The Open Public Health Journal




ISSN: 1874-9445 ― Volume 13, 2020
RESEARCH ARTICLE

Prevalence and Associated Factors of Poor Quality of Sleep among Prisoners in Mettu Town Prison, Oromia, South West Ethiopia, 2019



Zakir Abdu1, *, Mohammedamin Hajure1
1 Department of Psychiatry, Mettu University, Mettu, Ethiopia

Abstract

Background:

Sleep is one of the basic needs of human beings and is important to their health; sleeping problem has a wide range of causes, including medical and psychological. However, evidence on the burden of sleep problems in low-income countries is lacking. When compared to the general population, the risks of having poor sleep quality are substantially higher in prisoners. However, the prevalence of poor sleep quality among prisoners at national level is not known.

Objective:

To assess the prevalence and associated factors of poor quality of sleep among prisoners in Mettu town prison, 2019.

Methods:

A cross-sectional study design was employed with 310 prisoners selected by a systematic random sampling method. Data was collected by a face to face interview using the Pittsburgh Sleep Quality Index (PSQI). Data analysis was done using SPSS version 20.

Results:

The study revealed that 77.1% (n= 239) of participants had poor sleep quality. Marital status: single (AOR=0.11, 95%CI=0.05, 0.26), widowed and divorced (AOR=0.11, 95%CI=0.03, 0.37), history of previous incarceration (AOR=4.8, 95%CI=2.0, 11.79), urban residence (AOR=2.65, 95%CI=1.12, 6.27), unable to read and write and read (AOR=6.10, 95%CI=1.43, 25.9) and lifetime alcohol use (AOR=8.45, 95%CI=3.88, 18.36) had significant association with poor sleep quality.

Conclusion:

This study has shown that the prevalence of poor sleep quality among prisoners was very high. Marital status: single, widowed and divorced, history of previous incarceration, urban residence, cannot write and read and lifetime alcohol use found to have an impact on the prevalence of poor sleep quality.

Keywords: Sleep disorders, Pittsburgh sleep quality index, Prison, Sleepiness, Adult prisoners, PSQI.


Article Information


Identifiers and Pagination:

Year: 2020
Volume: 13
First Page: 94
Last Page: 100
Publisher Id: TOPHJ-13-94
DOI: 10.2174/1874944502013010094

Article History:

Received Date: 28/11/2019
Revision Received Date: 23/01/2020
Acceptance Date: 03/02/2020
Electronic publication date: 20/03/2020
Collection year: 2020

© 2020 Abdu and Hajure.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Department of Psychiatry, Mettu University, Mettu, Ethiopia; Tel: +251 (0)913845371;
E-mail: zakirabdu45@gmail.com






1. INTRODUCTION

Sleep is an important physiological process with many restorative functions. It is essential in maintaining the body’s circadian rhythm and one of the basic needs of human beings [1George S, Paul G, Paul N, Paul G, George S, Med JC, et al. Study on sleep quality and associated psychosocial factors among elderly in a rural population of Kerala. India 2018; 5(2): 526-31.-3Berhanu H, Mossie A, Tadesse S, Geleta D. Prevalence and associated factors of sleep quality among adults in jimma town. Southwest Ethiopia : A Community-Based Cross-Sectional Study 2018; 2018: 1-10.]. Sleep disorder is a common problem in adults and affects physical and mental health [2Kang J, Lee JA, Jang J, Kim YS, Sunwoo S. Factors Associated with Poor Sleep Quality in Primary Care 2013; 34(2): 107-14., 3Berhanu H, Mossie A, Tadesse S, Geleta D. Prevalence and associated factors of sleep quality among adults in jimma town. Southwest Ethiopia : A Community-Based Cross-Sectional Study 2018; 2018: 1-10.]. Poor sleep quality, often referred to as “sleep disturbance”, is found in up to 55% of the elderly population and consistently increases with age [1George S, Paul G, Paul N, Paul G, George S, Med JC, et al. Study on sleep quality and associated psychosocial factors among elderly in a rural population of Kerala. India 2018; 5(2): 526-31.]. In fact, one in four people experiences sleep difficulties, which include trouble falling asleep, trouble staying asleep, early morning waking, sleeping too much, or restless or unsatisfying sleep [4Environment CS, Breathing C, Relaxation PM, Physical G, Routine B. Getting a good night ’ s sleep 1-3.]. Today, poor sleep quality among adolescents is becoming a major worldwide concern and is widely recognized as a significant public health problem [5Kesintha A. Prevalence and predictors of poor sleep quality among secondary school students in Gombak District. Selangor 2018; 73(1): 31-40.].

The prison environment is one of the main challenges to the overall health of prisoners [6Article O. Incidence of depression among incarcerated woman in central prison, peshawar, pakistan 2012; 9(1): 33-8.]. In prison, communication and relationship with families and friends also restricted. It's understandable that anybody in prison would be generally affected by poor quality of sleep. Around a third of the general population experiences insomnia at some point in their lives; however, recent figures show prisoners are at least twice as likely to have insomnia and the majorities have poor sleep quality [7Dewa LH, Hassan L, Shaw JJ, Senior JSC. Trouble sleeping inside: A cross-sectional study of the prevalence and associated risk factors of insomnia in adult prison populations in England. Sleep Med 2017; 32: 129-36.]. This is problematic because insomnia has been shown to significantly contribute to poor cognitive functioning, depression, suicide, emotional deregulation, aggression and lack of treatment engagement, all of which may affect the safe running of the prison, an individual’s rehabilitation and, ultimately, the likelihood of reoffending [8Dewa LH, Hassan L, Shaw J, Senior J. Design of a treatment pathway for insomnia in prison settings in England : A modified Delphi study 2018; 1-8.
[http://dx.doi.org/10.1136/bmjopen-2018-022406]
].

