Prevalence and risk factors of mycrobacterium tuberculosis infection among prisoners in Kabul central prison [Puli Charkhi], Afghanistan

ABSTRACT

Afghanistan has the second highest tuberculosis [TB] burden in the Eastern Mediterranean Region with 76,000 new cases and 20,000 deaths each year. Among the highest risk settings for TB acquisition and transmission are prisons. There is a paucity of data to inform evidence-based design of health policies to control TB in prisons. This study aimed to determine the prevalence and relevant risk factors of TB in Kabul Puli Charkhi Prison. A cross-sectional study was conducted in Kabul Central Prison from January to September 2006. Using a structured questionnaire and tuberculin skin test [PPD], a total of 250 prisoners were selected using a stratified random sampling technique. Those who were sentenced to death, had less than 3 months remaining of their sentence, had a previously confirmed case of TB, or were pregnant, were excluded. The prevalence of TB infection was 55.7% [132/237] among the prison population. Using comparison analysis of two outcome groups [positive and negative PPD], we found that age [odds ratio [OR] = 4.14], income [OR = 7.62], duration of incarceration [OR = 2.62], accommodation area [OR = 3.51], personal hygiene [OR = 15.13], content of food [OR = 5.58] and low-grade fever [OR = 3.25] were positively associated with TB infection. To control TB in this environment, attention should be given to high risk groups such as those in low socio-economic classes, the elderly, and low-weight individuals. Rebuilding of damaged prison facilities and better distribution of prisoners will prevent overcrowding and decrease the likelihood of TB transmission. Improving the quality of food and hygiene would also reduce the level of infection. Based on preliminary findings of this study, the National TB program has strengthened its existing activities in prisons and has made a commitment to establish a comprehensive TB centre