Objective To summarise the extent and quality of evidence on the association between prison cell spatial density (a measure of crowding) and infectious and communicable diseases transmission among prisoners.
Design Systematic review.
Data sources Embase, PubMed, Medline, Scopus, Web of Science, PsycINFO, PsycExtra, ProQuest Databases, ProQuest Dissertations and Theses Global, Index to Legal Periodicals, InformitOnline, Cochrane Library, Criminal Justice Abstracts and ICONDA were searched to 31 December 2018.
Eligibility criteria Studies that reported on the association between prison cell spatial density (measured in square feet or square metres of cell floor area per person) and infectious and communicable diseases in juvenile and adult populations incarcerated in a correctional facility.
Data extraction and synthesis A review protocol was developed in consultation with an advisory panel. Two reviewers independently extracted data and used the Australian National Health and Medical Research Council’s (NHMRC) checklist to critically appraise individual studies. An assessment of the overall body of the evidence was conducted using the NHMRC’s Evidence Scale and Statement Form.
Results A total of 5126 articles were initially identified with seven included in the review from Pakistan (2003), Chile (2016), Nigeria (2012, 2013) and the USA (1980s). Infectious and communicable disease outcomes included pneumococcal disease/acute pneumonia, Mycobacterium tuberculosis, latent tuberculosis infection, infectious skin conditions and contagious disease reporting to the prison clinic. Five articles reported statistically significant positive associations but were countered by associations possibly being explained by chance, bias or confounding factors. Heterogeneity prevented meta-analysis.
Conclusion Overall, the body of evidence provides some support for an association between prison cell special density and infectious and communicable diseases, but care should be taken in the interpretation and transferability of the findings. Future research and policy responses should adequately consider prospective mediating factors implicated in associations between cell spatial density and health effects.
- communicable diseases
- public health
- spatial density
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Contributors PLS is the guarantor. PLS, MS, AA and TB drafted the manuscript. All authors contributed to the development of the selection criteria. PLS, MS and TB contributed to the risk of bias assessment strategy, data extraction templates and developed the search strategies. All authors read, provided feedback and approved the final manuscript.
Funding Under the direction of the New South Wales Ministry of Health, the New South Wales Department of Justice funded this review. To ensure appropriate management of perceived or potential conflicts of interest, the expert advisory panel that was formed to guide the review comprised diverse stakeholders, including medical practitioners, infectious diseases experts, public health professionals, a custodial administrator and academic staff. Author and custodial administrator LG, who although contributed to the scope of the search criteria and provided feedback and approval of the final manuscript, did not contribute to data extraction, confounder, bias and chance assessment, aggregated evidence appraisal and ratings and the interpretation of findings.
Competing interests There was grant support from the New South Wales Department of Justice during the conduct of the study. There are no financial relationships with any other organisations that might have an interest in the submitted work in the previous 3 years. Author LG is a custodial administrator and could give the appearance of potentially influencing findings. Although LG contributed to the scope of the search criteria and provided feedback and approval of the final manuscript, he did not contribute to data extraction, confounder, bias and chance assessment, aggregated evidence appraisal and ratings and the interpretation of findings. At the time of the review, MS was employed as a research associate of the Kirby Institute, University of New South Wales, Sydney.
Ethics approval Ethics approval was not required. Please see ‘Ethical approval for literature reviews and meta-analyses’ on the UNSW Sydney Research Ethics & Compliance Support Frequently Asked Questions (FAQs) page (https://research.unsw.edu.au/frequently-asked-questions-faqs).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
Patient consent for publication Not required.