Prevalence and risk factors of mycobacterium tuberculosis infection among prisoners in Kabul central prison (Puli Charkhi), Afghanistan

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


Tuberculosis (TB) is a chronic, infectious and granulomatous disease caused by infection with Mycobacterium tuberculosis. When a person with infectious TB coughs, sneezes or even speaks, the TB bacteria enter the air and people nearby might breathe in these bacteria and become infected. TB is much more prevalent and easily transmitted in crowded spaces such as prisons. Prisons work as store houses for TB, from where it can be transmitted to the general population. The World Health Organization (WHO) declared TB a global emergency in 1993 due to its growing importance as a public health problem. Almost 5,000 people die daily due to TB and every second a person gets TB infection. TB kills more people than any other single infectious disease agent. In Afghanistan, 76,000 cases develop and more than 20,000 die due to TB every year among the general population. The prevalence of tuberculosis is 10 — 100 times more common in prisons than in the general population. Studies around the world have found high prevalence of tuberculosis infection in prison population: for example 48% in NWFP prisons of Pakistan, 45% in Lebanese prisons, 56 % in Spanish prisons, and 17.9% in Italian prisons. The conditions of prisons in Afghanistan are poor. Due to continuous war and conflict over the last 25 years in the country all systems including the health system have been badly affected. Prisons have been one of the most neglected and war stricken areas in Afghanistan. An estimated high prevalence of TB in the population and poor condition of prison encouraged us to conduct this study to determine the prevalence of Mycobacterium tuberculosis (MTB) infection and risk factors associated to the above-mentioned infection in Kabul Puli Charkhi Prison, Afghanistan. A cross-sectional study was conducted to assess the prevalence and evaluate the risk factors related with MTB infection in Kabul Central Prison (Puli Charkhi), Afghanistan. Using a well-structured questionnaire, we administered tuberculin skin test (TST) – a WHO recommended test to screen inmates with TB infection, in order to determine the prevalence of TB infection. We enrolled all female and male prisoners excluding those who were sentenced to death, had less than 3 months of stay in prison, were confirmed TB case, or pregnant women. The total number of prisoners was 2,500 who were distributed in four blocks. Stratified random sampling was used to select prisoners for the study. We enrolled 250 inmates who undertook interview and tuberculin skin testing. Analysis was performed on 237 prisoners who completed the interview and were followed for TST testing. Of them, except eight (8), all were male prisoners. The prevalence of MTB infection was 55.7 % (132/237) amongst the prison population. In the final multivariate model by adjusting confounding factors, age, weight, monthly income prior to imprisonment, duration of incarceration, area of accommodation per prisoner, personal hygiene, content of food (meat and bean), low grade fever and night sweat were associated with TST positivity. It is essential for concerned authorities to take immediate measures for control and prevention of tuberculosis in prisons in Afghanistan. Joint management of national TB control programme and prison health centre is suggested for early case detection and appropriate treatment by following the WHO recommended Directly Observed Treatment Short-Course (DOTS) strategy. Due attention should be given to high risk group such as poor, low socio-economic class, old age, low weight, and prisoners. Rebuilding of damaged blocks and distribution of prisoners to decrease overcrowding, special consideration to those who have spent more time in prison is suggested. Encouragement of inmates for personal hygiene and enrichment of their meals with protein-material would decrease level of infection.

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