Inmate Health Status in Ikoyi Correctional Centre, Nigeria PDF

ABSTRACT Inmates are members of the vulnerable populations often housed in Correctional Centre with different health challenges, yet their health status remain underexplored in this country. This study examined the health status of inmates in Ikoyi Correctional Centre in Lagos, Nigeria. A descriptive cross-sectional survey of 423 inmates selected using a two-stage cluster sampling technique was carried out. The data was collected using structured questionnaires developed from validated tools and analysed using descriptive and inferential statistics, while prevalent diagnoses were documented to provided context. The findings revealed that malaria was the most prevalent disease affecting 31% of inmates. In regards to the inmate’s physical health status 77.8% rated as poor, 13.2% as fair and 9.0% as good. The results also showed the mental and emotional health status of the inmates with 25.5% hearing voices that others can’t hear, 41.4% screened for severe depression, 50% rated their emotional health as poor, 29.7% as fair and 20.3% as good. Furthermore, the study revealed that 41.3% of the inmates found it difficult to assess healthcare services, 48.5% mentioned long waiting times as a barrier to accessing healthcare, In regards to the quality of care, 52.3% rated as poor, 40.4% as fair and 7.3% as good. In addition, the findings showed an association between inmates socio-demographic factors, detention history, medical history and physical health status. The results revealed significant insights into the mental and physical health burden among inmates and highlights the gaps in access to healthcare and quality of care. Recommendations include increased budget allocation, hiring and training of healthcare personnels to identify and address mental health issues and regular screenings for communicable diseases. 1 CHAPTER ONE INTRODUCTION 1.1 Background of the study When an individual violates the law and is sentenced to a correctional centre, what happens to the offender's health while incarcerated? In Nigeria, the health of correctional centre inmates is a major subject that requires extensive examination. To understand the health situation, we must first grasp the concept of health. Previously, health meant the absence of sickness or illness. However, in 1948, the WHO constitution redefined health in what is known as the most notable definition still used presently, which is the state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. This definition is still incomplete as it doesn’t factor in the individual’s spiritual needs. A better definition would be that health is a complete physical, mental, social, emotional, and spiritual well-being, not merely the absence of disease or infirmity. Temiloluwa et al. (2022) described health status as the condition of an individual's health at a specific point, integrating various dimensions that contribute to one's overall quality of life. Healthcare infrastructure in Nigeria is still underdeveloped and lacks modern medical facilities. According to the International Trade Administration's assessment for 2023, Nigeria has some of Africa's most worrisome healthcare indices, with an annual population growth rate of 3.2% and an average of 5.5 live births per woman, it is one of the world's fastest-growing populations. Nigeria's population is projected to reach 400 million by 2050, making it the world's third most populated country. According to WHO estimates, medical professionals are in short supply, with only approximately 35,000 doctors out of a total of 237,000 needed, owing in part to the enormous exodus of healthcare workers overseas. The Nigerian Medical Association (NMA) 2 estimates that medical tourism costs the country at least $2 billion annually. India contributes to more than half of the outflow. Given the dire state of healthcare indicators in Nigeria's general society, one can only imagine the exacerbated conditions within its correctional centre system. With healthcare already strained by rapid population growth and limited resources, the challenges within correctional centres are likely magnified, potentially leading to even more severe healthcare disparities and inadequacies for incarcerated individuals. In Nigeria, the health status of correctional centre inmates is a critical concern, particularly regarding HIV, other sexually transmitted infections (STIs), Tuberculosis (TB), and Hepatitis B (HBV). The unique dynamics within correctional facilities, including risky behaviours, inadequate healthcare, and substandard living conditions where N750 is used to feed an inmate against the N3000 that was recommended by the Nigerian correctional service in 2023, facilitate the rapid spread of these diseases. Moreover, shortcomings in correctional centre infrastructure, management practices, and the broader criminal justice system exacerbate the vulnerability of inmates to HIV/AIDS, TB, HCV, HBV, and other health risks. According to Benjamin (2022), about 65 per cent of Nigeria's more than 47,000 correctional centres have not been convicted of a crime, with some waiting up to ten years behind bars for their trial. Additionally, data from the Nigerian Correctional Service Annual Reports (2024) reveal that 69% (55, 411) of the total 80, 858 inmates are in pre-trial detention, echoing the findings from the 2024 report which indicated that 69% of the total inmates are awaiting trial. These statistics underscore the severe overcrowding within correctional centres, predominantly driven by the high proportion of individuals awaiting trial, thereby intensifying the health challenges faced by incarcerated populations in Nigeria. The health status of correctional centre inmates is profoundly impacted by the dire conditions within correctional facilities, leading to outbreaks of infectious diseases and mental health 3 issues. Sharma et al. (2020) emphasize that poor hygiene practices and the lack of proper nutrition significantly worsen health issues among inmates. In environments where basic hygiene is neglected, the spread of infectious diseases becomes rampant, compromising the overall well-being of correctional centres. Additionally, inadequate nutrition further weakens their immune systems, making them more susceptible to illnesses and complicating existing health conditions. Addressing these fundamental needs is essential for improving the health and quality of life for those incarcerated. The prevalence of overcrowded correctional centres, a global phenomenon, poses significant challenges to maintaining correctional centre health and ensuring a safe environment, echoing findings from the UNODC (2020). Sebastian et al. (2020) observed that overcrowding creates unsanitary and violent conditions, which are harmful to the physical and mental well-being of incarcerated individuals. According to Olufemi O Aluko et al. (2021), sanitation involves several critical elements, such as access to clean water, proper waste management, hygienic living environments, and sufficient sanitation facilities. In Nigerian correctional centres, overcrowding and scarce resources make it extremely challenging to uphold acceptable sanitation standards. Poor sanitation not only facilitates the spread of infectious diseases but also negatively impacts the physical and mental health of inmates. The lack of clean water for drinking, bathing, and handwashing heightens the risk of waterborne diseases and skin infections, while unsanitary living conditions contribute to the prevalence of respiratory and gastrointestinal illnesses among correctional centres. The impact of poor sanitation on inmate health is profound and far-reaching. Infectious diseases such as tuberculosis (TB), cholera, hepatitis, and diarrheal illnesses proliferate in environments characterized by inadequate sanitation and overcrowding. Additionally, poor sanitation exacerbates the burden of non-communicable diseases, including hypertension, diabetes, and mental health disorders among inmates. Unhygienic living conditions and lack of access to 4 basic amenities compromise inmates' immune systems, increasing their susceptibility to a wide range of health issues. Recent studies by Nwosu and Okafor (2022) emphasize the critical need for improved correctional centre sanitation facilities to mitigate these health risks. Additionally, the psychological toll of living in unsanitary environments can lead to increased stress, anxiety, and depression among incarcerated individuals, further compromising their overall health and well-being. Ikoyi Correctional Centre, built to accommodate 800 inmates, according to a report in Prison Insider (2019) now has a population of 3,113 with 2,680 of them being persons awaiting trial, like many other Nigerian correctional centres, has fallen below acceptable standards. Overcrowding, inadequate infrastructure, and limited access to clean water and sanitation facilities pose significant challenges to maintaining proper hygiene. Poor sanitation contributes to the spread of infectious diseases and undermines the overall well-being and dignity of inmates. Addressing sanitation issues is imperative to safeguarding inmates' health and preventing the outbreak of infectious diseases within the correctional facility. Recently, Nigeria has seen a surge in the rate of crimes around the country, leading to an increase in the correctional centre population and this growth raises concerns about the healthcare needs of inmates who often have to live in suboptimal conditions, increasing the risk of infectious disease and mental illness. A large number of individuals transition through correctional centres annually, which according to UNODC (2020) is estimated to be about 30 million people worldwide. Hence, Nathaly et al. (2020) assert that enhancing the health of this vulnerable population is crucial for reducing health disparities and advancing public health. This study was designed based on the current, to assess the health state of inmates at Ikoyi Correctional Centre and identify prevalent diseases such as HIV, TB, HCV, and HBV, as well as assess the effectiveness of existing healthcare facilities in treating these health concerns to provide insights and recommendations for improving healthcare delivery in Nigerian 5 correctional facilities, thereby helping to reduce health disparities and improve public health outcomes for incarcerated people. 