Situations, characteristics, and relative risk factors of TB cases in prisons in the upper north of Thailand
Tuberculosis (TB) remains a public health problem for Thailand. The number of reported TB cases among prisoners in Thailand’s upper north has increased over the past 10 years. An important barrier to TB treatment success in prisoners was a frequent relocation of prisoners to other detention facilities during treatment period. This is a retrospective cohort study aimed to find the association between risk factors and death among TB-affected prisoners. Treatment outcomes were retrieved from TB case management database (TBCM online), which is the single recommended electronic TB recording in hospitals throughout Thailand. The study identified a total of 557 TB cases in prisons. Of these, 59 cases (10.6%) died while on treatment. Average time from start of treatment to death was 51.19 days. The risk factors associated with death were male (RR 1.3, 95% CI 0.03-4.9, p>0.05), age 61-65 yrs. (RR = 3.00; 95% CI = 0.39–23.07), age 66-70 yrs. (RR = 2.25; 95% CI = 0.30–16.63), age > 70 yrs. (RR = 2.00; 95% CI = 0.24–16.61), lung cavity (RR1.2, 95% CI 0.6-2.3, p>0.05), Human Immunodeficiency Virus positive (RR 3.6, 95% CI 2.2-6.0, p<0.05), and no administration of anti-retroviral drugs among HIV-infected cases (RR 4.0, CI 2.0-8.0, p<0.05). Mean body weight of fatal TB cases was 49 kg and in those who remained alive was 53 kg (p<0.05). It was concluded that major risk factors associated with death among TB-affected prisoners were age >60 years, co-infection with HIV, no initiation of anti-retroviral therapy, and body weight less than 50 kg. Early case detection revealed a reduction in disease severity and timely initiation of treatment could also reduce the death rates. In those with co-infection with HIV, early treatment with ART also reduced the mortality rates.
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