An outbreak of pellagra related to changes in dietary niacin among Mozambican refugees in Malawi.

Malfait P Moren A Dillon JC Brodel A Begkoyian G Etchegorry MG Malenga G Hakewill P
International journal of epidemiology 1993 Jun ; 22(3); 504-11. doi: . Epub 1993 09 30
Africa Africa South Of The Sahara Biology Case Control Studies Deficiency Diseases Delivery Of Health Care Demographic Factors Developing Countries Diet Diseases Eastern Africa English Speaking Africa Epidemics Epidemiologic Methods Food Supplementation Geographic Factors Health Health Services Malawi Migrants Migration Mozambique Niacin Nutrition Nutrition Disorders Nutrition Programs Physiology Population Population Characteristics Population Dynamics Portuguese Speaking Africa Primary Health Care Refugee Camps Refugees Research Methodology Research Report Residence Characteristics Sex Distribution Sex Factors Spatial Distribution Studies Vitamin B Complex Vitamins


Between February and October 1990, 18,276 cases of pellagra dermatitis (due to niacin deficiency) were reported among 285,942 Mozambican refugees in Malawi. Overall, 6.3% of the refugee population developed pellagra and the attack rate was 7.8 times higher among women than men. This outbreak followed a 5-month cessation of groundnut distribution (the major source of niacin) to refugees. A matched-pair case-control study confirmed the protective role of the daily consumption of groundnuts (Odds Ratio [OR] = 0.08), as well as the independent role of garden ownership (OR = 0.34), and home maize milling (OR = 0.3). Recommended corrective action included early case finding and treatment, distribution of niacin tablets, prompt identification of groundnut supply on the world market, fortification with niacin of the food ration and diversification of the food basket through access to local markets.