1.2 Statement of the problem In recent years, Nigeria has experienced a substantial surge in its inmate population, ranking first in West Africa as the country with the highest number of inmates, seventh in Africa and 27th in the entire world, reflecting a concerning trend in the country's criminal justice system (World Prison Brief, 2024). This increase, exemplified by the current inmate population of 84,767 as of September 2024, as reported by the World Prison Brief (2024), underscores a critical issue in the nation's incarceration practices. Nigeria, with its vast population of 223,804,632 (Statista, 2024), grapples with the challenge of accommodating its citizens within its correctional facilities, leading to severe overcrowding and dire living conditions. The official holding capacity of all the correctional centres in Nigeria is 50,153 but they currently hold 84,767 inmates nationwide (World Prison Brief, 2024) with an occupancy level of 136.7% based on the official capacity. The overcrowding and inadequate living conditions prevalent in Nigerian correctional centres pose significant threats to the health and well-being of inmates. Studies have revealed a multitude of health problems among inmates, ranging from psychiatric disorders to infectious diseases, exacerbated by congestion, insufficient nutrition, and poor hygiene standards. For instance, research conducted by the United Nations Office on Drugs and Crime (UNODC, 2020) highlights the heightened risk of HIV transmission within Nigerian correctional centres, with a prevalence rate of 2.8%, double that of the general population. Another study carried out by Olagunju et al. (2018) found that 60% of Nigerian inmates suffer from psychiatric disorders, a stark contrast to the 12% prevalence in the general population. Additionally, inmates' socio-economic backgrounds may predispose them to chronic illnesses such as hypertension and diabetes, compounding their health risks, plus the stigma associated 6 with incarceration often results in inadequate or substandard treatment of inmates' health needs, perpetuating poor health outcomes. Understanding and addressing these complexities are essential not only for the well-being of incarcerated individuals but also for public health efforts to curb disease transmission. Despite the alarming prevalence of health issues among inmates, there remains a notable lack of adequate healthcare provision within Nigerian correctional facilities with resource constraints, understaffing, and bureaucratic barriers further impeding effective healthcare delivery, exacerbating health disparities within the correctional system. The government's response to this public health crisis has been insufficient, failing to address the fundamental rights and well-being of incarcerated individuals effectively. Therefore, this study aims to delve into the health status of inmates at the Ikoyi Correctional Centre with a comprehensive assessment of their mental and physical well-being. By examining the root causes behind their health challenges and elucidating the implications on their overall health and quality of life, this research seeks to shed light on the urgent need for improved healthcare provisions within Nigerian correctional centres. 1.3 Aim and Objectives of the Study 1.3.1 Aim The research aims to assess inmates' health status in the Ikoyi Correctional Centre in Nigeria’s South Western geo-political zone. 1.3.2 Objectives The specific objectives of this study include 1. To identify the prevalent diseases suffered by the inmates of Ikoyi Correctional Centre, Lagos. 7 2. To assess the physical health status of inmates of Ikoyi Correctional Centre, Lagos. 3. To assess the mental and emotional health status of inmates in Ikoyi Correctional Centre 4. To determine the availability of healthcare services provided to inmates in Ikoyi Correctional Centre. 5. To ascertain the quality of healthcare services provided to inmates in Ikoyi Correctional Centre. 6. To identify the factors associated with the physical health status of the inmates in Ikoyi Correctional Centre. 1.4 Research Questions 1. What are the most common diseases and health conditions reported among the inmates of Ikoyi Correctional Centre? 2. Are there any observable trends or patterns in the physical health status of the inmates? 3. How prevalent are conditions such as depression, anxiety, and other mental illness among the inmates? 4. What healthcare services are available to the inmates of Ikoyi Correctional Centre? 5. What is the quality of healthcare services provided to the inmates of Ikoyi Correctional Centre? 6. What are the factors associated with the physical health status of the inmates in Ikoyi Correctional Centre? 1.5 Significance of the study Understanding the health status of inmates is crucial for public health interventions within correctional facilities due to unique health challenges, study findings can provide valuable 8 information for policymakers and administrators, contributing to policy reforms aimed at improving healthcare delivery and overall inmate well-being. Detailed insights into inmates' health can assist in better planning and management of healthcare services within the Ikoyi Correctional Centre, including optimizing resources and enhancing preventive care strategies. This study focuses on health status over disease profiles, filling a gap in current literature, particularly in Nigeria. It highlights the health challenges faced by inmates, advocating for equitable access to medical services. Improved healthcare in correctional facilities benefits inmates and has potential public health implications for the broader community, reducing the transmission of diseases and promoting healthier reintegration into society. This study's significance lies in its potential to bring about positive changes in the health and well-being of inmates in the Ikoyi Correctional Centre, several studies have been carried out concerning the mental status or disease profile of incarcerated individuals in states like Makurdi, Kaduna, Osun, Abakaliki, Onitsha, Enugu but there is minimal study on the health and well-being of inmates in Ikoyi Correctional facility. This study aims to shed light on the physical and mental status of incarcerated individuals in the Ikoyi Correctional facility which can influence policies and better health practices for incarcerated individuals, understanding the health status of inmates is crucial as the findings can impact public health policies, advocacy for better infrastructure, resource allocation, mental health advocacy, and successful rehabilitation and reintegration into society. 9 CHAPTER TWO LITERATURE REVIEW 2.1 Conceptual Framework The conceptual review of this study focuses on health, health status, inmates, correctional centres and healthcare for inmates. 2.1.1 Concept of Health Health is a multidimensional concept that transcends mere physical well-being, encompassing mental, emotional, and social stability, particularly in environments where individuals face restrictive conditions such as correctional facilities. In this context, health is shaped by both intrinsic and extrinsic factors that either promote or impede the quality of life for individuals. According to van der Linden and Schermer (2024), the complexity of health is best understood through a combination of empirical research and philosophical inquiry. They argue that the conceptualization of health and disease goes beyond straightforward definitions, as practical and moral dimensions influence clinical understandings and treatment approaches (van der Linden & Schermer, 2024). This aligns with the World Health Organization’s (WHO) broad definition of health, which emphasizes physical, mental, and social well-being rather than the absence of disease alone, underscoring that health in prison settings, like the Ikoyi Correctional Centre, should be viewed through a holistic lens. Correctional environments, however, introduce unique challenges to achieving holistic health, as seen in the studies by Bukie and Ogbanga (2024) and Afolabi et al. (2024). These authors 10 highlight that prison congestion, inadequate sanitation, and the psychological strain of incarceration negatively impact inmates’ well-being. Overcrowding, a common issue in Nigerian prisons, compounds these health risks as the physical proximity of inmates within limited spaces promotes the spread of communicable diseases and reduces access to essential health services (Bukie & Ogbanga, 2024). Additionally, the cramped environment fosters feelings of social isolation and exacerbates mental health challenges, including anxiety and depression (Afolabi et al., 2024). Health, in this context, involves not only the physiological aspects but also the psychological and social frameworks that enable inmates to maintain resilience and cope with the stresses of prison life. The mental and emotional dimensions of health are critical to inmate well-being, and they become particularly pronounced in correctional settings. Afolabi et al. (2024) emphasize the concept of emotional distress, which arises from conditions such as isolation, inadequate support systems, and the lack of mental health interventions. The study found that emotional distress manifests in symptoms like anxiety and depression, which can, in extreme cases, lead to suicidal ideation if left unaddressed. This underscores the importance of viewing health as a multifaceted construct that includes emotional and psychological stability (Afolabi et al., 2024). The notion that emotional health is as significant as physical health is crucial in understanding inmates’ needs and has implications for the type of healthcare services correctional facilities should provide. This perspective aligns with Bray’s (2024) research, which found that mental health issues among inmates in Ghana's Akuse Prison are exacerbated by poor living conditions and the absence of adequate mental health services. Bray's findings reveal that mental health must be prioritized alongside physical health, especially given the high incidence of depression and anxiety in correctional facilities where environmental stressors are prevalent (Bray, 2024). 11 Physical health within correctional facilities is influenced by sanitation, diet, and accessibility to healthcare services, as Bukie and Ogbanga (2024) illustrate in their study on Nigerian prisons. Incarcerated individuals are often subjected to unhygienic living conditions due to overcrowding, insufficient sanitation facilities, and inadequate food quality. Bukie and Ogbanga (2024) observe that many inmates suffer from malnutrition and related health complications because prison diets lack essential nutrients. Another study by Okojie and Oviawe (2020) found that malnutrition was prevalent in Nigerian Correctional Centres due to limited access to nutritious foods, poor meal planning, and lack of nutritional supplements. This poor diet contributes to numerous health issues, from weight loss to skin conditions, as described by Bray (2024), who similarly observed the inadequacy of prison meals in the Ghanaian correctional context. Bray’s (2024) study revealed that inadequate nutrition and poor sanitation together lead to health declines, further burdening the prison healthcare system. A report by Amnesty International (2018) highlighted the dire sanitary conditions in Nigerian correctional centres, noting that many inmates are forced to use buckets for toilets, which are rarely emptied and cleaned. The result of this poor sanitation is linked to the transmission of diarrhoeal diseases such as cholera and dysentery, as well as typhoid, intestinal worm infections and polio. Thus, health, in a correctional context, necessitates not only medical treatment but also systemic changes in sanitation practices, nutritional standards, and facility conditions to promote holistic well-being (Bray, 2024). Healthcare access within correctional settings is crucial for inmates’ overall health status, as highlighted by Bukie and Ogbanga (2024) and Afolabi et al. (2024). Healthcare services within correctional facilities must meet standards that allow for preventive care, routine check-ups, and timely treatment of illnesses to mitigate the spread of infectious diseases common in crowded environments. However, both Bukie and Ogbanga (2024) and Bray (2024) found that healthcare in prisons often falls short of these standards, with limited medical staff, inadequate supplies, and delayed responses to health emergencies. This lack of adequate healthcare 12 availability leads to an accumulation of untreated health issues, reinforcing cycles of poor health and reducing the capacity for rehabilitation. The finding of another study by Ibrahim et.al (2022) also shows that Nigerian correctional centres are chronically underfunded, which severely limits their ability to provide adequate healthcare. The budget allocated to correctional centre healthcare is minimal, resulting in shortages of essential medications, medical equipment, and personnel. The shortage of qualified medical staff in Nigerian correctional centres further exacerbates the health challenges faced by inmates. Many correctional centres lack sufficient doctors, nurses, and other healthcare professionals, leading to delayed or inadequate medical care. Additionally, the existing medical staff often lack the necessary training to deal with the unique health needs of inmates, particularly those with mental health issues or substance