Prevalence and Predictors of Pulmonary Tuberculosis among Prison Inmates in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Abstract

Introduction. Prisoners in Sub-Saharan Africa (SSA) are at a high risk of tuberculosis (TB) infection due to overcrowding and poor ventilation. Consequently, TB is a leading cause of morbidity and mortality in prison, and many inmates face a number of barriers to TB control and had limited information in the region. Thus, the aim of this systematic review and meta-analysis was to estimate the overall pooled prevalence of pulmonary TB and predictors among prison inmates in SSA. Methods. From 2006 to 2019, a systematic review and meta-analysis was conducted using various databases, including PubMed, Embase, Web of Science, and Scopus. The data were extracted in Microsoft Excel using a standardized data extraction format, and the analysis was carried out with STATA version 14. To detect heterogeneity across studies, the I 2 and the Cochrane Q test statistics were computed. To determine the overall prevalence of TB and predictors among prison populations, a random effect meta-analysis model was used. Results. Of the 3,479 retrieved articles, 37studies comprising 72,844 inmates met the inclusion criteria. The pooled prevalence of pulmonary TB among prison inmates in SSA was 7.74% (95% CI: 6.46-8.47). In the subgroup analysis, the highest prevalence was found in the Democratic Republic Congo (DRC) (19.72%) followed by Zambia (11.68%) and then Ethiopia (9.22%). TB/HIV coinfection (OR 4.99 (95% CI: 2.60-9.58)), Body mass index ( BMI < 18.5 ) (OR 3.62 (95% CI: 2.65-6.49)), incarceration (OR 4.52 (95% CI: 2.31-5.68)), and previous TB exposure (OR 2.43 (95% CI: 1.61-3.56)) had higher odds of pulmonary TB among inmates. Conclusion. The prevalence of pulmonary TB among SSA prison inmates was found to be high as compared to total population. TB/HIV coinfection, BMI, incarceration duration, and TB exposure were all predictors with pulmonary tuberculosis in prison inmates. As a result, emphasizing early screening for prisoners at risk of pulmonary TB is an important point to achieving global TB commitments in resource-limited settings.

Magnitude, associated risk factors, and trend comparisons of identified tuberculosis types among prisons in Ethiopia: A systematic review and meta‐analysis

“…The current study found a strong statistical relationship between the magnitude of TB and the duration of imprisonment (adjusted odds ratio = 1.29 [95% CI: −0.39-2.97]), with the risk of TB increasing with the duration of imprisonment for those prisoners whose duration of incarceration is short. This result was consistent with previous studies conducted in SSA, 46 South Africa, 48 and India. 66 This might be because prisoners are not in a closed system, due to the number of people entering, departing, and reentering and the poor environmental situation, possibly increasing the transmission probability.…”

“…The odds of developing TB were 2.75 times higher among prisoners who had a history of contact with TB patients as compared to their counterparts. It agrees with the findings conducted in SSA 46 and India, 66 which reported 2.43 and 3.64 times more infected, respectively. This might be because they are more likely to be exposed to TB bacteria.…”

“…43 The pooled magnitude of TB among prisoners was 9.84% (95% CI: 7.16-12.52; I 2 = 96.9%). This combined magnitude is comparable to findings from prisons in Paraguay, 44 Malaysia, 45 Sub-Saharan Africa (SSA), 46 Iran, 47 Ethiopia, 25 and South Africa, 48 where the prevalence rates are 7.1% in 2009, 7.7%, 7.74%, 7.9%, 8.33%, and 8.8%, respectively. However, the result of this meta-analysis was higher than the previous systematic review reports conducted from prison inmates in South Africa (2.1%), 49 Thailand (2.1%), 50 Peru (2.51%), 51 SSA (2%-3.6%), Brazil (4.5%), 52 Tajikistan (4.5%), 53 and Cameroon (5.23%).…”