28 February 2019

Trained prisoners detect tuberculosis in Ethiopian prisons

Tuberculosis (TB) is highly prevalent in Ethiopian prisons, sometimes people even say that a prisoner is also sentenced to the disease TBC in addition to his cell punishment. Research by the Ethiopian researcher Dr. Kelemework in collaboration with researchers from Maastricht University like Mark Spigt PhD, published today in Lancet Global Health, shows that prisoners can easily be coached to recognize TB in their fellow inmates at an early stage. This way further distribution within the prison can be prevented.

TB in Ethiopian prisons

Although TB does not occur much anymore in the rich countries, it is still a major problem in developing countries. Nevertheless, it is estimated that 23% of the total world population is infected with the TB bacteria. The emergence of resistant forms of TB is an additional and increasing threat. The problem is greater as the living conditions are worse. In prisons in developing countries, living conditions are often extremely poor. Due to illness, poor nutrition and overcrowding in cells, TB is much more common and speads much easier. Through family visits to prisoners and prison staff, the prisons remain a constant source of TB for society.

Training of prisoners

Dr. Kelemework developed a training for prisoners. During three days, a number of prisoners per prison received and extensive training on TB; how is TB caused, what are the consequences, how can you recognize it and what can you do about it? Through these prisoners, all prisoners in the prison were informed, in order to alert the entire prison population to recognize the symptoms of TB. In a large study of 16 Ethiopian prisons (total 18,032 prisoners), it appeared that in the 8 prisons in which the prisoners were trained 75 new TB cases were found, whereas in the 8 control prisons there were only 25. These 50 extra detected persons could be treated and further spreading could be prevented.

Implications

Ideally, every prisoner is screened for TB before he or she ends up in prison. But such screening is very expensive and that is why developing countries are looking for cheaper alternatives to detect TB and treat it early. The training of prisoners, as applied in this study, costs very little money and can therefore be applied on a large scale. 50 extra detected TB cases on a population of 8000 prisoners, means that a lot of lives are saved by applying this training. However, it does require a social prison system. In a prison where the prisoners cannot communicate with each other or where the situation is very threatening, such a training will probably be much less effective.

For the full article, click here: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30477-7/fulltext