history play no role in
the transmission and acquisition of TB. TB is not a hereditary disease (HCDCP,
2011).

In regard to nutritional status majority of TB patients 51% were in underweight

category followed by normal weight (39%) and over- weight (10%). This could
explain the occurrence of TB since underweight and had been linked to pulmonary
TB. WHO (2010) report indicated that underweight is one of the pre disposing
factors to pulmonary TB. It results from poor food habits and lack of balance diet.
Approximately half of the world‟s children are underweight and one in ten is

50
overweight. According to WHO, the upsurge in cases of TB is being propelled by
the growing prevalence of HFSS foods.

Weight variation during tuberculosis therapy follow-up can predict treatment

outcome. Patients losing weight during TB, treatment specially in the first month,
should be more closely followed as they are at risk of failure or death (Ortiz, et al.,
2011).

Food intake and percentage adequacy related to the daily mean intake was also
found to be inadequate for both males and females. The mean intake for different
food groups i.e. for cereals (40%-45%), milk and milk products (57%-63%), green
leafy vegetables (22%-33%), fruits (32%). other vegetables (68%-71%) and oil
(~43%) was low among both the groups. Pulses was almost adequate for both the
groups (88%-96%), whereas the intake of roots and tubers (104%-107%) was
found to be high in both the groups. The reason for this under nutrition was that
majority of subjects were suffering from underweight. Some similar studies
shows the same findings where new infection was associated with inadequate
intake of food, other vegetables, vitamin and minerals (Lee, et al., 2015).

In the present study it was observed that subjects were meeting only 44%-46%
adequacy of energy with 18% deriving from fat. Intake of protein (75%-86%),
vitamin B6 (91%-103%) and vitamin C (86%-93%) was fairly good meeting.
Intake of calcium and zinc met 61%-67% adequacy. Intake of iron and vitamin A
(retinol) was poor met 31%-47% adequacy. Some similar studies also found the
same result that nutritional status with respect to the micronutrients vitamin A,
zinc and iron. Low concentrations of these nutrients may affect host defense.
Vitamin A deficiency was found to be common among adults with TB and human
immunodeficiency virus (HIV) infection in Rwanda (Rwanganbwoba, et al.,
1998). Zinc has been shown to be essential in vitamin A metabolism because it is
required to mobilize vitamin A from the liver (Smith et al. 1973). Iron deficiency
anemia has been reported in patients with pulmonary TB, as indicated by low
hemoglobin concentrations, serum iron and total iron-binding capacity (Saha, et
al., 1989). Energy intake, protein, concentration of blood haemoglobin, plasma

51
retinol and plasma zinc were lower in TB patients than in well nourished healthy
controls (Karyadi, et al., 2000).

The results of the present study provide the insight into the level of knowledge,
attitude and practice about TB among parents. Overall Mean±SD knowledge score
was 7.98±2.96 which reflects that parents possessed fair knowledge and positive
attitude (mean attitude score 0.79±0.40) towards nutrition. Level of nutritional
practice can be a contributing factor to their poor dietary intake and food
consumption pattern which could lead to poor growth.

Some similar studies done in DOTS centres in Logos state where 64.3% of
respondents were able to correctly answer the knowledge questionnaire. Attitude
were mostly in compliance to TB infection control guidelines (Ekuma, et al.
2016). The parents of the TB partners showed good knowledge (57% of the
sample population) about the disease: its presenting symptoms; its infectiousness
and curability; modes of transmission; and the diagnostic modalities needed for
TB. 61%of the respondents had good attitudes and practices with respect to the
disease. (Domingo and Lim, 2009)

52
 CHAPTER- 5

SUMMARY AND CONCLUSION

Tuberculosis (TB) is now a chronic infectious illness with leading cause of

morbidity and mortality globally, as well as top infectious disease killer
worldwide (specially children under 15 years). Therefore, the present study was
conducted to assess the nutritional status of TB children.