Majority of the prisoners are kept in groups in a cell and are made to sleep on the floor, which is one of the main sources of infectious diseases [6Article O. Incidence of depression among incarcerated woman in central prison, peshawar, pakistan 2012; 9(1): 33-8.]. In most prisons, prisoners often lack space to sleep or sit, hygiene is poor, and food and clothing are inadequate, and also forced to work when sick [9Onoria H. The African Commission on Human and Peoples ’ Rights and the exhaustion of local remedies under the African Charter 1981; 1-24., 10Prisons in africa. An evaluation from a human rights perspective 2008; 4(December): 22-49.].

Furthermore, the prison experience can be inherently stressful, which can contribute to insomnia. For example, prisoners experience a complete upheaval of normal life, family and routine forced contact with others and lack of autonomy, all of which can augment the stressful experience. Moreover, poor sleep hygiene, including daytime naps, boredom or paucity of daytime activity, is evident in prisoners [11LINDSAY H. DEWA, LAMIECE HASSAN JJ. S and, SENIOR J.. Insomnia in prison Insomnia management in prisons in England and Wales : A mixed-methods study. J Sleep Res 2017; 26: 322-9.
[http://dx.doi.org/10.1111/jsr.12503]
]. Availing sleep management options in prison offers the potential to impact positively on a number of these common risk factors [8Dewa LH, Hassan L, Shaw J, Senior J. Design of a treatment pathway for insomnia in prison settings in England : A modified Delphi study 2018; 1-8.
[http://dx.doi.org/10.1136/bmjopen-2018-022406]
].

Very little research has been conducted on poor sleep quality in prison internationally. A study conducted on insomnia management in prisons in England and Wales reported prevalence rates from 11 to 81% [11LINDSAY H. DEWA, LAMIECE HASSAN JJ. S and, SENIOR J.. Insomnia in prison Insomnia management in prisons in England and Wales : A mixed-methods study. J Sleep Res 2017; 26: 322-9.
[http://dx.doi.org/10.1111/jsr.12503]
]. Another study completed in maximum security women's prison in the United States indicates that 72% of the sample met the criteria for poor sleepers [12Harner HM, Budescu M. HHS Public Access 2015; 63(3): 158-69.]. A cross-sectional study of the prevalence and associated risk factors of insomnia in adult prison populations in England reported an 88.2% rate of poor sleep quality [7Dewa LH, Hassan L, Shaw JJ, Senior JSC. Trouble sleeping inside: A cross-sectional study of the prevalence and associated risk factors of insomnia in adult prison populations in England. Sleep Med 2017; 32: 129-36.]. Researchers at the UK’s University of Warwick Medical School conducted large-scale, multinational study of sleep disorders among eight countries in Asia and Africa which showed an overall rate of nearly 17% of the populations in these developing nations suffering from sleep problems [13Stranges S, Tigbe W, Thorogood M, Kandala N, Africa S, Sciences H, et al. Sleep Problems : An Emerging Global Epidemic ? Findings From the INDEPTH WHO-SAGE Study Among More Than 40 , 000 Older Adults From 8 Countries Across Africa and Asia 2012; 35(8): 1173-81.]. The overall prevalence rate of insomnia among a mostly male population housed in a Swiss remand prison was 44% [12Harner HM, Budescu M. HHS Public Access 2015; 63(3): 158-69.]. One study in China on the prevalence and risk factors of poor sleep quality among Chinese elderly in an urban community showed rates of self-reported insomnia ranging between 10% and 48% [14Luo J, Zhu G, Zhao Q, et al. Prevalence and risk factors of poor sleep quality among Chinese elderly in an urban community: Results from the Shanghai aging study. PLoS One 2013; 8(11)e81261
[http://dx.doi.org/10.1371/journal.pone.0081261] [PMID: 24282576]
]. Another study conducted on bullying as a risk for poor sleep quality among high school students in China revealed that the number of adolescents involved in poor sleep quality worldwide varies between 18.7% and 25% [15Zhou Y, Guo L, Lu C, Deng J, He Y, Huang J. Bullying as a Risk for Poor Sleep Quality among High School Students in China 2015; 1-14.
[http://dx.doi.org/10.1371/journal.pone.0121602]
].

