Prison health situation and health rights of young people incarcerated in sub-Saharan African prisons and detention centres: a scoping review of extant literature

Climate Change and Human Health in Africa in Relation to Opportunities to Strengthen Mitigating Potential and Adaptive Capacity: Strategies to Inform an African "Brains Trust"

Background

Africa faces diverse and complex population/human health challenges due to climate change. Understanding the health impacts of climate change in Africa in all its complexity is essential for implementing effective strategies and policies to mitigate risks and protect vulnerable populations. This study aimed to outline the major climate change-related health impacts in Africa in the context of economic resilience and to seek solutions and provide strategies to prevent or reduce adverse effects of climate change on human health and well-being in Africa.

Methods

For this narrative review, a literature search was conducted in the Web of Science, Scopus, CAB Abstracts, MEDLINE and EMBASE electronic databases. We also searched the reference lists of retrieved articles for additional records as well as reports. We followed a conceptual framework to ensure all aspects of climate change and health impacts in Africa were identified.

Results

The average temperatures in all six eco-regions of Africa have risen since the early twentieth century, and heat exposure, extreme events, and sea level rise are projected to disproportionately affect Africa, resulting in a larger burden of health impacts than other continents. Given that climate change already poses substantial challenges to African health and well-being, this will necessitate significant effort, financial investment, and dedication to climate change mitigation and adaptation. This review offers African leaders and decision-makers data-driven and action-oriented strategies that will ensure a more resilient healthcare system and safe, healthy populations-in ways that contribute to economic resiliency.

Conclusions

The urgency of climate-health action integrated with sustainable development in Africa cannot be overstated, given the multiple economic gains from reducing current impacts and projected risks of climate change on the continent's population health and well-being. Climate action must be integrated into Africa's development plan to meet the Sustainable Development Goals, protect vulnerable populations from the detrimental effects of climate change, and promote economic development.

[PREVALENCE AND ASSOCIATED FACTORS OF HUMAN SCABIES IN PRISONS IN DOSSO, NIGER]

Background

Scabies is a contagious, pruritic, cosmopolitan dermatosis, widespread especially in human communities, due to parasitism by a mite Sarcoptes scabiei var hominis A lack of hygiene and overcrowding inside the houses are favourable factors. The aim of our study was to determine the prevalence and factors associated with the occurrence of human scabies in the prison environment in Dosso (Niger).

Materials and methods

Prospective descriptive cross-sectional study conducted in November 2022 in the civil prison of Dosso on authorization of the prison administration. The collected data were sociodemographic characteristics, personal history of pruritus and its characteristics, risk factors related to hygiene and conditions of incarceration, examination performed by a dermatologist to look for clinical signs of scabies. The diagnosis was retained in any inmate presenting one or more elements at the interrogation and at the physical examination.

Results

Out of a total of 352 inmates, 43 (38 males and 5 females) had scabies, a prevalence of 12%. The average age was 33 with extremes of 18 and 62 years. Of the scabies patients, 9% reported a history of intense, sleepless pruritus prior to incarceration. Most of the inmates, 86%, were in cells with more than 20 inmates. Among those with scabies, 42% showered twice a day, 81% changed clothes after showering and 74% used soap regularly for washing. The topography of the lesions was external genitalia (37%), buttocks (21%), inner thighs (16%), interdigital spaces (9%), elbows (9%) and wrists (7%). The inmates were informed about the disease, treatment information was explained to them, and they attended a session on hygiene promotion. All cases of scabies detected were prescribed a local treatment based on benzyl benzoate lotion 25%.

Discussion/conclusion

Human scabies is common in the prison environment in Dosso. Too often, scabies goes undetected and is confused with other pruritic dermatoses, such as eczema or atopic dermatitis. Prison medical staff should be trained in scabies in order to prevent scabies outbreaks. The authorities in the region should make the improvement of hygiene and detention conditions in prisons their priority.