The present study was a descriptive (cross sectional study) in which 100 subjects
suffering from tuberculosis from two different regions (Kailash Colony and Budh
nagar) of Delhi. All the tuberculosis subjects were selected by simple random
method in the age group of 10-12 years. The anthropometric measurements of
subjects was done, their height, weight, body mass index (BMI). A pre-designed
questionnaire was given to parents to obtain general information and their
nutritional knowledge. The food and nutrient intake was recorded with the help of
24 hour dietary recall method for three consecutive days which was then
compared with the modified RDA given by ICMR, 2010. Subjects were assessed
for their nutritional status, knowledge, attitude and practices regarding nutrition.
Specially designed questionnaires were used to collect data regarding
demographic profile, food and nutrient consumption, knowledge, attitude and
practices.

In our study out of 100 patients, majority of patients were female (66%), followed
by (34%) male. 31% of mother and 37% of father had higher secondary
certificate. Most of mothers (74%) were housewives whereas, fathers (51%) were
working as skilled worker. The data regarding socio-economic status revealed that
the majority of the population was belongs to upper lower class (43%) followed
by lower middle class (37%) and upper middle class (14%) and lower class (6%)
and no one belongs to upper class.

The BMI of the subjects were found to be 14.84±2.12 kg/m2 for females and
14.95±1.67 kg/m2 for males. According to their BMI scores. 51% of the children
were underweight. 39% of the subjects were found in normal category, Only 10%
of the children were found in overweight category.

53
The mean intake for different food groups i.e cereal and millets, green leafy
vegetables, fruits, sugar and edible oils was low meeting 31%-45% adequacy in
both the groups. Intake of pulses was almost adequate for both the groups meeting
88%-96%. Intake of roots and tubers was observed to be more than adequate,
meeting 104%-107%. Intake of milk and milk products and other vegetables met
57%-71% adequacy in both the groups.

Regarding nutrient intake, subjects were meeting only 44%-46% adequacy of

their energy requirement and were meeting 18% energy from fat. Intake of
protein, vitamin B6 and vitamin C was almost adequate (75%- 102%) in both the
groups. Intake of calcium and zinc (61%- 67%) was low in both the groups.
Intake of iron was poor meeting 62% and 67% adequacy.

Fair knowledge score was 7.98±2.96 and positive attitude (mean attitude score
0.79±0.40) towards nutrition. Level of nutritional practice shows poor dietary
intake and food consumption pattern which could lead to poor growth.

In conclusion, the present study shows that, decreased BMI, poor diet poor
sanitation, low immunity (because of not having balance diet) and inadequate
knowledge about tuberculosis are important predictors of tuberculosis.

It was concluded that balanced diet and tuberculosis goes hand in hand. The
consumption pattern of the respondents was not satisfactory and it is not optimal
to meet their nutrition needs. To increase the community well-being and thus
decrease the economic burden of tuberculosis, it is essential to educate the
population in general about childhood tuberculosis to help proper monitoring and
management of this disease. General public awareness on importance of
maintaining good weight and strategies of attaining the same should be enhanced.
The inadequate level of knowledge about tuberculosis need to be tackled
immediately through mass media and counseling by health care providers.

54
 CHAPTER-6

RECOMMENDATIONS

This chapter presents the recommendations for improving nutritional status,

dietary intake, knowledge attitude and practice of Tuberculosis patients. These
recommendations are based on the objectives of the study, focusing on policy and
practice as well as further research in the field of Tuberculosis. These
recommendations are

1. Pulmonary disease often adversely affects nutritional intake, due to poor

appetites, making patients at risk for malnutrition. Six smaller meals per
day are indicated instead of three meals.
2. Modify and plan the diet carefully to ensure adequate intake of food. The
provision of adequate energy and nutrients for a child with TB is
important.
3. Diet should be properly planned so as to meet the RDA of various
nutrients.
4. The diet should be supplemented, initially with appropriate vitamins and
minerals in those patients with nutritional deficiency symptoms, i.e., iron
supplementation to combat expectoration and haemorrhage, calcium
supplementation to combat tuberculosis lesions.
5. Drink plenty of water: staying hydrated can help thin and loosen mucus
in the lungs and airways.
6. TB patients should be followed up at regular intervals and should be
monitored for compliance to high calorie, high protein diet, their clinical
parameters such as weight, height, resolution of symptoms.
7. Eating plenty of proteins: protein play a key role in the health of
muscles, bones, blood and immunity. Because lung infection are more
common in people with TB, protein is an important component of the
diet. Good sources of protein include fish, egg, dairy, soy, nut and
legumes.
8. Parents should make nutritious food easily available for their children

55
 and try to make healthy food items more palatable for them.
9. Avoid foods high in fat, fried preparation, organ meats, red meats and
refined sugars.
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QUESTIONNAIRE

Fill the relevant information on the space provided and put a tick mark in
the boxes whichever is applicable to you.

