The true burden of tuberculosis
Prisons are common settings for tuberculosis (TB) outbreaks, yet screening and prevention services can be extremely limited. As the spread of drug-resistant TB increases, understanding and monitoring levels of the disease among vulnerable populations can minimise the delay of much-needed treatment.
Malaysia has witnessed decades of good TB control. However, a recent increase in new cases among the general population has fuelled concerns that this trend is linked, in part, to high rates of TB in crowded settings, including prisons.
Professor Adeeba Kamarulzaman and Dr Haider Al-Darraji from the University of Malaya's Centre of Excellence for Research in AIDS sampled and surveyed prisoners from Malaysia's largest prison. Their work was published in the journal BMC Public Health.
Over a six month period, the researchers asked all HIV-infected – as well as a comparative group of HIVuninfected – prisoners at Kajang prison to participate in tuberculin skin test surveys that included questions about previous incarcerations, history of TB disease and previous illicit drug use. Overall, they found that 88.8% of all prisoners had been exposed to TB, which represents the first empiric data in this population.
The team has also found similar rates among prisoners in Pengkalan Chepa prison in Kelantan State, confirming a high rate of TB exposure among the incarcerated population of Malaysia. When infected prisoners are released back into society, they may spread the disease among their community and the general population, which may be one of the factors responsible for increasing rates of TB.
According to the researchers, the high prevalence of TB in these samples suggests that evidence-based TB control programs urgently need to be implemented in Malaysian prisons. Such programs could have a positive impact on the overall rates of TB, not only among prisoners but also in the general population.