One study among undergraduate students reported 16 to 67% having poor sleep quality(16). Other studies in Taiwan and Hong Kong Chinese reported the prevalence of poor sleep quality ranging from 6% to 78% [14Luo J, Zhu G, Zhao Q, et al. Prevalence and risk factors of poor sleep quality among Chinese elderly in an urban community: Results from the Shanghai aging study. PLoS One 2013; 8(11)e81261
[http://dx.doi.org/10.1371/journal.pone.0081261] [PMID: 24282576]
]. In Mainland China, there was only one epidemiological study, reporting that 50% of elderly aged 60 or older had poor sleep quality in a sample population in rural areas [14Luo J, Zhu G, Zhao Q, et al. Prevalence and risk factors of poor sleep quality among Chinese elderly in an urban community: Results from the Shanghai aging study. PLoS One 2013; 8(11)e81261
[http://dx.doi.org/10.1371/journal.pone.0081261] [PMID: 24282576]
]. One study done in primary health care revealed that poor sleep quality was present in 38.0% of total subjects [2Kang J, Lee JA, Jang J, Kim YS, Sunwoo S. Factors Associated with Poor Sleep Quality in Primary Care 2013; 34(2): 107-14.]. Among Malaysian adults aged 30 to 70 years in four urban areas in Selangor, the prevalence of poor sleep quality with symptoms of insomnia was 33.8%, with 12.2% of them reported to have chronic insomnia [16Musa NA, Ming F, Wong LP. Prevalence and factors associated with poor sleep quality among secondary school teachers in a developing country 2018; 407-18.
[http://dx.doi.org/10.2486/indhealth.2018-0052]
]. A study in Malaysia on prevalence and factors associated with poor sleep quality among secondary school teachers in a developing country revealed the prevalence of poor sleep quality was 61% [16Musa NA, Ming F, Wong LP. Prevalence and factors associated with poor sleep quality among secondary school teachers in a developing country 2018; 407-18.
[http://dx.doi.org/10.2486/indhealth.2018-0052]
].

One study done among school students in Malaysia showed the prevalence of poor sleep quality was 24.0% (5). A study of the factors associated with poor sleep among medical students has been estimated to be 15% to 35% (17). The other study conducted among communities in Ethiopia showed that the overall prevalence of poor sleep quality was 65.4% [3Berhanu H, Mossie A, Tadesse S, Geleta D. Prevalence and associated factors of sleep quality among adults in jimma town. Southwest Ethiopia : A Community-Based Cross-Sectional Study 2018; 2018: 1-10.].

The known risk factors of insomnia include female sex [1George S, Paul G, Paul N, Paul G, George S, Med JC, et al. Study on sleep quality and associated psychosocial factors among elderly in a rural population of Kerala. India 2018; 5(2): 526-31., 2Kang J, Lee JA, Jang J, Kim YS, Sunwoo S. Factors Associated with Poor Sleep Quality in Primary Care 2013; 34(2): 107-14., 11LINDSAY H. DEWA, LAMIECE HASSAN JJ. S and, SENIOR J.. Insomnia in prison Insomnia management in prisons in England and Wales : A mixed-methods study. J Sleep Res 2017; 26: 322-9.
[http://dx.doi.org/10.1111/jsr.12503]
, 16Musa NA, Ming F, Wong LP. Prevalence and factors associated with poor sleep quality among secondary school teachers in a developing country 2018; 407-18.
[http://dx.doi.org/10.2486/indhealth.2018-0052]
], old age [2Kang J, Lee JA, Jang J, Kim YS, Sunwoo S. Factors Associated with Poor Sleep Quality in Primary Care 2013; 34(2): 107-14., 5Kesintha A. Prevalence and predictors of poor sleep quality among secondary school students in Gombak District. Selangor 2018; 73(1): 31-40., 9Onoria H. The African Commission on Human and Peoples ’ Rights and the exhaustion of local remedies under the African Charter 1981; 1-24., 15Zhou Y, Guo L, Lu C, Deng J, He Y, Huang J. Bullying as a Risk for Poor Sleep Quality among High School Students in China 2015; 1-14.
[http://dx.doi.org/10.1371/journal.pone.0121602]
], depression, snoring, low level of physical activity, the presence of underlying disease, low education level and economic status, living alone and stress [2Kang J, Lee JA, Jang J, Kim YS, Sunwoo S. Factors Associated with Poor Sleep Quality in Primary Care 2013; 34(2): 107-14., 14Luo J, Zhu G, Zhao Q, et al. Prevalence and risk factors of poor sleep quality among Chinese elderly in an urban community: Results from the Shanghai aging study. PLoS One 2013; 8(11)e81261
[http://dx.doi.org/10.1371/journal.pone.0081261] [PMID: 24282576]
, 15Zhou Y, Guo L, Lu C, Deng J, He Y, Huang J. Bullying as a Risk for Poor Sleep Quality among High School Students in China 2015; 1-14.
[http://dx.doi.org/10.1371/journal.pone.0121602]
, 17Priya J, Singh J. Study of the factors associated with poor sleep among medical students 2017; 2(June): 422-9.]. Chronic medical illnesses, depression, substance use, having lower levels of emotional support or being single, divorced or widowed, psychosocial factors and psychological influences are important factors that affect sleep quality [1George S, Paul G, Paul N, Paul G, George S, Med JC, et al. Study on sleep quality and associated psychosocial factors among elderly in a rural population of Kerala. India 2018; 5(2): 526-31., 2Kang J, Lee JA, Jang J, Kim YS, Sunwoo S. Factors Associated with Poor Sleep Quality in Primary Care 2013; 34(2): 107-14., 11LINDSAY H. DEWA, LAMIECE HASSAN JJ. S and, SENIOR J.. Insomnia in prison Insomnia management in prisons in England and Wales : A mixed-methods study. J Sleep Res 2017; 26: 322-9.
[http://dx.doi.org/10.1111/jsr.12503]
, 14Luo J, Zhu G, Zhao Q, et al. Prevalence and risk factors of poor sleep quality among Chinese elderly in an urban community: Results from the Shanghai aging study. PLoS One 2013; 8(11)e81261
[http://dx.doi.org/10.1371/journal.pone.0081261] [PMID: 24282576]
, 16Musa NA, Ming F, Wong LP. Prevalence and factors associated with poor sleep quality among secondary school teachers in a developing country 2018; 407-18.
[http://dx.doi.org/10.2486/indhealth.2018-0052]
-21Vitkova M, Gdovinova Z, Rosenberger J, et al. Factors associated with poor sleep quality in patients with multiple sclerosis differ by disease duration. Disabil Health J 2014; 7(4): 466-71.
[http://dx.doi.org/10.1016/j.dhjo.2014.05.004] [PMID: 25224987]
]. For some prisoners, “guilt” and “shame” over criminal actions also contributed to poor sleep [12Harner HM, Budescu M. HHS Public Access 2015; 63(3): 158-69.].

