Tuberculosis in correctional institutions in Albania Hasan Hafizi, Anila Aliko, Silva Bala, Silva Tafaj
Tuberculosis in correctional institutions • The level of TB in prisons has been reported to be up to 100 times higher than that of the civilian population. • Cases of TB in prisons may account for up to 25% of a country’s burden of TB. • Late diagnosis, inadequate treatment, overcrowding, poor ventilation and repeated prison transfers encourage the transmission of TB infection. • HIV infection and other pathology more common in prisons (e.g. malnutrition, substance abuse) encourage the development of active disease and further transmission of infection.
Why prisons are different? • Prisoners do not represent a cross section of society but a high proportion of inmates are poorly educated and socio-economically disadvantaged. • The ministry responsible for health care in prisons is the ministry of justice and the ministry of interior. • Delayed diagnosis and substandard treatment are common.
TB in correctional institutions in Albania • Data on TB in correctional institution in Albania started to be reported in 2003. • There are around 5200 imamates in Albania and more or less the same number Albanian inmates abroad (in Italy and Greece) • Few cases were reported annually and underreporting and no diagnosis was suspected
OBJECTIVE • To estimate the prevalence of latent TB infection (LTBI) in the correctional institutions • To estimate the prevalence of TB
METHOD • Cross sectional study. • 8 out of 25 institutional corrections randomly chosen. • 1500 inmates out of 5200 of all inmates underwent tuberculin test skin (TST), clinical and chest x-ray examination. • In suspected cases: smear examination and culture.
RESULTS • Of 1500 inmates selected, evaluable TST were obtained from 1361 because 139 declined examination(9%). • The overall prevalence of LTBI for inmates taking into account the induration size of TST ≥ 5mm, was 57% (788 cases). • The most affected inmates with LTBI were young adult group belong to age group 25-34 old and people originated by higher incidence areas of the country.
RESULTS • The prevalence of LTBI is much higher than general population, 57% of inmates were with LTBI compare to 12% of general population. • The number of inmates candidates for chemoprophylaxis (TST≥10mm) was 489 (36%).
RESULTS • The most prevailing symptom was chronic cough - 10.2% of inmates but cough was associated with smoking as 90% of imamates were smoker. • All cases with chronic cough underwent smear and culture examination and only 1 case resulted with TB
RESULTS • 1080 inmates underwent x-ray examination with portable fluoroscopy. • 1 TB pulmonary case was detected by fluoroscopy and confirmed by smear and culture • 6 cases resulted with fibrotic lesion due to previous TB.
CONCLUSION • TB in correctional institutions reflects the TB epidemiological situation in Albania and doesn’t constitute a problem for the time being. • Nevertheless, considering the high rate of LTBI, strengthening of the preventive measures is recommended • Active screening is expensive and is not recommended for TB detection in correctional institutions