Prevalence and factors associated with pulmonary tuberculosis among prisoners in Dar es salaam, Tanzania, 2012.

Abstract

Tuberculosis (TB) is the disease caused by the bacterium called Mycobacterium tuberculosis which mostly affects the lungs but also other organs and tissues. It is estimated that about one third of the world‟s population is infected by Mycobacterium tuberculosis. The disease is the leading cause of death from infectious diseases in adults and responsible for an estimated 2 million preventable deaths each year. African region contribute about 26% of all deaths due to TB. Prisoners form a group of the society with a high risk of TB. Where studies have been done, the prevalence of TB among prisoners has been found to be up to 100 times higher than that of the corresponding non institutionalized population. In Tanzania, data on the knowledge on the prevalence and factors contributing to TB in prisons is limited. The data collected from TB surveillance system by the National Tuberculosis and Leprosy Program (NTLP) cannot be reliable for estimating the prevalence and risk factors for transmission of Pulmonary Tuberculosis (PTB) in prison populations. This study aimed at determining the prevalence of PTB among prisoners in Segerea, Dar es Salaam and associated factors. Methods: A cross section study was conducted in Segerea prison from December 2012 to February 2013. The study population consisted of prisoners. The study population was stratified by sex and prison cell to get proportional representation of both sexes and by prison cell. Prisoners who consented were interviewed using a structured questionnaire and asked to provide sputum for microscopic examination of Acid Fast Bacili. HIV test was done to those who consented. The dependent factor was the presence/absence of PTB while the independent variables included factors related social demographic, health, lifestyle and prison system. Data analysis was done using Epi info version 5.3.1. Prevalence of PTB was determined and Adjusted Odds Ratio(AOR) was calculated to ascertain the association between the dependent variable PTB and the explanatory variables. vii Results: A total of 448 prisoners aged between 18 to 68 years were recruited. Males were the predominant group forming 401(89.7%) of the prison studied population. A total of 380(84.5%) were still on remand and had not being sentenced to jail terms, about half 194(43.3%) had stayed in the prison for less than one month. Out of 448, 16 had PTB, making a prevalence of 3.6% (95%CI=2.1-5.9). There was no significant difference in prevalence in respect to gender or among the age groups (p value= 0.2 and 0.4 respectively). A total of 441 out of 448(98.4%) consented to HIV testing and out of those, 34(7.7%) were HIV positive and six were TB/HIV co infected (17.6%). About half, 221(48.3%) of the respondents had history of smoking, two thirds, 278(60.7%) had history of consuming alcohol and 84(18.6 %) had ever used addictive drugs. The factors that were independently associated with development of PTB included HIV infection (AOR= 6.7, 95%CI=1.7-26.1), previous history of TB (AOR=5.9, 95%CI=1.5-22.6), smoking cigarettes for more than 5 years (AOR=4.5, 95%CI=1.3-15.0), under-nutrition[BMI<18kg/m2](AOR=4.8,95%CI=1.3-16.8) and unemployment (AOR=5, 95%CI=1.57- 19.67). Although 391(87.3%) of the respondents were exposed to overcrowding, this did not contribute to PTB as one of the risk factors (OR=0.4, 95%CI=0.1-1.8, p=0.1) Conclusion and Recommendations: This study has shown that the prevalence of PTB in prisons in Dar es Salaam is comparable to other studies and it is contributed by individual prisoner risk factors rather than prison system factors. Screening for TB before entry to prisons is recommended for early detection of cases. The results from this study have implications for individual management of PTB as well as collective impact on the prison community as one of the high risk groups.