Noncommunicable cardiovascular diseases in prisons in Sub-Saharan Africa: A scoping review

Abstract

Background: The dual epidemic of noncommunicable diseases (NCDs) and HIV (Human Immunodeficiency Virus)/AIDS (Acquired Immunodeficiency Syndrome) in Sub-Saharan Africa (SSA) has increased substantially in recent times, with prison populations also being impacted. Cardiovascular disease (CVD) is a significant contributor to the burden of NCDs. Despite their health vulnerabilities, very little is known about cardiovascular NCDs (NCCVD) in the SSA prison population. This scoping review aims to map and describe what is known about NCCVD in the SSA prison population.

 Methods: A scoping review methodology was utilised, with a particular focus on mapping what is currently known about NCCVD in SSA prison populations, in terms of trends and common themes, identifying gaps in knowledge and areas for future research. A systematic search of peer reviewed literature with no date limitation was conducted in key databases between April and July 2022. Following the application of predetermined inclusion and exclusion measures, 16 studies remained, reflecting papers from six SSA countries. The data extracted was charted, categorised and thematically analysed.

Results: Literature included in the review was drawn from sixteen studies conducted in Burkina Faso, Cameroon, Ethiopia, Ghana, Guinea and Nigeria. These were predominantly observational studies, comprising of mainly cross-sectional, retrospective and case-control studies. The main themes that were generated from an in-depth thematic analysis of these studies were: custodial deaths and autopsy, cardiorespiratory fitness (CRF) and exercise, elderly inmates and CVD, women and CVD, influence of sleep patterns on CVD, and burden of CVD and associated risk factors.

Conclusion: Routine monitoring and expansion of existing healthcare services in prisons are crucial in tackling the NCD epidemic in SSA prisons. Most natural deaths at autopsy of custodial deaths are due to CVD. CRF is low in prisons, worsened by the closed environment and lack of effective intervention programmes aimed at tackling risk factors for CVD. The plight of elderly prisoners and women remains unaddressed, worsened by the burden of a multitude of additional risk factors and poorer health outcomes. There is substantial need to expand the body of knowledge on NCDs in SSA prisons and improve current prison health systems through integration of NCD services with existent infectious disease (HIV and tuberculosis) prison programmes. Poor sleep patterns and dietary deficiencies are likely contributors to the burden of CVD in SSA prisons. Future prison health research focused on these areas can provide a foundation for effective health intervention programmes appropriate to the prison environment.