Evaluation of massive education in prison health: a perspective of health care for the person deprived of freedom in Brazil

Education, with an emphasis on prison health, has acted as a policy inducing changes in work processes, which the Brazilian National Health System (SUS) has used, and which is present in permanent health education, which promotes health care for people deprived of liberty. This article aims to present an analysis of the impacts of the strategy of massive education on prison health in Brazil from the perspective of health professionals and other actors operating in the Brazilian prison system. The data used in the study come from a questionnaire consisting of 37 questions applied nationwide between March and June 2022. Responses were collected from students who completed the course "Health Care for People Deprived of Freedom" of the learning pathway "Prison System", available in the Virtual Learning Environment of the Brazilian Health System (AVASUS). This course was offered nationally, whose adhesion (enrollment) occurred spontaneously, i.e., the course was not a mandatory. The data collected allowed us to analyze the impacts of massive education on prison health. The study also shows that the search for the course is made by several areas of knowledge, with a higher incidence in the health area, but also in other areas, such as humanities, which also work directly with the guarantee of the rights of people deprived of liberty, which are professionals in the areas of social work, psychology, and education. The analysis based on the data suggests that the massive education mediated by technology through the courses of the learning pathway, besides disseminating knowledge-following the action plan of the 2030 Agenda of the United Nations Educational, Scientific and Cultural Organization (UNESCO)-, are an effective tool to promote resilience in response to prison health and care demands of people deprived of liberty.

The state of cervical cancer screening in imprisoned women in Malawi: a case of Maula Prison

BACKGROUND

Malawi is one of the countries with the highest burden of cervical cancer in the world with less than ten percent of women screened for cervical cancer annually. The study aimed to investigate the state of cervical cancer screening among incarcerated women at Maula prison. The study highlights key challenges that women in prison face to access cervical cancer screening to inform policies and strategies to address them.

METHODS

The study employed a cross-sectional qualitative study design. A total of 31 prisoners aged between 18 to 49 participated in the study. Among these, 15 women participated in in-depth interviews, while 16 women participated in two focus group discussions consisting of 8 women per group. All interviews were recorded and transcribed verbatim. Data was analysed using inductive content analysis.

FINDINGS

Majority of women at Maula prison demonstrated knowledge of cervical cancer, its associated risk factors and the benefits of cervical cancer screening. Most women also expressed willingness to undergo cervical cancer screening. However, the following were identified as factors that hinder women from accessing cervical cancer screening services at the prison:-limited availability of the services, pain during the screening process, the presence of male practitioners conducting screening, poor treatment by authorities and health workers and favouritism.

CONCLUSION

To improve cervical cancer screening and its uptake at Maula prison there is a need to ensure unlimited availability of the screening services which should be conducted by female health practitioners. There is also a need to include this service as part of the mandatory health screening exercise that is conducted upon entry into the prison by all prisoners. Conducting in-depth awareness and sensitization with participants before screening would help to eradicate fear, provide assurance and clarification of the screening process. Prison officers and health workers should also be sensitised to improve prisoners' access to healthcare during incarceration.

Children in detention amidst COVID-19 in Africa: A wound untreated

Children in detention in Africa are part of the vulnerable population exposed to the COVID-19 pandemic due to factors such as overcrowding, poor healthcare of inmates, and lousy state of the facilities. The number of children in detention was estimated to be about one million in 2010, and this has further increased threat to global health. The fall in operating criminal justice systems, from the aspect of rehabilitation and reform in Africa, to its being plagued with crisis, overpopulation, and inability to conform to fundamental human rights and health standards. It was noted that children in detention in Africa end up in prison mainly because they are either given birth to by incarcerated mothers or sentenced to jail based on their alleged criminal activity. Also, certain limitations in some African countries to track the prevalence of COVID-19 and other diseases include inaccessible data, non-specificity of data, and unreliable information regarding the current prison situation. Sometimes, these data could be insufficient and hard to comprehend, primarily if written in the local language. The efforts to resolve the untreated wounds of children in detention during COVID-19 are somewhat tricky. However, this paper identifies these limitations and proffers recommendations such as; the identification and implementation of strategies that support the continuity of child-centered services, prioritizing children for immediate release, and ensuring adequate protection of their health and well-being, among others.

