South Africa: Overcrowding fuels TB in prisons
Tuberculosis (TB) rates in South Africa's prisons could be cut by up to 94 percent if the country reduced overcrowded conditions in cells and implemented active TB case finding, according to research presented at the recent South African TB Conference.
Overcrowding and poor living conditions have driven TB in
prisons for centuries, but a recent court case has finally given
South African researchers at the Desmond Tutu HIV Centre at the
University of Cape Town enough information on conditions in one
of the country's prisons to mathematically model TB transmission
risks.
Using witness testimonies to deduce TB risk factors for inmates,
researchers found that overcrowding - more so than poor
ventilation or a lack of access to outside yards - was the main
driver of TB in a prison environment.
Reducing overcrowding by conforming to South Africa's own
national guidelines would lower the risk of TB infection for
inmates by almost a third, and bringing the country's prisons in
line with international standards would halve the risk. However,
researchers found that implementing international standards as
well as active case finding could bring down the risk by 94
percent.
"Having communal cells with more than 20 prisoners per cell in a
country like ours is a total disaster," said Prof Robin Wood of
the Desmond Tutu HIV Centre, who called prison conditions a
human rights abuse.
South Africa is ranked at 17 among the 22 countries that account
for 80 percent of all TB cases globally, according to the World
Health Organization (WHO). South Africa diagnoses about 400,000
cases annually.
Although many people carry TB, only 10 percent will ever develop
the active disease. But people with compromised immune systems,
such as those living with HIV, are up to 37 times more likely to
develop active TB.
In 2011 a former inmate of Cape Town's Pollsmoor prison, Dudley
Lee, took the Department of Correctional Services to court,
arguing that the conditions he was forced to live in for almost
five years as an awaiting-trial prisoner caused him to develop
active TB.
Pollsmoor was built to house 1,800 inmates but now has about
4,200, Wood said. South Africa's 240 correctional facilities
hold about 160,000 prisoners, about a third more than the
facilities were built to accommodate, according to the Institute
for Security Studies, a South African think-tank.
Lee's legal team argued that although the Department of
Correctional Service was aware of the elevated TB risk
associated with overcrowding and poor ventilation, it failed to
respond to prisoner requests for adequate TB prevention and
treatment. The department could also have reduced the risk by
segregating prisoners with active TB during the period they were
infectious.
A judge initially ruled in favour of Lee, who sought about
US$46,600 in compensation from the state, but the ruling was
later overturned.
PlusNews
http://www.irinnews.org/Report/95684/SOUTH-AFRICA-Overcrowding-fuels-TB-in-prisons
