Screening for tuberculosis on admission to highly endemic prisons? The case of Rio de Janeiro State prisons
Abstract:SETTING: Rio de Janeiro (RJ) State prisons, where tuberculosis (TB) is highly endemic.
OBJECTIVE: To measure TB prevalence, identify risk factors and ascertain the most appropriate screening method among inmates of the RJ prisons.
DESIGN: Systematic chest X-rays (CXRs) were performed in 1696 male inmates of three RJ prisons. Inmates were selected for sputum examination and culture if their CXRs showed evidence of any pulmonary, pleural or mediastinal abnormality. TB diagnosis was based on bacteriological results or, if bacteriological results were negative, on response to TB treatment.
RESULTS: TB prevalence was 2.7% (46/1696), and 32/46 cases (69%) were bacteriologically confirmed, including 19 smear-positive cases. CXR lesions were extensive in 43% of cases. In the logistic regression model, TB-associated variables were being illiterate (adjusted OR 2.10, 95%CI 1.02–4.34), cough ≥3 weeks (aOR 2.85, 95%CI 1.54–5.27), history of TB treatment (aOR 3.61, 95%CI 1.76–7.39), and living in Rio City suburbs (aOR 4.54, 95%CI 1.02–20.07) and in Rio City (aOR 5.48, 95%CI 1.29–23.33). A screening based on cough ≥3 weeks followed by sputum smear examination would have identified only 9 of the 46 cases.
CONCLUSION: These results call for screening on admission to prison based, if feasible, on CXR, and demonstrate the urgent need to improve detention conditions and medical assistance in police remand cells.
Document Type: Regular Paper
Affiliations: 1: Programa de Controle de Tuberculose, Coordenação de Gestão em Saude Penitenciária, Rio de Janeiro, Rio de Janeiro, Brazil 2: Institut National de la Santé et de la Recherche Médicale U707, Paris, France; and Université Pierre et Marie Curie–Sciences et Médecine, Paris 6, UMR-S 707, Paris, France 3: Universidade do Estado e Universidade Federal, Rio de Janeiro, Rio de Janeiro, Brazil 4: Fundação Athaulfo de Paiva, Rio de Janeiro, Rio de Janeiro, Brazil 5: Centro de Referência Hélio Fraga, SVS/MS, Rio de Janeiro, Rio de Janeiro, Brazil
Publication date: 2009-10-01
The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.
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