abuse problems Benjamin et al. (2023). The availability of healthcare services thus forms an integral part of health in correctional facilities, linking directly to physical, mental, and social well-being as emphasized by WHO's health framework (Bukie & Ogbanga, 2024; Bray, 2024). Mental and social health in correctional settings is also significantly shaped by the availability and quality of healthcare services. Afolabi et al. (2024) argue that social isolation and inadequate mental health support heighten the psychological burden on inmates, making them more susceptible to emotional and mental health challenges. They found that the presence of structured social support networks, such as group therapy sessions and peer support programs, can alleviate some of these challenges and improve overall mental health outcomes (Afolabi et al., 2024). A robust health system within prisons would incorporate not only physical healthcare but also mental health services that address inmates' emotional needs, reducing the likelihood of mental health deterioration. This approach resonates with Bray’s (2024) call for integrated mental health interventions in Ghanaian prisons to tackle issues of isolation and emotional strain among inmates. Providing such mental health services within correctional facilities is 13 essential, as it supports rehabilitation and aligns with broader health definitions that emphasize mental and social well-being (Bray, 2024). The quality of healthcare services in correctional facilities, as discussed by Bray (2024), is essential in maintaining inmates' health. Bray’s (2024) study found that the quality of health services in Ghanaian prisons is often subpar due to insufficient resources, inadequate staffing, and limited health programs. This lack of quality care directly impacts inmates' physical and mental health, as substandard medical attention leaves many inmates vulnerable to worsened health conditions. Similar findings by Bukie and Ogbanga (2024) indicate that Nigerian prisons also struggle with quality healthcare provision, as overcrowding strains resources and reduces the effectiveness of available health services. For health to be genuinely achieved in a correctional setting, the quality of healthcare services must be improved to meet standards that address the diverse health needs of inmates. Improving healthcare quality in prisons can foster better health outcomes and support rehabilitation efforts, aligning with the concept of health as a holistic and inclusive state (Bukie & Ogbanga, 2024). In a nutshell, the concept of health for inmates in correctional facilities such as the Ikoyi Correctional Centre extends beyond the absence of disease to encompass physical, mental, and social dimensions that contribute to overall well-being. This holistic view of health underscores the importance of addressing the unique challenges faced by inmates, including overcrowding, poor sanitation, limited healthcare access, and social isolation. As van der Linden and Schermer (2024) suggest, empirical and philosophical perspectives on health can deepen our understanding of the factors that shape inmates' health experiences, informing more effective healthcare strategies in correctional settings. The studies by Bukie and Ogbanga (2024), Afolabi et al. (2024), and Bray (2024) collectively illustrate the urgent need for comprehensive health interventions in prisons, including improved sanitation, adequate nutrition, mental health support, and high-quality healthcare services. By addressing these factors, correctional 14 facilities can create environments that foster better health outcomes for inmates, aligning with the broader definitions of health and promoting rehabilitation within the justice system. 2.1.2 Health Status of Inmates The health status of inmates in prison is a critical component of public health and criminal justice, directly impacting individual well-being and broader community health outcomes. Health status, in this context, is a multidimensional concept that refers to the physical, mental, and social well-being of incarcerated individuals, measured by the prevalence of diseases, availability and quality of healthcare, mental health conditions, and the impact of environmental factors on overall health. Incarcerated individuals often face a high burden of non-communicable diseases (NCDs), infectious diseases, mental illnesses, and poor living conditions that exacerbate existing health vulnerabilities. Gavi et al. (2024) highlight the prevalence of NCDs, particularly cardiovascular diseases, among prison populations in Sub- Saharan Africa, emphasizing that incarcerated individuals experience significant health disparities relative to the general population. These disparities are further aggravated by structural factors within correctional facilities, including inadequate exercise opportunities, poor sleep conditions, and dietary deficiencies, which all contribute to poor cardiovascular health outcomes in prisons (Gavi et al., 2024). Social determinants of health, such as socioeconomic status, education, employment, and social support available for inmates have a profound influence on health outcomes, Braveman and Gottlieb (2015). Prison inmates often experience poorer health due to factors like limited access to healthcare, unhealthy living conditions, and higher levels of stress. Inmates’ health is influenced by various socio-environmental factors that impact their physical and mental well- being. The challenges to mental health among inmates are severe, as research by Audu et al. (2024) demonstrates a high prevalence of depression, especially due to inadequate coping strategies 15 within prisons. In their study, Audu et al. (2024) found that emotion-focused disengagement and a history of mental illness before incarceration significantly predicted depression among inmates, underscoring the heightened vulnerability of prisoners to mental health issues. This finding aligns with Omaku et al. (2024), who explored the effects of loneliness on psychological distress among inmates awaiting trial and noted a direct correlation between the lack of social support and increased psychological distress. According to Omaku et al. (2024), the isolation that often accompanies incarceration exacerbates psychological issues among inmates, suggesting that psychological interventions like Cognitive Behavioural Therapy (CBT) and behaviour modification may alleviate some of the mental health strains experienced by inmates. Gender-specific health needs also play a significant role in shaping the health status of inmates. According to Arua et al. (2024), women inmates face unique challenges, including inadequate access to personal hygiene products, lack of nutritional care, and insufficient healthcare tailored to their needs. The study conducted by Arua et al. (2024) emphasizes the deplorable conditions that female inmates often face, which are exacerbated by a prison system primarily designed to meet the needs of male inmates. This systemic neglect underscores the need for gender- specific policies and practices to address health disparities within the prison system effectively. Women’s health in prison, particularly maternal and reproductive health, remains under- researched and inadequately addressed, highlighting a crucial gap in the prison health infrastructure (Arua et al., 2024). Additionally, the health needs of elderly inmates are insufficiently considered, especially regarding age-related health conditions such as cardiovascular diseases and degenerative illnesses (Gavi et al., 2024). The lack of age- appropriate healthcare services places elderly inmates at higher risk of adverse health outcomes, which is further exacerbated by poor access to diagnostic and treatment resources within the prison system (Gavi et al., 2024). 16 A primary determinant of health status among inmates is the availability and quality of healthcare services. Okeke (2024) points out that prison congestion is a significant barrier to accessing adequate healthcare, as overcrowding strains limited medical resources and diminishes the overall quality of care that inmates receive. In the South-East of Nigeria, where prison facilities often exceed capacity, inmates awaiting trial experience even more pronounced neglect due to limited medical attention and resources dedicated to their health (Okeke, 2024). Sebastian et al. (2020) observed that overcrowding creates unsanitary and violent conditions, which are harmful to the physical and mental well-being of incarcerated individuals. This overcrowded and resource-deficient environment often results in unprofessional treatment and unaddressed health needs, as described by Okeke (2024), where inmates face poor diets, lack of adequate medical care, and inadequate separation between awaiting trial and convicted prisoners, resulting in substandard quality of healthcare and overall living conditions for these individuals. The physical health status of inmates is often the most readily observed dimension of health status and is notably affected by the prison environment, which contributes to the spread of communicable diseases and exacerbates pre-existing health conditions. Prisons, being confined environments with limited access to hygiene and sanitation facilities, often act as breeding grounds for infectious diseases, further complicating the health status of inmates. Poor dietary provisions, insufficient exercise opportunities, and lack of access to routine health screenings increase the vulnerability of inmates to both infectious and non-communicable diseases (Gavi et al., 2024). The cumulative effects of these inadequacies are profound, as Gavi et al. (2024) report a high prevalence of cardiovascular diseases and other NCDs within the prison population, which are largely preventable through basic health interventions that are not readily available in most prisons. Moreover, the limited availability of healthcare services within correctional facilities often results in undiagnosed or untreated health issues, leading to long- term health complications for inmates (Gavi et al., 2024). 17 Mental and emotional health, equally crucial aspects of health status, but often neglected are profoundly impacted by incarceration, as the prison environment is often characterized by stress, isolation, and lack of social support. The study by Omaku et al. (2024) illustrates how loneliness and lack of social support contribute significantly to psychological distress among inmates, particularly those awaiting trial. Inmates, especially those isolated from family and community support systems, experience heightened psychological distress, which is exacerbated by the punitive nature of imprisonment rather than rehabilitative support (Omaku et al., 2024). Additionally, Audu et al. (2024) reveals that the coping mechanisms employed by inmates play a critical role in their mental health, with maladaptive strategies, such as emotion- focused disengagement, correlating with higher rates of depression. In Nigeria, the prevalence of substance use disorders among inmates is high, with many individuals using drugs and alcohol as coping mechanisms. A study by Ugwuoke and Mfon (2018) found that over 50% of Nigerian correctional centre inmates reported using substances, leading to increased rates of infectious diseases, mental health disorders, and violence. The consequence extends to the prevalence of mental health disorders among Nigerian correctional centre inmates is alarmingly high. Studies, such as that by Ogunlesi and Ogunwale (2018), have found that a significant proportion of inmates suffer from depression, anxiety, and post-traumatic stress disorder (PTSD). These conditions are often exacerbated by the stressful and violent environment of correctional centres. The lack of structured mental health support within prisons results in a reliance on coping strategies that may not effectively mitigate psychological distress, leading to worsening mental health outcomes over time (Audu et al., 2024). This finding underscores the importance of introducing mental health interventions that address the unique stressors faced by inmates and promote adaptive coping mechanisms. 