Serial no.
Date:
Patient Name ................................

BOD …………………………………………

Gender : Male Female

Family history of : BD Yes No

Food habits : Vegetarian Non-vegetarian

Duration of Tuberculosis

S.No. Duration
a. Less than 9
b. More than 6 months
c. 4-6 months
d. 1-3 months

Is he/she on medication ?
Yes No
For how long he/she is on medication ?

S.No. Duration

a. >6 months

62
 b. 4-6 months

c. 2-4 months
d. <1 month

What were the symptoms in case of your child ?

 Coughing
 Weakness
 Weight loss
 Decrease in appetite

Tick (√) the appropriate answer.

S.No. 1.What is your educational qualification? Self Spouse

a
Post Graduate & above
b
Graduate
c Higher Secondary Certificate
d
High School Certificate
e
Middle School Certificate
f
Literate, less than Middle School Certificate
g
Illiterate

S.No. 2. What is your occupation? Self Spouse

a Semi-Professional
b Arithmetic Skill Jobs
c Skilled Worker

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 d Semi-Skilled Worker
e Unskilled Worker
f
Unemployed

S.No. 4. Number of earning members in your family? Specify. Tick the

correct answer
a One
b Two

c Three
d More then three
e None

S.No. 5. In which type of family do you live? Tick the

correct answer
a Joint family
b Nuclear family
c Alone

d With friends

6. In what type of house do you live?

a. Own house with 5 rooms or more
b. Own house with 3-4 rooms
c. Own house with 1-2 rooms
d. Rented house with 1-2 rooms
e. Own Juggi
f. Rented Juggi

7. Possessions of Vehicles by the family

64
 Tick the
S.No. 0 children you 1are having?
8. No. of 2 More than 2
correct answer

a
Car 1
Scooter
b 2
Bike
c 3
Cycle
d 4
None
e >4

What is the birth order of the subject? Tick the

S.No. 9 correct
answer
a First
b Second

c Third
d Fourth
e If other, please specify ………………….

Tick the
S.No. 10. Public Facilities in your area. correct answer

a Park/playground of children

b latipuoH
tiswphiteausisesioHus
c Electricity
d Trash box

i reteW connection

65
 KNOWLEDGE ASSESSMENT QUESTIONNAIRE

Here is a questionnaire, please read the statement. You have to put a tick mark on
the option whichever you agree or is applicable to you.
(With the help of this questionnaire we will check your knowledge about
Tuberculosis)
1. A „Balance‟ diet means.
A. A group of food that contains spicy food.
B. A diet which provides all the nutrients that our body needs in right quantities
and quality.
C. A meal that only has a one kind of food.
D. I don‟t know

2. How many meals should you take per day?

A. >5 temes
D. 5 times
C. 4 times
D. 3 times
E. I don‟t know

3. Which of the following is a good source of the protein?

A. Milk and milk products
B. Vegetables
C. Oil
D. I don‟t know

4. Which of the following is very good source of iron?

A. Milk
B. Green vegetables
C. Ghee
D. Roti

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E. I don‟t know
5. What is the function of Iron?
A. Helping in formation of blood.
B. Help in formation of strong teeth.
C. Help in good eye vision.
D. I don‟t know

6.tavshieavewpuocpuesedsphsepteoecaaWe ?
A. Potato
B. Almond
C. Carrot
D. I don‟t know

