Tuberculosis incidence in Cameroonian prisons: a 1-year prospective study.

BACKGROUND Rates of tuberculosis (TB) transmission in prisons are reported to be high worldwide. However, a recent systematic review identified only 19 published studies reporting TB incidence in prisons, most of them from the last century and only one from sub-Saharan Africa. OBJECTIVES To assess the persisting risk of smear-positive pulmonary tuberculosis (PTB) among prison populations benefiting from a comprehensive TB/HIV control programme in Cameroon, compared with that in the community. METHODS This descriptive and prospective study evaluated PTB incidence rates over a 1-year period. The study population was inmates of 10 major prisons, sampled by convenience, comprising about 45% of the country's prison population. As PTB incident cases, all prisoners with incident PTB after a prison stay of > or = 90 days were considered. The prison TB incidence rate was compared with that of the corresponding male population in the community. RESULTS The mean annual PTB incidence in Cameroonian prisons in this study was 1 700 cases in 100 000 person-years at risk, the incidence rate ratio being 9.4 (95% confidence interval 8.1-10.9). CONCLUSION Findings suggest that internationally recommended prison TB control measures alone may not help protect prisoners from within-prison spread of TB. Imprisonment policies and conditions therefore require fundamental changes.