2. METHODOLOGY

2.1. Study Area

This study was conducted in Mettu town prison, which located in Ethiopia, Oromia Regional State, Illubabor Zone. Mettu is a capital town of the Illubabor administrative Zone and it is located at 600 Km South West of Addis Ababa, a capital city of Ethiopia.

Study design and period: An institutional based cross-sectional study was conducted from June 1 to 15, 2019.

2.2. Study Population

All prisoners in Mettu town prison was included in the sampling frame to get an equal chance to be selected during the data collection period and seriously ill were excluded from study.

2.3. Sample Size Determination

Reviewing a literature, no similar study with the same title was found, therefore, 50% estimated proportion was used in order to get sufficient sample size. The single population proportion formula used to determine a sample. The total number of prisoners in Mettu town prison was 1111 which is less than 10,000. Using finale population correction formulas and considering 10% of the non - response rate, the final sample size becomes = 314.

2.4. Sampling Technique

Systematic random sampling was done using the prisoner's list, and the sampling interval size was calculated using the formula (N/n = k). Where N is the total population (1111), n is sample size (314), while k is sampling interval size, K =(approximately 4). Therefore, participants were selected every 4 interval, starting from the first study unit.

2.5. Data Collection Procedure and Tools

Data was collected by face to face interview technique. Initially, a questionnaire in the English language was translated into local language, Amharic and Afan Oromo and back to English by an independent person to check consistency. The questionnaire has seven different subsections: 1st socio-demographic data, 2nd socioeconomic factors, 3rd Pittsburgh Sleep Quality Index (PSQI), 4th prison environment-related factors, 5th clinical related factors, 6th social support and 7th lifetime substance use. Questionnaires about socio-demographic data and structured questionnaires for assessment of associated factors were developed after extensive review of literature and similar study tools. PSQI was used to screen the presence and absence of poor quality of sleep [22Carole B, Msn S, Gnp ANP. The Pittsburgh Sleep Quality Index (PSQI). Pittsburgh Sleep Quality Index 2012; 29(6): 1-2.]. It is valid and reliable to assess the presence and absence of poor quality of sleep [22Carole B, Msn S, Gnp ANP. The Pittsburgh Sleep Quality Index (PSQI). Pittsburgh Sleep Quality Index 2012; 29(6): 1-2.]. The PSQI is an effective instrument used to measure the quality of sleep and patterns of sleep in the adult. It differentiates “poor” from “good” sleep by measuring seven domains: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, and sleep disturbances, use of sleep medication, and daytime dysfunction over the last month. The respondent self-rates each of these seven areas of sleep. Scoring of the answers is based on a 0 to 3 scale, whereby 3 reflects the negative extreme on the Likert scale. A cut off point “5” or greater indicates a “poor” sleeper [22Carole B, Msn S, Gnp ANP. The Pittsburgh Sleep Quality Index (PSQI). Pittsburgh Sleep Quality Index 2012; 29(6): 1-2.]. Clinical factors were assessed by developing structured questionnaire. The Oslo 3-item social support scale was used to assess social support [23Bøen H, Dalgard OS, Bjertness E. The importance of social support in the associations between psychological distress and somatic health problems and socio-economic factors among older adults living at home: a cross sectional study. BMC Geriatr 2012; 12(27): 1-2.
[http://dx.doi.org/10.1186/1471-2318-12-27] [PMID: 22682023]
, 24Abiola T, Udofia O, Zakari M. Psychometric Properties of the 3-Item Oslo Social Support Scale among Clinical Students of Bayero University Kano, Nigeria. Malaysian J Psychiatry 2013; 22: 32-41.]. The magnitude of substance like lifetime alcohol use, cigarette use and khat chewing was assessed by developing structured questionnaire.

2.6. Operational Definition

2.6.1. Poor Quality of Sleep

Participants who scored PSQI “5” or greater indicate poor quality of sleep [22Carole B, Msn S, Gnp ANP. The Pittsburgh Sleep Quality Index (PSQI). Pittsburgh Sleep Quality Index 2012; 29(6): 1-2.].

