FeedbackBy reducing cell-mediated immunity, undernutrition increases the risk of TB, while the catabolic effect of TB disease results in weight loss and wasting, creating a vicious cycle (105, 228). Globally, about 45% of deaths in children aged under 5 years are attributable to undernutrition (228). Undernutrition may be acute or chronic and categorized as moderate or severe. Data from the 2021 Global Tuberculosis Report suggest that 1.9 million TB cases per year (19%) are attributable to undernourishment (1). Data on TB prevalence among acutely malnourished children show a wide variety of prevalence levels, with 2–24% of acutely malnourished children in high TB burden settings diagnosed with TB (229).
A review of guidelines on acute malnutrition showed that TB screening is not consistently included in guidelines for acute malnutrition in high TB burden countries (229). Routine TB risk assessment, especially history of TB exposure, among acutely malnourished children, combined with improved referral linkages with TB services, could help increase TB case-finding and improve outcomes. Integration and coordination between TB and nutrition services are important to ensure children and adolescents with malnutrition are routinely evaluated for TB (5). Integrated models of care are covered in Chapter 6.