Saiful Islam¹, Mohammad Abdus Salam², Mohammad Anwar Hossain³, Pronoy Kumer Sarker⁴, Debash Chandra Poddar⁵, Mst. Papiya Sultana⁶, Oliour Rahman⁷, Md Anisur Rahman⁸, Md. Al Amin⁹, Kohely Ahamed Sorovy^*,10

¹CRL Diagnostics, Dhaka, Bangladesh

²Bangladesh Medical University, Dhaka, Bangladesh

³Bangladesh Medical University, Dhaka, Bangladesh

⁴Popular Diagnostic Centre Limited, Dhaka, Bangladesh

⁵Sakib Hospital & Diabetes Center, Chandpur, Bangladesh

⁶Shaheed Tajuddin Ahmed Medical College Hospital, Gazipur, Bangladesh

⁷The United Hospital and Diagnostic Center, Brahmanbaria, Bangladesh

⁸Bangladesh Fertility Hospital Ltd, Dhaka, Bangladesh.

⁹Islamia Diagnostic and Consultant Center, Cumilla, Bangladesh.

¹⁰Ashiyan Medical College, Dhaka, Bangladesh

*Corresponding author: Kohely Ahamed Sorovy, Assistant Professor, Department of Microbiology, Ashiyan Medical College, Dhaka, Bangladesh.

Received: 17 February 2026; Accepted: 28 February 2026; Published: 18 April 2026

Article Information

Citation: Saiful Islam, Mohammad Abdus Salam, Mohammad Anwar Hossain, Pronoy Kumer Sarker, Debash Chandra Poddar, Mst. Papiya Sultana, Oliour Rahman, Md Anisur Rahman, Md. Al Amin, Kohely Ahamed Sorovy. Social-demographic characteristics, Dietary intake pattern and Nutritional status of Tuberculosis Patients seeking Health Care Services at 250 Bedded TB Hospital, Bangladesh. Archives of Microbiology and Immunology. 9 (2026): 47-55.

DOI: 10.26502/ami.936500239

Abstract

Keywords

Tuberculosis; Malnutrition; Dietary intake; Nutritional status; Bangladesh

Article Details

Introduction

Tuberculosis (TB) remains one of the most persistent global public health challenges, particularly in low- and middle-income countries, where it disproportionately affects socioeconomically disadvantaged populations. Despite the availability of effective chemotherapy, TB continues to cause substantial morbidity and mortality worldwide, largely due to delayed diagnosis, poor treatment adherence, and the presence of coexisting conditions such as malnutrition¹. The World Health Organization has consistently emphasized that TB is not merely a biomedical disease but one that is deeply rooted in social, economic, and nutritional determinants². Malnutrition and tuberculosis are linked through a well-established bidirectional relationship. On one hand, undernutrition significantly increases susceptibility to TB infection and progression from latent to active disease by impairing cell-mediated immunity, the primary host defense mechanism against Mycobacterium tuberculosis³. Protein-energy malnutrition and deficiencies of essential micronutrients such as iron, zinc, and vitamins A and D compromise immune responses, thereby increasing the risk of infection and poor treatment outcomes⁴. On the other hand, active TB exacerbates malnutrition through reduced appetite, increased metabolic demands, malabsorption of nutrients, and systemic inflammation, leading to progressive weight loss and wasting⁵.

Evidence from diverse settings consistently demonstrates a high prevalence of undernutrition among TB patients at the time of diagnosis. Low body mass index (BMI) has been shown to be strongly associated with delayed sputum conversion, increased risk of treatment failure, relapse, and mortality⁶. Studies from Asia⁷ and Africa⁸ indicate that between one-third to two-thirds of TB patients are underweight at treatment initiation, highlighting undernutrition as both a risk factor and a consequence of TB. Importantly, nutritional recovery during TB treatment has been associated with improved clinical outcomes, reinforcing the role of nutrition as a modifiable determinant in TB management. Socio-demographic and household-level factors further compound the nutritional vulnerability of TB patients. Poverty, food insecurity, low educational attainment, unemployment, substandard housing, and inadequate access to safe water and sanitation are commonly observed among TB-affected households⁹. These factors not only limit dietary quantity and quality but also influence health-seeking behavior and treatment adherence. In densely populated urban settings of developing countries, such as Dhaka, these structural determinants remain critical yet underexplored contributors to poor nutritional status among TB patients¹⁰.

