Madhavi was still a student when some friends introduced her to Dr Anurag Bhargava, working at a rural hospital in Gujarat. Little did the common friends then know that they had laid the foundation for a groundbreaking and inspiring finding of “a blind spot in TB care and prevention”, as Dr Madhavi Bhargava would tell years later.
After the first meeting, the two minds connected over their shared desire to help the under-served. They became partners in research and life.
Poverty and malnutrition form a lethal cocktail for tuberculosis, one of the major health problems in India, where, according to NITI Aayog, 14.96 percent of the country’s population is considered to be in a state of multidimensional poverty.
Between 2000 and 2009, Dr Anurag and Dr Madhavi Bhargava’s single centre in rural Bilaspur, Chhattisgarh, diagnosed around 600 people with tuberculosis each year. They also observed the impact of widespread undernutrition on the progression and severity of tuberculosis, a factor often overlooked in traditional treatment protocols.
Seeking to deepen their understanding and impact, the couple pursued further research at McGill University, Montreal, in Canada. On returning to India in 2012, they continued their research at the Himalayan Institute of Medical Sciences, Dehradun, and later at Yenepoya Medical College, Mangaluru, where Dr Madhavi now serves as an Associate Professor in the Department of Community Medicine, and Dr Anurag as a Professor in the Department of Medicine and Head of the Centre for Nutrition Studies.
Their research paid off. They initiated food-based interventions to arrest tuberculosis, and their efforts made The Lancet — one of the world’s most prestigious medical journals — feature them for their innovative approach to combating tuberculosis.
“At the non-profit Jan Swasthya Sahyog (People’s Health Support Group) that Anurag and Madhavi Bhargava set up with fellow physicians, the toll of tuberculosis was clear,” London-based Health and Science writer Udani Samarasekera wrote in The Lancet article published on Friday, 10 November. Her reference was to the around 600 annual cases the couple had found in Chhattisgarh.
The Jan Swasthya Sahyog has been at the forefront of tuberculosis care since 2000.
RATIONS, an eyeopener
Their landmark study, the RATIONS (Reducing Activation of Tuberculosis by Improvement of Nutritional Status) trial, investigated the effect of nutritional supplementation on tuberculosis incidence in household contacts of patients.
Contrary to conventional methods using processed supplements, their trial employed food-based interventions, notably increasing intake of pulses and animal protein. The results were remarkable, showing a reduction in tuberculosis incidence by 39-48% in the intervention group.
Their method might look simple. “The team used a comprehensive and locally adapted approach and used food-based interventions rather than processed nutritional supplements. We ensured that they got enough proteins, both animal-based and pulses as well. This design paid off,” Dr Anurag had told South First earlier about the trial,
The Lancet profile highlighted the Bhargavas’ commitment to a holistic approach to tuberculosis treatment, emphasising the critical role of addressing undernutrition as a comorbidity. Their work aligned with global health priorities, showcasing the importance of integrating nutritional support with medical treatment in managing the disease.
The global publication also lauded the couple for their humanistic approach to healthcare. They have been instrumental in providing care for patients with multidrug-resistant TB, often through innovative funding methods like crowdfunding, when governmental support was limited.
Fountain of knowledge
Dr Gopal Dabade, President of Drug Action Forum-Karnataka spoke about his acquaintance with Dr Anurag Bhargava, known among close friends as Anu.
“Anurag always impressed me with his quick and sharp responses to challenging questions. I remember our encounters at MFC annual meetings, where he was a fountain of knowledge on public health matters, presenting even the most intricate issues in a clear and accessible way,” Dr Dabade told South First.
“One vivid memory is meeting him in Delhi during a tough court case. Anurag’s ability to swiftly analyse complex information and summarise key points was remarkable. While the rest of us spent hours delving into our documents, he could distill the essence of the issues quickly,” he added.
“I particularly admire his dedication and continuous efforts in TB research. His work in this field is not just commendable but truly groundbreaking,” Dr Dabade said.
Dr Madhu Pai, Inaugural Chair, the Department of Global & Public Health at McGill University, shared another insight. “In The Lancet’s 200-year history, they are the third couple, and the second Indian couple to be jointly featured, after Abhay and Rani Bang. Their work is very inspiring and I hope their work will influence India’s approach to both TB and undernutrition,” he told South First.
