Tuberculosis (TB) is a leading killer among infectious diseases, and a major public health issue in Lao PDR – every 53 minutes, one person falls ill with TB. In 2023, more than 9000 people were diagnosed with TB, with cases particularly prominent among hard-to-reach populations in remote areas.
As WHO’s technical officer working to end TB in Lao PDR, I closely support the Ministry of Health, and sadly, often see the impact of TB on patients, and the increasing financial burden it puts on them and their families – an often-overlooked impact of this deadly disease.
As a result of the disease and their symptoms, TB patients often lose physical ability to work, meaning loss of income. Poverty is linked to higher risk of TB infection and disease, poor care-seeking behaviour, late diagnosis and poor treatment – all of this can lead to people selling their belongings, or taking loans, trapping them in the cycle of poverty and TB. Unfortunately, we have seen this many times among patients.
Seeking to identify solutions to this problem, in 2018-2019 the Lao National Tuberculosis Programme conducted the first National TB Patient Cost Survey. The survey identified the cost of additional food or nutritional supplements as the major driver of catastrophic financial difficulty as a result of having TB, and recommended improving nutritional support for TB patients.
During a field visit to Savannakhet Province in 2023, I met Ms Khouanta - she was grappling with an undiagnosed illness and unusual weight-loss. Not knowing the exact issue, her family had drained their savings on medical and non-medical care at private clinics, including traditional medicine providers, in hope that she would feel better. The financial strain was so severe that they had to sell belongings from their home to cover the costs. Yet, nothing seemed to work.
Ms Khouanta told me that she was afraid that she might not make it.
Ms Khouanta’s family decided to bring her to Savannakhet Provincial Hospital, where she was diagnosed and treated for TB. Her nutritional status was assessed, revealing malnutrition. At the hospital, she received nutritional counselling and nutrition supplementary support from healthcare workers, which helped her recover significantly. A few weeks later, she had gained weight, felt stronger and was able return to work. She told me she was very happy and relieved that healthcare workers were able to properly diagnose and support her.
The prevalence of malnutrition among TB patients in the country was unknown before the study, and nutritional assessment and support were not routinely provided at the point of TB care. As WHO and the Ministry of Health, we knew we had to identify ways to expand these types of solutions to others in similar situations.
Taking another step forward, 2022-2024 saw the National Tuberculosis Programme, in close collaboration with the National Nutritional Centre and WHO, conduct ground-breaking research (“Effect of Nutritional Intervention on TB treatment outcome and financial burden due to TB”) to better understand the issue and potential solutions.
The study showed:
- A high prevalence of undernutrition among 312 people newly diagnosed with TB. 41% were malnourished at the time, with a BMI of under 18.5 kg/m2. Associated risk factors included younger age (15–24 years), having drug-resistant TB, hospitalization prior to diagnosis, and poverty.
- The impact of nutritional intervention (nutrition assessment, counselling and providing nutritional supplementary support) on financial protection: those TB-affected households provided low-cost nutrition support (the intervention group) experienced significantly lower nutritional supplement costs and a reduced incidence of catastrophic costs (30.2% vs. 46% in the observation group).
- The impact of nutritional intervention on BMI recovery: the intervention group showed earlier nutritional recovery, particularly during the intensive phase of TB treatment.
The findings from this new study provided good evidence of how multi-sectoral nutritional interventions can help mitigate the financial burden of TB-affected households by reducing direct non-medical costs for families – and can inform future national policy aimed supporting patients.
On 4 July 2025, the Lao Ministry of Health and WHO co‑hosted a national dissemination workshop in Vientiane to share the study findings and discuss policy options. More than 130 participants from across government, WHO and partner organizations examined how to scale nutrition assessment and support within TB services, and how to align financing and social protection to reach the most vulnerable. (Photo: National dissemination workshop, Vientiane, 4 July 2025.)
Further work is needed to assess cost-effectiveness, identify locally available nutritious foods, and define best dietary practices that can sustain support at a scale. But, we already have clearer evidence than before – and as Ms Khouanta’s experience shows, timely diagnosis and integrated nutrition support can help families regain their health and livelihoods, and help recover faster and better from TB.
WHO remains committed to working alongside the Lao Ministry of Health and partners to improve and finance TB service delivery, and to enhance social protection for people affected by TB - including investment in research and innovation to fast-track progress towards a TB-free Lao PDR.
Vilath Seevisay is National Professional Officer at WHO Lao PDR. With seven years working in the health sector, Vilath is focused on supporting the Lao Ministry of Health and other partners to end TB nationwide.