Prevalence of latent tuberculosis infection and identification of associated risk factors in overcrowded Central Prison Rawalpindi, Pakistan
Authors: Fatima Kainat , Zaheer Rabia , Sohail Zaib , Shakeel Mehr-un-Nisa 
Published: December 2024

Purpose
This paper highlights public health issues arising in prisons due to overcrowding – focusing on existence of tuberculosis (TB) and its transmission in a TB endemic country. It further addresses feasible TB management, to develop an applicable preventive intervention that will control TB transmission and development within and outside prisons. This study aims to decrease morbidity and mortality caused by TB by identifying latent tuberculosis infection (LTBI) cases.

Design/methodology/approach
A novel cross-sectional study conducted on male prisoners of Central Prison Rawalpindi, dividing them into three strata, i.e. under-trial (UTP), convicted (CTP) and condemned (CP) prisoners. Prevalence of latent TB infection within prisoners was methodologically calculated using multiple statistical analysis at 95% confidence interval. This research sourced an invasive skin test (Mantoux test) for primary data collection from targeted key population.

Findings
This research calculated existing prevalence of LTBI at 47.25%, 47.45% and 53%, respectively in UTP, CTP and CP prisoners, and 32.2% in total prison population. Overcrowding, poor health conditions and excessive smoking presented strong statistical significance to high LTBI prevalence across the prison population.

Research limitations/implications
Limitations included accessibility to prisons due to procedural concealment, and unannounced release of UTPs that was dealt through supplementary testing. The presented research findings highlight the disease spread across key populations, and the importance of identifying, containing and controlling them. It elaborates the crucial use of Mantoux tuberculin skin test (TST) to identify and isolate LTBI and potential TB cases in a closed population. It also facilitates policy implications that promote health and safety for prisoners, law enforcers and associated external population.

Practical implications
TB is one of the top 10 fatal illnesses and second highest infectious disease worldwide. For decades, TB ruled over human health and threatened their survival. Health-care professionals face challenges in locating, isolating, treating and controlling TB across the globe. Pakistan is a TB endemic country that internationally ranks fifth in nations with high TB burden. LTBI prevalence is unknown in Pakistan. Key populations are well-known to comparatively live with higher rates of infectious disease. Therefore, this research targeted a key population and has successfully calculated LTBI prevalence in overcrowded male prison population.

Social implications
Key populations are at high risk of contracting and transmitting communicable diseases. They not only possess higher disease incidences, but are also responsible for disease-spread within and outside their community. Targeting them will help in controlling for LTBI across prison population as well as the external population that is associated with the prisoners. TST allowed maximum screening coverage, encapsulated LTBI, spread awareness and eliminated stigmatisation.

Originality/value
Prevalence of TB and LTBI are unknown in Pakistan. This novel research calculated LTBI prevalence through primary data collection and targeted key populations. Authors collected primary data on case-by-case basis. This study has efficaciously located and isolated LTBI cases among the sample population following internationally standardised TST procedures.