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Indian Journal of Community Medicine

Health Status of Inmates of a Prison

Author(s): R.K. Gupta, G.P.I. Singh*, (Mrs.) Rajshree R. Gupta**

Vol. 26, No. 2 (2001-04 - 2001-06)

G.B. Pant Cantt. Hospital, Jammu *Deptt. of PSM, Armed Forces Medical College, Pune **Cantt. Hospital, (Kirkee) Pune

Abstract:

Research question: What is the extent of physical morbidity in a prison set up?

Objective: To assess physical health status of inmates.

Study design: Cross-sectional study.

Setting: Central Prison, Yervada, Pune.

Participants: Convicted male prisoners.

Sampling: Stratified random sampling done from convicted inmates of all sentence categories. A sample of 227 was taken up.

Study variables: Age, past illness, hospitalization, scabies, TB, HIV, STD, Helmenthiasis, Anaemia.

Statistical analysis: Rate, Ratio, Chi square test. Results: Majority of inmates fell in age group 30-39 years. 44% gave history of past illness and 14.5% got hospitalized in past year. Scabies and fungal infections showed a significant association with duration of stay, dental illness, TB, STD, helminthiasis and anaemia were other common conditions.

Keywords: Prisoners, Health status, Skin diseases, TB, HIV, STD

Introduction:

The prison system as seen today came into being at the end of 18th century. The concern for health of prisoners also began about 200 years back. The population confined behind bars in the US is about 7,50,0001. India has about 1200 prisons with an authorised accommodation of about 200,0002. Prisoners carry a much greater burden of illness than other members of the society. They harbour diseases that are determined both by the environment out of which they come and by the prison in which they live. There are problems of severe drug abuse, alcoholism, trauma, homicide, suicide, HIV and AIDS, STDs, TB, skin infections etc.3

Prison health is a neglected area. Those who are incarcerated represent a medically underserved population and are at a high risk of medical disorders. Hardly any health professional wants to work in a prison set-up. The lack of concern, facilities and expertise further deteriorates the health of inmates. This explains the reason for such limited studies in a prison set-up, especially in India.

This study is an attempt to determine the physical health status of persons from a section of our society, who condemned by law, are behind the high walls of one of the largest prisons of our country.

Material and Methods:

A cross-sectional descriptive study was carried out at Central Prison, Yervada, Pune. Out of 1100 convicted prisoners incarcerated, a sample of 227 was taken up. A stratified random sampling was done based on the sentence category. Study was carried out between July 1995 and January 1996. A pilot study was undertaken first. The inmates were subjected to an interview and a physical examination. The prison medical records were also consulted to ascertain the past medical status of inmates.

Results:

Age distribution: Majority of inmates were in the age group of 30 to 39 years (38.82%), followed by age group of 40 to 49 years (24.2%). 18.5% inmates fell in 20 to 29 years and 8.8% in the geriatric group (60 years and above).

Table I: Past illness and present morbidity as per major diagnostic groups.

Group disorder Past illness Present morbidity on physical exam
No. Prevalence
%(n=227)
No. %(n=227)
Respiratory system 32 14.0 65 28.6
GIT 26 11.4 8 3.5
Musculoskeletal 9 3.9 3 1.3
Malaria 9 3.9 - -
CVS disorders 8 3.5 12 5.3
Skin disorders 4 1.8 132 58.15
CNS disorders 2 0.9 3 1.3
STDs 2 0.9 22 9.7
Genitourinary 2 0.9 22 9.7
Drug withdrawal 2 0.9 - -
Eye 2 0.9 58 25.6
Injuries 2 0.9 - -
ENT - - 83 36.56
Dental - - 89 39.20
HIV - - 1 0.4
Total 100 - 498 -

Past illness: On interviewing the inmates, it was found that about half the inmates (44%) had reported sick in the preceding one year. Table I shows the prevalence of various disorders. Respiratory and gastrointestinal diseases dominated the list.

Hospitalization: 33 inmates (14.53%) gave a history of hospitalization in the past one year. GIT and respiratory group of diseases were mainly responsible for hospitalization (36.4% and 24.3% respectively).

Prevalence of disease: Table I also indicates that skin disorders were the commonest ailments which were encountered in this set-up accounting for 26.5% of all cases, followed by dental and ENT disorders.

Skin disorders: Scabies accounted for 57.6% of all skin conditions followed by fungal infections (34.9%). A statistically significant association was found between these two infections with the duration of stay of inmates in the prison.

Respiratory disorders: 28.6% of inmates suffered from respiratory diseases. Chronic bronchitis and TB contributed to 19 and 17 cases with overall prevalence of 8.4% and 7.5% respectively. Acute upper respiratory infections contributed to 22 cases (9.7%). No statistical association was observed between prevalence of TB and duration of stay in prison (p<0.05).

STDs and genitourinary disorders: Penile ulcers were found in 13 inmates and acute urethritis in 7, giving an overall prevalence of 5.7% and 3% respectively. Two cases each of LGV and urinary tract infection were also diagnosed.

Helminthic infestations: The stool of 61 inmates (26.8%) was found to be positive for ova/cyst of intestinal helminths. 36 inmates (15.8%) had Ascariasis, followed by 19(8.4%) who had Ancylostomiasis and 6(2.6%) had Taeniasis.

