Tuberculosis treatment outcomes among prisoners and general population in Zomba, Malawi

Singano, Victor; Kip, Esther; Ching’ani, Wilson; Chiwaula, Lawrence

doi:10.1186/s12889-020-08841-z

Cited by 17 publications

(10 citation statements)

References 25 publications

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“…All the TB patients studied were males, this is similar to the study among persons in prison in North Shoa Ethiopia and Zomba Malawi [ 21 , 28 ]. The prison population is predominantly male and most prisons are male only institutions, including prisons staff.…”

Section: Discussionsupporting

confidence: 81%

“…The TB TSR in this study indicates that the TB control programme in prison settings in Bauchi State is effective especially for inmates who completed their treatment in the facilities. The TSR in this study is higher than that recorded among persons in prison in European region and in Debribirhan prison Ethiopia but lower compared to that found among inmates in Malawi prisons and Northern Ethiopian prisons [ 20 , 21 , 27 , 28 ]. This finding is due to the fact that about a third of the TB patients were transferred out of the treatment facilities during treatment without follow-up to evaluate the treatment outcomes.…”

Section: Discussioncontrasting

confidence: 80%

“…HIV negative TB patients had higher odds of successful treatment outcome compared to HIV positive TB patients. This is in contrast to finding among persons in prison in northern Ethiopia where HIV co-infection was not associated with treatment outcomes but similar to that in Ethiopian university hospital and persons in prison in Zomba Malawi [ 27 , 28 , 41 ]. This could be attributed to the immune compromised associated with both disease, poor adherence to drugs due to large daily pills intake and the negative drug-to-drug interaction between Anti-TB and Anti-Retroviral drugs.…”

Section: Discussionsupporting

confidence: 45%

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Drug-susceptible tuberculosis treatment outcomes and its associated factors among inmates in prison settings in Bauchi State, Nigeria, 2014–2018

et al. 2022

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Tuberculosis (TB) is a contagious disease and its transmissibility is increased in congregate settings. TB incidence rates are five-to-fifty times higher among inmates in prison settings than the general population which has a direct impact on the outcome of TB treatment. There is paucity of information on TB treatment outcomes and its associated factors in Nigerian prison settings. We therefore assessed TB treatment outcomes among inmates in prison settings in Bauchi State, Nigeria. We conducted a retrospective data analysis of inmates with TB in the five-main prison settings in Bauchi State. We extracted socio-demographic, clinical and treatment outcome characteristics from TB treatment register of inmates treated for TB between January 2014 and December 2018, using a checklist. We calculated the TB treatment success rate (TSR) and explored the relationship between the TSR and socio-demographic and clinical characteristics. Related variables were modelled in multiple logistic regression to identify factors associated with TSR at 5% level of significance. All 216 inmates were male with mean (SD) age of 37.6±11.4 years. Seventy-six (35.2%) were cured, 61 (28.2%) completed treatment, 65 (30.1%) were transferred-out without evaluation and 14 (6.5%) died. Overall TSR was 72.9%. Factors associated with successful-treatment-outcome were age, weight, imprisonment duration and HIV status. The results indicate that inmates who are 20–29 years are at least ten times more likely to be successful (aOR = 10.5; 95%CI: 3.2–35.1) than inmates who are 55 years or older. Inmates who are 30–39 years are about four times more likely to be successful than inmates who are 55 years or older (aOR = 4.2; 95% CI: 1.3–13.1). In general, the younger an inmate, the more successful he is. Inmates with pretreatment-weight; 55kg or more are 13 times more likely to be successful (aOR = 13.3; 95%CI: 6.0–29.6) than inmates with weight below 55kg. Inmates who were imprisoned for 2 years or less are about three times more likely to be successful (aOR = 2.6; 95%CI: 1.3–5.4) than inmates who were imprisoned for more than 2 years and HIV negative inmates were three times more likely to succeed (aOR = 3.3; 95%CI:1.4–7.8) than inmates who were HIV positive. We recommended that to improve TB treatment outcome among inmates; age, duration-of-imprisonment, weight and TB/HIV co-infection should be the major consideration during pretreatment, psychological and nutritional counselling and a tracking-system be developed by the authority to follow-up inmates transferred-out to other health facilities to ensure they complete the treatment and outcomes evaluated.

