Tuberculosis in prisons.
“22 out of 1000 detainees tested positive for TB,” said Dr. Maridel Borja, professor in the College of Public Health, University of the Philippines Manila and principal investigator of the study Prevalence of Bacteriologically Confirmed Pulmonary Tuberculosis among Prisoners and Jail Officers in Selected Prisons in the Philippines.
The study aimed to determine the baseline magnitude of active tuberculosis (TB) in some prisons in the country, determine the prevalence of multi-drug resistant TB, and determine the knowledge, attitudes, practices and behavioral intentions of inmates and jail officers regarding the deadly disease.
TB is a contagious disease that can spread through the air when an infected person coughs, sneezes, talks or spits. If left untreated, a single person with active TB disease can infect an average of 10-15 people every year according to the World Health Organization (WHO).
However, “The infection rate is different in high population density areas like prisons, which is expected to be higher, compared to general population,” clarifies Dr. Borja. “That is why this study is very important not only for the implementers of TB prevention and control program in the country but also to the prisoners and jail officers to be aware whether they are already infected with the disease or not.”
Subjects of the study were randomly selected from Antipolo City Jail, Cebu City Jail, Correction Institution for Women, Davao City Jail, Manila City Jail, Metro Manila District Jail, and National Bilibid Prison.
Out of the 2,450 respondents, there were 1204 inmates that are TB suspects. “These are the respondents either symptomatic and/or had chest x-ray results suggestive of TB,” Dr. Borja explained. However, only twenty five among these suspects confirmed positive in the direct smear sputum test (DSSM).
The study also determined the prevalence of multi-drug resistant TB, where prisoners with DSSM and culture positive results are subjected to drug susceptibility test (DST) for Streptomycin, Isoniazid, Rifampicin, Ethambutol, Kanamycin, Ofloxacin and Levofloxacin.
Results showed that twenty two (73%) were sensitive to all drugs, three cases (10%) were multi-drug resistant tuberculosis (MDR-TB), four cases (13%) were mono-resistant, one (3%) was poly-resistant, eight (27%) were resistant to at least one drug, while four (13%) were resistant to at least two drugs.
The study also noted that the majority of the respondents are not aware of the signs and symptoms of the disease and exhibit attitudes such as stigmatism, fatalism and perceived inaccessibility of health care. Thus, the study recommends further campaign to increase awareness and knowledge among prisoners and jail officers about TB.
On the other hand, in order to minimize the incidence of TB transmission, the study recommends improving the jail facilities to lessen over-crowding and maintain the recommended number of inmates per cell.
The study suggests further to review the guidelines in discharging and releasing prisons with positive TB. “There should be an established referral system – where the currently under-medication prisoner-for-release would be referred to an outside facility to continue the treatment or medication. This also serves as preventive measure for the relatives, friends and neighbors not to get infected by the disease,” said Dr. Borja.
This study is a collaborative effort of the Philippine Council for Health Research and Development of the Department of Science and Technology (PCHRD-DOST), World Health Organization (WHO), International Committee of the Red Cross (ICRC), Philippine Tuberculosis Society (PTS), Department of Health (DOH) and the College of Public Health University of the Philippines Manila (CPH-UPM).
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