Tuberculosis in prisons in sub-Saharan Africa--the need for improved health services, surveillance and control.
Prisons have long been associated with rapid transmission of infectious diseases. The HIV/AIDS epidemic in sub-Saharan Africa (SSA) has fuelled the spread of TB and HIV in prisons. The poor living conditions and ineffective health services in prisons in SSA are a major breeding ground of Mycobacterium tuberculosis (Mtb). The spread of TB between prisoners, prison staff and visitors and the emergence of drug-resistant TB in prisons now poses a threat to control efforts of national TB programmes in SSA. Accurate data required to develop appropriate interventions to tackle the ominous problem of TB in African prisons are scanty and unreliable. The health of prisoners is by default a neglected political issue. This article reviews the available literature on TB and drug-resistant TB in prisons from SSA countries, discusses the risk factors for acquiring TB and highlights the priorities for further translational research in prisons. Ethical issues pertaining to research on captive African populations are discussed. Scientific, political and funder attention is required urgently to improve prison health services.
Department of Infection, University College London Medical School, Windeyer Institute, 46 Cleveland Street, London W1T 4JF, UK.
Justin
J
O'Grady
Michael
M
Hoelscher
Rifat
R
Atun
Matthew
M
Bates
Peter
P
Mwaba
Nathan
N
Kapata
Giovanni
G
Ferrara
Markus
M
Maeurer
Alimuddin
A
Zumla
D017954:Africa South of the Sahara / Q000453:epidemiology; D035843:Biomedical Research / Q000941:ethics; D006301:Health Services Needs and Demand; D006801:Humans; D011159:Population Surveillance / Q000379:methods; D011330:Prisons / Q000592:standards / Q000706:statistics & numerical data*; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology / Q000635:transmission