2.6.2. Social Support

Participants who scored 3-8 have poor support; those who scored 9-11 have moderate social support and score of 12-14 showed strong support [23Bøen H, Dalgard OS, Bjertness E. The importance of social support in the associations between psychological distress and somatic health problems and socio-economic factors among older adults living at home: a cross sectional study. BMC Geriatr 2012; 12(27): 1-2.
[http://dx.doi.org/10.1186/1471-2318-12-27] [PMID: 22682023]
, 24Abiola T, Udofia O, Zakari M. Psychometric Properties of the 3-Item Oslo Social Support Scale among Clinical Students of Bayero University Kano, Nigeria. Malaysian J Psychiatry 2013; 22: 32-41.].

2.6.3. Chronic Illness

Illnesses that can be managed, but cannot be cured and have a greater risk of developing the poor quality of sleep, such as heart diseases, Diabetic mellitus, HIV/AIDS, past mental illness etc.

2.7. Data Processing, Analysis, Interpretation and Presentation

Once all necessary data were obtained, data were checked for completeness. Data were coded, entered to EpiData version 3.1, edited, exported to SPSS and cleaned. The collected data were analyzed using SPSS version 20.0. Data was processed by using descriptive analysis, bivariate analysis and multivariate logistic regression. Descriptive analysis (median, percentage, frequencies and interquartile range) was used to compute demographic characteristics of participants. In addition, bivariate analysis was used to see the significance of the association. variable that shows strong association (p-value <0.25) in bivariate analysis was entered to multivariate logistic regressions to identify independently associated variables. Multicollinearity was checked by variance inflation factor (VIF). Statistical significance was declared at p-value less than 0.05. association of the variables was described using AOR with a 95% confidence interval. The results was presented in frequency tables, pie chart and discussed with previous findings.

3. RESULTS

3.1. Socio-Demographic and Economic Characteristics of Respondents

From a total of 314 participants, 310 were interviewed, giving a response rate of 98.7%. The reasons for nonresponse is 1.3% of the data were not complete. Among 310 prisoners that participated, the majority were males (265; 85.5%). The median age of the respondents was 30 years with an interquartile range of 10 years. Of all participants, nearly half (47.7%) married and about three out of seven (41.9%) were Muslim. About five out of seven (71.6%) were originally from urban in residence prior to incarcerated (Table 1).

Table 1
Sociodemographic characteristics of prisoners in Mettu town prison, South West Ethiopia, June 2019 (N=310).



The study revealed that more than one in five (23.2%) of participants had a history of previous incarceration. About one fourth (25.2%) were staying >44 months in prison and the median time spent in prison was 24 months with an interquartile range of 34 months. About 13 out of 14 (92.9%) respondents had worked in a prison. About half (48.4%) of respondents reported they have moderate social support.

The study revealed that nearly one fifth (18.4%) of respondents had a chronic physical illness (Table 2).

3.2. Prevalence of Poor Sleep Quality

The on-month prevalence of study revealed that nearly seven in every nine (77.1%) (95% CI, 72.8-81.4%) prisoners had poor sleep quality.

3.3. Factors Associated with Poor Sleep Quality

3.3.1. Bivariate Analysis

Socioeconomic and prison environment characteristics of respondents, including sex, age, having children, family history mental illness, duration of stay in prison, having a job before imprisonment and social support have not show any association with poor sleep quality on bivariate analysis. However, marital status being married, residence before incarceration, educational status, having a history of previous incarceration, having a chronic physical illness, history, past mental illness, history of lifetime alcohol, cigarette and khat use and having common mental disorder were associated with poor sleep quality in the bivariate analysis.

3.3.2. Multivariate Analysis

Multivariate logistic regression analysis revealed that marital status, educational status, history of previous incarceration, residence before incarceration and lifetime alcohol use had significant association with poor sleep quality.

Accordingly, prisoners who were single were 11% less likely to develop poor sleep quality when compared with married prisoners (AOR=0.11, 95%CI=0.05, 0.26) and prisoners who were widowed and divorced were 11% less likely to develop poor sleep quality when compared with married prisoners (AOR=0.11, 95%CI=0.03, 0.37). The odds of having poor sleep quality was 4.8 times more likely (AOR=4.8, 95%CI=2.0, 11.79) in prisoners who had a history of previous incarceration compared with prisoners who have no previous incarceration. Prisoners who came from the urban residence were 2.65 times (AOR=2.65, 95%CI=1.12, 6.27) more likely to develop the poorer quality of sleep than prisoners who were from rural residential prisoners. Prisoners who could not write and read were 6.10 times more likely (AOR=6.10, 95%CI=1.43, 25.9) to develop a poor quality of sleep when compared with prisoners who went to college. Prisoners who obtained education from grade 1 to 8 were 7.36 times more likely (AOR=7.36, 95%CI=2.0, 27.38) to develop a poor quality of sleep when compared with prisoners who went to college joined prisoners. The odds of having poor quality of sleep among prisoners who were lifetime alcohol use was 8.45 times (AOR=8.45, 95%CI=3.88, 18.36) than prisoners who did not use alcohol in their lifetime (Table 3).

Table 2
Clinical factors and Lifetime substance use characteristics of prisoners in Mettu town prison, South West Ethiopia, June 2019 (N=310).


Table 3
Bivariate and multivariate logistic regression among prisoners in Mettu town prison, South West Ethiopia, June 2019 (N=310).