Bangladesh is among the high TB burden countries, where TB coexists with widespread undernutrition and socioeconomic inequality. Although the national TB control program has made significant progress in expanding diagnosis and treatment coverage, nutritional assessment and dietary support remain inadequately integrated into routine TB care¹¹. Empirical data on the socio-demographic characteristics, dietary intake patterns, and nutritional status of TB patients in tertiary healthcare settings are limited, particularly using standardized anthropometric and dietary assessment tools. The present study aimed to assess the socio-demographic characteristics, dietary intake patterns, and nutritional status of tuberculosis patients seeking health care services at a tertiary-level TB hospital in Dhaka, Bangladesh.

Materials and Methods

Study Design, Setting and Duration

A quantitative descriptive cross-sectional study was conducted at the 250 Bedded TB Hospital, Shyamoli, Dhaka-1207, a government tertiary-level specialized hospital providing diagnostic, treatment, and counseling services for tuberculosis and other chest-related diseases. The study was carried out over a period of three and a half months, from 16 December 2019 to 31 March 2020. During this period, data were collected from both outpatient and inpatient departments of the hospital.

Study Population and Inclusion Criteria

The study population consisted of confirmed tuberculosis patients attending the outpatient and inpatient departments of the study hospital. Patients aged 15 years and above with a confirmed diagnosis of tuberculosis based on clinical evaluation, laboratory investigations, and imaging were included. Patients diagnosed with multidrug-resistant tuberculosis (MDR-TB) and those who were critically ill or unable to respond to interviews were excluded from the study.

Sample Size and Sampling Technique

The required sample size was calculated using the single population proportion formula, assuming a prevalence of malnutrition among TB patients of 39.7%, 95% confidence level, and 5% margin of error. The calculated sample size was 369. However, due to time constraints, limited funding, and the nature of a student thesis, a total of 81 participants were finally included. A purposive sampling technique was applied to select eligible participants based on the inclusion criteria.

Data Collection Procedures

Data were collected using a pre-tested structured questionnaire through face-to-face interviews. The questionnaire captured socio-demographic characteristics, household information, tuberculosis-related clinical history, and dietary intake patterns. Food Frequency Questionnaire (FFQ) and 24-hour dietary recall method were used to assess dietary intake. Anthropometric measurements including weight, height, waist circumference, and hip circumference were measured using standard procedures and calibrated instruments. Medical records were reviewed using a checklist to ensure completeness and accuracy of clinical information.

Data Analysis

Collected data were coded, entered, and analyzed using SPSS software (version 25). Body Mass Index (BMI) and waist–hip ratio were calculated to assess nutritional status. Descriptive statistics such as frequency, percentage, mean, and standard deviation were used to summarize socio-demographic characteristics, dietary intake patterns, and nutritional status of the participants. Where appropriate, bivariate analysis was performed.

Quality Control

Data collectors received prior training on interview techniques, dietary assessment tools, and standardized anthropometric measurements. The questionnaire was pre-tested before final data collection. Approximately 5% of collected data were randomly checked by the principal investigator to ensure consistency and quality.

Ethical Considerations

Ethical approval was obtained from the Human Research Ethics Committee (HREC) of Asia Institute of Disability and Development (AIDD). Written informed consent was obtained from all participants prior to data collection. Confidentiality and anonymity of participants were strictly maintained, and participation was voluntary.

