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M. tuberculosis among jail inmates of Ethiopian prisons: risk factors, molecular epidemiology and drug resistance
M. tuberculosis among jail inmates of Ethiopian prisons: risk factors, molecular epidemiology and drug resistance
Background: In the 21st century the advancements of science have broaden our understanding about the pathology, treatment, drug resistance, evolutional phylogeny, population structure and transmission dynamics of the TB bacilli. However, these advancements were not sufficient enough to halt the TB epidemic in many Sub Saharan countries. Especially, the emergence of multi drug resistance tuberculosis has posed a significant threat to global TB control. In Ethiopia, TB is one of the three top killer infectious diseases. It is still the major problem in some pocket geographical areas, refugee camps and prisons. TB in prison was not receiving enough attention in the past years, considering the role prisons are playing in ongoing local TB epidemics. As a result, the burden of TB in Ethiopian prisons was largely obscured. Objective: To determine the epidemiology and risk factors of TB in prisons, together with the population structure, transmission dynamics and drug resistance profile of Mycobacterium tuberculosis complex isolates in Ethiopian prisons. Methodology: A two phases cross sectional study was done between Jan, 2013 and May, 2015. Prisons and communities living in south western, southern and Eastern part of the country were included. In the first phase 13 zonal prisons from Oromia, SNNPRS and Harari were included to determine the magnitude and identify the risk factors for TB in prison. In phase two, all M.tuberculosis complex (MTBC) strains isolated in prison and additional 106 control MTBC strains collected from newly diagnosed smear positive TB patients attending selected hospitals at regional states of Oromia, South Nations and Nationalities Peoples, Harari, Somali and Dire Dawa city administration were included. Result: A total of 15,495 inmates were screened by WHO TB screening criteria and 765 suspects were identified. The prevalence of tuberculosis in Ethiopian prison was 458/100.000 inmates. Alcohol consumption, contact with TB patients at home, window availability in prison cells had contributed for the observed prevalence. Furthermore, a total of 11 different lineages/ sub-lineages were identified by combined technique of MIRU-VNTR and spoligotyping. The clustering rate of isolates from prison and community was 28.57% and 31.82% respectively, with some strains from prison and communities sharing the same cluster. The predominant genotype was the recently described Ethiopian_H37Rv like with equal distribution between the prison and the community isolates. The MDR prevalence in the community was 2.27% with no difference with that of prison. Conclusion: The prevalence of tuberculosis in Ethiopian prisons is more than twice higher than the population estimate. The diverse population structure and low clustering of MTBC observed in this study has indicated that most of the TB cases in prison and communities were resulted from reactivation of remote infection. The magnitude of MDR in prison as well as community is very worrisome. Hence, The TB control strategy in Ethiopia should be tailored to address MDR and latent infection.
Tuberculosis, prison, population structure, drug resistance, Jimma university
Mohammed, Solomon Ali
2017
English
Universitätsbibliothek der Ludwig-Maximilians-Universität München
Mohammed, Solomon Ali (2017): M. tuberculosis among jail inmates of Ethiopian prisons: risk factors, molecular epidemiology and drug resistance. Dissertation, LMU München: Faculty of Medicine
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Abstract

Background: In the 21st century the advancements of science have broaden our understanding about the pathology, treatment, drug resistance, evolutional phylogeny, population structure and transmission dynamics of the TB bacilli. However, these advancements were not sufficient enough to halt the TB epidemic in many Sub Saharan countries. Especially, the emergence of multi drug resistance tuberculosis has posed a significant threat to global TB control. In Ethiopia, TB is one of the three top killer infectious diseases. It is still the major problem in some pocket geographical areas, refugee camps and prisons. TB in prison was not receiving enough attention in the past years, considering the role prisons are playing in ongoing local TB epidemics. As a result, the burden of TB in Ethiopian prisons was largely obscured. Objective: To determine the epidemiology and risk factors of TB in prisons, together with the population structure, transmission dynamics and drug resistance profile of Mycobacterium tuberculosis complex isolates in Ethiopian prisons. Methodology: A two phases cross sectional study was done between Jan, 2013 and May, 2015. Prisons and communities living in south western, southern and Eastern part of the country were included. In the first phase 13 zonal prisons from Oromia, SNNPRS and Harari were included to determine the magnitude and identify the risk factors for TB in prison. In phase two, all M.tuberculosis complex (MTBC) strains isolated in prison and additional 106 control MTBC strains collected from newly diagnosed smear positive TB patients attending selected hospitals at regional states of Oromia, South Nations and Nationalities Peoples, Harari, Somali and Dire Dawa city administration were included. Result: A total of 15,495 inmates were screened by WHO TB screening criteria and 765 suspects were identified. The prevalence of tuberculosis in Ethiopian prison was 458/100.000 inmates. Alcohol consumption, contact with TB patients at home, window availability in prison cells had contributed for the observed prevalence. Furthermore, a total of 11 different lineages/ sub-lineages were identified by combined technique of MIRU-VNTR and spoligotyping. The clustering rate of isolates from prison and community was 28.57% and 31.82% respectively, with some strains from prison and communities sharing the same cluster. The predominant genotype was the recently described Ethiopian_H37Rv like with equal distribution between the prison and the community isolates. The MDR prevalence in the community was 2.27% with no difference with that of prison. Conclusion: The prevalence of tuberculosis in Ethiopian prisons is more than twice higher than the population estimate. The diverse population structure and low clustering of MTBC observed in this study has indicated that most of the TB cases in prison and communities were resulted from reactivation of remote infection. The magnitude of MDR in prison as well as community is very worrisome. Hence, The TB control strategy in Ethiopia should be tailored to address MDR and latent infection.