title: Controlling tuberculosis in prisons against confinement conditions: a lost case? Experience from Cameroon.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: German Development Cooperation (GTZ), Yaounde, Cameroon. juergennoeske@yahoo.fr
authors.forename: J
authors.initials: J
authors.lastname: Noeske
authors.forename: N
authors.initials: N
authors.lastname: Ndi
authors.forename: S
authors.initials: S
authors.lastname: Mbondi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D002163:Cameroon / Q000453:epidemiology; D016009:Chi-Square Distribution; D003140:Communicable Disease Control / Q000379:methods; D016358:Contact Tracing; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008853:Microscopy; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011237:Predictive Value of Tests; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data; D011330:Prisons / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D018088:Tuberculosis, Multidrug-Resistant / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents