Ocular morbidity prevalence of 43.1% among incarcerated populations in sub-Saharan AfricaFactors Linked to Eye Conditions in Sub-Saharan African Prisons

Ocular morbidity remains poorly characterized among prisoners; this systematic review and meta-analysis quantified its prevalence, spectrum and associated factors across sub-Saharan Africa (SSA). This review followed a published Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Protocols (PRISMA-P) and searched eight databases using prespecified terms, with study selection guided by PRISMA. Data were standardized and synthesized using random-effects meta-analysis to estimate pooled prevalence with 95% confidence intervals (CIs), with heterogeneity assessed using I2 and sensitivity and condition-specific analyses used to assess variation. Six studies comprising 3,361 participants from four SSA countries, Nigeria, Uganda, Tanzania and Kenya, met the inclusion criteria. The pooled prevalence of ocular morbidity was 43.1% (95% CI: 12.4–77.1%; I2 = 99.2%). Conjunctivitis was the most prevalent condition (23.9%; 95% CI, 10.7–40.1%), followed by refractive error (19.5%; 95% CI, 12.5–27.5%) and presbyopia (18.6%; 95% CI, 5.2–37.7%). Cataract (7.4%), glaucoma (5.6%) and corneal scar or opacity (3.0%) were less prevalent. Age >50 years (OR = 11.96; 95% CI, 5.31–26.94) and a history of ocular trauma (OR = 5.21; 95% CI, 1.52–17.87) were associated with higher odds of ocular morbidity. Longer imprisonment was associated with xerophthalmia (OR = 20.1; 95% CI, 8.3–48.8%), whereas access to food from outside prison was associated with lower odds of ocular morbidity (OR = 0.45; 95% CI, 0.26–0.79). Ocular morbidity affects approximately four in ten prison inmates in SSA, with much of this burden preventable or treatable, despite considerable between-study heterogeneity and limited geographical evidence. Collectively, these findings support integrated prison eye care and standardized research to advance equitable interventions across SSA.