Prevalence and Determinants of Malaria among Inmates of Afokang Prison, Calabar, Nigeria

Malaria among Inmates of Afokang Prison, Calabar, Nigeria

Abstract

Malaria remains a public health challenge in Nigeria, driven by poor conditions, overcrowding, vector-control gaps, and limited healthcare access. Correctional facilities are vulnerable yet under-researched transmission settings, where inmates face prolonged exposure to these risks. This study assessed malaria prevalence and identified associated demographic, environmental, behavioural, and healthcare-related factors among inmates at Afokang Prison in Calabar, Cross River State. A cross-sectional design enrolled 240 inmates selected from 16 cells between August and October 2025. Malaria infection was confirmed via rapid diagnostic tests on finger‑prick blood, while a structured questionnaire captured socio‑demographics, knowledge, preventive practices, environmental conditions, and healthcare‑seeking behaviours. Data were analysed using descriptive statistics and chi‑square tests (p<0.05), supplemented by a review of prison health records from 2023–2024. Overall, 176 of 240 inmates (73.3%) tested positive. Prevalence was comparable between males (73.1%) and females (75.0%, χ²=0.38, p=0.846) and did not differ significantly across age groups, peaking at 79.62% among those aged 30–34 years and lowest at 68.08% among those aged 35–39 years (p=0.514). Although prevalence varied by incarceration duration, from 65.51% (six months) to 80.64% (one year), this association was non‑significant (p=0.743). Environmental deficiencies were pervasive: 84.2% reported stagnant water, 74.2% cited nearby bushes, 80.0% noted irregular cleaning or fumigation, 76.7% lacked window screens, and 72.9% were not provided with mosquito nets. While 90.8% acknowledged malaria’s preventability and 87.9% correctly identified mosquito transmission, only 30.0% consistently used nets. Historical records revealed an upward trajectory, from 56.77% in 2023 to 65.45% in 2024, culminating in 73.3%. These findings confirm a high malaria burden within Afokang Prison, driven by substandard sanitation, insufficient vector control, delayed healthcare access, and a pronounced knowledge‑practice gap. Urgent, multi‑pronged interventions are required, including intensified environmental sanitation, indoor residual spraying, universal provision and enforced use of insecticide‑treated nets, prompt diagnosis and treatment, and health education tailored to the prison population.