4. DISCUSSION

This study revealed an overall prevalence of poor sleep quality was nearly seven in every nine (77.1%). History of previous incarceration, marital status, urban in residence, educational status and lifetime alcohol use had significant association with poor sleep quality.

The finding of this study showed that the prevalence of poor sleep quality among prisoners in Mettu town prisoners was 77.1%. The finding was in line with studies carried out in England and Wales, where the prevalence of poor sleep quality was 11-81% [11LINDSAY H. DEWA, LAMIECE HASSAN JJ. S and, SENIOR J.. Insomnia in prison Insomnia management in prisons in England and Wales : A mixed-methods study. J Sleep Res 2017; 26: 322-9.
[http://dx.doi.org/10.1111/jsr.12503]
]. The probable reason for the similarity of the findings might be both current and previous, population was the same which is a marginalized population.

However, the finding was higher than the study done in high-security women's prison in the US (72%) [12Harner HM, Budescu M. HHS Public Access 2015; 63(3): 158-69.], the study done in China on the prevalence and risk factors of poor sleep quality among Chinese elderly in an urban community (10% and 48%) [14Luo J, Zhu G, Zhao Q, et al. Prevalence and risk factors of poor sleep quality among Chinese elderly in an urban community: Results from the Shanghai aging study. PLoS One 2013; 8(11)e81261
[http://dx.doi.org/10.1371/journal.pone.0081261] [PMID: 24282576]
], the study done on prevalence and factors associated with poor sleep quality among secondary school teachers in a developing country (16 to 67%) [16Musa NA, Ming F, Wong LP. Prevalence and factors associated with poor sleep quality among secondary school teachers in a developing country 2018; 407-18.
[http://dx.doi.org/10.2486/indhealth.2018-0052]
] and study conducted among community in Ethiopia showed that the overall prevalence of poor sleep quality was 65.4% [3Berhanu H, Mossie A, Tadesse S, Geleta D. Prevalence and associated factors of sleep quality among adults in jimma town. Southwest Ethiopia : A Community-Based Cross-Sectional Study 2018; 2018: 1-10.].

The first probable reason for the different prevalence rates might be due to the different study areas. Most of the previous studies were in developed countries [12Harner HM, Budescu M. HHS Public Access 2015; 63(3): 158-69., 14Luo J, Zhu G, Zhao Q, et al. Prevalence and risk factors of poor sleep quality among Chinese elderly in an urban community: Results from the Shanghai aging study. PLoS One 2013; 8(11)e81261
[http://dx.doi.org/10.1371/journal.pone.0081261] [PMID: 24282576]
], in developed countries there might be a supply of better health services for prisoners. The second reason could be most of the previous study were done in the general community [3Berhanu H, Mossie A, Tadesse S, Geleta D. Prevalence and associated factors of sleep quality among adults in jimma town. Southwest Ethiopia : A Community-Based Cross-Sectional Study 2018; 2018: 1-10., 14Luo J, Zhu G, Zhao Q, et al. Prevalence and risk factors of poor sleep quality among Chinese elderly in an urban community: Results from the Shanghai aging study. PLoS One 2013; 8(11)e81261
[http://dx.doi.org/10.1371/journal.pone.0081261] [PMID: 24282576]
, 16Musa NA, Ming F, Wong LP. Prevalence and factors associated with poor sleep quality among secondary school teachers in a developing country 2018; 407-18.
[http://dx.doi.org/10.2486/indhealth.2018-0052]
], but the current study was conducted on the prisoners. Prisoners sleep on the floor from lack of space [9Onoria H. The African Commission on Human and Peoples ’ Rights and the exhaustion of local remedies under the African Charter 1981; 1-24.]. In view of this, the prevalence of poor sleep quality is higher among prisoners than the general population.

On the other hand, this study finding was lower than the study done in England in adult prison populations showed prevalence poor sleep quality 88.2% [7Dewa LH, Hassan L, Shaw JJ, Senior JSC. Trouble sleeping inside: A cross-sectional study of the prevalence and associated risk factors of insomnia in adult prison populations in England. Sleep Med 2017; 32: 129-36.]. The variation might be in the previous study, the participants were collected across three different prisons, two male prisons and one female prison [7Dewa LH, Hassan L, Shaw JJ, Senior JSC. Trouble sleeping inside: A cross-sectional study of the prevalence and associated risk factors of insomnia in adult prison populations in England. Sleep Med 2017; 32: 129-36.] but the current study was conducted only on one prison. The other possible reason for difference might be in the previous study the data was collected for long duration of time, which is more than one year. while, in the current study, the data were collected within a month.

Regarding factors affecting poor sleep quality, the study finding revealed that marital status, educational status, history of previous incarceration, residence before incarceration and lifetime alcohol use had significant association with poor sleep quality.