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Children in detention in African continent, are vulnerable to worsening of their health condition amidst COVID pandemic as well as fueling pandemic in the prisons having children and adult population as inmates.

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On observation, the children in detention in Africa are detained for crimes ranging from minor to status crimes. The detention of children, should present, with measures put in place to guarantee the protection of their fundamental rights of peace and justice.

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Interventions, policy formation, and recommendations such as Child-centered services in prisons that are focused on equity of access to social, health amenities; Prioritizing children for immediate release; and development of a comprehensive migration framework that addresses the detention of children to prevent them from being kept in detention; are worthy contributions.

Global prevalence of hepatitis C in prisoners: a comprehensive systematic review and meta-analysis

Hepatitis C virus (HCV), one of the most significant causes of liver inflammation, has a high annual mortality rate. The unfavorable hygiene conditions and inadequate health monitoring in many prisons increase the risk of blood-borne infections such as hepatitis C. The growing incidence of this disease among prisoners results in overspill transmission to the general population from undiagnosed prisoners that have been released. Therefore, the aim of this study was to investigate the prevalence of hepatitis C among the world's prison population. A systematic review and meta-analysis of studies on the prevalence of hepatitis C was carried out using the keywords "Prevalence", "Hepatitis C", and "Prisoner" in the Iranian and international databases SID, MagIran, Iran Doc, Science Direct, Scopus, PubMed, and Web of Science (WoS) from January 1990 to September 2020. After transferring the articles to the information management software EndNote and eliminating duplicate studies, the remaining studies were reviewed based on inclusion and exclusion criteria, three stages of primary and secondary evaluation, and qualitative evaluation. Comprehensive meta-analysis software and Begg and Mazumdar and I² tests were used for data analysis and assessment of dissemination bias, and heterogeneity, respectively. Out of 93 studies (22 from Asia, 26 from Europe, seven from Africa, 29 from America, and nine from Australia) with a total sample size of 145,823 subjects, the prevalence of hepatitis C in prisoners worldwide was estimated to be 17.7% (95% confidence interval, 15-20.7%). The highest prevalence of hepatitis C on the continents included in this study was reported in prisoners incarcerated in Australia and Oceania, with 28.4% (95% CI: 21.6-36.4) in nine studies, and Europe, with 25.1% (95% CI: 19.4-31.8) in 26 studies. All studies used an ELISA test for the detection of HCV antibodies. The results showed a prevalence of HCV of 17.7% in prisoners worldwide, ranging between 10 and 30% over five continents (Asia, Europe, America, Africa, and Australia and Oceania). The highest prevalence was reported in Australia and Oceania (28.4%), indicating the need to pay more attention to this issue on the continent. It is necessary to reduce the incidence of the disease in prisons by appropriate policy-making and the development of accurate and practical programs, including the distribution of free syringes and examination, testing, and screening of prisoners.

Lead Poisoning among Male Juveniles Due to Illegal Mining: A Case Series from South Africa

Illegal mining is a major public health and societal concern. Recent scientific evidence indicates elevated blood–lead levels in illegal gold miners and associated communities. Yet, there is little research in this regard from low- to middle-income countries (LMICs), where illegal mining is growing. This case series is extracted from a cross-sectional study of lead exposure in incarcerated juveniles in greater Johannesburg. From survey records (blood–lead levels and questionnaires), three males had elevated blood–lead levels and presented with health conditions and behavioural problems putatively linked with lead poisoning. Based on the record review, all three juveniles were in a secure facility due to illegal mining-related activities. All three cases had high blood–lead levels and demonstrated a tendency toward aggressive or violent behaviour. They also presented with conditions associated with lead poisoning, such as anaemia, respiratory illness, abdominal disorders, and musculoskeletal conditions. Juveniles involved in illegal mining are at risk of exposure to heavy metals such as lead, and there is a need for relevant preventative action and health care programmes in this group.

