Tuberculosis Prevalence Among Entrants and Stock Population in a Haitian Prison: A Quality Assessment of Screening Procedures Open Access

Mercer, Daniel William (2013)

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Introduction : Tuberculosis among the most common causes of morbidity and mortality in correctional settings due to high prevalence among entrants and conditions that promote disease transmission among the stock population. This assessment seeks to evaluate the tuberculosis screening efforts at the Prison Civile in Port-au-Prince, Haiti by comparing prevalences among new entrants and stock prisoners and by identifying factors associated with prevalence among the stock population.

Methods : Prison and staff from a non-governmental organization at the Prison Civile collected tuberculosis-related data during and after a universal screening effort from March-June 2012. The investigator conducted logistic regression on the comparison between stock population and entrants and covariates including body mass index, age, and tuberculosis treatment history to determine prevalence odds ratios for the screened population. Logistic regression on covariates among stock prisoners determined prevalence-associated factors.

Results : The overall prison prevalence of tuberculosis was 1,540 cases per 100,000 persons, which is higher than the national prevalence (307/100,000). The odds of having tuberculosis among stock prisoners was 2.72 (95% CI: 1.65, 4.49) times the odds for new entrants after controlling for body mass index. Each month of time served in the Prison Civile since 2010 was associated with a 4% increase in the odds of having tuberculosis (OR: 1.04, 95% CI: 1.02, 1.06). Stock prisoners not included in the mass screening had odds twice those of assessed stock prisoners (OR: 2.15, 95% CI: 1.15, 4.03). Among stock prisoners, prevalence was associated with residence on a particular floor (OR: 3.31, 95% CI: 1.90, 5.75) and lower body mass index (OR: 0.76, 95% CI: 0.67, 0.85).

Conclusions : Tuberculosis prevalence in the Prison Civile is higher than in the general Haitian population, but the magnitude of the difference is less than that seen in many developing countries. Higher prevalence is significantly associated with length of time spent in the prison, though causal conclusions cannot be drawn from this cross-sectional study. The Prison Civile may be acting as a reservoir, with those incarcerated earlier experiencing different underlying tuberculosis exposure before incarceration. Given the differences in prevalence between stock and entrants, a future longitudinal study might be warranted.

Table of Contents

Contents Introduction 1 Background 2 Tuberculosis 2

Tuberculosis Information and Pathogenesis

2 Transmission 3 Symptoms 4

Testing and Diagnosis

4 Treatment 6 Infection Control 7

Haiti and the 2010 Earthquake

9 Health in Haiti 9

Tuberculosis in Haiti


Health and Tuberculosis in Prisons


Recommendations from the Literature


Barriers to Health Improvement


Prisons in Haiti - Prison Civile


Health through Walls in Haiti

18 Methods 19 Data Sources 20 Data Security 21 Data Cleaning and Analysis 21 Results 23 General Results 23

Stock Population / Entrant Classification


Entrant / Mass Screening Stock / Other Stock


Population Classification


Continuous Time from Entry to Screening


Stock Population Prevalence Factors

26 Discussion 26 Limitations 30 Recommendations 31

Public Health Impact

32 Tables and Figures 34 References 40 Appendix: IRB Determination 43 43

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