Researchers from Makerere University School of Public Health found that 48% of the prisoners tested positive of Latent TB. They found that TB cases in Uganda's prisons are eight times higher than the general population.
Uganda’s Prison system is facing a severe dual burden of tuberculosis
and HIV, with infection rates significantly higher than those in general population.
Findings from a survey by Makerere University’s School of Public
Health finds that active TB infection in Uganda’s prisons is eight times higher
than the general populations.
The survey conducted in 2023 in correctional facilities located
d in different part of Uganda revealed close to half of the prisoners (48%) of
the prisoners tested positive of latent TB.
People with
latent TB infection do not feel sick and do not have symptoms. Dr. Simon Kasasa,
the leader investigator of the survey whose result were release on Thursday
told Uganda Radio Network that the person with latent TB infection can develop
TB disease at any time and become sick.
“You have the
virus but you don’t have the disease. You are living like any other person.
With active TB, you have the disease and you are already sick” explained
Kasasa, a Senior Lecturer, Department of Epidemiology and
Biostatistics, School of Public Health, Makerere University.
The Dean of Makerere
University School of Public Health(MakSPH),
Professor
Rhoda Wanyenze said the poor living conditions in prison can affected one’s
immune system and therefore trigger latent TB to active TB.
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disease to others”///
“A 48% latent TB
infection rate in a prison population should be cause for worry and prompt
action. A high percentage of latent TB indicates significant risk of active TB
cases developing with prisons and potentially spreading outside prison walls”
she said.
According to WHO, he
scourge of tuberculosis (TB) in prisons remains a persistent problem; rates
among inmates remain much higher—from 5 to up to 50 times—than those of
national averages across both the developed and the developing world.
Prisoners, and people who work in prisons, are known to be
especially vulnerable to the disease. However, it is not known how many
people in prison become infected with Mycobacterium
tuberculosis or develop active TB each year compared with the general
population.
Professor Wanyenze said the survey provides critical baseline
and recommendations that will shape interventions and resources allocation.
“The implications extend beyond prison walls, as individuals
released from incarceration can re-enter the community, posing a risk to the general
population” she warned.
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WHO recommends that prison authorities put in place TB screening
mechanisms before one is sent the cells.
It also recommends that a person diagnosed with TB disease
should begin treatment before they are integrated into the general correctional
facility population.
For the survey, overcrowding, inadequate ventilation and insufficient
screening methods were major contributing factors to high rates of TB in
prisons.
Deputy Commissioner General of Prisons, Samuel Akena admits
the Uganda prison carries a heavy burden of disease especially tuberculosis and
HIV.
“And this burden is shaped by the very environment in which
people are confined –overcrowded, poor ventilation and insufficient access to
timely diagnosis and treatment” he said.
He said women in prison face disproportionately higher risks,
yet often remain invisible in program planning.
“This is not acceptable if we are serious about health equity,
we must prioritize gender-responsive strategies within prisons” said Akena.
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Akena said as per international standards, Uganda’s prisons should
be carrying only twenty thousand prisoners but there were over 79000 prisoners
by the beginning of this week.
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“There is overcrowding. We must accept it. Of course, some of
the structures are old. British or colonial, with ventilations which are high
there. But with the reforms, the structures are better” he said.
“Any slightest entry of disease in such an environment is very
dangerous. How we survived COVID. I think it put us at a very high level because
they expected that everybody was going to flatten down,” Akena stressed.
Gaps in TB Diagnosis in prisons
The researchers found that some of the common TB diagnosis screening
were not very effective in detecting the bacteria leading to what they described
as missed diagnosis.
The said symptom screening missed 50% of the cases, while
chest X-rays missed 40% of the cases. Form the survey GneXpert or molecular testing
ultra-diagnosed 40% of the cases that symptom screening and chest X-ray
screening missed.
They found that nearly 67%of the TB was imported due to missed
or inadequate screening methods. The
survey further found that 80% of the prisons were overcrowded and that 95% of
the prisons wards lacked ventilation.
They called for the strengthening of screening, improving of prison
infrastructure and the expansion of access to integrated TB and HIV services in
prisons.
Ministry of Health responds
Newly appointed Director Generals of Health Services, Dr
Charles Olaro said Uganda remains among the 30 HIV/TB high-burden countries.
He
revealed that over 94000 people were diagnosed with TB this year and that
thirty thousand of those are co-infected with HIV.
He said congestion in prison becomes a medium of transmission of
TB.
“So even if you had one case, it can become a potential for
many more cases. So if prisons are a high risk for TB, we should have screening
for TB every year. And if we do so, we should be able to identify those cases. Because
we need to know that TB is treatable” said Olaro.
