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 >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.