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Section: Discussionsupporting

confidence: 81%

Section: Discussioncontrasting

confidence: 80%

Section: Discussionsupporting

confidence: 45%

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Drug-susceptible tuberculosis treatment outcomes and its associated factors among inmates in prison settings in Bauchi State, Nigeria, 2014–2018

et al. 2022

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“…The Malawi Prison system can leverage the COVID-19 situation and lessons learnt during State disaster measures to build on their considerable progress to date in the mitigation of other communicable diseases (HIV and TB). There has been progress built on commendable efforts to employ active case finding, detect, monitor and mitigate disease among staff and those detained in the Malawian prison system (mainly Chichiri and Zomba prisons), particularly HIV and TB, provide treatment and care, whilst navigating the challenges of insufficient financial and human resources as well as the overcrowded unsanitary conditions of detention and fragmented referral systems (Kachisi et al, 2002;Harries et al, 2004;National Tuberculosis Programme, Ministry of Health, 2007;Chimphambano et al, 2007 ;Makombe et al, 2007;Kanyerere et al, 2012;Tuberculosis Control Programme, Ministry of Health, 2014;Mpawa et al,, 2017;Singano et al, 2020;Gondwe et al, 2021) functional taps and toilets and screening of all on entry to the prison using lateral flow testing. Thirdly, to decongest prisons, the prison management should work together with the judiciary and their line ministry to enact and sustain policies and practice.…”

Section: (I) Our Prisons Had Already Started Registering Covid Cases ...mentioning

confidence: 99%

A multi-stakeholder situation assessment of COVID-19 disease preparedness and mitigation measures in a large prison complex in Malawi

Jumbe

Mhango²,

Muula³

et al. 2022

IJPH

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Purpose Prisons in the sub-Saharan African region face unprecedented challenges during the COVID-19 pandemic. In Malawi, the first prison system case of COVID-19 was notified in July 2020. While prison settings were included in the second domestic COVID-19 response plan within the Law Enforcement cluster (National COVID-19 preparedness and response plan, July–December 2020), they were initially not included in the K157bn (US$210m) COVID-19 fund. The purpose of the study was to assess prison preparedness, prevention and control of COVID-19 in Malawi.. Design/methodology/approach A multi-method situation assessment of the COVID-19 response and human rights assurance of prisoners and staff was conducted in a large prison complex in Malawi. Qualitative research underpinned by the Empirical Phenomenological Psychological (EPP) framework consisted of interviews with key informants such as prison health personnel, senior prison staff, penal and judicial policymakers, government and civil society organisations (n = 14) and focus group discussions with consenting male (n = 48) and female prisoners (n = 48) and prison wardens (n = 24). Prison site visits were supported by detailed observations based on the World Health Organisation Checklist for COVID-19 in prisons (n = 9). Data were collected and analysed thematically using the EPP stepwise approach and triangulated based on Bronfenbrenner’s model conceptualising COVID-19 as a multi-level event disrupting the prison eco-system. Findings The results are presented as MICRO-MESO level individual and community experiences of incarceration during COVID-19 spanning several themes: awareness raising and knowledge of COVID-19 in prisons; prison congestion and the impossibility of social distancing; lack of adequate ventilation, hygiene and sanitation and provisions and correct use of personal protective equipment; MESO-MACRO level interplay between the prison community of prisoners and staff and judicial policy impacts; medical system COVID-19 response, infrastructure and access to health care; COVID-19 detection and quarantine measures and prisoner access to the outside world. Originality/value This unique situation assessment of the Malawian prison system response to mitigate COVID-19 illustrates the dynamics at the micro-level whereby prisoners rely on the state and have restricted agency in protecting themselves from disease. This is due to severe structural inadequacies based on low resource allocation to prisons leading to a compromised ability to prevent and treat disease; an infirm and congested infrastructure and bottlenecks in the judicial system fuelling a continued influx of remand detainees leading to high overcapacity. Multi-pronged interventions involving key stakeholders, with prison management and line Ministry as coordinators are warranted to optimise COVID-19 interventions and future disease outbreaks in the Malawian prison system.

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“…Malawi, being a resource-constrained country, is also facing similar challenges evidenced in the burden of TB and MDR-TB. [ 15 – 17 ] An increase in MDR-TB cases and poor treatment outcomes presents a formidable challenge to TB control that will lead to failure in achieving the end TB strategy. Therefore, it is the main objective of this paper to explore the programmatic challenges that Malawi NTP is facing in managing MDR-TB.…”

Section: Introductionmentioning

confidence: 99%

Programmatic challenges in managing multidrug-resistant tuberculosis in Malawi

Charlie¹,

Saidi²,

Getachew³

et al. 2021

Int J Mycobacteriol

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Tuberculosis treatment outcomes among prisoners and general population in Zomba, Malawi

Cited by 17 publications

References 25 publications

Drug-susceptible tuberculosis treatment outcomes and its associated factors among inmates in prison settings in Bauchi State, Nigeria, 2014–2018

Drug-susceptible tuberculosis treatment outcomes and its associated factors among inmates in prison settings in Bauchi State, Nigeria, 2014–2018

A multi-stakeholder situation assessment of COVID-19 disease preparedness and mitigation measures in a large prison complex in Malawi

Programmatic challenges in managing multidrug-resistant tuberculosis in Malawi

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