This study demonstrated that more than half of PTB patients were suffering nutritional deficiency at the time of starting treatment. Moreover, employment status of the patients and chewing Khat were factors significantly associated with nutritional deficiency among new PTB patients.
The prevalence of nutritional deficiency among PTB patients was 63.2 % which is much higher than the study done in Addis Ababa, Ethiopia, 39.7% . This is probably because the patients of Addis Ababa were not naïve to treatment, certain proportion of them may have already started recovery as a result of chemotherapy (anti TB treatment) and the dissimilarity of life style between the two settings.
The current ND finding is comparable with study done in Gondar, Ethiopia 65.4% ; while lower than study done in Sidama, Ethiopia 77.9%  which could be as a result of the duration of the study which is 11 years ago that may contribute to change in economic development through time. The other studies done in African countries also show similar results; Ghana, 51% ; Malawi, 59%  and Uganda, 62 % . The study done in Gulbarga, India, 62.2 % ; kuala Lumpur, Malesia, 52.4% ; and Bahia, Salvador, Brazil, 50%  are also not far from the current finding.
In the study done in central India, moderate to severe under nutrition was 80% for females and 67% for males . The 80% under nutrition for females in India is much higher than that of this study and more surprisingly the degree of under nutrition in this proportion is moderate to severe. This could be due to characteristic of the study population which is a marginalized social group, with higher rates of poverty, illiteracy, and infant and maternal mortality and under-nutrition, than the average Indian population.
Regarding those associated factors assessed for nutritional deficiency, age may contribute to deficiencybecause of the body requirement at different stage of life for growth and development. When any infection is encountered and nutritional intake is not appropriate ND is inevitable . In this study the age is not normally distributed across the three groups; we have very few under-fives and adolescents and it is difficult to draw conclusion about its association with ND.
Educational status, has a role in ones nutritional status because knowledge of nutritive food stuff, attitude towards food items related to a lesser chance of avoiding certain food items and good practices of food preparation are all important in having normal range of nutritional standard. The result in this study regarding education is consistent with this concept; family size, matters in adequacy of food for a house hold member particularly in households with scarcity of food; residence, between rural and urban category may play a role in nutritional status probably based on life style including feeding practices.
Employment is a means for generating income for an individual or house hold (HH) to purchase food items also to help in health care. Consistently, this study has shown that employment status, not working, is significantly associated with having ND, p-value 0.012 AOR 1.82 (95% CI 1.14, 2.89) i.e. people who are not working were 1.82 time more likely to have ND.
Khat chewing may influence nutritional status in several ways among which decrease in appetite and drawing financial deposit and making shortage of money to buy food items are worth mentioning. The current study also shows association between Khat chewing and ND p-value 0.02 AOR 0.43 (95% CI 0.23, 0.85) in the multivariable regression which means people who were not chewing khat were less likely to develop ND or not chewing khat was protective enough not to develop ND.
With regard to associated factors a study conducted in Ghana  also shows that income, educational status and family size were factors associated with under nutrition which is supported by this study. The study done in Addis Ababa  also shows functional status of the patient and dietary counseling are associated with ND which is a different aspect of investigating under nutrition. A study in Gondar shows that the prevalence of under nutrition in adult TB patients co-infected with HIV was 71.6 % and it is associated with ND , but in the current study co-infection was only 11.6% among which 7.53% were having ND and there is no association. This could be due to the fact that the study in Gondar has included high number of TB/HIV co-infected patients who were more exposed to under nutrition because of double burden.
The magnitude of ND in the study population is high where employment status and chat chewing, might have contributed to the problem. Therefore, regular nutritional counseling with focusing on the effect of Khat chewing by frontline, nutritional supplementation to those who are disadvantaged at least for the period of intensive phase for earlier recovery and good adherence to treatment, program set for TB/HIV co-infected cases where support is being rendered can be considered.
The proportion of people who respond on monthly income was very limited to the extent that it is difficult to draw conclusion on the effect of nutritional status.