Controlling tuberculosis in prisons against confinement conditions: a lost case? Experience from Cameroon

BACKGROUND: Tuberculosis (TB) is recognised as a major public health problem in the prisons of sub-Saharan Africa. In Cameroon, the main prisons have created diagnostic and treatment units linked to the National Tuberculosis Programme (NTP).

OBJECTIVE: To assess the effectiveness of routine TB control activities in a prison population by determining the prevalence of undetected pulmonary tuberculosis (PTB).

METHODS: In 2009, a PTB case-finding survey was undertaken at the Central Prison of Yaounde (CPY), Cameroon. All prisoners with cough of ≥1 week's duration were screened by sputum smear microscopy. Smears were sent to the national reference laboratory for culture and drug susceptibility testing (DST). Voluntary testing for human immunodeficiency virus (HIV) was offered to all inmates.

RESULTS: Among 3219 inmates screened, 40 (1.2%) identified with PTB had been missed by the prison TB control programme. Missed PTB was positively associated with severe crowding, low body mass index and previous TB treatment. Of the 40 inmates, four (10%) were TB-HIV co-infected. The DST of three inmates revealed resistance to anti-tuberculosis drugs.

CONCLUSION: Despite a well-performing TB control programme in the CPY, the number of undetected PTB cases remains unacceptably high. It is doubtful whether TB transmission can be controlled under conditions of confinement, such as the CPY.