IN-DEPTH: How Nigeria’s prisons became hotbeds for tuberculosis

…No GeneXpert machines in Nigerian prisons, inmates referred outside for tests, NCoS confirms

By Muslim Muhammad Yusuf

Kala Daniel, found himself trapped in a waiting trial for six long months in a Nigerian prison. Initially healthy, Daniel began serious coughing within weeks of his incarceration, only to later learn that he had contracted tuberculosis (TB).

“Three weeks in, and I started coughing uncontrollably,” Daniel recalls. Despite receiving some treatment from the prison’s facility, the medication he said was insufficient, and the symptoms persisted long after his release.

“They gave me some red pills,” Daniel says, describing the medication he took.

Hundreds of inmates, many awaiting trial, inside the crowded Suleja correctional facility prison in Niger state, are left with little more than herbs, paracetamol, and remedies to fight serious illnesses —including TB—  quietly spreading; a common case in many Nigerian prisons.

Health units within Nigeria’s facilities are reportedly empty or under-equipped, and medicines donated by NGOs allegedly vanish into opaque channels, leaving prisoners to fend for themselves.

Abdul Rasaki (pseudonym), 26, currently awaiting trial at Suleja prison, said has been battling tuberculosis for over nine months. Living in a crowded room with more than 25 inmates, Rasaki said he contracted TB within just two months of entry.

Speaking to this reporter through a trusted source from inside the prison, Rasaki described the treatment as inadequate, leaving him barely able to breathe. “The illness has been tormenting me and causing me so much suffering.”

“Doctors said I am beginning to have drug resistance, but they promised to try another regimen, and they won’t allow us to seek help outside.” Although they said the medicine is free, provided by the government, it’s not helping,” Rasaki added.

Added to his testimony, some ex-inmates insisted that the health system in Nigerian prisons is “not something to write about.”

Warders, speaking in confidence to this reporter from Niger and Kaduna correctional facilities, also say health units meant to serve inmates are often empty. They said Medicines are scarce, and those who fall ill must rely on prayers or fate.

The World Health Organisation’s 2023 Global Tuberculosis Report underscores the severity of the crisis. WHO said TB prevalence in prison populations is about ten times higher than in the general population.

Globally, in 2019, an estimated 125,105 people in prisons fell ill with TB. The incidence rate was 1,148 cases per 100,000 person-years, yet only 53% of these cases were detected. In other words, nearly half of incarcerated people with TB remain undiagnosed, untreated, or unreported, hidden in cells where infection can spread silently.

How inmates self-medicate to survive

With clinics running with little medicine or empty, many inmates in Kuje and Suleja prisons have learnt to treat illness on their own, mixing herbs, sharing tablets, or bribing warders to smuggle drugs from outside pharmacies.

Bello Maikudi, who spent a year inside Kuje Prison between 2022 and 2023, told this reporter that he walked into the facility completely healthy, only to fall sick months later. He recalled the struggle with medication while in custody. “There is a clinic inside, yes, but it doesn’t have enough drugs for all of us. The shelves are almost always empty,” he said.

“We sometimes get drugs from NGOs. The drugs are strong for me because there is no adequate food. I fall sick when I take the medication and feel healthy when I do not take it,” he said.

He alleged that, because of the intensity of the drugs and the lack of proper nutrition, many inmates began hiding their diagnoses and test results to avoid treatment.

“As a result, self-medication became common. Inmates mixed herbs, shared tablets, or bribed warders to bring medicines from outside, creating dangerous habits that worsened health outcomes and increased the risk of drug resistance,” he alleged.

A secret source from inside Suleja prison attempted to capture the health facility, but said doing so openly would have exposed him to risk, as inmates are not permitted to possess mobile phones.

According to him, he was in isolation for TB contraction during the interview and could only safely photograph the conditions of the cells, which he said typically housed no fewer than 20 to 25 inmates per cell.

A warder from the Niger state correctional facility also corroborated Maikudi’s claim, saying, “Yes, sometimes we do help some inmates to get things outside the prison, but at a higher price. We buy whatever they want”, the anonymous warder said.

Nigerian law, particularly the Nigerian Correctional Service Act (2019) and the Prisons Act, mandates that inmates receive healthcare, including providing curative and preventive care, and ensuring humane living conditions.