Results

The study participants were predominantly middle-aged adults, with tuberculosis affecting individuals across a wide age range and showing clear socio-demographic disparities. The age of the tuberculosis patients ranged from 16 to 80 years, with the highest proportions observed in the 31–40 years and 51–60 years age groups (each 19.7%). The mean age of the participants was 44.67 ± 18.06 years, indicating that tuberculosis predominantly affected individuals in their economically productive years. Male participants constituted the majority (58.0%), while females accounted for 42.0%, demonstrating a male predominance among the study population. Most participants were married (77.8%), reflecting the social and family responsibilities associated with illness in this group. Educational attainment was generally low, as more than one-third of participants (35.8%) had no formal education or were illiterate, and only 22.2% had completed secondary education or higher. In terms of occupation, unemployment was the most common status (24.7%), followed by manual laborers and housewives (each 19.8%), highlighting the overall socioeconomic vulnerability of the study participants (Table 1).

Table 1: Socio-demographic characteristics of the study participants (N = 81)

Table 2 describes the household income, expenditure, and financial balance of the participants. The majority of respondents (60.5%) reported a personal monthly income of ≤5000 BDT, highlighting a high prevalence of low individual earning capacity. In terms of total family income, 30.8% of households earned between 10,001 and 15,000 BDT, while 39.6% had an income exceeding 15,000 BDT. Monthly household expenditure showed an almost equal distribution, with 50.6% spending ≤15,000 BDT and 49.4% spending more than this amount. Despite this, nearly half of the households (45.7%) experienced a monthly financial deficit, whereas only 2.5% reported a surplus, indicating substantial economic strain among TB-affected families (Table 2).

Table 2: Household income, expenditure and financial balance (N = 81)

Housing and living conditions are summarized in Table 3. Most participants lived in houses with cemented floors (60.5%), although a considerable proportion still resided in dwellings with raw soil or wooden floors (39.5%). Tin or wood roofing was predominant (91.4%), and only a small fraction had cemented or tiled roofs. The majority of houses had walls made of tin, wood, or bamboo (81.5%), reflecting substandard housing conditions. Although most households had two or more sleeping rooms (85.2%), household crowding remained evident, as over half of the households (54.4%) accommodated four to five members, and 19.8% had more than five residents. These living conditions may facilitate disease transmission and negatively affect recovery (Table 3).

Table 3: Housing and living conditions of the participants (N = 81)

Table 4 outlines water, sanitation, and hygiene characteristics. Tube-well water was the primary drinking water source for most households (65.4%), and 86.4% had water sources located within their own dwelling. Although three-quarters of participants perceived their drinking water as safe, nearly one-quarter reported unsafe or uncertain water quality. Among those who treated drinking water (n=20), the stand-and-settle method was the most common practice (60.0%). Sanitation facilities were largely unimproved or shared, as 71.6% used unimproved/shared toilets, and 48.1% of households shared toilet facilities with others. These findings suggest potential environmental health risks that may influence nutritional and disease outcomes (Table 4).

Table 4: Water, sanitation and hygiene characteristics (N = 81)

Smoking exposure and treatment adherence are presented in Table 5. Household exposure to smoking was reported by 61.7% of participants, indicating a high prevalence of passive smoke exposure. Among smoking households, most smokers consumed two or fewer cigarettes per day (78.0%). Treatment adherence was generally high, as 97.5% of participants reported taking TB drugs under observation, primarily in the presence of family members (97.5%). Nevertheless, 9.9% of patients admitted missing at least one dose, which could adversely affect treatment outcomes (Table 5).

Table 5: Smoking exposure and TB treatment adherence (N = 81)

Anthropometric characteristics of the participants are shown in Table 6. The mean body weight was 47.31 ± 11.44 kg, with values ranging from 25 to 82 kg. The average height was 157.74 ± 9.8 cm. Mean waist and hip circumferences were 25.0 ± 4.2 inches and 30.0 ± 3.1 inches, respectively. These measurements indicate generally low body mass and body size among TB patients, reflecting poor nutritional reserves (Table 6).

