Incidence and Risk Factors Associated With Tuberculosis Treatment Outcomes Among Prisoners: A Multicenter Study in Malaysia

Abstract

Background: Prison represents an important setting for tuberculosis (TB) control. Higher TB rates have been reported in prison when compared with general population. Aims and objective: The current study evaluates the incidence of TB among prison inmates from 4 states of Malaysia to identify factors associated with Mycobacterium tuberculosis infection and treatment outcomes. Methodology: A multicenter, cross-sectional, retrospective study was conducted in the 11 prisons in 4 Malaysian states, which were selected based on high burdens of TB in Malaysia (Sabah, Sarawak, Pulau Pinang, and Selangor). Patients with confirmed TB were selected for the study based on tuberculin skin testing and further established by chest radiograph and positive sputum and culture test results. Results: A total of 405 inmates were diagnosed as having TB, with most them being male inmates (n = 397; 98%). The mean ± SD age of TB inmates was 39.28 ± 10.12 years. The sample was ethnically diverse and consisted mostly of Malays (203; 50.1%) followed by Chinese (98; 24.2%), Indians (64; 15.8%), and other ethnicities (40; 9.9%). Of the total 405 TB inmates, most belonged to the Selangor state prison (n = 312; 77%), with an incidence rate of 755/100,000. The overall incidence of TB among 4 state prisons in Malaysia was 440/100,000. Treatment outcome for 279 (68.8%) TB inmates was successful, 31 (7.7%) were defaulters, 12 (3%) were transferred out, 34 (8.4%) died, and treatment of TB for 49 (12.1%) inmates was continued. On univariate analysis, patient sex (odds ratio [OR], 2.21; 95% confidence interval [CI], 0.2-6.8; P < 0.001), age group (OR, 1.65; CI, 1.08-2.53; P = 0.02), area (OR, 1.08; CI, 0.3-3.1; P < 0.001), pulmonary TB (OR, 1.96; CI, 1.2-3.1; P = 0.05), extrapulmonary TB (OR, 0.53; CI, 0.3-0.8; P = 0.015), and TB with diabetes mellitus (OR, 2.21; CI, 0.7-2.7; P = 0.01) were statistically significant as predictors of treatment outcomes. These variables were further analyzed on multivariate analysis, and patient age group (OR, 1.60; CI, 1.0-2.5; P = 0.02) was a more likely factor that affected treatment outcome. Conclusion: Low TB treatment success rates and multiple factors affecting treatment outcomes refer to the fact that attention is needed in improving existing medical setup at prisons.