18 The structural inadequacies of healthcare within the prison system further exacerbate the health challenges faced by inmates. Arua et al. (2024) emphasize that female inmates, in particular, suffer from a lack of access to basic hygiene supplies and medical care tailored to their specific needs. This gender-based disparity within the prison healthcare system highlights a failure to provide equitable healthcare services, contributing to the dehumanizing experiences faced by female inmates, especially concerning maternal health and personal hygiene (Arua et al., 2024). Such inadequacies in healthcare provision are compounded by the broader neglect of prison health infrastructure, where even basic medical services are often scarce, and specialized care for women, elderly inmates, and those with chronic illnesses is grossly inadequate (Gavi et al., 2024). Additionally, the role of social determinants in shaping health outcomes within prisons is evident in the high rates of psychological distress and physical illness observed among inmates. Social support networks, including family and community connections, are crucial for mental health; however, these networks are often disrupted or absent in the prison setting, exacerbating the psychological burden on inmates (Omaku et al., 2024). In the context of limited social support and substandard living conditions, the prison environment intensifies the challenges faced by inmates, leaving many without access to the resources and care necessary for maintaining mental and emotional health (Omaku et al., 2024). Moreover, the stigma and marginalization associated with incarceration further isolate inmates from social support, reducing their ability to access health services both during and after imprisonment (Audu et al., 2024). The assessment and understanding of health status have important implications for healthcare delivery, public health policy, and individual health. health status data inform public health policies and programs, enabling targeted interventions to address specific health issues and populations. For example, epidemiological data on the prevalence of chronic diseases can guide 19 resource allocation and the development of prevention strategies. In a nutshell, the health status of inmates is a complex interplay of physical, mental, and social factors that are significantly impacted by the prison environment, access to healthcare, and individual coping strategies. The studies by Gavi et al. (2024), Arua et al. (2024), Audu et al. (2024), Omaku et al. (2024), and Okeke (2024) collectively highlight the urgent need for comprehensive healthcare reforms within the correctional system to address the multifaceted health challenges faced by inmates. These reforms should include increased access to both physical and mental health services, gender-sensitive care, improved nutritional provisions, and enhanced social support systems. Without these structural changes, the health status of inmates will remain a neglected area, with long-term consequences for individual well-being and public health. 2.1.3 Concept of Inmates Inmates also known as prisoners or detainees are individuals confined to a correctional facility, such as a prison or jail, as a result of a criminal conviction or while awaiting trial (United Nations Office on Drugs and Crime, 2017). The concept of inmates encompasses a diverse population with unique needs, challenges, and experiences. Inmates in Nigerian prisons face a broad array of health, security, and rehabilitative challenges, exacerbated by significant issues within the correctional system. Overcrowding is one of the most pressing issues, as highlighted by Bukie and Ogbanga (2024), who stress the immediate need for governmental intervention to alleviate congestion by constructing additional facilities and renovating existing ones. The overcrowded conditions lead to deteriorating physical health among inmates, as limited space makes it difficult to maintain proper sanitation and hygiene (Bukie & Ogbanga, 2024). This environment often breeds communicable diseases, which flourish due to insufficient ventilation and the high inmate density within confined spaces. Further, Bukie and Ogbanga (2024) underscore that crowded prison conditions deviate from 20 the United Nations Standard Minimum Rules for the Treatment of Prisoners, demonstrating how Nigeria’s prison conditions fall short of international standards. Mental health among inmates is also a critical issue in Nigeria's correctional facilities. Studies by Bukie and Ogbanga (2024) and Omoruyi and Agbontaen (2024) highlight the compounded psychological strain arising from overcrowding, lack of rehabilitation opportunities, and challenging prison conditions. Mental health issues in prison are frequently aggravated by inadequate support services, an aspect Omoruyi and Agbontaen (2024) identify as limiting inmate well-being and eventual reintegration into society. Although rehabilitation programs exist, Omoruyi and Agbontaen (2024) found that the resources available to correctional facilities are insufficient to address the diverse needs of the prison population effectively. This insufficiency hampers inmates’ ability to cope with the psychological and emotional demands of prison life, worsening mental health conditions that are often left untreated or ignored. The concept of inmates also raises important questions about human rights, dignity, and rehabilitation. The United Nations has established standards for the treatment of prisoners, including the right to humane conditions, access to healthcare, and opportunities for rehabilitation and reintegration into society (United Nations Office on Drugs and Crime, 2017). In addition, inmates often experience stigma and social exclusion, which can make it difficult for them to reintegrate into society upon release (Goffman, 1963). This can lead to a cycle of recidivism which refers to a person's relapse into criminal behaviour, often after the person receives sanctions or undergoes intervention for a previous crime, as individuals may struggle to find employment, housing, and social support. Furthermore, the concept of inmates highlights the need for alternative approaches to punishment and rehabilitation. Consequently, as Quinn-Hogan (2021) noted, unless these released convicts receive help to counter and face these derailments, offenders are highly predisposed to increased risk of failed social reintegration, recidivism, reconviction, and ultimate social rejection. 21 The challenges within Nigeria's correctional system extend beyond the individual to the institution's structure and operational limitations. According to Nebeife et al. (2024), the correctional system suffers from poor funding and staffing deficiencies, both of which are pivotal in exacerbating overcrowding and creating an insecure environment. This issue has led to a series of jailbreaks, which are partly attributed to the lack of adequate surveillance technology and the poor utilization of intelligence to mitigate risks within correctional facilities (Nebeife et al., 2024). Jailbreaks not only indicate severe administrative shortcomings but also highlight the failure to maintain a secure environment conducive to rehabilitation and societal reintegration (Nebeife et al., 2024). The correctional services' infrastructural inadequacies and inability to effectively implement security measures underscore a systemic failure that continues to compromise inmate safety and public security. Rehabilitation programs in Nigerian prisons vary, with some efforts directed toward preparing inmates for reintegration into society, yet these programs lack consistency and sufficient resources. As Omoruyi and Agbontaen (2024) observed, while some correctional centres offer diverse rehabilitation programs to address convicts' different needs, the quality and accessibility of these programs remain inconsistent across various facilities. The program’s efficacy is further hampered by inadequate funding and institutional support, which limits the range of services and materials available to inmates. The lack of a standardized rehabilitation framework makes it challenging to implement these programs effectively across the entire correctional system, leaving many inmates without the necessary skills or support for successful reintegration post-incarceration (Omoruyi & Agbontaen, 2024). Inmates also face substantial barriers to accessing information, which further complicates their experiences within prison walls. Udem et al. (2024) underscore that information needs in areas such as legal representation, prison rules, and basic literacy are not adequately met, particularly as prison libraries lack the necessary resources. This inadequacy denies inmates access to 22 critical information that could inform their rights and responsibilities within the correctional environment. In Udem et al.'s (2024) study, the resources available in Anambra State’s prison libraries were mostly outdated and limited, leaving many inmates without the information needed for self-improvement or to pursue their legal rights adequately. The inadequacy of these information resources severely limits inmates' ability to improve their circumstances or address legal concerns, which, in turn, undermines their preparedness for life outside the correctional system (Udem et al., 2024). Library services in Nigerian prisons also suffer from resource and staffing shortages, an issue identified by Ifeabor et al. (2024) in their study on Enugu Maximum Prison. The reliance on non-governmental organizations (NGOs) to provide library services further exacerbates this problem, as these organizations are often restricted by funding limitations and are unable to offer consistent support. Ifeabor et al. (2024) point out that a lack of professional staff and high levels of material censorship makes it difficult to offer inmates a wide range of information that would otherwise help them meet their educational or recreational needs. The absence of comprehensive library services thus limits inmates’ access to educational resources and hampers their intellectual development, contributing to a cycle where incarceration does little to address the factors that initially led to criminal behaviour (Ifeabor et al., 2024). Additionally, prisoners’ rights, though enshrined in Nigeria’s legal framework, are often neglected within the practical operation of correctional facilities. The Nigerian constitution provides for fundamental rights such as freedom from torture and access to legal representation, yet in practice, many prisoners face inhumane treatment due to overcrowded facilities, poor sanitation, and physical abuse (Prisoners’ Rights, 2024). These rights violations underscore a disparity between the legal guarantees of prisoner welfare and the reality within correctional centres. The neglect of these rights is further exacerbated by limited oversight and the absence 23 of a robust monitoring mechanism to ensure adherence to legal standards (Prisoners’ Rights, 2024). Efforts to address prisoners’ rights in Nigeria face numerous obstacles, with reform initiatives often stalled by political and economic factors. As suggested by the Prisoners' Rights (2024) study, sustainable funding and effective monitoring systems are necessary to uphold prisoners’ rights in practice. However, governmental inertia and bureaucratic challenges delay the implementing of these improvements. Without a structured approach to reform and enhanced transparency in correctional services, conditions are unlikely to improve, leaving inmates subject to human rights violations that further erode their dignity and well-being (Prisoners’ Rights, 2024). The need for reform within Nigeria’s correctional system is undeniable, as overcrowding, lack of healthcare, insufficient rehabilitation programs, and unfulfilled information needs continue to undermine inmates' rights and welfare. As evidenced by the studies of Bukie and Ogbanga (2024) and Nebeife et al. (2024), the compounding issues of limited resources, poor administration, and inadequate infrastructure paint a bleak picture of the Nigerian prison system. The concept of inmates encompasses a complex and multifaceted population with unique needs, challenges, and experiences. The current conditions within these correctional facilities not only fail to rehabilitate inmates but also compromise their health and security, raising questions about the correctional system’s role in the larger criminal justice framework. This systemic failure underscores an urgent need for legislative and policy interventions that prioritize humane treatment, access to healthcare, and adequate rehabilitation for inmates in Nigeria’s correctional facilities. 