An unprecedented study, conducted by the research group on Health in the Prisions [Saúde nas Prisões] of the National School of Public Health (Ensp/Fiocruz), and coordinated by Alexandra Sánchez, through technical cooperation with the Public Prosecutor's Office/RJ, analyzed the causes of deaths in the Prison System of the State of Rio de Janeiro (2016-2017). The results indicate that infectious diseases were responsible for 30% of deaths in the prison population, followed by diseases of the circulatory system (22%), external causes (12%) and diseases of the respiratory system (10%). Among infectious diseases are HIV/AIDS (43%), tuberculosis (40.7%) and septicemia (13%). Considering deaths with mention of tuberculosis in other lines of the death certificate, this percentage rises to 52%.
The survey showed that deaths from infectious diseases were three times more frequent in the prison population than in the general population of the state. Incarcerated people are about nine times more likely to die from tuberculosis (TB), five times more likely to have TB/HIV co-infection, and three times more likely to die from HIV and its complications.
"The research also allowed visibility to chronic injuries involved in deaths, but totally absent in death certificates, such as diabetes mellitus, which, after our review, contributed with 7.7% of deaths, in addition to mental disorders associated with deaths from aggression. The study of the trajectory of the patients allowed a better understanding of the aspects that contributed to the fatal evolution of these cases, especially in those with preventable, treatable and potentially curable diseases," the author said.
The very low percentage (0.7%) of cases that evolved to death in extramural services (greater complexity) illustrates the existing barrier to care for the incarcerated population in public hospitals, even for severe cases such as septicemia, diabetic ketoacidosis, trauma renal failure, acute myocardial infarction, which contradicts the precepts of the Brazilian Public Health System and the laws of the country.
The confined, poorly ventilated and overcrowded environment of prisons favors the spread of airborne diseases, along with TB. The restriction on the use of water, the lack of personal hygiene material and an appropriate place for washing and drying clothes contributes significantly to the proliferation of skin diseases such as mycoses, scabies that can be overinfected by bacteria, and furunculosis, impetigo among others, which often serve as a gateway to bacteria that will lead to severe septicemia that lead many to death.
"In relation to tuberculosis, considering that it is a disease of easy diagnosis and treatment, with state-of-the-art diagnostic test made available free of charge by the Ministry of Health, evidently the poor environmental conditions of prisons play an important role in the spread of the disease. However, what is determinant for the evolution to death is the difficulty of the patient to have access to diagnosis and treatment and the lack of resolution of the intramural health service, associated with the impossibility of accessing extramural services in cases of greater complexity," said Sánchez.
This study shows a severe situation of lack of care, with insufficient and poorly resolving intramural services, in addition to the non-access of imprisoned patients to extramural services, resulting in an excess of deaths from potentially curable diseases. It also highlights the non-inclusion of the incarcerated population in the Public Health System, despite the existence of policies with this objective since 2006 (the National Health Plan in the Penitentiary System - PNSSP and, more recently, the National Policy for Integral Attention to People's Health Prisoners - PNAISP, 2014).
The results of this study have contributed, for example, to the reorganization of health care in prisons in Rio de Janeiro, especially with regard to access to the diagnosis and treatment of TB.