According to the law, Inmates are entitled to medical attention. The Act states that in cases of serious illness, an inmate can be moved to a hospital on the medical officer’s certification.

Nigeria’s inmate data

According to data from the World Prison Brief (WPB), Nigeria ranks as the 7th country with the largest prison population in Africa and 29th in the world, holding an estimated 81,349 inmates across its correctional facilities.

It added that as of April 28, 2025, Nigeria’s prisons are operating at 136.7% capacity, indicating severe overcrowding. The total inmate population includes both convicted individuals and pre-trial detainees.

However, data from Nigerian Correctional Service portals indicates that as of November 2025, Nigeria’s prison population is around 79,873 inmates, with a significant majority of 66% being pre-trial detainees. Of this figure, 77,968 are male,s while 1,905 are females.

The population includes 27,039 males and 507 convicted females, with an additional 50,929 males awaiting trial and 1,398 females awaiting trial.

Recent research by the South Asian Journal of Research in Microbiology indicates high TB rates in specific prisons, with some studies finding prevalence rates like 2.76% in some facilities or over 12% in others, highlighting an ongoing public health concern.

It studies have found a significant prevalence of TB among inmates in different Nigerian prisons. For example, one study in Benue State found a 2.76% prevalence, while another in Aba prison reported a high rate of 2405 cases per 100,000 inmates.

However, it said the prevalence can vary significantly depending on the specific prison, as shown by studies in different states and facilities.

The research conducted in May 2025 by samples of 144 inmates within the age ranges of 21years and above 60 years, were screened for pulmonary tuberculosis. Sputum samples were collected among inmates and were investigated for pulmonary tuberculosis by Gene Xpert/Truenant.

The Gene Xpert system is an automated molecular diagnostic platform primarily used to detect various infectious diseases, most notably tuberculosis and simultaneously identify drug resistance.

According to the research, of the 144 inmates screened, 134(93.06%) were males, 10(6.94%) were females, and the overall prevalence of pulmonary tuberculosis obtained from the study was 2.76%. Tuberculosis infection was higher (4.07%) within the age range of 31-40 years.

The prevalence of the infection during their months of stay in prison showed that inmates with a short period (6-12) months (4.81%) of stay were infected most with this disease. In relation to gender, males had a higher prevalence (5.92%) than females.

Emotional and psychological trauma

After his release, Kala Daniel faced the lingering trauma of his ordeal. “I could not go out, could not mingle with people. Constant coughing, shortness of breath, and sleepless nights further strained my mental health.

Even now, Daniel battles the aftereffects of TB. Financial constraints limit his access to quality healthcare, and his once-active life has been put on hold.

“Financial constraints limit my access to quality healthcare, and my once-active life remains on hold,” he said.

The trauma of both the disease and the unjust imprisonment continues to affect him daily.

A lot of inmates do not have access to proper medical care – CSO

Premium Times reported in 2021 that inmates are poorly fed, with official allocations of just N750 (half dollar) per day, barely enough to sustain a person, and only a modest increase from N450 in previous years. These conditions make prisoners especially vulnerable to illnesses like tuberculosis.

According to statistics from a prison advocacy group, Prison Insider, 70% of inmates in Nigerian prisons are awaiting trial, meaning they have been arrested and charged but not convicted.

While about 26,000 children are in prison, either born to incarcerated parents or detained under unclear legal circumstances.

Joke Aladesanmi of the Centre for Legal Support and Inmate Rehabilitation paints a stark picture of health conditions in Nigeria’s prisons. According to her, the well-being of incarcerated persons is yet to be prioritised.

“One thing people forget is that these are human beings. If you look at the prison statistics and the overpopulation in our centres, it may sound like numbers, but behind each number is a person facing serious health risks.” Aladesanmi said.

She highlighted the extreme congestion in many facilities, noting that some prisons built to hold 800 inmates are housing up to 3,000.

She said this makes it easier for any disease to find its way into such a crowded space. Aladesanmi specifically mentioned tuberculosis, saying that, given the situation and limited access to medical care, outbreaks are unsurprising. “A lot of inmates do not have access to proper medical care,” she explained.

