One-fourth of the prisoners are underweight in Northern Ethiopia: a cross-sectional study

Khat consumption and undernutrition among adult population in Ethiopia: A systematic review and meta-analysis

BACKGROUND

In Ethiopia, malnutrition is a public health threat causing a significant burden of morbidity, mortality, and economic crisis. Simultaneously, khat consumption is alarmingly increasing among adults, yet it might contribute to the existing burden of malnutrition, where the current evidence is inconclusive. Hence, this review was to estimate the association between khat consumption and undernutrition among adults in Ethiopia.

METHODS

A comprehensive search for Google, Google Scholar, and PubMed, coupled with a thorough manual search of the literature, was done up to date, October 18, 2023, using relevant search terms: "impact," "effects," "khat chewing," "khat consumption," "Ethiopia," "nutritional status," and "undernutrition." An updated PRISMA guideline was used to select relevant literature. The extracted data was summarized in narrative summaries, descriptions, and meta-analyses. The risk of bias was assessed. The results are presented in forest plots and funnel plots to assess publication bias. A pooled effect size (odds ratio) with a 95% certainty level was reported.

RESULTS

While a total of 17 articles (n = 45,679) were included in the narrative review, only 15 articles were included in the quantitative meta-analysis. The majority of studies had a low and moderate risk of bias (based on risk of bias assessment tool), mainly due to unclear exposure assessment and high study heterogeneity. A total of 11 studies were cross-sectional studies (71%), three were comparative studies (17.4%), and three were case control studies (17.4%). There is a higher risk of publication bias as evidenced by the funnel plot. Overall, five studies were from the Oromia region, and three studies were conducted at the national level. Overall, chewing had been shown to significantly increase the risk of undernutrition by 53% (pooled OR = 1.53; 95% CI: 1.09-2.16) under a random effect model. Under the fixed effect model, higher weight was given to national-level studies with higher samples, where chewing contributed to a 12% increased risk of undernutrition (AOR = 1.12; 95% CI: 1.01-2.23). Hence, khat chewing could raise the odds of undernutrition by 12-53%.

CONCLUSION

There is evidence of an association between khat chewing and an increased risk of undernutrition among adults in Ethiopia, which highlights the need for public health interventions to address the potential adverse effects of khat chewing on nutritional status.

Diet-Related Risk Factors for Chronic Noncommunicable Diseases in Italian Prisoners: B.A.C.I. (Benessere All'interno delle Carceri Italiane, Well-Being Inside the Italian Prisons) Project by the Italian Society of Penitentiary Medicine and Public Health (S.I.M.S.Pe. Società Italiana di Medicina e Sanità Penitenziaria)

PURPOSE OF REVIEW

The review aims to present an overview of inmate health, focusing on lifestyle-related diseases, physical activity levels, and nutritional status. It also presents the B.A.C.I. (Benessere All'interno delle Carceri Italiane, well-being inside the Italian prisons) project, which aims to offers an innovative path of prevention, diagnosis, and treatment of noncommunicable diseases (NCDs) related to unhealthy lifestyles in prisons in the Campania region, Italy.

RECENT FINDINGS

The global prison population has risen by 24% since the year 2000, with over 10.77 million people detained worldwide in 2021. In Italy alone, there are currently over 57,000 inmates. Inmates face a higher risk of NCDs such as cardiovascular disease due to unhealthy lifestyles characterized by poor diets and lack of physical activity. Additionally, sleep disorders, particularly insomnia, are prevalent among inmates, further contributing to health disparities. While physical activity has shown positive effects on inmate well-being, there is limited research on nutritional status and interventions in prison populations. Providing quality healthcare to inmates is an international policy norm, but the standards vary globally and are often inadequate. The economic burden of NCDs is rising, and this is exacerbated in prisons, making it challenging for individuals to reintegrate into society after release.

Undernutrition and associated factors among adult prisoners in Fiche town, central Ethiopia: a facility-based cross-sectional study

Background

Undernutrition is a major public health problem worldwide, particularly in developing countries like Ethiopia. However, nutritional problems are frequently overlooked in low-income countries, especially among vulnerable populations such as imprisoned people. The scientific data on the rate of undernutrition among imprisoned people in Ethiopia is limited. Hence, this study aimed to assess the magnitude and associated factors of undernutrition among adult prisoners in Fiche town, central Ethiopia.

Methods

A facility-based cross-sectional study was conducted from August 15 to September 15, 2020. A systematic random sampling technique was used to select participants. All prisoners whose age was 18 years and above who have been in prison for at least 6 months were included. Data were collected using interviewer-administered pretested semi-structured questionnaires and standard anthropometric measurements. A cut-off point of body mass index <18.5 kg/m² was used to measure undernutrition. Data were coded, entered into Epi-data version 3.1, and analyzed using Statistical Package for Social Sciences version 20.0. A binary logistic regression analysis was conducted to identify factors associated with undernutrition. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was calculated to measure the strength of the association and a p-value of less than 0.05 was considered statistically significant.

