A recent report by Makerere University School of Public Health reveals a major health crisis in Uganda’s prisons. Nearly half of all inmates have latent tuberculosis, a condition that can easily progress into active disease. Specifically, the report shows that 48 percent of prisoners carry latent TB, while 1.9 percent have active TB. This active TB rate is eight times higher than what is found in the general population.
The findings come from a national survey conducted between July and August 2023. Researchers interviewed 6,000 inmates and prison staff across multiple facilities. Makerere University collaborated with the Uganda Prisons Service, the Ministry of Health, and the US Centers for Disease Control and Prevention. Moreover, the US government provided funding for the study.
Dr Simon Kasasa, who led the research, linked the crisis to dire prison conditions. He explained that overcrowding, poor ventilation, high HIV prevalence, and malnutrition contribute significantly. As a result, TB spreads easily and dormant infections quickly become active.
The report highlights that male inmates are the most affected. Their latent TB rate stands at 47.9 percent. By contrast, the rate is 38 percent among female inmates and 39 percent among prison staff. Clearly, prison conditions affect men more severely, likely due to greater congestion in male prison blocks.
Furthermore, the data reveals stark regional differences. Western Uganda and Kampala recorded the highest active TB rates at 2.8 percent, surpassing the national prison average. Notably, new inmates face the greatest risk. Harsh prison environments often trigger infections that were already present but inactive upon entry.
According to the report, overcrowded and poorly ventilated cells make it easier for TB to spread. Newly incarcerated individuals often arrive with latent TB. However, the stress, poor diet, and unsanitary conditions can rapidly activate the infection. These findings emphasize the urgent need for targeted health interventions.
Professor Rhoda Wanyenze, Dean of the School of Public Health, described the 48 percent latent TB rate as a public health crisis. She stressed that prison conditions are transforming dormant infections into active, contagious disease. Additionally, she warned that the danger does not end behind bars. Once released, inmates can carry TB into the general population.
Dr Mary Boyd, CDC Country Director in Uganda, echoed these concerns. She stated that the findings offer vital data for improving TB control strategies. Addressing TB in prisons, she added, will also protect surrounding communities.
Dr Charles Olaro, Director General of Health Services at the Ministry of Health, confirmed that the report’s findings will guide Uganda’s 2025–2030 National TB and HIV/AIDS Strategy. He acknowledged the severity of the situation, pointing out that Uganda reports about 94,000 TB cases and 4,700 related deaths each year. Therefore, acting on this new evidence could help reduce both infections and fatalities.
Deputy Commissioner General of Prisons Samuel Akena attributed the worsening crisis to severe overcrowding. Uganda’s prisons hold 79,000 inmates, although they were built to accommodate only 22,000. Consequently, he called for increased investment in prison healthcare. He also noted that prisoners are frequently overlooked during policy-making and budget allocation.
Ultimately, the Uganda Prisons TB findings call for immediate attention and action. Without proper interventions, the country could face widespread outbreaks that reach beyond prison walls. Improving prison health conditions—through better ventilation, reduced congestion, and timely medical screening—is not just humane, but essential for public safety.
