At Lilongwe Prison in Malawi’s capital city, a monotonous diet of porridge-like nsima and undercooked beans is taking its toll on TB patients, who require nutritious food to effectively respond to treatment.
Inmates on TB treatment at the correctional facility widely known as Maula Prison sleep on an empty stomach.
This undermines national progress to achieve global Sustainable Development Goals (SDGs) to ensure access to quality healthcare and nutrition for all.
Collins Banda, 19, was diagnosed with TB last year while serving a seven-year jail term.
“I initially ignored the early signs, which included night sweats and weight loss. When I went to see a clinician, sputum tests confirmed I had TB. Despite my initial reservations, I accepted the results and started treatment immediately,” he narrates.
Banda sometimes skips treatment due to food shortages and poor nutrition.
“I follow the prescription, but taking the drugs on an empty stomach can be challenging. I am supposed to take the pills in the morning, but leads to terrible dizziness because prisons don’t serve any breakfast. I sometimes skip medication as we go without food for two to three days,” he says.
The prisoner asks authorities to urgently address nutrition gaps for TB patients to receive quality care.
“Our lives depend on it,” he states.
Emmanuel Chimwala, who was diagnosed with TB earlier this year, says the punitive diet leaves him weak and slow to heal.
“Improved nutrition would mean improved health for TB patients on treatment. That would be great,” he says, scratching sore joints.
Lilongwe Prison clinic in-charge Inspector Edward Msoyowa, spoke of 96 percent treatment success rate in the past five years—with only four deaths out of 92 patients—despite poor diet and overcrowding.
“We request government and other stakeholders to increase the food budget to assist inmates on TB treatment. Please come to our rescue,” he said.
Maula clinic has 13 inmates on TB treatment.
Their nsima and porridge is supplemented with Ready-to-Use Therapeutic Food, a fortified peanut butter supplement for treating severe malnutrition.
According to assistant Superintendent Justin Chisi, the prison holds 3 400 inmates, more than double its 1 400-head capacity.
Congestion increases the risk of airborne diseases such as TB, coughs and scabies.
“With the current economic situation, government funding is insufficient to meet the suppliers’ demand and provide adequate nutrition, even for inmates with critical illnesses,” he says.
Centre for Human Rights, Education, Advice and Assistance (Chreaa) executive director Victor Mhango urges government to ensure TB patients receive proper meals for lifesaving treatment.
“We have been advocating for increased budget allocation for prison food. Even when things are difficult, TB patients require nutritious food, but these calls haven’t been acted upon,” he says.
Ministry of Health spokesperson Adrian Chikumbe says the ministry only provides TB screening and medication in prison clinics, “but providing food for TB patients remains a challenge”.
This year, Parliament revised the Malawi Prisons Act to democratise prison conditions.
The repeal of the prisons law of 1956 raised hopes for improved conditions in correctional facilities.
Chreaa is optimistic that the law reforms will improve prison conditions given adequate resources and political will.
Still, the gaps in prison diet and healthcare remain glaring.
The worst affected groups include TB patients.
The punitive diet puts inmates in danger of preventable death.
Malawi has committed to eliminating TB as a public health threat by 2030.
Kachere Women’s Prison in the capital city was designed to accommodate 80 inmates but now houses 119 inmates.
The prison has not registered any TB since its establishment in 2023.
Assistant superintendent Wilbes Tembo, in charge of the prison’s clinic, says every inmate is screened before entering the facility to prevent the spread of TB.
“We can combat TB with proper implementation and adherence to preventive measures,” he says.
However, Kachere Prison is not exempted from nutrition woes.
Tembo backs calls for a more humane prison environment where health, justice and equality are part of rehabilitation process.
