Food and Nutrition Insecurity in Prisons in Ghana

Abstract

Background: There is food security “when all people at all times have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life”. Achieving food security is a key goal of existing global conventions on human rights that support the provision of adequate food for all persons. These Rights-based instruments also seek to preserve the rights of legally incarcerated persons so that they can access food of adequate nutritional value, of wholesome quality, and prepared and served with dignity for health and wellbeing. The right to be free from inhuman and degrading treatment or punishment or other conditions that detract from human dignity and worth is entrenched in Ghana’s 1992 Constitution. However, there is evidence that these constitutional provisions are lacking in Ghana’s prisons. Moreover, very little is known about food and nutrition insecurity in prisons, its drivers, as well as how prisoners are coping with these issues. Objective: The main objective of the study was to determine the food and nutrition insecurity status of inmates in Ghana’s prisons and the driving factors. Specifically, the study sought to assess quality of prisoners’ diets, nutritional status and explore their coping strategies during times of food hardship. Methods: A cross-sectional design was employed and mixed methods were used to collect and analyse data from 449 inmates and 88 prison officers randomly and purposively selected respectively, from twelve prisons. Food insecurity status, diet quality and coping strategies were assessed using the Household Food Insecurity Access Scale (HFIAS), 24 hour dietary recalls to derive Dietary Diversity Scores (DDS) and the Coping Strategies Questionnaire respectively. Data was analysed using SPSS version 25 (IBM SPSS Statistics for Windows., 2016) and Stata version 15 (StataCorp, 2017). Univariate, bivariate and multivariable analysis were conducted and a p-value <0.05 was used to establish statistical significance for all variables of the quantitative aspect of the study. In-depth interviews were conducted and content analysis of transcripts and field notes were triangulated with the quantitative data. Results: The mean age of prison inmates was 37.04 (± 14.2) years and more than half (52.6%) were <35 years old. The majority (98.2%) were males; 15.8% had no education, and 57% had completed high school. A majority (86.5%) were convicted prisoners with a mean duration of 61.8 months (± 48.6). Almost all (91.1%) were food insecure; 83.3% of the food insecure were severely food insecure. Average dietary diversity score was 2.90 ± 0.7. Most prisoners (79%) had low diet diversity (scores ≤ 3). Working while in prison and receiving financial and other support from family and friends were significant predictors of diet diversity (p<0.05). Most inmates (67%) had normal BMI; only 6% were underweight. Similarly, the majority of prisoners (99.5%) had normal MUAC. Mean BMI was significantly low among prisoners with higher levels of food insecurity (p=0.039). More than half of prisoners frequently relied on less preferred foods when they experienced food insecurity. The type of prison (p=0.006), overcrowding (p=0.005), the level of food insecurity (p<0.0001) and smoking (p=0.014) were significantly associated with the coping strategies index of prisoners. Relying on produce from prison farms and appealing for food donations were the main coping strategies employed by Prison Authorities. Receiving support from family and friends (β: 0.46, 95% CI: 0.28 – 0.78), working while in prison (β: 0.52, 95% CI: 0.28 - 0.97), engaging in recreational activities (β: -2.0, 95% CI: -3.5, -0.6), and having been previously incarcerated (β: -2.5, 95% CI: -4.66, -0.26,) were significantly associated with food security and nutrition status of prisoners while smoking, that is, use of narcotic drugs (β: -1.77, 95% CI: -3.5, -0.05), prison overcrowding ((β: 4.03, 95% CI: 1.14, 6.92) as well as the type of prison (prison category) were the risk factors for food insecurity and low nutrition status among prisoners. From the perspectives of inmates and officers, the low feeding budget, health conditions of prisoners, delayed payment of food contractors, power and resource control among prisoners also influenced food and nutrition insecurity of inmates in Ghana’s prisons. Conclusion: The study found almost universal food insecurity; prisoners reported low quality diets, although most had normal BMI. These findings suggest a need for interventions to improve food provisions in Ghana’s prisons.