2.1.4 Correctional Centres in Nigeria Correctional centres in Nigeria are institutions established to detain individuals convicted of crimes, and they are intended to provide avenues for rehabilitation, reform, and reformation of 24 inmates (Nebeife et al., 2024). In Nigeria, these centres, governed by the Nigerian Correctional Service, are overburdened by several structural and operational challenges. There is no gain to say about the overpopulation of Nigerian correctional centres. Nigerian correctional centres are well overcrowded with inmates both sentenced and awaiting trial, and this poses a great threat to the actualization of the goals of establishing the correctional centres. The correctional centre environment in Nigeria is noticeably characterized by severe overcrowding, poor sanitation, and inadequate nutrition, creating breeding grounds for diseases such as tuberculosis, HIV/AIDS, and malaria, Habib (2024). Joseph et al (2021) elucidate on the overcrowding issue, highlighting that many Nigerian correctional centres operate at capacities significantly exceeding their intended limits. For every correctional centre, there is a capacity of inmates to accommodate. In recent years, the issue of overcrowding in Nigerian correctional centres has increasingly captured the attention of both the Nigerian public and the academic community. This heightened awareness is primarily attributed to an unprecedented surge in the correctional centre population, leading to critical levels of overcrowding across numerous facilities nationwide. Cheche et al. (2020) in his study posit that correctional centres throughout Nigeria are experiencing conditions of severe overcrowding, posing significant risks to the safety and well-being of both inmates and correctional centre staff. This chronic overcrowding, as elucidated further by Ohazulike and Chikwendu (2023) not only exacerbates existing operational challenges but also severely hampers the effective administration of rehabilitation and reformative programs within these institutions. As such, the phenomenon has become a central focus for research aimed at understanding its implications and driving policy reforms to mitigate its adverse effects. It is worth noting that the word “overcrowding” is used as a term of art in this sense. More than just the ratio of inmates to rated space, overcrowding in correctional centres refers to the degree to which a jail, or a correctional centre system, holds more correctional centres than the 25 facilities can humanely handle. According to recent statistics, the problem of overcrowding in Nigerian correctional centres, primarily due to a high number of inmates awaiting trial, continues to be a significant concern. The latest data from the Nigerian Correctional Service Annual Report indicates that a substantial proportion of the correctional centre population remains in pre-trial detention. Specifically, 68% of the total 84,011 inmates, amounting to approximately 56,757 individuals, are still awaiting trial. This percentage aligns closely with figures from previous years, such as those reported in 2015, where 63% of inmates had not yet been convicted. These consistent statistics underscore the persistent issue of overcrowding in Nigerian correctional centres, largely fuelled by prolonged pre-trial detentions. This situation highlights a critical area in need of reform within the justice system to enhance efficiency and uphold the rights of detainees. Oyeyipo et al. (2021) however, attributed the rise in Nigeria's crime rate to overcrowding, challenging the notion that correctional centre congestion results merely from static correctional centre capacities and population growth. They argued that an increase in the overall population inevitably affects all aspects of life, including crime and criminality. Consequently, they advocated for an expansion in correctional centre capacities to address these challenges effectively. Correctional centres are intended not only to punish wrongdoing, as prescribed by society’s laws but also to correct and rehabilitate offenders for their eventual reintegration into society. In Nigeria, however, this overcrowding exacerbates other problems such as inadequate healthcare, poor sanitation, and limited access to nutritious food (Udom, 2023). These conditions not only impede the rehabilitation process but also pose severe health risks to inmates, occasionally sparking human rights concerns both domestically and internationally. Correctional centre conditions have led to outbreaks of infectious diseases and mental health problems among inmates. Hygiene standards are inadequately maintained, and access to nutritious food is not guaranteed, both of which have adverse effects on the health of inmates (Van Hout and Mhlanga-Gunda, 2019). The problem of overcrowding in Nigerian correctional 26 centres mirrors a global challenge, as congested correctional centres create hazardous conditions that jeopardize the physical and mental rehabilitation of inmates (UNODC, 2020). The rehabilitation programs, which include carpentry, adult literacy, arts/crafts, tailoring and welding which are intended to prepare inmates for reintegration into society, are another focal point. The study by Nwune et al. (2019) reveals that although there are established theoretical frameworks for rehabilitation programs, their implementation is frequently obstructed by a lack of resources, such as inadequate funding and insufficient personnel. Data from the study showed that as long as an inmate is in the correctional centre, he/she undergoes rehabilitation. However, the study revealed that the rehabilitation programs have been fairly successful. The major obstacle to rehabilitation was identified as a lack of funding/inadequate funding. The finding was seen to agree with the Correctional Centre Annual Report (2001/ 2002) which indicated that inadequate funding was a major constraint which hampers both rehabilitation and aftercare of correctional centres. Additionally, Wasiu (2023) highlights in their study that existing programs are often inconsistent and not uniformly accessible across all facilities. This disparity in program quality and availability greatly diminishes the effectiveness of rehabilitation efforts, which in turn contributes to the high recidivism rates reported in various studies. Another significant issue identified in the correctional system is the recurring problem of jailbreaks, often attributed to poor administrative structures and systemic inefficiencies. Nebeife et al. (2024) argue that factors such as poor funding, staff shortages, overcrowding, inadequate intelligence utilization, and insufficient technological support for surveillance have culminated in heightened jailbreak incidents, which, in turn, have increased insecurity nationwide. This lack of investment in correctional security infrastructure has compromised the government’s ability to curb insurgency, banditry, kidnapping, and other crimes that continue to challenge the nation's stability (Nebeife et al., 2024). 27 Another issue faced by Nigeria’s correctional facilities is the negative socio-economic impact on communities surrounding these centres. Ingiabuna (2024) points out that the abrupt eviction notices to shop owners near correctional premises can lead to financial losses, forcing the affected individuals to dismantle their businesses and relocate within very short notice periods. This has an adverse economic impact on these communities and individuals, as relocating entails high financial costs and disrupts livelihoods (Ingiabuna, 2024). Furthermore, when eviction processes occur without adequate notice or engagement with affected shop owners, they contribute to socioeconomic distress and community grievances (Ingiabuna, 2024). In addition to structural issues, recidivism rates have also become a significant concern within the Nigerian correctional system. The issue of repeated offenses after prison release indicates that the country’s correctional institutions have struggled to achieve long-term inmate reform (Mayowa, 2024). According to Mayowa (2024), the prevalence of recidivism is exacerbated by a lack of social and economic support for ex-convicts, leading many to return to criminal activities within two to three years post-release. Factors such as limited job opportunities and intense social stigma against ex-convicts contribute to the high rates of reoffending, as many former inmates face significant barriers to reintegration and social acceptance. These challenges underscore the need for enhanced support structures to facilitate smoother transitions for ex-convicts back into society, as well as the need to address systemic issues within the correctional framework that limit its efficacy in curbing crime and encouraging reformation (Mayowa, 2024). To mitigate recidivism, the Nigerian Correctional Service has implemented various rehabilitation programs that aim to reform inmates by providing them with practical skills for reintegration. According to Omoruyi and Agbontaen (2024), these rehabilitation programs have been structured to address different reformation needs, helping convicts gain new skills and attitudes that support a law-abiding lifestyle after release. Rehabilitation programs are crucial 28 in improving inmates’ prospects upon release, as they enable convicts to acquire skills that increase their employability, thereby reducing the likelihood of reoffending (Omoruyi & Agbontaen, 2024). Omoruyi and Agbontaen (2024) emphasize that continuous improvement and support of these rehabilitation programs are vital, suggesting that initiatives like prison work programs and post-release support should be institutionalized to ensure effective reformation of inmates and reduce recidivism. One important factor influencing the likelihood of recidivism among Nigerian inmates is the role of social support, which, according to Olaleye and Oyeyemi (2024), does not significantly impact inmates’ tendency to reoffend. Their findings show that although social support may help in some circumstances, it has limited effectiveness in deterring recidivism, possibly due to broader socio-economic issues such as poverty and political instability that increase crime rates and, consequently, the number of individuals re-entering correctional facilities. In other words, social support alone is insufficient in combating the cycle of crime, especially given the wider structural problems that exacerbate criminality in Nigeria (Olaleye & Oyeyemi, 2024). Moreover, the Nigerian government has recently recognized the role of non-custodial measures in reducing prison congestion. Non-custodial sentences, including probation, parole, and community service, provide alternatives to incarceration and aim to alleviate the overpopulation within correctional facilities (Meshach & Ogboji, 2024). However, despite the institutionalization of non-custodial