Prisoners' access to HIV services in southern Malawi: a cross-sectional mixed methods study

BACKGROUND

The prevalence of Human Immunodeficiency Virus (HIV) among prisoners remains high in many countries, especially in Africa, despite a global decrease in HIV incidence. Programs to reach incarcerated populations with HIV services have been implemented in Malawi, but the success of these initiatives is uncertain. We explored which challenges prisoners face in receiving essential HIV services and whether HIV risk behavior is prevalent in prisons.

METHODS

We conducted a mixed-methods (qualitative and quantitative), cross-sectional study in 2018 in six prisons in Southern Malawi, two large central prisons with on-site, non-governmental organization (NGO) supported clinics and 4 smaller rural prisons. Four hundred twelve prisoners were randomly selected and completed a structured questionnaire. We conducted in-depth interviews with 39 prisoners living with HIV, which we recorded, transcribed and translated. We used descriptive statistics and logistic regression to analyze quantitative data and content analysis for qualitative data.

RESULTS

The majority of prisoners (93.2%) were male, 61.4% were married and 63.1% were incarcerated for 1-5 years. Comprehensive services were reported to be available in the two large, urban prisons. Female prisoners reported having less access to general medical services than males. HIV risk behavior was reported infrequently and was associated with incarceration in urban prisons (adjusted odds ratio [aOR] 18.43; 95% confidence interval [95%-CI] 7.59-44.74; p = < 0.001) and not being married (aOR 17.71; 95%-CI 6.95-45.13; p = < 0.001). In-depth interviews revealed that prisoners living with HIV experienced delays in referrals for more severe illnesses. Prisoners emphasized the detrimental impact of poor living conditions on their personal health and their ability to adhere to antiretroviral therapy (ART).

CONCLUSIONS

Malawian prisoners reported adequate knowledge about HIV services albeit with gaps in specific areas. Prisoners from smaller, rural prisons had suboptimal access to comprehensive HIV services and female prisoners reported having less access to health care than males. Prisoners have great concern about their poor living conditions affecting general health and adherence to ART. These findings provide guidance for improvement of HIV services and general health care in Malawian institutionalized populations such as prisoners.

Addressing Common Mental Health Disorders Among Incarcerated People Living with HIV: Insights from Implementation Science for Service Integration and Delivery

PURPOSE

Despite evidence of disproportionate burden of HIV and mental health disorders among incarcerated people, scarce services exist to address common mental health disorders, including major depressive and anxiety disorders, post-traumatic stress disorder, and substance use disorders, among incarcerated people living with HIV (PLHIV) in sub-Saharan Africa (SSA). This paper aims to summarize current knowledge on mental health interventions of relevance to incarcerated PLHIV and apply implementation science theory to highlight strategies and approaches to deliver mental health services for PLHIV in correctional settings in SSA.

RECENT FINDINGS

Scarce evidence-based mental health interventions have been rigorously evaluated among incarcerated PLHIV in SSA. Emerging evidence from low- and middle-income countries and correctional settings outside SSA point to a role for cognitive behavioral therapy-based talking and group interventions implemented using task-shifting strategies involving lay health workers and peer educators. Several mental health interventions and implementation strategies hold promise for addressing common mental health disorders among incarcerated PLHIV in SSA. However, to deliver these approaches, there must first be pragmatic efforts to build corrections health system capacity, address human rights abuses that exacerbate HIV and mental health, and re-conceptualize mental health services as integral to quality HIV service delivery and universal access to primary healthcare for all incarcerated people.

Prison health during the COVID-19 era in Africa

The world is facing a dreadful outbreak of a novel disease, COVID-19, that has claimed the lives of thousands. African countries have recorded the least number of COVID-19 cases despite their weak healthcare systems. However, African prisons could be an hotspot for the spread of the virus. In this article, we focused on describing certain possibilities of an uncontrollable outbreak of this pandemic in African prisons considering the overcrowding, poor access to healthcare among inmates, and already existing abuse of human rights. We hypothesized that negligence to prison health in Africa during this pandemic could lead to devastating events. It is therefore important that inmates are not forgotten in COVID-19 responses.