In India, prisoners 5 times more at risk of TB: Study

NEW DELHI: Prisoners in India are five times more at risk of developing Tuberculosis (TB) than the general population, a first-of-its-kind study to assess prevalence of the communicable disease in prisons across the world has revealed.
According to the study, published in The Lancet Public Health, the incidence of TB in Indian prisons is 1,076 cases per 100,000 persons in prisons. In general population, TB incidence is 210 per 100,000 population, according to WHO TB report 2022.
“Overcrowding and lack of ventilation is a known cause of high incidence of TB in prisons. To prevent this, authorities should conduct regular health screening,” Dr Raj Kumar, director, Vallabhbhai Patel Chest Institute, University of Delhi.
A study published in the International Journal of Infectious Diseases in 2017, in which researchers examined the availability of TB services in country’s prisons, revealed diagnostic and treatment services for TB were available in 18% and 54% of the prisons respectively. “Only half of the prisons screened inmates for TB on entry, while nearly 60% practised periodic screening of inmates,” the study found.
In the latest study, which looked at the incidence of TB among prisoners in 193 out of 195 countries researchers found approximately 125,105 of the 11 million people incarcerated globally developed TB in 2019 – a rate of 1,148 cases per 100,000 people per year; significantly higher than the global incidence rate among all persons – 127 cases per 100,000 people per year. However, the case detection rate was just 53% of all TB cases in prisons globally, the study published in The Lancet Public Health found. Furthermore, the researchers found a strong relationship between country-level tuberculosis incidence rates and overcrowding in prisons
Leonardo Martinez, study lead from School of Public Health, Boston University, USA, said: “This connection between TB and overcrowding suggests that efforts to limit the number of people who are detained may be one potential public health tool to combat the TB epidemic in prisons.” The elevated risk of TB among incarcerated populations exceeds that of diabetes, alcohol use disorders, smoking and undernourishment.
The study team, consisting of researchers from across the world, identified that prison TB rates varied greatly by World Health Organization (WHO) region in 2019, with: the greatest incidence rate in the African region – 2,242 cases per 100,000 people per year – almost double the global estimate for this population. The Americas region, largely driven by Central and South America, had the largest estimated absolute number of TB cases among incarcerated persons – 30,509
Anthony D Harries, senior adviser at the International Union Against Tuberculosis and Lung Disease, said: “These findings give us a much clearer picture of tuberculosis in prisons than we’ve ever had before. The high rate of tuberculosis and low rate of detection indicates that current control measures are insufficient for preventing the spread of the disease in prisons globally. Therefore, further research is vital to identify and implement the most effective interventions.”
Martinez added: “The high incidence rate globally and across regions, low case detection rates, and consistency over time indicate that this population represents an important, under-prioritised group. Continued failure to detect, treat, and prevent tuberculosis in prisons will result in the unnecessary disease and deaths of many incarcerated persons. And, of course, when incarcerated persons are released from prison they can take this infectious disease back into the communities in which they live, further contributing to the spread of tuberculosis globally. Greater focus and resources for addressing the tuberculosis epidemic in prisons are needed to protect the health of incarcerated people and their communities.”