Aladesanmi also stressed that this problem is not confined to one location. She said Urban centres such as Lagos, Kano, and Rivers face extreme overcrowding, while smaller cities struggle with resource availability.

Aladesanmi, who is also a legal practitioner in Nigeria, emphasised that solutions begin with government prioritisation of justice and public health.

“Many countries still see justice as a liability or expense, and it looks like supporting prisoners is wasting resources. We need to move past that. These are citizens who deserve equal access to government support. If the government is serious about public health, prisons cannot be excluded.”

Stakeholders react

In response to questions about tuberculosis management in Nigerian prisons, Dr. Adesigbin Clement Olufemi, who serves as the Head of the Programmatic Management of Drug-Resistant Tuberculosis (PMDT) Unit at the National Tuberculosis and Leprosy Control Programme (NTBLCP) in Nigeria, acknowledged the severity of the problem while highlighting government measures.

He explained that the NTBLCP has expanded molecular diagnostic capacity, including GeneXpert, Truenat, and TB-LAMP platforms, and deployed mobile X-ray and CAD units to congregate settings, including prisons, through partner-supported initiatives.

“TB treatment is provided free of charge, and treatment initiation has been part of prison screening campaigns,” he said

Dr. Clement noted that while many prisons nominally have health units, staffing and equipment gaps remain significant. He said implementation relies on interagency coordination between the NTBLCP, Nigerian Correctional Service (NCoS), and state Ministries of Health, supported by NGOs and donor partners.

He also recognised the heightened risk posed by overcrowding and a large pre-trial population, particularly for vulnerable groups such as women, children, and adolescents.

NCoS responds, says no GeneXpert machines in Nigerian prisons

The Nigerian Correctional Service has a Health and Welfare Directorate responsible for providing both curative and preventive healthcare to inmates.

In a written response to this reporter, dated December 4, 2025, signed by Dr. Stanley S. Otalu, Assistant Controller General of Corrections and Chief Medical Director of the Henry Akingba Medical and Research Centre, said the NCoS is structured in a way that places a high premium on the welfare and healthcare of inmates.

The Service denied allegations that inmates are required to bribe officials to access medical care, insisting that healthcare services in custodial centres are provided free of charge.

It described such claims as “anecdotal and unsubstantiated”, adding that the current leadership does not tolerate corrupt practices and would impose sanctions if any such conduct is proven.

“The Service provides medications and medicaments to inmates at no cost. If such prescribed medications are out of stock, the superintendent of the facility procures them for the inmate and subsequently gets reimbursed.” Dr. Otalu said.

He noted that facilities such as the Medium Security Custodial Centre (MSCC), Kuje, serve as reference points for prison healthcare delivery, with doctors, nurses, pharmacists and laboratory scientists deployed to manage inmates’ health needs.

On tuberculosis control, the Service said it routinely screens, diagnoses and treats TB and other communicable diseases within custodial centres. Dr. Otalu explained that some facilities are equipped with X-ray machines and laboratories capable of detecting acid-alcohol-fast bacilli (AAFB), the organism responsible for TB, citing MSCC Kuje, Ikoyi and Gusau as examples.

Inmates referred outside for TB tests

Addressing concerns about diagnostic capacity, the Service acknowledged that GeneXpert machines are not yet available within custodial centres. However, it said inmates are referred to external health facilities for the test at no cost.

“Genexpert is not available in any of the custodial centres yet, but inmates are referred to outside facilities to do it at no cost to them.” Dr. Otalu said.

He, however, added that the screening for other communicable diseases is also done regularly, and especially at the point of admission of new inmates.

While acknowledging the challenges, including a shortage of healthcare personnel, However, Dr. Otalu attributed it to the wider national and global trend of medical professionals emigrating.

“The dearth of health personnel is not peculiar to NCOS, which is a microcosm of the country, but a national and global phenomenon as the ‘tsunami’ of the ‘Japa’ Syndrome does not spare the Service.” He said.

Meanwhile, Dr. Otalu added that the Federal Government has approved the recruitment of additional health professionals, including doctors and nurses, a process he said is already underway.

NOTE: This report received support from the Thomson Reuters Foundation as part of its global programme aiming to strengthen free, fair and informed societies. Any financial assistance or support provided to the journalist has no editorial influence.  

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Credit: Daily Trust