Table 6: Anthropometric characteristics of the participants (N = 81)

The nutritional status based on BMI is summarized in Table 7. Nearly half of the participants (49.4%) were underweight (BMI <18.5 kg/m²), while 43.2% had a normal BMI. A small proportion were overweight (6.2%) or obese (1.2%). The high prevalence of undernutrition underscores the strong association between tuberculosis and poor nutritional status in this population (Table 7).

Table 7: Nutritional status based on BMI (N = 81)

Dietary intake patterns assessed using the Food Frequency Questionnaire are presented in Table 8. Consumption of cereals was relatively adequate, with 62.2% of participants consuming approximately 300 g per day. In contrast, intake of nutrient-dense food groups such as pulses, fruits, milk, and animal-source foods was limited. More than one-third of participants reported no fruit intake (38.3%), and three-quarters did not consume milk or milk products. Intake of fats, oils, and miscellaneous foods was also minimal for most participants. Overall, dietary diversity was poor, indicating insufficient intake of essential macro- and micronutrients (Table 8).

Table 8: Dietary intake pattern (FFQ) of the study Participants (N=81)

Table 9 presents daily energy and nutrient intake along with metabolic indices. The mean daily energy intake was 1530.6 kcal, which was lower than the mean total daily energy expenditure (TDEE) of 1626.9 kcal, indicating an overall energy deficit. Mean protein intake was only 35.4 g/day, which is inadequate for individuals with increased metabolic demands due to TB. The average BMI was 18.9 kg/m², further confirming widespread undernutrition. These findings highlight a mismatch between dietary intake and physiological requirements among TB patients, which may compromise treatment response and recovery (Table 9).

Table 9: Daily energy and nutrient intake and metabolic indices (N = 81)

Discussion

In this study, tuberculosis predominantly affected middle-aged adults, with a mean age of 44.67 ± 18.06 years and nearly 40% of patients clustered within the 31–40 and 51–60 years age groups. This pattern indicates that TB disproportionately impacts individuals in their economically productive years, potentially amplifying household financial stress. Other studies conducted in similar settings have reported mean ages ranging from the late 30s to mid-40s, suggesting a consistent age distribution of TB patients across high-burden regions. The observed male predominance (58.0%) aligns with findings from other research, where male proportions commonly range between 55% and 65%. This disparity has been attributed to occupational exposure, smoking habits, and delayed health-seeking behavior among men. However, the substantial proportion of female patients (42.0%) highlights that TB remains a significant public health concern across genders. Socioeconomic vulnerability was pronounced among the participants. More than one-third of patients (35.8%) had no formal education or were illiterate, and only 22.2% had completed secondary education or higher. Similar studies have documented illiteracy rates between 30% and 45% among TB patients, underscoring education as a persistent structural determinant. Unemployment affected nearly one-quarter of participants (24.7%), while an additional 39.6% were engaged in low-income manual labor or agriculture¹². Comparable research has reported unemployment or informal employment rates exceeding 40% among TB populations, reinforcing the association between limited income-generating opportunities and disease burden¹³.

Economic analysis further revealed severe financial constraints. A majority of respondents (60.5%) earned ≤5000 BDT per month, and nearly half of households (45.7%) reported a monthly financial deficit. Although 39.6% of families reported total household incomes exceeding 15,000 BDT, this income was often insufficient to offset expenditures, as 49.4% of households spent more than 15,000 BDT monthly. Other studies have reported deficit rates ranging from 35% to 60% among TB-affected households, suggesting that TB-related indirect costs frequently outweigh household earning capacity even when treatment is subsidized¹⁴. Living conditions observed in this study reflect environmental risk factors for TB transmission and poor recovery. While 60.5% of households had cemented floors, a substantial proportion still lived in dwellings with raw soil or wooden flooring (39.5%). Tin or wood roofing predominated (91.4%), and 81.5% of homes had walls constructed from non-permanent materials. Household crowding was common, with 54.4% of families housing four to five members and 19.8% housing more than five individuals. Other studies in urban South Asian contexts have reported crowding rates exceeding 60%, highlighting its role in sustained TB transmission¹⁵.

