Nutritional status and associated factors among inmates at Fort Portal prison Kabarole district, Uganda
Abstract
Introduction: Globally, more than 11 million people were incarcerated in prisons in 2016. Uganda has got a total prison population of approximately 54,059 inmates including pre-trial detainees or remand inmates. Inmates face different nutritional problems arising from a number of underlying factors that alter dietary intake. Prevalence of under nutrition among inmates in Northern Ethiopia has been reported to be as high as 25.2% (Abera & Adane, 2017). However, the prevalence of under nutrition in Uganda prisons may not be any better. Objective: To determine the nutritional status and associated factors among inmates at Fort Portal main and women prison in Kabarole district. Methods: An institutional based cross sectional quantitative study was conducted among 206 male and female inmates incarcerated in Fort Portal main and women’s prison in Kabarole district from September to October 2019. A standard 24-hour food recall questionnaire was used to collect data on dietary diversity while an interviewer administered pretested questionnaire was used to collect data on socio-demographics, health history, dietary history, water and sanitation and psychosocial care and support. Anthropometric data was generated by taking anthropometry of each study participant. The outcome variable was nutritional status defined by BMI (body mass index) and categorized as underweight (BMI<18.5kg/m2), normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9 kg/m2) and obesity BMI >30kg/m2. The independent variables were demographic characteristics, dietary factors, health and lifestyle factors, water and sanitation factors and psychosocial care and support. Data was entered in Microsoft Excel 2013 and statistical data analysis run with Stata College Station TX Version 14. Results. A total of 206 inmates were interviewed (100% response rate). Majority of the respondents 79% (163/206) had normal nutritional status with BMI 18.5-24.9kg/m2 16.5% (34/206) of the respondents were underweight (BMI < 18.5) while 4.4% (9/206) were overweight (BMI 25-29.9). One fourth of the inmates with chronic illness were underweight (19/75, 25.3%) while 2.7 % (2/75) were overweight. Underweight was more common among the males (17.3%, 34/196) than the females (0%, 0/10) while overweight was more pronounced among the females (30%, 3/10) than the males (3.1%, 6/196) and the mean BMI was 20.7 kg/m2 . Nearly one third (30.8%, 12/39) of inmates aged 45 years and above were underweight. Overall, more than three quarters of the inmates 85.4% (176/206) did not meet the minimum dietary diversity of consuming at least five food groups daily. At multivariate analysis, the prevalence of underweight was found to be significantly associated with number of meals (aPR of 0.42, 95% CI=0.22-0.79) P=0.008, history of having a chronic disease (aPR=0.56, 95% CI; 0.32-0.99) P=0.045 and psychosocial support (aPR= 0.21, 95% CI; 0.08-0.53) P=0.001. Conclusion: The prevalence of underweight among inmates at Fort Portal prison was slightly higher than the prevalence among the free- living population in Uganda. Having history of a chronic disease, consuming fewer meals and having low psychosocial support were probable factors associated with underweight. Furthermore, dietary diversity among the inmates was quite poor since only 14.6% consumed the minimum number of food groups. Malnutrition if not managed, will have devastating consequences on the development of the country as inmates whose productive capacity has been compromised by malnutrition and effects of incarceration are released back to the community yet further still the younger productive age group comprises the biggest proportion of the inmate population. Therefore, more efforts are needed to prevent malnutrition in prisons and promote dietary diversity. Recommendation: Uganda Prisons Service needs to; - Ensure dietary diversification for inmates, early detection and management of inmates with chronic diseases and promote psychosocial support among inmates. A follow up study with sufficient sample size is recommended.