Assessing Factors Associated with Positive TB Diagnosis in a Mozambican Prison Restricted; Files Only

Abstract

Abstract

Assessing Factors Associated with Positive TB Diagnosis in a Mozambican Prison

By Kanak Belgaum

Background:

Tuberculosis (TB) remains a major public health threat in high-burden countries like Mozambique, where overcrowded prisons amplify TB transmission risk. Many people entering the Mania Regional Prison were previously exposed to TB. Frequently they have environmental and medical risk factors for disease. This study aimed to assess key predictors —including HIV, malnutrition, age, and time incarcerated—associated with TB diagnosis during a prison-wide screening in Manica Regional Prison.

Methods:

A cross-sectional study was conducted in conjunction with a prison-wide health screening from March 18 to April 5, 2024, at Manica Regional Prison, Mozambique. Of 2,000+ male residents, 1,890 consented to participate and were screened for TB, HIV, and other health indicators using a digital health platform and AI-assisted chest x-ray software. Residents with TB symptoms, a positive HIV test, or abnormal x-ray findings were referred for GeneXpert Mtb/RIF Ultra sputum testing.

Results:

Seventeen residents (0.9%) had bacteriologically positive sputum, while 60 additional residents were clinically diagnosed with TB. In adjusted models, HIV-positive residents had significantly higher odds of TB diagnosis (aOR = 2.01, 95% CI: 1.10–3.68, p = 0.03), as did residents from Pavilion A (aOR = 3.95, 95% CI: 1.26–12.40, p = 0.02). Longer incarceration duration (aOR = 1.15 per year, 95% CI: 1.08–1.21, p < 0.001) and older age (aOR = 1.03 per year, 95% CI: 1.00–1.06, p = 0.01) were also significantly associated with TB diagnosis. BMI and alcohol use were not significantly associated with TB outcomes.

Conclusion:

In this high-burden prison setting, conventional factors such as HIV status, older age, and duration of incarceration were significantly associated with TB diagnosis. In addition, assignment to a particular dorm (Pavilion A) heightened risk of disease. The finding that one dorm had more cases suggests TB transmission may be ongoing in this prison, highlighting the need for ongoing screening, sequestration of infected individuals and delivery of curative treatment.

Table of Contents

i. Distribution Agreement

ii. Approval Form

iii. Abstract Cover Page

iv. Abstract

v. Cover Page

vi. Background

1. Introduction

3. Materials and Methods

6. Results

12. Additional Figures

13. Discussion

18. References

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	TB Tuberculosis Carceral Health Epidemiology Incarceration
Committee Chair / Thesis Advisor	Anne C. Spaulding, MD MPH, Emory University

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