Risk Factors for Pulmonary Tuberculosis Transmission Among Prisoner in Indonesia

A sharp 13-fold rise in tuberculosis (TB) cases from 2022 to 2023 at the Lhokseumawe City Correctional Institution in Aceh, Indonesia, highlights a brewing public health crisis within the prison system. This facility, built to house 150 inmates but currently holding over 600, exemplifies the overcrowded and high-risk conditions that fuel TB transmission—conditions further complicated by widespread tobacco use, poor health infrastructure, and a high number of inmates with prior exposure to TB. Despite these clear risk factors, no predictive modeling had previously been conducted to understand and prevent TB outbreaks in this setting.

To address this gap, a four-month case-control study was conducted in mid-2024 involving 100 randomly selected male inmates. The study used a semi-structured questionnaire and direct medical examinations to assess individual risk factors. Key findings revealed that 12% of inmates were diagnosed with TB. Statistically significant risk factors included marital status, poor nutritional status, preexisting comorbidities, and close contact with active TB patients. Among these, comorbidities and poor nutrition emerged as the strongest predictors, with odds ratios of 5.52 and 4.46 respectively, emphasizing the role of both underlying health and environmental exposure in TB vulnerability.

The study calls for urgent, actionable interventions tailored to the prison context. Improving nutritional support and routine medical screenings—both at intake and periodically—could drastically reduce undetected TB cases and improve overall health outcomes. Early identification of inmates with comorbidities, along with structured TB contact tracing and treatment protocols, is crucial. These measures, combined with efforts to reduce overcrowding and address broader social determinants of health, would represent a meaningful step toward breaking the cycle of TB transmission in high-risk, confined populations.

Source: Khairunnisa C, Mardiati, Millizia A, Wahyuni S, Nabilah Lubis P, Ikhsan M. Risk Factors for Pulmonary Tuberculosis Transmission Among Prisoner in Correctional Facilities in Lhokseumawe City, Aceh, Indonesia. Natl J Community Med 2025;16(6):582-588.