Results

The overall magnitude of undernutrition among adult prisoners was 20% (95% CI: 16.5-23.6). Duration of imprisonment, incarcerated for 25 to 59 months (AOR = 3.07; 95% CI: 1.33, 7.04) and for greater than 59 months (AOR = 4.56; 95% CI: 2.0, 10.45), mild and moderate depression (AOR = 1.9; 95% CI: 1.05, 3.45), and moderately severe and severe depression (AOR = 2.78; 95% CI: 1.17, 6.60) were significantly associated with increased odds of undernutrition. However, being female (AOR = 0.51; 95% CI: 0.26, 0.98), having financial support (AOR = 0.36; 95% CI: 0.15, 0.87), engaging in income-generating work within the prison (AOR = 0.27; 95% CI: 0.15, 0.47), having medium dietary diversity (AOR = 0.35; 95% CI: 0.15, 0.80), and having good dietary diversity (AOR = 0.23; 95% CI: 0.08, 0.61) significantly decreased the odds of undernutrition.

Conclusion

The magnitude of undernutrition among adult prisoners was high, with one in five prisoners in Fiche town prison having undernutrition. Sex, financial support, duration of imprisonment, income-generating work in the prison, dietary diversity, and depression were predictors of undernutrition. Hence, access to healthy food and diversified diets should be ensured for prisoners, and implementing early screening and treatment of depression, as well as encouraging prisoners to engage in income-generating work within the prison is recommended to reduce the burden of undernutrition.

Prevalence of Vitamin-D deficiency and insufficiency among prisoners across the globe: A systematic review and meta-analysis

BACKGROUND AND AIM

Inadequate nutrition is linked to a wide range of detrimental chronic and infectious illness outcomes among the prison populations. However, there is a paucity of thorough analysis of the prevalence of vitamin D deficiency among jail inmates. Consequently, in order to bridge this gap, we conducted a thorough research to ascertain the incidence of vitamin D deficiency among prisoners worldwide.

METHOD

Six computer-based literature indexes were thoroughly searched for topic focused publications. The I2 test was used to determine heterogeneity among the studies. The overall effect was assessed using a random-effects model with a 95% confidence interval. We used metafor package in R version 4.2.1 for the analysis of data.

RESULT

Out of 612 studies, 4 studies were included for analysis. The estimated pooled prevalence of vitamin D deficiency was 55% among prisoners. On the other hand, 29.41% were found to have insufficient vitamin D levels.

CONCLUSION

Despite the scant available research, vitamin D deficiency is prevalent among prisoners. Regular vitamin D status evaluations using reliable health tests, dietary inspection and supplementation are crucial.

PROSPERO REGISTRATION ID

CRD42023396203.

Assessment of menstrual hygiene management practice and associated factors among prisoners in South Nation Nationalities and peoples region, Ethiopia

Introduction

Menstrual hygiene management practice is the requirements and necessities; such as the use of a sanitary pad or clean and mushy absorbents, sufficient washing of the genital area, proper disposal of the used absorbents, and other special needs for the women during menstruation.

Objective

To assess menstrual hygiene management practice and associated factors among prisoners in south Nation Nationalities and Peoples Region, Ethiopia, 2022.

Methods

An institution-based cross-sectional study was conducted from May 1 to July 30/2022. The total sample size was 605 and a simple random sampling technique was used to select prison institutions and women. The data were collected through face-to-face interviews. Data were entered using Epi data 4.6 version and analyzed by using SPSS version 26 software. Multicollinearity was checked and the goodness of fit test was done by using the Hosmer Lemeshow model of goodness fit test. Univariate analysis was done and variables with p value less than 0.25 were taken to bivariate logistic regression analysis. Adjusted odds ratio with the 95% confidence interval was considered and statistical significance was at a p-value less than 0.05 in bivariate logistic regression analysis.

Result

The prevalence of menstrual hygiene management practice was 50.6% (95% CI 47.3-54.4). Age 19-29 years old [AOR: 5.03, 95% CI 1.73-14.62], educational status; not formally educated [AOR: 0.05, 95% CI 0.02-0.13], educational status; primary level [AOR: 0.17, 95% CI 0.07-0.39], previous occupation; student [AOR: 2.56, 95% CI 1.06-6.21], previous occupation; a private employee [AOR: 4.11, 95% CI 1.48-11.42], previous occupation; government employee [AOR: 3.46, 95% CI 1.18-10.14], absence of support from family [AOR: 0.14, 95% CI 0.08-0.24] and absence of work engagement in prison [AOR: 0.44, 95% CI 0.25-0.78] were associated with MHMP.