Water, sanitation, and hygiene conditions further illustrate environmental vulnerability. Although 86.4% of households accessed water within their dwelling, nearly one-quarter (24.7%) perceived their drinking water as unsafe. Only 20 participants reported treating drinking water, and among them, 60.0% relied on stand-and-settle methods rather than more effective filtration or boiling. Moreover, 71.6% of participants used unimproved or shared sanitation facilities, and 48.1% shared toilets with other households. Comparable studies have reported shared sanitation rates between 40% and 70% among TB patients, linking poor sanitation with increased exposure to secondary infections and nutritional compromise¹⁶. Household exposure to smoking was notably high, with 61.7% of participants reporting smoking exposure at home. Among these households, 78.0% reported consumption of two or fewer cigarettes per day, indicating chronic low-to-moderate exposure. Other research has documented smoking exposure rates ranging from 50% to 65% in TB households, emphasizing its role in respiratory vulnerability. Treatment adherence in this study was relatively high, with 97.5% of patients taking medication under observation; however, 9.9% still reported missing doses. Studies from similar settings have reported missed-dose rates between 8% and 15%, suggesting that even with supervised treatment, adherence challenges persist¹⁷.

Anthropometric assessment revealed marked nutritional depletion. The mean body weight was 47.31 ± 11.44 kg, and nearly half of participants (49.4%) were underweight, with a mean BMI of 18.9 kg/m². Other studies have reported underweight prevalence among TB patients ranging from 40% to over 60%, placing the current findings within the higher end of this spectrum¹⁸. The coexistence of overweight and obesity in 7.4% of participants suggests an emerging double burden of malnutrition, although undernutrition remains the dominant concern. Dietary intake patterns demonstrated heavy reliance on staple cereals, with 62.2% consuming approximately 300 g per day. In contrast, 38.3% of participants reported no fruit intake, 75.3% did not consume milk or milk products, and nearly half reported no intake of nuts or seeds¹⁹. Similar dietary patterns characterized by low dietary diversity have been observed in other TB populations, where fruit and dairy non-consumption rates frequently exceed 30–50%²⁰. Energy and nutrient intake analysis further confirmed nutritional inadequacy. Mean daily energy intake was 1530.6 kcal, falling short of the mean total daily energy expenditure of 1626.9 kcal, indicating a persistent energy deficit. Mean protein intake was only 35.4 g/day, substantially lower than recommended levels for TB patients. Other studies have reported average energy intakes between 1400 and 1800 kcal/day among TB patients, often insufficient to meet increased metabolic demands²¹. This imbalance between intake and requirement likely contributes to the high prevalence of underweight observed in this study

Conclusion

In conclusion, tuberculosis in this setting is closely linked with poverty, inadequate nutrition, and unfavorable living conditions. Integrating routine nutritional assessment, targeted dietary support, and broader socioeconomic interventions into tuberculosis care programs is essential to improve treatment outcomes and reduce disease-related morbidity and mortality in Bangladesh.

Recommendations

1. Tuberculosis control programs should integrate routine nutritional assessment and structured nutritional support alongside DOTS to address the high burden of malnutrition among TB patients.
2. Ensuring access to nutritionally adequate and balanced diets, particularly for socioeconomically disadvantaged patients, is essential to improve recovery and treatment effectiveness.
3. Adequate protein intake and protein-rich foods should be emphasized, as they play a critical role in supporting immune function and resistance to tuberculosis.
4. Public health authorities should strengthen community awareness and education programs focusing on tuberculosis transmission, prevention, treatment adherence, and the importance of nutrition during illness.
5. Tuberculosis management should adopt a holistic approach, recognizing that pharmacological treatment alone is insufficient without appropriate nutritional and socioeconomic support.

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