Tuberculosis highest in Uganda’s prisons
“The causes of the high TB prevalence in prisons are due to overcrowding, poor ventilation, high level of malnutrition and the high HIV prevalence rate of 15 contrary to the National average of 5.1,” Kisambu attributed.
In white an inmate leader responsible for the prisoner 's sick bay is being assisted by a fellow inmate to feed a sick prisoner who could not eat on his own. (Photos by Petride Mudoola)
NewVision Reporter
@NewVision
___________________ Inmates patients suffering from tuberclosis converge within the isolatation centre of Murchison Bay Inmate's National Refferal hospital based at Luzira prisons.
The prison’s department has expressed concern over the high rate of tuberculosis among prisoners.
In an interview with the New Vision, the commissioner for Prison Health Services, Dr James Kisambu, disclosed that, “The current TB prevalence in prisons is estimated at 642 per 100,000 population much higher than the National TB prevalence rate of 134 per 100,000 people countrywide.”
“The causes of the high TB prevalence in prisons are due to overcrowding, poor ventilation, high level of malnutrition and the high HIV prevalence rate of 15 contrary to the National average of 5.1,” Kisambu attributed.
He observes that “Transmission of TB in prisons is rampant as a result of congestion poor infrastructure yet detention facilities lack adequate units to isolate inmates suffering from tuberculosis.”
“TB is a general problem in prisons countrywide, being with the highest number of TB patients, Mbarara prison is still the only up-country prison with an isolation facility for TB patients and since it has more multi-drug resistant (MDR) TB cases,” Kisambu went on to explain.
With a current prison population of 74,400 prisoners countrywide, the TB prevalence in prisons is estimated at 642/100,000 population of these, a total of 445 inmate patients are undergoing TB medical treatment.
The crowding had led to a spike in diseases that include the MDR-TB MDR-TB - a deadly drug-resistant strain of tuberculosis. He cites instances where hardcore prisoners on capital charges are locked up in poorly ventilated rooms with little fresh air.
In a bid to reduce TB prevalence behind bars, Kisambu says the prison has instituted a robust TB response strategy that involves accreditation for TB diagnosis and treatment at 45 facilities, 111 outreach TB treatment centers, and 111 community-based TB treatment centers.
The prison’s department has strengthened diagnosis of TB by screening all new admissions to prison. This he says they have established cough monitors in every prison ward to ensure early identification of new TB cases within prisons.
Kisambu adds that the prison’s authority recommended that all officers in charge of prisons must ensure that they conduct mass TB screening in all facilities that exhibit many cases of TB.
Staff working in the prison clinics now are stocking TB drugs received from the DTLS and a new system is in place to screen each new arrival for TB. So far, there is provision of separate rooms for TB patients to control infections.
The World Prison Brief report of 2013 indicated that Uganda’s prisons are 293.2% occupied revealing a severe overcrowding that needs to be quickly fixed to avoid a catastrophe Luzira a facility meant to accommodate only 1000 inmates currently accommodates over 3,000 prisoners.
The USAID Defeat TB a project that works with the Uganda Red Cross on the burdened districts and high-risk populations carried out research and findings indicated that over 50% of the cases of MDR-TB in Uganda were found in prisons
The report identified a lack of drugs, Inadequate health infrastructure, Treatment delays, frequent treatment interruptions due to the mobility of prison populations, and lack of follow-up after release among the challenges jailed TB patients face.
Highlighting missed opportunities for TB case detection and prevention in Uganda, the report recommended that all prisons should ensure that they carry out intensified TB case-finding and prevention efforts.
All prisoners should be screened at entry and routinely during their stay to improve TB case notification and infection prevention. All prison clinic staff should be trained in TB case management and provided with TB drugs and infection control supplies.
Since prisons represent a mobile community, a proper treatment plan should be in place to allow TB patients to continue with treatment.
The USAID project recommended follow-up care in local clinics to ensure that prisoners with TB and HIV continue their treatment after release to reduce the spread of disease to other communities.