DRC prison TB outbreak brings conditions, risks to wider community, to light

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At a prison where more than one in five inmates was confirmed to be sick with TB, an outbreak investigation sparked recommendations for reforms

With a large stock of soon-to-expire Xpert cartridges, at the end of 2014 the diagnostic laboratory near the Democratic Republic of Congo’s Mbuji-Mayi medium security prison started using the technology for the first time to test samples from facility inmates showing symptoms of tuberculosis. The confirmation of 31 cases, three of them resistant to the first and most effective treatments used to treat TB sparked an outbreak investigation, as well as a wider look at conditions inside the prison.

More than 20 percent of the prison’s inmates were sick with tuberculosis, the investigation found, an additional 14 sick with treatment-resistant disease. The findings reflected some of the realities in the world outside the prison’s gates, in a country where limited resources challenge control of the disease, where an estimated 326 of every 100,000 people is affected, and where at least 2 percent of those who get sick are infected with drug-resistant strains of disease. But conditions inside the prison, where no one was tested on the way in, where hunger and malnutrition are norms, and where prisoners occupy slivers of floor space in dark cells built to hold a fraction of the numbers who occupy them now, amplify impacts of the disease in the outside world, and then add to those impacts, according to a report in Emerging Infectious Diseases.

Built in 1950 to hold 150 inmates, the prison held more than 900 as the outbreak investigation began, each assigned a fixed, less-than-2-and-a-half-feet of floor space, the authors note. The rear of the cells, furthest from air and light were home to 60 percent of those diagnosed with tuberculosis. The detrimental health impacts of these conditions were not confined to the prisoners, who were incarcerated there for durations of a month to more than 15 years, and who interacted with prison and court staff as well as with family members during that time. Nor were the conditions unique, the authors write, noting that some prison studies in southern Africa have found higher rates of tuberculosis, as well as higher HIV prevalence.

Screening of prisoners on entry, efforts to avoid overcrowding and provide adequate nutrition as well as sunlight are essential, both to prisoners’ health and broader public health concerns, the authors write. But, they note, protecting those most basic rights of prisoners has been shown to be dependent on independent, and external efforts.

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