He took to X and posted, “I am happy to see this inspiring Indian couple profiled @TheLancet! 👏🏾👏🏾 @dranuragb & @dr_madhavib have shown us we can address social determinants of TB if we choose to,”
So happy to see this inspiring Indian couple profiled @TheLancet! 👏🏾👏🏾@dranuragb & @dr_madhavib have shown us we can address social determinants of TB if we choose tohttps://t.co/ttZ365h2Bx pic.twitter.com/jWtxh57KS9
— Madhu Pai, MD, PhD (@paimadhu) November 10, 2023
Anant Bhan, Researcher, Bioethics, global health also took to X: “Delighted to see Anurag @dranuragb & Madhavi @dr_madhavib who I am privileged to have as friends, featured in the Lancet this week (10 November 2023 issue) Their life journeys, choices, and work has continued to be inspiring,”
Delighted to see Anurag @dranuragb & Madhavi @dr_madhavib who I am privileged to have as friends, featured in the Lancet this week (10 November 2023 issue)
Their life journeys, choices, and work have continued to be inspiring#TB #nutrition #publichealth https://t.co/SePD9btGkz pic.twitter.com/SlZjpvKfNx
— Anant Bhan (@AnantBhan) November 11, 2023
Dr SP Kalantri, Director of Mahatma Gandhi Institute of Medical Sciences, tweeted: “Beginning at the Mecca of Medicine at AIIMS, navigating a decade amidst the tribal landscapes of Bilaspur, delving into research at McGill, culminating in faculty positions at Yenepoya, and featuring in @TheLancet. Truly, a Bollywood story! Congratulations, Madhavi and Anurag!
Beginning at the Mecca of Medicine at AIIMS, navigating a decade amidst the tribal landscapes of Bilaspur, delving into research at McGill, culminating in faculty positions at Yenepoya, and featuring in @TheLancet. Truly, a Bollywood story!
Congratulations, Madhavi and Anurag! pic.twitter.com/rpWXBkpv56
— SP Kalantri (@spkalantri) November 11, 2023
Road ahead for India
The RATIONS trial demonstrated that a monthly food basket rich in protein and multivitamins could reduce the incidence of tuberculosis by nearly half among family members of patients in India. The next crucial step is the large-scale implementation of the trial and the development of related policies.
Dr Anurag earlier told South First that the aim of the RATIONS trial extended beyond mere publication, and the Indian Council of Medical Research (ICMR) has shown an interest in its outcomes.
“There are ongoing discussions about policy changes. Naturally, considering the scope, this will require time. The ICMR is highly engaged with the trial’s results and is committed to their practical application. A national-level dissemination meeting was also conducted, co-organised by the DG of ICMR and the Secretary of the Health Ministry. I am optimistic about this,” he spoke about the large-scale implementation of nutritional interventions.
Incidentally, the WHO’s Global TB Report 2023 highlighted India’s advancements in controlling tuberculosis. “India’s commitment to fighting TB represents a significant advance. There has been a remarkable improvement in case detection, with treatment now covering 80 percent of estimated TB cases — a substantial 19 percent increase from the previous year.”
The WHO also commended India’s Pradhan Mantri TB Mukt Bharat Abhiyan, noting that over one lakh Ni-kshay Mitras have supported more than 11 lakh patients.
The Lancet’s feature ends with Dr Anurag’s quote which says, “If you improve nutrition overall, it will boost population health and the growth and cognitive development of our future citizens as well as reduce the frequency and severity of many communicable diseases and burden of non-communicable diseases”
“All countries have committed to achieving the Sustainable Development Goals by 2030 and improved nutrition is central to this task,” he added.
Dr Anurag’s thought is in line with a quote by a 19th-century German physician, Dr Madhavi Bhargava shared on X.
“For if medicine is really to accomplish its great task, it must intervene in political and social life. It must point out the hindrances that impede the normal social functioning of vital processes, and effect their removal. — Rudolf Virchow.”
The Lancet said the Bhargavas are focused on advocating the inclusion of nutritional assessment and support in national and international tuberculosis treatment guidelines. They aim to demonstrate that comprehensive care, including nutritional support, can significantly improve patient outcomes and potentially reduce tuberculosis incidence.
for representing issues that we worked on & also to many colleagues in our journey. Undernutrition in patients & communities with TB needs a response on grounds of science & ethics, now.@WHO @YenUniT @McGill_TB @paimadhu @dr_madhavib https://t.co/lQczJzguRp
— Anurag Bhargava (@dranuragb) November 10, 2023
Their recognition by The Lancet not only highlights their significant contributions to TB research but also serves as an inspiration for global health communities.
Expressing happiness and thanking her colleagues, Madhavi Bhargava posted: “Makes me feel humbled & remember colleagues @jssbilaspur, many unsung heroes in public health whom we met on the way, the frontline workers, communities in distress yet resilient. Most importantly, our lovely boys @thedivtagguy & Anshuman who were always part of our choices,”