Tuberculosis Treatment Outcomes Among Prisoners And Non-prisoners In Zomba, Malawi

Abstract

Background TB remains a major global health problem. It is particularly prevalent in prisons in sub-Saharan Africa due to overcrowding, malnutrition, high HIV prevalence and insufficient medical services. Prisoners have experienced worse treatment outcomes than the general population. We investigated the TB treatment outcomes and predictors of unsuccessful treatment outcomes among prisoners and non – prisoners.Methods We retrospectively reviewed TB registers of prisoners and non - prisoners diagnosed with TB from January 2011 to December 2016 at Zomba Maximum Central Prison and Zomba Central Hospital, Malawi. The study used routinely collected data extracted from national, standardized TB treatment monitoring tools. Successful treatment outcome was classified as the total for cured and completed treatment while unsuccessful treatment outcome was classified as the total of deaths and treatment failures. We used descriptive statistics to compare the demographics and TB treatment parameters among prisoners and non – prisoners and computed multivariate analysis to predict the independent factors of unsuccessful treatment outcomes.Results Of 1652 registered cases, 27% were prisoners (all males) and 72% were non-prisoners (58% males). The median age was 35 years (IQR: 29 - 42); 76% were Pulmonary TB cases (78% among prisoners vs 75% among non-prisoners); 83% were new TB cases (77% among prisoners vs 86% among non-prisoners); and 65% were HIV positive (50% among prisoners vs 71% among non – prisoners). Regarding treatment outcome, 1472 (89%) were cured and/or completed treatment (93% among prisoners vs 88% among non – prisoners), 2(0.2%) were treatment failures, 122 (8%) died (5% among prisoners vs 8% among non – prisoners) and 55 (3%) were not evaluated (1% among prisoners vs 4% among non – prisoners). Independent factors of unsuccessful TB treatment outcomes were noted in those with age greater than 35 years (aOR = 0.68: 95% C.I: 0.58 – 0.80), Extra-Pulmonary TB (aOR=1.69: 95% C.I: 1.08 – 2.63), HIV positive status (aOR = 0.63: 95% C.I: 0.42 – 0.94).Conclusion Good TB treatment outcomes which are comparable to the general population can be achieved among Malawian prisoners despite the challenging prison conditions.