Nutritional Status of Inmates in the Central Prison of Mbuji-Mayi, Democratic Republic of Congo

1University of Lie ge, Department of Public Health Sciences, Belgium 2Official University of Mbuji-Mayi, School of Public Health, DR Congo 3Mbuji-Mayi Higher Institute of Medical Engineering, DR Congo 4University of Lie ge, Faculty of Law, Political Science and Criminology 5Kinshasa Higher Institute of Medical Engineering, DR Congo 6University of Lie ge, Department of General Practice, Belgium Nutritional Status of Inmates in the Central Prison of Mbuji-Mayi, Democratic Republic of Congo


Results
The inmates were aged between 18 and 70 years and primarily males (88.7%). Of them, 24% were suffering from severe malnutrition and 62% of moderate malnutrition as based on the NRI. At the time of study, 88% of inmates were incarcerated for more than 6 months. Multivariate logistic regression analysis showed that factors independently associated with severe malnutrition were incarceration of more than 6 months (OR=5.

Conclusions
The nutritional situation in the Central Prison of Mbuji-Mayi is precarious. There is urgent need to supply enough nutrient-rich food to improve health of inmates.

Background
Food is a crucial element in the life of inmates. It plays a key role in their physical and mental health [1].
Nutritional deficiency remains a daily challenge in prisons of developing countries [2]. A poor health condition among inmates is partly linked to an insufficient food intake and to precarious conditions in prison settings [3]. April and November 2004, the situation is far from being improved in prisons twelve years later [5]. In this particular field, international and national standards continue to be violated with dramatic consequences (deadly for many inmates).  [5,7].

Study Population
The study involved inmates aged ≥ 18 years old.
To determine subjects eligible for the study, we used the

Ethics Approval and Consent to Participate
The study was approved by the Mbuji-Mayi Inter as well as what we expected from them; furthermore, they were also given some time for reflection. When malnutrition was diagnosed, the patient was provided immediate healthcare. All terms of data use were respected in accordance with the DRC law and requirements. Anonymity was guaranteed.

Statistical Analyses
Results were expressed by mean and standard  (Table 2).
As seen in Table 3, no significant difference was found between inmates who were suffering from severe NRI-based malnutrition and the others, when considering sociodemographic variables, smoking status and alcohol consumption. Severe malnutrition however was more frequent among inmates whose meals were provided by  (table 4).

Discussion
This study conducted in the Central Prison of    wide range of tools used to assess nutritional risk and other factors such as those related to organization and conditions of detention in these prison settings.
Adequate nutrition is a fundamental human right; inmates should benefit from healthy food for a better health. Our study revealed that the origin of meals was closely related to severe malnutrition.
Inmates who were exclusively fed with prison meals were 5 times more at risk to develop severe malnutrition compared to those receiving meals prepared by their family or an NGO. The lack of access to a diversified food, rich in nutrients, is frequently observed in DRC prisons. The budget for food is almost non-existent. Enough food, as a fundamental right, is denied to most inmates; thus, weight loss and death occur, especially among inmates infected by TB and/or HIV [5]. Inmates who were initially fragile because of their health status and those who had spent more than 6 months in prison were 5 times more likely to suffer from severe malnutrition compared to other inmates. A long-lasting incarceration is a risk factor, especially in DRC prisons, which have become places of deprivation of all fundamental rights despite the UN Charter [16].
Such conclusion is in line with the results of previous studies performed in Gondar and Bahirdar, in northwest Ethiopia [15]. Our results also showed that inmates who were suffering from HIV, TB and/or intestinal infections were twice more likely to develop severe malnutrition; this is due to the lack of protein rich meal, loss of appetite, vomiting and nauseas, which are frequent consequences of antiretroviral and anti-tuberculosis drugs-related secondary effects, the difficulty swallowing because of oral candidiasis or ulcer [17][18][19]. In our case, no association was evidenced between sex, age of inmate, tobacco smoking or alcohol consumption, and the occurrence of severe malnutrition in prison. Contrary to our results, some authors observed that women in prison had a muscular mass less developed and a higher proportion of total body fat compared to men, for an equivalent BMI [20]. This could increase the prevalence of malnutrition in men, as sex and muscular mass can affect the relation between BMI and body fat [20]. A significant association between infections and severe malnutrition was highlighted in  It should be noted that during the investigation period, 5 inmates (1.7%) died in unexplained cachexic conditions. Our observations confirm previous findings in the way that poor and insufficient food increases the risks of exposure to a disease and accelerates its evolution [4]. A 2004 study performed in the Guinean prison named 'Central House' showed that 10 to 15% of inmates were suffering from malnutrition; seven inmates were dying per month, either of malnutrition or of diseases [25]. The poor conditions of detention were exacerbated by the lack of appropriate and in time-health care. In prison, medical care is generally of poor quality. Food, as a fundamental right, is essential for inmates and should receive more attention. Food is one of the most important aspects in the life of inmates; it helps them disconnect from daily routine but also decreases hostility and antisocial behaviour.

Limitation of the Study
The range of tools used to assess nutritional risk is an obstacle to the comparison with other studies.
Differences related to scales, scoring system and thresholds selected restrict the possibility to compare prevalence data. It is important to note that comparing prevalence with other studies is also limited due to differences in age categories and the threshold defining severe malnutrition in the elderly. In our study, the usual weight was estimated on the basis of what people told the investigators, due to lack of knowledge on the weight of several inmates upon their arrival at the prison.

Conclusion
This study showed that 25% of inmates of the Central Prison of Mbuji-Mayi (DRC) were suffering from severe malnutrition. Health status of inmates receiving homemade or NGO meals was less alarming compared to inmates whose meal was provided by the prison, in low quantity and once a day. Malnutrition is the major cause of morbidity and mortality in developing countries. An incarceration of more than 6 months expose inmates to malnutrition, especially individuals suffering from TB, HIV and/or intestinal infections. A correct and well-balanced food, in sufficient quantity, is crucial to avoid exposure to severe malnutrition and potential mortality. The involvement of national and regional authorities is essential to avoid transforming the prison rehabilitation centre in a site of infection, with all negative consequences that may arise.