The results of this study revealed that prisoners, those incarcerated previously, had poor sleep quality compared to those admitted for the first time in prison. This might be explained by the fact that prisoners develop poor sleep quality as a result of repeated exposure to the prison environment. In addition, prison is a place where high control and restriction of movement is common; absence of different services and recreational activities, not well designed or equipped to provide different requirement prisoners. Furthermore, the prison experience can be inherently stressful, which can contribute to poor sleep quality. For example, prisoners experience a complete upheaval from normal life, family and routine, forced contact with others and lack of autonomy [11LINDSAY H. DEWA, LAMIECE HASSAN JJ. S and, SENIOR J.. Insomnia in prison Insomnia management in prisons in England and Wales : A mixed-methods study. J Sleep Res 2017; 26: 322-9.
[http://dx.doi.org/10.1111/jsr.12503]
]. Thinking about the past and looking back on life choices also contributed to poor sleep. For some prisoners, guilt and shame over criminal actions also contributed to poor sleep [12Harner HM, Budescu M. HHS Public Access 2015; 63(3): 158-69.]. Occurrence of poor sleep quality is high in stressful environment.

Prisoners who came from urban residence were more likely to develop poorer quality of sleep compared to rural dwellers. The probable reason might be that urban residents go to bed later than rural residents. In addition, use of technology and social media is higher in urban dwellers than rural dwellers during night time; however, in the prison, such service are restricted which resulted in poor sleep quality in the current study. The results of this study showed that single, widowed and divorced prisoners were less likely to develop poor sleep quality when compared to married status. The probable reason might be married prisoners have different responsibility as they are responsible for their family.; as it's known, married individuals support their children, parents or other relatives and when imprisoned they might develop poorer sleep quality than single prisoner. On the other hand, when a married individual incarcerated, because of separation from partner, they are more prone for poor sleep quality.

This study revealed that there was statistically significant association between low educational status and poor sleep quality. This finding is supported by a study completed in South Korea on factors associated with poor sleep quality in primary care [2Kang J, Lee JA, Jang J, Kim YS, Sunwoo S. Factors Associated with Poor Sleep Quality in Primary Care 2013; 34(2): 107-14.]. The possible reason might be living conditions in prison are worst and lack autonomy which leading to poor sleep quality. Those educated might be taking different measures to get better sleep quality, like involving work in prison. The other possible reason could be regularly performing physical exercise was a protective factor of poor sleep quality [14Luo J, Zhu G, Zhao Q, et al. Prevalence and risk factors of poor sleep quality among Chinese elderly in an urban community: Results from the Shanghai aging study. PLoS One 2013; 8(11)e81261
[http://dx.doi.org/10.1371/journal.pone.0081261] [PMID: 24282576]
].

In the current study, lifetime alcohol use and poor sleep quality shown significant association. This finding agrees with a study done in England and Wales, insomnia management in prisons in a mixed-method study [11LINDSAY H. DEWA, LAMIECE HASSAN JJ. S and, SENIOR J.. Insomnia in prison Insomnia management in prisons in England and Wales : A mixed-methods study. J Sleep Res 2017; 26: 322-9.
[http://dx.doi.org/10.1111/jsr.12503]
]. The reason might be explained by the fact that many people used alcohol for relaxation, followed by relieving stress. it's clear that, prison is stressful environments which make prisoners distressed and disturb their sleep pattern. As in prison, when they want alcohol to get enough sleep, they could not get as they need. This can be devastating to prisoners, thereby leading to deterioration in their psychological and social wellbeing making more prone to poor sleep quality.

5. STRENGTH OF THE STUDY

It is the first study of the national and international level done on prisoners for poor sleep quality, and will serve as a baseline for future researches.

Standardized and internationally recognized tools were used, with highly reliable to screen poor sleep quality.

6. LIMITATIONS

Participants of the study were recruited from one prison, which is the only found in Mettu town.

CONCLUSION & RECOMMENDATIONS

In conclusion, poor sleep quality among prisoners was significantly high. Marital status, educational status, history of previous incarceration, residence before incarceration and lifetime alcohol use had significant association with poor sleep quality. Routine screening and availing management in the prison may be of great importance.

Based on the findings, recommendations are made to the administrators of prison:

Employ/hire mental health professionals to work in prison.

Provide training for prisoners on effect of substance use.

Formal education in prison, linking to the nearby educational institutions.

Follow condition of the prisoners by improving bedroom and better bedding.

Recommendations for University:

Availing routine screening and treatment options for poor sleep quality for the prisoners.

Launch workshops on type of stress management linked with the prison’s clinic.

Recommendations for Ministry of health

Provide coordinated mental health services in prison.

Recommendations for researcher:

As the first study, further studies are needed to assess poor sleep quality and associated factors among prisoners and its possible intervention.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

The study was carried out after ethical clearance was obtained from the ethical review committee of the department of psychiatry, faculty of health and medical sciences of Mettu University, Ethiopia.

HUMAN AND ANIMAL RIGHTS

Not applicable.

CONSENT FOR PUBLICATION

Selected prisoners were informed about nature, purposes, benefits and adverse effects of the study and invited to participate. Confidentiality was ensured and all related questions they raised were answered. Participation was completely voluntary, with no economic or other motivation, and each participant signed written informed consent for their participation.

AVAILABILITY OF DATA AND MATERIALS

The data supporting the findings of the article is available from the Mettu University, but restrictions apply to the availability of these data, which were used under license for the current study and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Mettu University at any time.

FUNDING

None.

CONFLICT OF INTEREST

The authors declare that there is no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Our heartfelt gratitude goes to Mettu University faculty of public health and medical science department of psychiatry for offering this educative and golden opportunity to under take this study. We would also like to thank Mettu town prison administrator for allowance and providing the necessary information. Lastly, we would like to pass our heartfelt gratitude to all respondents who participated in this study.

