Pulmonary tuberculosis and drug resistance in Dhaka central jail, the largest prison in Bangladesh.
BACKGROUND
There are limited data on TB among prison inmates in Bangladesh. The aim of the study was to determine the prevalence of pulmonary tuberculosis (TB), its drug resistance and risk factors in Dhaka Central Jail, the largest prison in Bangladesh.


METHODS
Cross sectional survey with, active screening of a total number of 11,001 inmates over a period of 2 years. Sputum samples from TB suspects were taken for acid- fast bacilli (AFB) microscopy, culture and drug susceptibility testing.


RESULTS
Among 1,781 TB suspects 245 (13.8%) were positive for AFB on microscopy and/or culture. The prevalence rate of sputum- positive pulmonary TB was 2,227/100,000. Fifty three cases (21.6% of 245 cases) were AFB- negative on microscopy but were found positive on culture. Resistance to isoniazid, rifampicin, streptomycin and ethambutol was 11.4%, 0.8%, 22.4% and 6.5% respectively. No multidrug resistance was observed. The main risk factors of TB in prison were exposure to TB patients (adjusted odds ratio 3.16, 95% CI 2.36-4.21), previous imprisonment (1.86, 1.38-2.50), longer duration of stay in prison (17.5 months for TB cases; 1.004, 1.001-1.006) and low body mass index which is less than 18.5 kg/m(2) (5.37, 4.02-7.16).


CONCLUSIONS
The study results revealed a very high prevalence of TB in the prison population in Dhaka Central Jail. Entry examinations and active symptom screening among inmates are important to control TB transmission inside the prison. Identifying undiagnosed smear-negative TB cases remains a challenge to combat this deadly disease in this difficult setting.
Banu
Sayera
S
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh. sbanu@icddrb.org
Hossain
Arman
A
Uddin
Mohammad Khaja Mafij
MK
Uddin
Muhammad Reaj
MR
Ahmed
Tahmeed
T
Khatun
Razia
R
Mahmud
Asif Mujtaba
AM
Hyder
Khurshid Alam
KA
Lutfor
Afzalunnessa Binte
AB
Karim
Md Sirajul
MS
Zaman
Khalequ
K
Khan
Md Ashraful Islam
MA
Barua
Pravat Chandra
PC
Luby
Stephen P
SP
D000293:Adolescent; D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D003710:Demography; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D016017:Odds Ratio; D011330:Prisons; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000382:microbiology