7. What is HFSS food?

A. Food which is only rich in calories.
B. Food which is healthy.
C. Food which is tasty.
D. I don‟t know

8. Why is it important to weigh todi weedht during TB?

A. It indicates that how well am I ?
B. It tells how short am I?
C. It tells how tall am I?
D. I don‟t know.

9. Which kind of disease is TB?

A. Communicable
B. Non-communicable
C. Hereditary
D. I don‟t know

10. How dangerous a disease is TB?

A. Fatal
B. Non Curable
C. Curable

67
D. I don‟t know
11. What is the symptom of TB?
A. Headache
B. Nausea
C. Fever
D. Dizziness
E. I don‟t know

12. How TB spread?

A: Through water
B: Through touch
C: Through saliva
D: I don‟t know

13. Which body part is affected en pummoneWi TB?

A. Brain
B. Kidney
C. Lungs
D. Liver
E. I don‟t know

14. In which condition TB can spread more?

A. Hygienic condition
B. Unhygienic condition
C. Both
D. I don‟t know

Answer Key for Knowledge Questionnaire

1 2 3 4 5 6 7 8 9 10 11 12 13 14
B A A B A C A A A C C C C B

68
 ATTITUDE ASSESSMENT QUESTIONNAIRE
Here is a questionnaire, please read the statement. You have to put a tick mark on
the option whichever you agree or is applicable to you.
(With the help of this questionnaire we will check your attitude about
Tuberculosis)

S.No. Strongly Disagree Undecided Agree Strongly

Questions
Disagree Agree
I think we should only eat Balanced
1.
diet.
All food that we eat are not
2.
Nutritious.
I prefer todeve protein rich sources
3. like milk, pulses, eggs etc. to my
.dhemd.
I think all green leafy vegetables
4.
are rich in iron.
I think HFSS food is not one of the
5. major cause of TB in case of my
child.
My dhemdlikes to eat HFSS food
6.
but I don‟t give it to him/her.
I give milk to my child to fulfill the
7.
requirement of protein and calcium.
I do not encourage my child to
8.
share food with everyone.
My dhemd feel suffocating while
9. wearing mask but he/she do not
turns to remove it.
I think regular checkup of TB is
10.
necessary.
I will still continue the treatment
11. (TB) of my child once the
symptoms are not visible.
12. TB is a hereditary disease.
According to me balance died as
13. well as medicines are equally
important during TB treatment.
I think exposure to TB patients lead
to infection and infection means
14.
sure disease.

69
 PRACTICE ASSESSMENT QUESTIONNAIRE

Here is a questionnaire, please read the statement. You have to put a tick mark on
the option whichever you agree or is applicable to you.
(With the help of this questionnaire we will check your practice about
Tuberculosis)

1. Which of the following HFSS foods iouW dhemd eat?

How often Children eat HFSS food ?

Once a day
Twice in a week
3 Times in a week
Don‟t know

2. Which food do youW dhemd like toeet when hesshe feels hungry ?
A. Pizza
B. Fruits
C. Khichdi
D. Noodles
E. Biscuit
F. If other, please specify ………………….

3. Do you W dhemd te e milk on daily basis ?

A. Yes
B. Sometimes
C. reveW

4. Do your child take breakfast daily?

Yes No If No, then why?

A. Hesshedon‟t feel hungry.

B. I don‟t get time to cook.
C. Breakfast is not important

70
 5. Where does he/she spend pocket money mostly ?

A. On noodles
B. On juice
C. On biscuits
D. On chocolates

If other, specify ……………

6. Do you deve medicines to iouW dhemdon regular basis?

A. Yes
B. No
C. Hardly ever
D. Often
7. How many hours in a day do your child play outdoor games?
A. Half an hour

B. More than 1 hour

C. More than 2 hours

D. He/she don‟t

8. Where do you get most of your information about how to get & keep your child
healthy?

Hardly Ever Sometimes Often Always

School
Friends
TV
Others

9. Where do you get information about what kind of food you should give to your
child to eat?

Hardly Ever Sometimes Often Always

School
Friends
TV
Others

71
 DIETARY ASSESSMENT

Here dietary data for 2 working (between Monday-Friday) and 1 non-working day
(Saturday/Sunday) is noted down.

Meal Name of Name of Amount in terms of Total

recipe ingredients katori/spoon/cup raw
quantity
Early morning

Breakfast

Mid morning

Lunch

Evening

Dinner

Post dinner

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