Tuberculosis treatment and undernutrition on Daru Island, Papua New Guinea: A qualitative exploration of a local foodscape

A substantial proportion of people with tuberculosis (TB)-one of the world's deadliest infectious diseases-live in resource-poor, food insecure settings. It is widely recognised that undernutrition significantly heightens vulnerability to TB, as well as contributes to poor treatment adherence and outcomes. However, more attention is needed to understand what shapes food insecurity and undernutrition in a particular setting. We use the concept of "foodscapes" to explore the distinct food environment on Daru Island, a recognised "hotspot" for multidrug-resistant TB in the Western Province of Papua New Guinea. Drawing on 128 qualitative interviews and 10 focus groups (conducted July 2019 and July 2020) with people with TB, family members, healthcare providers, community leaders and other stakeholders, we seek to elucidate the critical entwinement of food insecurity, people with TB, and their treatment experiences on Daru Island. We argue that potential solutions need to focus on the social and structural conditions that contribute to undernutrition in the first place, rather than on undernutrition itself.