Conclusion

In this study, about five from ten women in prison practice menstrual hygiene management. Age, educational status, previous occupation, support from family, and work engagement in prison were important risk factors for MHMP. Therefore, support from family and engaging the women to work in prison institutions may increase the MHMP in prison institutions.

Assessment of Nutritional Status and Health Perception among Male Inmates in Israeli Prisons

The nutritional and health perceptions of inmates are crucial to their overall well-being. However, limited research has been conducted on this topic. This study aimed to assess the nutritional and health perception state of male inmates in eleven prisons in Israel. A cross-sectional study was conducted between February and September 2019 with 176 voluntary participants. Structured questionnaires were used to collect data on socio-demographic characteristics, healthy habits, subjective health status, and prison situation variables. The study found that the prevalence of overweight (40%) and obesity (18.1%) among 18-34-year-old inmates was significantly higher than in the reference Israeli population. Short detention periods (up to one year) predicted less weight gain, while older age predicted poorer health status. Better emotional status significantly predicted better subjective health status among male inmates. There is a need for nutrition interventions to improve the health of inmates. The significant weight gain during incarceration and the associated lower health index and stress highlights the importance of increasing knowledge and promoting a healthier lifestyle in incarceration as early as possible and continuing over time.

Assessment of Satisfaction with Health Services among Prisoners—Descriptive Study

Aim: The aim of the study was to assess the access of prisoners to healthcare services, as well as the level of satisfaction with the provided services and health assessment among prisoners. Methods: The research was conducted in one of the penitentiary centers in Poland among people jailed between 1 January to 31 January 2020. The response rate of the self-administrated questionnaire was 52.05% (469/901) participants. There were 389 men and 77 women. Results: Prisoners assessed access to health services including GP doctors, specialist doctors, dentists, and hospitals in 3 categories: “bad” ranged: 27.03–67.60%; “medium” ranged: 22.54–53.57%; “good” ranged: 7.02–33.96% depending on the type of arrest, but no statistical significance was demonstrated. Satisfaction with the health services defined as “bad” ranged: 25.00–61.11%; “medium” ranged: 18.97–55.56%; “good” ranged: 5.56–34.62% depending on the type of arrest but no statistical significance was demonstrated. Of 469 prisoners, 215 prisoners (45.84%) declared no addictions. The frequency of addiction does not differ depending on the place/type of punishment served (p = 0.9). In turn, 317 prisoners (68%) declared no chronic diseases. Conclusions: Most of the prisoners described access to health services as “bad”, except female prisoners from a semi-open facility. In turn, satisfaction with healthcare services was most often assessed as “bad”, except for temporarily arrested men and female prisoners from a semi-open facility.

Undernutrition and associated factors among incarcerated people in Mizan prison institute, southwest Ethiopia

BACKGROUND

In resource-limited countries like Ethiopia, where malnutrition is a common problem, incarcerated people's sentences might be changed into a death sentence if the problems of undernutrition are not well understood and managed properly. There is limited evidence on nutritional status and associated factors among incarcerated people in low- income countries like Ethiopia, including the study area.

OBJECTIVE

To assess the magnitude of undernutrition and associated factors among incarcerated people in Mizan prison institute, southwest Ethiopia.

METHODS

An institution based cross-sectional study was conducted among 340 incarcerated people in Mizan prison institute from April 1 to 27, 2020, using a stratified sampling technique. An interviewer-administered structured questionnaire was used to collect data. The outcome variable (undernutrition) was assessed by measuring body mass index (BMI). Binary logistic regression was used to identify factors associated with undernutrition. Adjusted odds ratio (AOR) and 95% confidence intervals (CI) were used to measure the strength of association and a p-value less than 0.05 was used to declare the level of statistical significance.

RESULTS

The magnitude of undernutrition was 18.6% (95%CI: 14.4%, 22.8%). Being in the age category of 18-29 years (AOR = 2.60; 95%CI: 1.22,5.52), history of previous incarceration (AOR = 2.31;95%CI: 1.23,4.34), duration of imprisonment (AOR = 1.19; 95%CI: 1.05,1.34), having depression (AOR = 2.1; 95% CI: 1.10,3.97) and sleeping in group (AOR = 2.17; 95% CI: 1.18,4.01) were factors significantly associated with an increased odds of undernutrition. However, the presence of family support significantly decreased (AOR = 0.29; 95%CI: 0.12, 0.69) the odds of undernutrition.

CONCLUSION

The magnitude of undernutrition in the prison was found to be comparable to that of the general population in Ethiopia. The efforts on the ground to tackle undernutrition in the general population shall be extended to incarcerated people, especially by focusing on vulnerable groups such as those who had longer durations of incarceration, history of previous imprisonment, depression and no support.