REFERENCES

[1] George S, Paul G, Paul N, Paul G, George S, Med JC, et al. Study on sleep quality and associated psychosocial factors among elderly in a rural population of Kerala. India 2018; 5(2): 526-31.
[2] Kang J, Lee JA, Jang J, Kim YS, Sunwoo S. Factors Associated with Poor Sleep Quality in Primary Care 2013; 34(2): 107-14.
[3] Berhanu H, Mossie A, Tadesse S, Geleta D. Prevalence and associated factors of sleep quality among adults in jimma town. Southwest Ethiopia : A Community-Based Cross-Sectional Study 2018; 2018: 1-10.
[4] Environment CS, Breathing C, Relaxation PM, Physical G, Routine B. Getting a good night ’ s sleep 1-3.
[5] Kesintha A. Prevalence and predictors of poor sleep quality among secondary school students in Gombak District. Selangor 2018; 73(1): 31-40.
[6] Article O. Incidence of depression among incarcerated woman in central prison, peshawar, pakistan 2012; 9(1): 33-8.
[7] Dewa LH, Hassan L, Shaw JJ, Senior JSC. Trouble sleeping inside: A cross-sectional study of the prevalence and associated risk factors of insomnia in adult prison populations in England. Sleep Med 2017; 32: 129-36.
[8] Dewa LH, Hassan L, Shaw J, Senior J. Design of a treatment pathway for insomnia in prison settings in England : A modified Delphi study 2018; 1-8.
[http://dx.doi.org/10.1136/bmjopen-2018-022406]
[9] Onoria H. The African Commission on Human and Peoples ’ Rights and the exhaustion of local remedies under the African Charter 1981; 1-24.
[10] Prisons in africa. An evaluation from a human rights perspective 2008; 4(December): 22-49.
[11] LINDSAY H. DEWA, LAMIECE HASSAN JJ. S and, SENIOR J.. Insomnia in prison Insomnia management in prisons in England and Wales : A mixed-methods study. J Sleep Res 2017; 26: 322-9.
[http://dx.doi.org/10.1111/jsr.12503]
[12] Harner HM, Budescu M. HHS Public Access 2015; 63(3): 158-69.
[13] Stranges S, Tigbe W, Thorogood M, Kandala N, Africa S, Sciences H, et al. Sleep Problems : An Emerging Global Epidemic ? Findings From the INDEPTH WHO-SAGE Study Among More Than 40 , 000 Older Adults From 8 Countries Across Africa and Asia 2012; 35(8): 1173-81.
[14] Luo J, Zhu G, Zhao Q, et al. Prevalence and risk factors of poor sleep quality among Chinese elderly in an urban community: Results from the Shanghai aging study. PLoS One 2013; 8(11)e81261
[http://dx.doi.org/10.1371/journal.pone.0081261] [PMID: 24282576]
[15] Zhou Y, Guo L, Lu C, Deng J, He Y, Huang J. Bullying as a Risk for Poor Sleep Quality among High School Students in China 2015; 1-14.
[http://dx.doi.org/10.1371/journal.pone.0121602]
[16] Musa NA, Ming F, Wong LP. Prevalence and factors associated with poor sleep quality among secondary school teachers in a developing country 2018; 407-18.
[http://dx.doi.org/10.2486/indhealth.2018-0052]
[17] Priya J, Singh J. Study of the factors associated with poor sleep among medical students 2017; 2(June): 422-9.
[18] Dewa LH, Hassan L, Shaw JJ, Senior J. Insomnia management in prisons in England and Wales: A mixed‐methods study. J Sleep Res 2017; 26(3): 322-9.
[19] Fiona L, Ireland JL, Chu S, Ireland CA. Sleep and its association with aggression among prisoners : Quantity or quality ? Int J Law Psychiatry 2016; 47: 115-21.
[20] Estrada ER, Chiesa I, Orellana AF, Reyes-terán G. Factors associated with poor sleep quality among HIV-positive individuals in Mexico City 2018; 41(3): 123-9.
[21] Vitkova M, Gdovinova Z, Rosenberger J, et al. Factors associated with poor sleep quality in patients with multiple sclerosis differ by disease duration. Disabil Health J 2014; 7(4): 466-71.
[http://dx.doi.org/10.1016/j.dhjo.2014.05.004] [PMID: 25224987]
[22] Carole B, Msn S, Gnp ANP. The Pittsburgh Sleep Quality Index (PSQI). Pittsburgh Sleep Quality Index 2012; 29(6): 1-2.
[23] Bøen H, Dalgard OS, Bjertness E. The importance of social support in the associations between psychological distress and somatic health problems and socio-economic factors among older adults living at home: a cross sectional study. BMC Geriatr 2012; 12(27): 1-2.
[http://dx.doi.org/10.1186/1471-2318-12-27] [PMID: 22682023]
[24] Abiola T, Udofia O, Zakari M. Psychometric Properties of the 3-Item Oslo Social Support Scale among Clinical Students of Bayero University Kano, Nigeria. Malaysian J Psychiatry 2013; 22: 32-41.
Track Your Manuscript:


Endorsements



"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


Browse Contents




Webmaster Contact: info@benthamopen.net
Copyright © 2020 Bentham Open