Change in Chest Radiography and Examination of Clinical Features to Identify Pulmonary Tuberculosis in a Haitian Prison Open Access

Smith, Liz (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/m039k541c?locale=en
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Abstract

Introduction : TB is a major cause of morbidity and mortality among prisoners worldwide. Prison environments are often conducive to tuberculosis transmission due to overcrowding, poor ventilation, and limited access to medical care and tuberculosis treatment. This study aims to determine if there is active tuberculosis transmission in a Haitian prison and to identify features that are most indicative of progression to active TB disease.

Methods : Data was collected from chest radiograms and BMI measurements taken of 309 prisoners in a Haitian prison during routine health screenings. Univariate and multivariate logistic regression analyses were conducted to identify predictors of TB by chest X-ray (CXR) and GeneXpert analysis.

Results : Univariate predictors of TB positivity by CXR were decreasing length of incarceration; multivariate predictors were decreasing incarceration time and BMI ≤ 20 kg/m2. Univariate predictors of TB positivity by GeneXpert analysis were age, increasing length of incarceration, and any positive CXR reading. BMI ≤ 20 kg/m2 and length of incarceration over 2 years were examined in a multivariate model to determine their suitability as predictors of TB positivity by GeneXpert and both were found to be significant.

Conclusions : Length of incarceration may not be a suitable predictor of TB positivity by CXR but may be a suitable predictor of TB positivity by GeneXpert. Length of incarceration and BMI ≤ 20 kg/m2 are easy covariates to obtain in the prison setting and can be used to improve selection of high risk persons for TB screening. Active transmission of TB cannot be determined from the available data. Therefore, improvement of health and nutritional status, implementation of infection control practices, and reduction of overcrowding should be all performed to reduce TB incidence in the absence of more targeted TB reduction approaches.

Table of Contents

Introduction.
Background.
Natural History of Tuberculosis
Risk Factors.
Tuberculosis in Prison Populations
Epidemiology of Tuberculosis
Globally.
In Haiti
Role of Haiti's Health Systems in Tuberculosis Control
Infection Control and Prevention
Diagnostic and Screening Methodologies
Diagnosis.
Screening.
Treatment
Multi-Drug Resistant Tuberculosis
Methods.
Data Source.
Data Security.
Data Cleaning and Analysis
Descriptive Statistics.
Limitations.
Recommendations.
Public Health Impact
Tables and Figures.
Table 1. Overall Descriptive Statistics
Table 2: Descriptive Statistics by TB Determination Method
Table 3: Univariate Logistic Regression Analysis
Table 4: Multivariate Logistic Regression Analysis
References.
Appendix I: IRB Approval

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