Impact of incarceration on nutritional status and oral health among male inmates of central jail of Jaipur city, India

AIM

Prison is an especially difficult environment for promoting oral health and leads to the exacerbation of unhealthy behaviors. This study set out to assess the impact of incarceration on nutritional status and oral health among the male prison inmates of Central Jail of Jaipur city, Rajasthan, India.

MATERIAL AND METHOD

A cross sectional study was conducted among 181 male inmates. Dental caries and periodontal status were assessed by using modified the Decayed Missing Filled Teeth (DMFT) index and Community Periodontal Index (CPI) and Loss of Attachment (LOA) index as per the WHO methodology 1997. Nutritional status was assessed by Body Mass Index (BMI) and weight (kg)/height (m2).

RESULTS

Out of 181 inmates, 141 (77.90%) had normal BMI. The majority (n=128, 70.70%) of inmates were incarcerated for less than 6 years. A significant difference (P<0.05) was found between age and periodontal status. A significant difference was observed (P<0.05) in the CPI score 3 and LOA 0 and 1 score. However, no significant difference (P>0.05) was observed in DMFT and period of incarceration. Age was the significant (P<0.001) risk factor for CPI and LOA.

DISCUSSION

Dental caries and periodontal health deteriorates with age and period of incarceration. Oral hygiene maintenance along with comprehensive oral care can be accomplished by establishing dental care facilities in prisons.

Coordinating the prevention, treatment, and care continuum for HIV-associated tuberculosis in prisons: a health systems strengthening approach

PURPOSE OF REVIEW

To advance a re-conceptualized prevention, treatment, and care continuum (PTCC) for HIV-associated tuberculosis (TB) in prisons, and to make recommendations for strengthening prison health systems and reducing HIV-associated TB morbidity and mortality throughout the cycle of pretrial detention, incarceration, and release.

RECENT FINDINGS

Despite evidence of increased HIV-associated TB burden in prisons compared to the general population, prisoners face entrenched barriers to accessing anti-TB therapy, antiretroviral therapy, and evidence-based HIV and TB prevention. New approaches, suitable for the complexities of healthcare delivery in prisons, have emerged that may address these barriers, and include: novel TB diagnostics, universal test and treat for HIV, medication-assisted treatment for opioid dependence, comprehensive transitional case management, and peer navigation, among others.

SUMMARY

Realizing ambitious international HIV and TB targets in prisons will only be possible by first addressing the root causes of the TB/HIV syndemic, which are deeply intertwined with human rights violations and weaknesses in prison health systems, and, second, fundamentally re-organizing HIV and TB services around a coordinated PTCC. Taking these steps can help ensure universal access to comprehensive, good-quality, free and voluntary TB/HIV prevention, treatment, and care, and advance efforts to strengthen health resourcing, staffing, information management, and primary care access within prisons.

Tuberculosis treatment outcome and predictors in northern Ethiopian prisons: a five-year retrospective analysis

BACKGROUND

The prison situations are notorious for causing interruptions of tuberculosis (TB) treatment and occurrence of unfavorable outcomes. In Ethiopian prisons, though TB treatment programs exist, treatment outcome results and factors contributing to unsuccessful outcome are not well documented. In this study, we assessed the treatment outcome of TB cases and identified risk factors for unsuccessful outcome in northern Ethiopian prisons.

METHODS

A retrospective record review was conducted for all prisoners diagnosed with TB between September 2011 and August 2015. Outcome variables were defined following WHO guidelines.

RESULTS

Out of the 496 patients, 11.5% were cured, 68% completed treatment, 2.5% were lost to follow-up, 1.6% were with a treatment failure, 1.4% died, and 15% were transferred out. All transferred out or released prisoners were not appropriately linked to health facilities and might be lost to treatment follow-up. The overall treatment success rate (TSR) of the 5 years was 94% among the patients who were not transferred out. The odds of unsuccessful outcome were 4.68 times greater among re-treatment cases compared to the newly treated cases. The year of treatment was also associated with variations in TSR; those treated during the earlier year were more likely to have unsuccessful outcome. Sputum non-conversion at the second-month check-up was strongly associated with unsuccessful outcome among the smear-positive cases.

CONCLUSIONS

The mean TSR of the prisoners in the study prisons was quite satisfactory when gauged against the target level set by the End TB Strategy. However, the lack of appropriate linkage and tracking systems for those prisoners transferred or released before their treatment completion would have a negative implication for the national TB control program as such patients might interrupt their treatment and develop drug-resistant TB. Being in a re-treatment regimen and sputum non-conversion at the second-month check-up were significantly associated with unsuccessful treatment outcome among the all forms of and smear-positive TB cases, respectively.