Food insecurity in South Indian households with TB during COVID-19 lockdowns and the impact of nutritional interventions: A qualitative study

Tuberculosis (TB) mortality rose during the COVID-19 pandemic, as did food insecurity worldwide. Undernourished individuals are at increased risk for incident TB disease and TB mortality. This study examines the impact of COVID lockdowns on the food security of households with TB in Southern India. In-depth interviews and focus group discussions were conducted with household contacts enrolled in a nutritional intervention study, conducted in Puducherry and Tamil Nadu (2018-2024), which provided household contacts of persons with TB with a six-month nutritional intervention. During the COVID-19 lockdowns, 78% of households in our study had no income; 67% resorted to distress financing, such as loans, to afford food; and 44% changed their eating habits, such as buying less food or different items. Respondents reported that the provided nutritional intervention improved their food security. Crises such as the COVID-19 pandemic can reduce both food access and diversity, leading to macronutrient and micronutrient deficiencies that increase the risk of TB incidence and mortality. Undernutrition due to food insecurity may have been a driver for hastened disease progression or disease-related morbidity and increased mortality during the pandemic. Nutritional support interventions should be implemented as a part of pandemic response.