Anaemia: Haemoglobin estimation was carried out with standard technique. 40(17.6%) inmates were found to be anaemic with Hb levels of less than 13g%.

Discussion:

Even though both, health surveys and prisons have a long history, unfortunately hardly any comprehensive survey has been undertaken. Most of the prison studies have concentrated on a single health condition, in a given prison.

Past illness and hospitalization: 44% of all inmates had fallen sick and 14.5% had to be admitted to hospital in past one year. 36.4% of those admitted, were for GI diseases. A similar trend is seen in other prisons too. As per the annual report of DGHS on Indian Jails, cholera accounted for 0.95 admissions per 1000 average daily population4. However, no cases of cholera were encountered in the present study. Hospital admission rates for respiratory illnesses and malaria was of the order of 0.35 and 0.13 per 1000 average population, as against 0.56 and 0.5 in other prisons in India in the mid seventies4.

Present morbidity status: 58.15% of all inmates suffered from skin disorders but ironically there are no studies on skin disorders in other jails in the world, which could be traced by the author. Scabies and fungal infections of skin showed a significant relationship with the duration of stay in prison. It is easy to infer that a prolonged prison stay helped in development of skin diseases. However no such relationship was seen in case of Leprosy.

Respiratory disorders: TB is the commonest illness observed in the present study, 25.15% of all respiratory disorders or a population prevalence of 7.5% which is about 4 times higher than national figures of about 1.8%, Goyal et al5. Reasons for this high rate could be, first, overcrowding and close contact as highlighted by Ables and second, over-representation of poor6,7.

AIDS, STDs and genitourinary disorders: Present study shows a prevalence of penile ulcers to the level of 5.7%. Various American studies quote the prevalence of Syphilis to be 9 and 15% (Byrd8) and 22% (Bickell et al9). 3% inmates suffered from acute urethritis (Gonorrhoea) in the present study, as against higher figures reported by US workers, 21% by Byrd8, 5 and 7% by O'Brien and Bickell9,10 and 3.7% in the general population of the US11. 0.9% inmates showed clinical signs of LGV. O'Brien reported a serological prevalence of 11% in a US prisons10. These high figures could be due to the fact that they are based on serological positivity also and not on clinical diagnosis alone.

HIV positivity prevalence of 0.4% was detected in the present study. Maharashtra state has a prevalence of 0.026-0.034%12, in the general population. No figures on HIV are available from other Indian prisons. HIV/AIDS prevalence in American prisons has been quoted to be of the order of 0.0137-0.536% in various studies13,14.

Anaemia: Pallor was observed in 20.7% inmates and 17.6% were anaemic as per lab tests. No admissions were reported for anaemia. As per Govt. of India document, average hospital admission rate for anaemia, in different state prisons was 5.7%4.

Limitations of the study:

This study had certain limitations. Undertrials and TADA detenues could not be included in the study owing to administrative restrictions. Explicit lab investigations for HIV and TB, etc. could not be undertaken. Moreover, any study based on an interview technique does suffer from `subjectivity' of response.

Acknowledgements:

The authors gratefully acknowledge the co-operation and assistance of staff and inmates at Central Prison, Yervada, Pune. The authors also acknowledge the help extended by IG (Prisons), Maharashtra, whose kind permission made the study possible and to CMO, Prison, for his guidance.

References:

  1. US Justice Deptt. Statistics on criminal justice, 1989.
  2. Govt of India. Health Services in India 1984-87. New Delhi: CBHI; 1987.
  3. Weisbuch JC. Prison Health. In: Last JM, Wallace RB, editors. Public Health and Preventive Medicine, 13 ed. California: Appleton and Lange; 1992. p.1159-62.
  4. GOI. Health Services in Jails. In: Annual report of DGHS 1975 New Delhi: CBHI; 1977. p. 83-4.
  5. Park K. Textbook of Preventive and Social Medicine. 12th ed. Jabalpur: Banarsidas Bhanot; 1989. p.132.
  6. Snider DE, Hutton RN, Mary D. TB in correctional institutions, JAMA 1989; 261(3): 436-7.
  7. Abeles H, Feibes H. The large city prison - Reservoir for TB. Am Review of Resp Dis 1970; 101: 708-9.
  8. Byrd DE. Venereal Disease in Health. Philadelphia, WB Sauders Company; 1966: 270-71.
  9. Bickell NA, Vermund SH, Holmes M, Safyer S, Burk MD. HPV, Gonorrhoea, Syphilis and cervical dysplasia in jailed women. Am J Public Health 1991; 81(10): 1318-20.
  10. O'Brien, Stephan S. Leucocyte Esterase Dipstic to detect Chlamydia Tracomatis and Niesseria gonorrhoea urethritis in asymptomatic adolescent male detainees. Am J Public Health 1988; 78: 1583.
  11. Sharrar RG. Epidemiology and prevention of selected acute illnesses. In: Cassens BJ, editors. Preventive Medicine and Public Health. 2nd ed. Pennsylvania: Harwal Publishing Company; 1992. p.105.
  12. SK. Express News Service. Indian Express - Citizen 1993: 9.
  13. Editorial. Tuberculosis in Correctional Institutions. JAMA 1989; 262(3).
  14. Weisfuse IB. HIV-1 Infection among New York City Inmates. AIDS 1991; 5(9): 1133-8
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