measures through the Correctional Service Act of 2019, implementation has been hindered by bureaucratic hurdles, insufficient funding, and legal constraints, which have limited the reach and effectiveness of these measures (Meshach & Ogboji, 2024). These measures are primarily designed for post-sentencing diversion, leaving the issue of pre-trial congestion unaddressed, which remains a significant contributor to overpopulation in correctional centres (Meshach & Ogboji, 2024). An effective non-custodial 29 framework requires further legislative adjustments and the removal of bureaucratic obstacles that hinder the system's functionality. The impact of correctional education as a transformative tool for inmates is another crucial aspect of Nigeria’s correctional framework. Oduntan (2024) highlights that correctional education is pivotal in equipping inmates with skills that enhance their employment prospects, thereby contributing to reduced recidivism. Correctional education fosters positive behavioural changes by preparing inmates for societal reintegration and empowering them with tools to sustain a crime-free lifestyle post-release (Oduntan, 2024). Despite its potential benefits, correctional education programs require greater focus and investment to maximize their rehabilitative impact and ensure long-term societal benefits. Furthermore, issues such as prison congestion and the treatment of inmates awaiting trial remain areas of significant concern. Okeke (2024) discusses the adverse effects of prison overcrowding and inadequate treatment for awaiting trial persons (ATPs), who often face poor dietary conditions, limited medical care, and substandard living environments. The overpopulation issue in correctional centres stems from delays in the judicial system, which prolongs pre-trial detention periods and exacerbates prison congestion. Additionally, the cohabitation of convicted inmates with ATPs contributes to an environment of maltreatment, diminishing the overall quality of correctional services and failing to respect the presumption of innocence for ATPs (Okeke, 2024). Okeke (2024) advocates for systemic reforms in prison management to ensure that ATPs are treated humanely and receive adequate healthcare and living conditions while awaiting trial. In terms of healthcare, Akwaji et al. (2024) underscore the importance of social support in the rehabilitation of inmates, arguing that support from family, administrative bodies, and fellow inmates significantly improves rehabilitation outcomes. Their study suggests that integrating social support structures within correctional settings can enhance the emotional well-being of 30 inmates, which is crucial for their successful reformation and rehabilitation. Akwaji et al. (2024) contend that family support plays a foundational role in an inmate’s rehabilitation journey, providing a critical psychological anchor for individuals navigating the correctional system. Therefore, integrating social support mechanisms into correctional practices is essential for effective rehabilitation and reintegration of inmates into society post- incarceration. The finding of another study by Ibrahim et.al (2022) also shows that Nigerian correctional centres are chronically underfunded, which severely limits their ability to provide adequate healthcare. The budget allocated to correctional centre healthcare is minimal, resulting in shortages of essential medications, medical equipment, and personnel. The shortage of qualified medical staff in Nigerian correctional centres further exacerbates the health challenges faced by inmates. Many correctional centres lack sufficient doctors, nurses, and other healthcare professionals, leading to delayed or inadequate medical care. Additionally, the existing medical staff often lack the necessary training to deal with the unique health needs of inmates, particularly those with mental health issues or substance abuse problems Benjamin et al. (2023). The Nigerian correctional system, as observed across multiple studies, faces a complex array of challenges, including inadequate funding, poor administration, overcrowding, limited rehabilitation programs, and insufficient healthcare provisions. Nebeife et al. (2024) and Mayowa (2024) highlight the connection between these systemic challenges and high recidivism rates, suggesting that without substantial reforms in funding, administrative practices, and structural support for post-release reintegration, correctional centres will continue to fall short of their rehabilitative mandate. Similarly, Omoruyi and Agbontaen (2024) stress the critical need for expanding rehabilitation programs and offering substantial post- release packages to convicts, which would help reduce the high rates of recidivism in the 31 country. Additionally, Okeke (2024) recommends that the government implement policies to improve the living conditions of ATPs, reduce overcrowding, and streamline the judicial process to reduce delays that contribute to congestion. Ultimately, these findings underscore the need for a comprehensive overhaul of Nigeria’s correctional system, one that prioritizes effective rehabilitation, adequate healthcare, structural improvements, and social support integration. By addressing these key areas, the Nigerian Correctional Service could better fulfil its mandate of reforming convicts, reducing recidivism, and contributing to national security. The studies reviewed indicate that sustained investment in correctional facilities and services, coupled with an effective policy framework, is essential for transforming Nigeria’s correctional system into a functional rehabilitative institution that not only detains but also transforms inmates for societal reintegration (Meshach & Ogboji, 2024; Oduntan, 2024). 2.1.5 Healthcare for Inmates Healthcare for inmates refers to the medical services provided within correctional facilities to address the health needs of incarcerated individuals. In Nigeria, the Nigerian Correctional Service Bill, enacted in 2019, mandates that all inmates must receive medical, counselling, spiritual, and psychological services as part of their rehabilitation process (Dataphyte, 2020). This legislation aims to ensure humane treatment and adequate healthcare for incarcerated individuals, although the implementation of these rights often falls short in practice due to systemic challenges within the correctional system. Additionally, international human rights standards, such as the Basic Principles for the Treatment of Prisoners outlined by the United Nations, assert that all prisoners have the right to health and must have access to health services without discrimination (Dataphyte,2020). These principles influence national policies and highlight the obligation of the Nigerian government to provide adequate healthcare services to inmates. 32 However, healthcare for inmates in Nigerian correctional facilities faces numerous challenges, encompassing both mental and physical health concerns that often remain unmet, particularly in overcrowded and resource-limited settings. The implementation of psycho-legal and mental health support in Nigerian correctional institutions is limited, with Olagunju (2024) highlighting that mental health care strategies, which include assessments and psycho-legal services, are still rare despite a substantial percentage of incarcerated individuals struggling with mental health issues, such as schizophrenia and substance use disorders. The majority of incarcerated persons are diagnosed with their first clinical mental illness only after imprisonment, revealing an inadequacy in mental health care within the Nigerian correctional system (Olagunju, 2024). In many prisons, inmates lack access to specialized care and depend on external psychiatric support for treatment, demonstrating the insufficient internal capacity of the prison system to address inmates' mental health needs (Olagunju, 2024). The healthcare service utilization rates among prisoners are generally low, especially for mental health services, despite evidence that a significant proportion of inmates suffer from mental health issues (Yesuf et al., 2024). In Ethiopia, a study demonstrated that while there was a relatively high utilization rate for general medical and counselling services, psychiatric services were underutilized, potentially due to stigma and a lack of awareness among inmates (Yesuf et al., 2024). Additionally, social and demographic factors, such as marital status and education level, significantly impact the use of these services, further complicating healthcare access within prisons (Yesuf et al., 2024). The urgent need for improved healthcare promotion and awareness efforts in correctional facilities is clear from these findings, underscoring the importance of educating inmates about available health services (Yesuf et al., 2024). Additionally, there is a chronic shortage of healthcare professionals working in prisons, which exacerbates the problem of inadequate medical care and surveillance. Communicable diseases such as tuberculosis (TB), HIV, and hepatitis are highly prevalent in Nigerian prisons. These 33 conditions are often exacerbated by overcrowding, poor ventilation, and substandard sanitary conditions (Okonkwo, 2019). The existing health surveillance systems are not sufficiently robust to effectively manage these diseases, often leading to unchecked outbreaks and poor health outcomes among the prison population. Stigma associated with diseases like HIV/AIDS further complicates the effective management of health conditions within prisons. Inmates may be reluctant to come forward for screening due to fear of discrimination and social isolation, thereby undermining the effectiveness of health surveillance and intervention measures (John, Eze, & Lasisi, 2021) Mental health issues, especially within the prison population, are further compounded by the attitudes of correctional officers, which significantly impact the overall health and well-being of inmates (Adeoti et al., 2024). Stigmatization, negative attitudes, and discrimination by correctional staff exacerbate mental health problems, as they create an environment where inmates may feel discouraged from seeking mental health support or participating in rehabilitative programs (Adeoti et al., 2024). A strong relationship exists between the quality of the counselling services provided and the mental health of inmates, showing that without proper mental health support, these individuals may suffer from worsening conditions during their incarceration (Adeoti et al., 2024). Correctional officers’ attitudes have been found to correlate directly with the mental health outcomes of inmates, emphasizing the need for improved training and awareness among officers regarding the mental health needs of incarcerated individuals (Adeoti et al., 2024). Furthermore, specific physical health issues are prevalent in correctional facilities due to a combination of overcrowding, poor hygiene, and inadequate healthcare provisions (Onyemali, 2024). Viral infections, such as hepatitis B and hepatitis C, present significant health risks to inmates, with social determinants like overcrowding and poor living conditions contributing to high infection rates (Onyemali, 2024). Inadequate healthcare resources in prisons exacerbate 34 these issues, as inmates often lack access to timely treatment and preventative care for infectious diseases (Onyemali, 2024). These conditions highlight an urgent need for systemic reforms, improved healthcare infrastructure, and better disease prevention measures in correctional centres to mitigate the risks associated with infectious diseases among inmates (Onyemali, 2024). Mental health issues also have a profound impact on the emotional well-being and quality of life of inmates, as emotional distress frequently goes unnoticed or untreated in the prison system (Afolabi et al., 2024). Emotional distress, characterized by symptoms