The prevalence of active pulmonary tuberculosis among prisoners at Kamiti Maximum Security Prison, Kenya.

Abstract

Background: Tuberculosis (TB) is one of the leading causes of mortality in Kenyan prisons. No systematic studies have been done to determine the prevalence of TB in this population. This study set out to determine the prevalence of active pulmonary TB in one of the largest prisons in Kenya. Methods: A survey involving all the inmates at the Kamiti Maximum Security Prison was done between November 2007 and May 2008. Each block in the prison was visited and enquiry made for prisoners with a cough of 2 or more weeks duration. These prisoners were recruited into the study after an informed consent. The prisoners’ baseline characteristics were recorded. Prisoners with a productive cough submitted 3 sputum specimens for smear microscopy. If microscopy was negative for Mycobacterium tuberculosis, sputum culture and chest radiography were done. For those with dry cough, a chest radiograph was done. Depending on the outcome of these tests, the prisoners were either classified as having active pulmonary tuberculosis by active case finding or none. The data for active pulmonary TB by passive case finding was abstracted from the TB notification summaries available at the prison clinic. The data collected was recorded in a proforma and transferred to SPSS version 14.0 statistical package for analysis. Results: By passive case finding, the prevalence of TB was 1425/100 000 of population. Active case finding strategy yielded an extra 931/100 000 of population with active pulmonary TB. The overall prevalence of active pulmonary TB in this prison was 2356 per 100 000 of population. Only age was found to have a statistically significant association (p value <0.05) with a prisoners’ TB status. Conclusion: The prevalence of active pulmonary TB in this Kenyan prison was 7 times the national prevalence. A larger study is needed to document the prevalence of TB in the whole prison population in Kenya. Interventions to control TB targeting the prisons are urgently needed in Kenya.