Development of a Nutritional Supplementation and Behavioral Counseling-Based Care Guideline for Underweight Tuberculosis Patients in Phrae Province

Abstract

Tuberculosis (TB) remains a significant global public health challenge. In Thailand,
the incidence of new cases is approximately 143 per 100,000 population. Malnourished patients (BMI<18.50 kg/m²) are at a heightened risk of adverse treatment outcomes. In Phrae Province, the proportion of underweight TB patients increased from 31.91% to 47.27%, with an average mortality rate of 7.62%. This study developed and evaluated a care model for tuberculosis (TB) patients with a below-normal Body Mass Index (BMI) in Phrae Province, integrating nutritional supplementation with behavioral counseling. Adopting a three-phase Research and Development (R&D) framework, the study involved: (1) a situational analysis of existing TB care practices, (2) the design of the integrated care model, and (3) an evaluation of its clinical effectiveness. The evaluation phase employed a one-group pretest–posttest quasi-experimental design. A mixed-methods approach was used, incorporating qualitative data for situational analysis and quantitative data to measure outcomes. The PRECEDE–PROCEED Model was applied to analyze predisposing, enabling, and reinforcing factors affecting health behaviors. The sample included 195 underweight TB patients (BMI<18.50 kg/m²) registered at 8 hospitals in Phrae Province. Data were collected from December 1, 2024, to November 30, 2025, using a consecutive sampling method. Data were analyzed using descriptive statistics and the paired t-test to compare mean scores of health behaviors, treatment adherence, BMI, albumin levels, treatment success rates, and mortality. The results of this study found that following the implementation of the guideline, the mean scores for health behaviors and treatment adherence increased siificantly. Both BMI and serum albumin levels showed statistically significant improvements (p < 0.05). Furthermore, treatment success rates (cured and treatment completed) increased, while the mortality rate during treatment markedly decreased compared to the pre-implementation period, resulting in improved treatment continuity.
The care guideline developed through this R&D process effectively improved nutritional status, health behaviors, and treatment outcomes. It significantly increased BMI levels and treatment success rates. Consequently, this guideline should be integrated into local standard operating procedures, emphasizing proactive nutritional screening upon admission and continuous BMI monitoring alongside pharmacological treatment.