of anxiety, depression, and a sense of isolation, is prevalent among inmates and can lead to more severe outcomes, including suicidal ideation if left unmanaged (Afolabi et al., 2024). The lack of social interaction, combined with the stress of incarceration, contributes to significant psychological distress among prisoners, making it critical to implement supportive services such as peer counselling and group therapy to improve inmates' mental resilience (Afolabi et al., 2024). Addressing emotional distress through structured social and psychological support could alleviate the mental health burden on inmates and potentially reduce the incidence of severe psychological issues within the prison environment (Afolabi et al., 2024). The health-related quality of life (HRQoL) of inmates in Nigerian correctional facilities remains low, with evidence pointing to poor scores in physical, psychological, social, and spiritual domains (Omirin et al., 2024). In a study conducted at Abeokuta Maximum Correctional Centre, Omirin et al. (2024) found that the majority of inmates reported low HRQoL, with socio-demographic characteristics such as gender and length of stay correlating with overall quality of life. This low quality of life reflects the impact of inadequate healthcare, lack of social support, and challenging prison conditions on inmates' physical and mental health (Omirin et al., 2024). Prison administrators must consider these factors when implementing 35 health programs, as enhancing inmates' quality of life could foster more effective rehabilitation and improve overall outcomes for incarcerated individuals (Omirin et al., 2024). The dual epidemic of non-communicable diseases (NCDs) and HIV further exacerbates the health challenges faced by the incarcerated population in Nigeria (Gavi et al., 2024). Cardiovascular diseases are particularly prevalent among inmates, with factors such as poor dietary provisions, inadequate exercise opportunities, and disrupted sleep patterns contributing to the high incidence of these conditions (Gavi et al., 2024). Elderly inmates and women are particularly vulnerable to cardiovascular issues, as the lack of tailored healthcare services for these groups in correctional facilities compounds their risk (Gavi et al., 2024). To address this issue, correctional facilities must adopt comprehensive healthcare strategies that account for the unique needs of different inmate demographics (Gavi et al., 2024). In the constrained and often volatile environments of Nigeria prisons, access to medication is not merely a healthcare concern but a fundamental human rights issue. Prison environment in Nigeria is noticeably characterized by severe overcrowding, poor sanitation, and inadequate nutrition, creating breeding grounds for diseases such as tuberculosis, HIV/AIDS, and malaria, Habib (2024). The importance of medication in such settings cannot be overstated, as it becomes a crucial line of defence against the spread of communicable diseases that can thrive in crowded conditions. Providing adequate medical care in prisons is essential not only for the welfare of the inmates but also for public health at large. This is so because Ahmad and Muktar (2020) had noted that functional medical efforts can mitigate the transmission of diseases within prison environment and in the society at large, as the majority of prisoners will with time be reintegrate into society. Access to healthcare in prison settings is also seen as a critical aspect of public health and human rights. Collectively, these studies underscore the critical gaps in healthcare provision within Nigerian correctional facilities, with both mental and physical healthcare remaining insufficiently 36 addressed (Olagunju, 2024; Yesuf et al., 2024; Adeoti et al., 2024; Onyemali, 2024; Afolabi et al., 2024; Omirin et al., 2024; Gavi et al., 2024). Implementing reforms to address these healthcare deficits is essential to improving inmates’ well-being and supporting successful reintegration post-incarceration (Olagunju, 2024; Yesuf et al., 2024). HISTORY OF CORRECTIONAL SERVICE IN NIGERIA Before the British colonisation, communities and tribes in Nigeria had their rules and laws, and any disobedience would emit appropriate punishment such as fines, mutilations, castrations, lynching, ex-communications and dedication to the gods, whereby the offender becomes untouchable (Ebbe, 1997). The modern Nigerian Correctional Service [NCoS], formerly Nigerian Prison Service [NPS], originated in 1861 before Nigeria gained independence in 1960. Colonial-era prisons were established in Lagos and initially focused on protecting trade, ensuring British merchant profits, and supporting missionary activities. In 1863, four courts were established in Lagos during the colonial period: a Police court for petty disputes, a criminal court for severe cases, a slave court addressing issues related to abolishing the slave trade, and a commercial court for disputes among merchants. The operation of these courts and the police indicated the necessity for a prison to complement the legal system. Subsequently, in 1872, the Broad Street prison was founded, initially accommodating up to 300 inmates. Colonial prisons primarily served the purpose of maintaining law and order and providing labour for public works. During the colonial period, prisons were often poorly run and lacked a systematic penal policy. In 1917, prison regulations were introduced, emphasising containment rather than inmate treatment. In 1934, efforts were made to modernise the Prison Service, with subsequent directors introducing vocational training, classification of prisoners, and other reforms. 37 The Nigerian Correctional Service (NCS) officially began in 1968 with the abolition of Native Authority prisons and the unification of the Prisons Service. In 1972, Decree No. 9 outlined the goals and orientation of the NCS, emphasising secure custody, reform, and rehabilitation. The NCS underwent significant transformations in 1972, with the reorganisation, recruitment of a skilled workforce, and introduction of specialised units. The service continued to evolve, experiencing reorganisation in 1986 and removal from the Civil Service in 1992. The introduction of the Nigerian Correctional Service Act in 2019 aimed to align the service with international best practices, emphasising non-custodial services as part of the penal system. Today, the NCS has eight directorates, including Staff Training and Development and the Non- Custodial Directorate. The focus is on achieving the aim of imprisonment, and the recent Act seeks to position the Nigerian Correctional Service in line with global corrections standards, introducing non-custodial services into the penal system (National Correctional Service, 2024). There are 240 federal prisons in Nigeria, five of which are in Lagos, Nigeria. The recent statistics as of 3rd December 2024 state the total inmate population in Nigeria as 82,382 with males 80,570 and females 1,812 (National Correctional Service, 2024) The Nigerian Correctional Facility was established as an institution to correct social deviants, punish and reform criminals, and complement the processes of legal adjudication and law enforcement (Federal Government of Nigeria, 1990). The main aim of establishing prison institutions in all parts of the world including Nigeria is to provide rehabilitation and 38 correctional facilities for those who violate the rules and regulations of their society (Olugbenga-Bello et al., 2013). However, the living conditions in Nigerian prisons have repeatedly been described as harsh, appalling, and unfit for humans. Inmates are forced to survive in the worst living conditions such as overcrowding, poor nutrition, denial of contact with family and friends, and lack of medications (Nwefoh et al., 2020). Correctional facilities are overcrowded, with many holding more inmates than their capacities. Ikoyi Correctional Centre was built with a capacity of 800 people, and it currently houses 3,113 inmates with 2,680 awaiting trial (Adebanjo, 2019). Living conditions in Nigerian Correctional facilities are subpar and pose a dangerous risk to the health of these inmates, the poor conditions these inmates are subjected to lead to physical, mental and psychological illnesses and infringe upon their fundamental right to health. In addition to this congestion, reports have been made of sexual abuse, torture, and poor funding (Olugbenga-Bello et al., 2013). Addressing the health status of inmates is not only a matter of justice but crucial to public health in Nigeria as the needs and health of the disadvantaged population are a core public health initiative. This research study outlines a descriptive cross-sectional study aimed at investigating the health status of the inmates in Ikoyi Prison and providing valuable findings for policy development, public health strategies and improved healthcare delivery within the prison system. 2.2 Theoretical Framework Three theoretical frameworks are guiding this research namely: the biopsychosocial model, the stress-coping model and the total institution theory. 2.2.1 Biopsychosocial Model 39 The Biopsychosocial Model, developed by psychiatrist George Engel in the 1970s, posits that health and illness result from the interplay between biological, psychological, and social factors. This model emphasizes that physical health cannot be fully understood without considering psychological well-being and the social context in which individuals live. In the context of the health status of inmates at Ikoyi Correctional Centre, the Biopsychosocial Model can be applied to assess how various dimensions of inmates’ lives influence their health outcomes. Biologically, the model allows for the examination of prevalent diseases among inmates, such as communicable diseases (e.g., tuberculosis, HIV) and non-communicable diseases (e.g., hypertension, diabetes). Researchers can assess the health profiles of inmates by analysing medical records and conducting health screenings to identify common ailments. This biological component also includes understanding the nutritional status of inmates, which is crucial in a correctional setting where diet may be inadequate or unbalanced. Psychologically, the model facilitates an exploration of the mental and emotional health status of inmates. The incarceration environment can lead to significant psychological stress, anxiety, depression, and other mental health issues. Using standardized assessment tools, researchers can evaluate the prevalence of these conditions and how they affect inmates' overall health and coping mechanisms. Understanding the psychological aspect also involves looking at the inmates’ perceptions of their health, their attitudes towards seeking medical care, and their coping strategies in the face of incarceration-related stressors. Socially, the Biopsychosocial Model underscores the importance of the correctional environment and the social determinants of health that impact inmates. This includes access to healthcare services within the prison, the quality of these services, the availability of mental health support, and the social interactions inmates have with each other and with staff. By assessing the adequacy of healthcare provisions, researchers can identify barriers to accessing 40 care and the quality of treatment received. Furthermore, the model allows for the exploration of how factors such as social support, family connections, and the overall prison environment affect inmates’ health and well-being. In a nutshell, the application of the Biopsychosocial Model to the study of health status in Ikoyi Correctional Centre provides a multi-faceted approach that considers the complex interrelationships between biological, psychological, and social factors. This holistic perspective is crucial for understanding the health challenges faced by inmates, identifying the most pressing health issues, evaluating the effectiveness of current healthcare services, and developing interventions aimed at improving the health and well-being of this vulnerable population. By utilizing this model, the study can contribute to a more nuanced understanding of inmate health, ultimately informing policy and practice within correctional healthcare systems. 