Indian Doctor Couple’s Research Into TB Gains Global Recognition

Mangaluru couple Dr. Anurag Bhargava and Dr. Madhavi Bhargava's extensive research has established a strong scientific link between TB treatment and nutritional support. Based on their findings, the WHO now recommends specific nutrition-based guidelines for TB patients and their families. This marks a major global shift in TB management and opens new pathways toward TB elimination.

Dr. Anurag Bhargava, Professor in the Department of Medicine at Kasturba Medical College, has been studying the relationship between TB and undernutrition for several years. His fieldwork, particularly in rural Jharkhand, revealed that TB patients suffering from severe malnutrition face a significantly higher risk of death. His wife, Dr. Madhavi Bhargava, a Professor in the Department of Community Medicine at Yenepoya Medical College, has focused on the community health aspects of TB. She has collaborated with her husband and several national and international institutions to advance research on nutrition and disease prevention.

Tuberculosis remains one of the world’s deadliest infectious diseases, claiming hundreds of thousands of lives in India each year. Undernutrition has long been identified as one of the most critical causes of TB-related mortality. According to Dr. Anurag Bhargava, poor nutrition is the single most important risk factor for TB in India — surpassing even diabetes, HIV, smoking, or alcohol consumption.

Dr. Anurag Bhargava has been studying the relationship between TB and undernutrition for several years (ETV Bharat)

In this context, the couple’s research marks a historic milestone.

Local Research To National Policy

Their work has far-reaching implications. In 2017, the National Tuberculosis Elimination Programme (NTEP) invited the Bhargavas, along with other experts, to draft guidelines on the role of nutrition in TB care. These guidelines recommended that every TB patient be nutritionally assessed at diagnosis and throughout treatment. Recognizing the widespread problem of undernutrition, the document proposed providing every patient with a “food basket” as part of treatment support.

Building on this, the couple led the RATIONS Trial (Reducing Activation of Tuberculosis by Improvement of Nutritional Status) — the world’s first scientific trial designed to determine whether improved nutrition could reduce TB deaths and prevent new infections among family members.

Global Breakthrough

The RATIONS Trial addressed two key questions:

1. Could improving the diet of TB patients lower death rates?
2. Could providing better nutrition to their families reduce the risk of new infections?

This pioneering study tested whether food-based interventions could boost immunity and prevent TB transmission within households. After the initial results were published in 2023, the WHO convened its Guideline Development Group (GDG) in 2024 to revise the decade-old TB guidelines. The Bhargavas were invited as technical advisors and participated in multiple rounds of consultations over six months. The group reviewed extensive quantitative and qualitative data from the RATIONS study, including patient experiences.

The qualitative research, conducted by the Forum for Medical Ethics Society, revealed that patients who received food baskets were more consistent with medication, reported improved energy, and noted better productivity among family members.

Landmark Moment For Indian Medicine

On October 7, 2025, the WHO officially released its new TB treatment guidelines, citing evidence from the RATIONS study.

Dr. Anurag Bhargava told ETV Bharat, “TB is an infectious disease, but immunity plays a key role. Nutrition is fundamental. Even before modern medicine, TB declined in 19th-century Europe because people had better wages and diets. In Karnataka alone, around 60,000 TB cases are reported annually, with a 7% mortality rate. If we combine nutritional support (such as a food basket with pulses) with the existing Nikshay Poshan Yojana, we can dramatically improve outcomes and prevent TB-related family tragedies.”

Based on the Bhargavas’ work, India’s TB programme introduced nutrition-based recommendations in 2017 and launched the Nikshay Poshan Yojana, providing ₹500 per month to TB patients for nutritional support. However, logistical challenges prevented widespread distribution of actual food baskets, prompting the shift to cash transfers. Before the RATIONS trial, there was no scientific evidence to confirm whether food baskets improved survival or reduced new infections. The Bhargavas’ study filled that gap.

What Their Findings Showed

Conducted across four districts in Jharkhand, the RATIONS trial covered 2,800 households affected by pulmonary TB. Over two years, new TB cases among family members fell by 39% overall and by 48% for pulmonary TB in households that received food baskets.

The impact was equally strong among patients. Those receiving food support experienced a 35% lower death rate, and among the severely malnourished, mortality dropped by 50%. Many patients gained significant weight during treatment, and over 75% returned to work (a key indicator of recovery).

The trial began in August 2019, just before the COVID-19 pandemic disrupted normal life. Lockdowns, infections, and logistical challenges made fieldwork extraordinarily difficult. Yet, the research team persevered.

“Our field and nutrition delivery staff faced unimaginable challenges, but we completed the trial despite the pandemic,” recalled Dr. Madhavi Bhargava. She added that TB rarely affects only one person in a family: “TB spreads within households living in poverty and food insecurity. By giving food baskets to all family members, we aimed to boost immunity and prevent new infections — and that’s exactly what we demonstrated.”

Patients in the study said the food baskets helped them complete treatment, regain strength, and resume work... small victories that made a big difference.

Real-World Impact

The qualitative research confirmed that nutritional support significantly improved patients’ adherence to treatment and quality of life. Dr. Anurag Bhargava added, “Without food, it’s extremely difficult to complete such a long course of medication. Adequate nutrition reduces deaths and helps patients recover faster.”

The 2024 WHO guidelines marked a turning point. Earlier, the 2013 version focused mainly on assessing nutritional status and offering advice — recommending food support only in severe cases. The new guidelines, influenced by the RATIONS findings, now formally endorse food support as an essential part of TB treatment.

The RATIONS study’s findings were published in The Lancet and The Lancet Global Health in 2023, earning global attention. The Indian government subsequently improved nutrition delivery under the Nikshay Mitra initiative, with states like Jharkhand and Himachal Pradesh already implementing food basket schemes.

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