2.2.2 Stress-Coping Model The Stress-Coping Model is a psychological framework that focuses on how individuals perceive and respond to stressors in their environment (Lazarus & Folkman, 1984). It emphasizes the importance of the individual’s appraisal of stressors, which determines their emotional and behavioural responses. This model categorizes coping strategies into problem- focused coping, which involves actively addressing the stressor, and emotion-focused coping, which aims to manage emotional responses to stress. In the context of the health status of inmates in the Ikoyi Correctional Centre, the Stress-Coping Model can be applied to understand how inmates manage the unique stressors associated with incarceration, such as loss of freedom, social isolation, and potential violence, as well as the healthcare limitations they may face. 41 By applying the Stress-Coping Model, the study can assess the psychological and emotional challenges faced by inmates and how these affect their overall health status. It provides a framework for identifying specific stressors prevalent in the correctional environment, such as overcrowding, inadequate healthcare services, and mental health stigma. Furthermore, the model allows for an examination of the coping strategies employed by inmates, such as seeking social support from fellow inmates, engaging in recreational activities, or using maladaptive strategies like substance abuse. The application of this model can also facilitate understanding the relationship between coping strategies and health outcomes. For instance, inmates who utilize effective problem-focused coping may experience better physical and mental health outcomes than those who resort to avoidance or denial. The study can thus investigate how different coping mechanisms correlate with reported health issues, including stress-related disorders, depression, anxiety, and physical ailments. Additionally, the Stress-Coping Model can guide the assessment of available mental health resources within the correctional facility. It can identify gaps in support systems that inmates rely on and highlight the need for enhanced psychological services. This model can also provide insights into how the correctional environment can be modified to reduce stressors, such as implementing stress management programs or improving healthcare access, ultimately aiming to improve inmates' overall well-being. By focusing on the interplay between stress, coping mechanisms, and health, the study can contribute valuable knowledge on the mental health challenges faced by inmates and inform interventions that enhance their health outcomes. 2.2.3 Total Institution Theory Total Institution Theory, proposed by sociologist Erving Goffman, refers to a type of social organization in which individuals are cut off from wider society for an extended period and 42 lead an enclosed, formally administered life. In a total institution, such as a prison, the environment is highly controlled, and the daily lives of the inmates are regulated by institutional rules and routines. This structure impacts the inmates' identities, behaviours, and interactions, as they are subjected to a system that often diminishes personal autonomy and agency. In the context of the study on the health status of inmates in Ikoyi Correctional Centre, Total Institution Theory can be applied to understand how the correctional environment shapes inmates' health outcomes. The theory suggests that the rigid structure and surveillance within the institution can contribute to a variety of health issues, including both physical and mental health problems. The lack of freedom and personal agency can lead to increased stress, anxiety, and depression, as inmates may struggle to cope with their confinement and the challenges of adapting to life in prison. Furthermore, Total Institution Theory highlights the impact of institutional norms on health behaviours. For example, the lack of privacy and autonomy may prevent inmates from seeking medical help for prevalent diseases or from engaging in healthy behaviours. Additionally, the healthcare services available within the correctional facility may be limited and subject to the institution’s rules, potentially compromising the quality of care. By understanding these dynamics, the study can identify barriers to health service access, evaluate the mental and emotional health status of inmates, and assess how the correctional setting affects their overall well-being. Moreover, this theory can help explore how the social environment within the correctional facility influences inmates’ health-related behaviours, including adherence to treatment for physical ailments and mental health support. The institutional culture may foster a sense of hopelessness or resignation, leading to a lack of engagement with available healthcare services. By examining these interactions, the study can provide valuable insights into the systemic 43 factors that affect inmates’ health, ultimately guiding recommendations for improving healthcare delivery within the Ikoyi Correctional Centre. This application of Total Institution Theory emphasizes the need to consider not just the individual health issues but also the broader institutional context that shapes inmates' health experiences. 2.3 Empirical Review 2.3.1 Prevalent Diseases Suffered by the Inmates Audu, Akorede, and Joshua (2014) conducted a five-year review of inmates' disease profiles in Kaduna, the results showed the most prevalent diseases were psychiatric cases (24.1%), gastrointestinal diseases (22.6%), malaria (21.6%), respiratory diseases (10.9%), dermatology/allergy (5.4%) and cardiovascular diseases (2.4%). These findings showed a huger burden of communicable and non-communicable disease in Kaduna State. Otuu and Shu (2019) in their study on prevalent diseases among Inmates in Three Federal Prisons in the Southeast geopolitical Zone of Nigeria found that the most prevalent disease was malaria (81.06%, 77.67% and 73.33%), followed by cough and catarrh (63.79%, 68.67%, 60.0%), rashes (58.77%, 59.27%, 58.97%) in Abakaliki, Enugu and Onitsha respectively. This study showed a high burden of communicable diseases in the three correctional centres. Sagoe et al. (2023) studied the prevalence of Hepatitis B and HIV infections in Ghanaian correctional facilities and the HIV and HBV prevalence among inmates in Ghana was 2.4% and 12.38% respectively. This study showed a need to have a critical look into the health practices of the inmates. 44 Adekanmbi et al. (2023) explored the dietary diversity and nutritional status of inmates in Osun State correctional centres and the prevalent diseases found among the respondents revealed that cracked lips (9.3%), ulcer (8.6%), skin dermatoses (7.2%), fever (6.6%) and short-sightedness (6.6%) are the most common conditions identified among the respondents while the least common disease were hypertension (1.7%), malaria (1.0%), anaemia (1.0%), asthma (0.7%), tuberculosis (0.7%), diabetes (0.3%), epilepsy (0.3%), brain damage (0.3%). 2.3.1 Physical Health Status of Inmates Butler et al. (2004) reported on the self- reported health status of prisoners in New South Wales. They discovered that 37% of the female prisoners and 28% of the male prisoners rated their health as either poor or fair, only 10% of the inmates perceived their health as excellent. The study emphasized the opportunity incarceration presents to initiate treatment that improves the health of the disadvantaged group. Nobile et al. (2011) in their study examined the self-reported health status and accessibility of health services among prisoners in Italy and found that 31.6% of the inmates had poor physical health while 53.6% had good physical health and 14.8% had very good physical health. The study recommends the need to implement programs for correction of risk behaviour and prevention of long-term effects of incarceration on prisoner’s health. Geitona and Milioni (2016) cross sectional survey examined the health status and access to health services of female prisoners in Greece. They found 60.4% rated their health status as poor. The study recommended the attention of decision makers with regards to provision and quality of healthcare, effective interventions should be aimed at meeting the prisoner’s needs. 45 Augsburger et al. (2022) study assessed incarcerated women’s physical and mental health status and needs in a Swiss prison. The study showed that 31.7% of the inmates rated their health as poor/very poor while 68.3% of the women rated their health as Very good/good/fairly good. Almost half of the women (48.3%) self-reported a physical health problem, the study called for better gender- responsive healthcare management. Li et al. (2022) explored the mental and physical health challenges of older incarcerated individuals who have aged in prison. They discovered that 36.9% reported a fair health status while 25.8% had a poor health status. The study highlighted the impact incarceration had on lifers and aged inmates, the health-related differences have implications for prison systems including staff training, advance care planning and need for expanding prison-based hospice programs. Lanzano et al. (2023) investigated the health perceptions and healthcare satisfaction of detained male individuals in Italy, finding that 72.8% had a good health status while 27.2% had a poor health status. The study highlighted the need to promote evidence-based intervention to strengthen the role of healthcare services provided in prisons. 2.3.2 Mental and Emotional Health Status of Inmates Afolabi et al. (2024) study explored predictors of emotional distress among inmates in Agodi Correctional Centre, finding that social isolation, quality of life, and prison resilience significantly influenced distress, accounting for 22.7% of the variance (R =.476). Recommendations include creating supportive programs to mitigate isolation and distress in correctional facilities. 46 A study was carried out by Audu et al. (2024) that examines coping strategies and depression among 269 inmates in Nigeria, this two-stage study identified a 30.5% depression rate, linked to emotion-focused disengagement and prior mental health issues. Problem-focused engagement appeared protective. The study emphasizes the need for mental health interventions prioritizing coping strategies to aid inmate well-being. Olagunju (2024) investigated the mental health strategies in Nigerian prisons, this study highlights the effects of collaborative care and psycho-legal services among 74 inmates, with a high prevalence of schizophrenia and substance use. Psycho-legal support linked 73% of participants to multidisciplinary care, demonstrating skill enhancement as a sustainable approach in resource-limited settings. Olapegba et al. (2023) study examined the influence of inmate category, incarceration duration, and depression on suicidal ideation among 297 inmates in Agodi prison, Ibadan. Findings indicated that convicted inmates reported higher suicidal ideation than those awaiting trial, and depression significantly influenced suicidal ideation, with higher scores among depressed inmates. However, the length of incarceration did not significantly impact suicidal ideation. The study concludes that inmate category and depression are primary factors affecting suicidal thoughts, suggesting policy implications to address mental health in prisons. Emmanuel (2023) carried out a study that explored the impact of the prison environment on inmates' self-harm urges, focusing on the mediating role of re

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