terça-feira, 18 de novembro de 2008

Epidemia de pelagra na Angola

O artigo a seguir fala sobre uma epidemia de pelagra na Angola, lá as pessoas são extremamente pobres e têm uma alimentação bastante precária, que se tornou ainda mais difícil num momento em que o país passou por uma guerra civil. Mesmo em Inglês, o artigo é muito interessante, vale a pena ler.

Pellagra outbreak in Kuito, Angola

Sophie Baquet, François Wuillaume, Kathia Van Egmond and Felicitas Ibañez

"Since late 1998, over 100000 people living in Bie province, Central Angola, have fled the armed conflict and sought asylum in camps around Kuito, the provincial capital city. Most of the displaced people (estimated 110 000 people) depend entirely on the World Food Programme (WFP) food distribution. The resident population of about 135 000 is also badly effected by the enclavement of one of the most heavily mined cities in the world. Small agricultural fields and seeds have been distributed to the displaced population but the next harvest due about now is expected to be insufficient.
A pellagra outbreak started in Kuito in July, 1999. From July, 1999, until mid-February, 2000, 908 cases of pellagra were recorded at the hospital. The definition used is a dermatitis on two different and symmetrical sites exposed to sunlight or with a typical casal's necklace.
The entire pellagra attack rate is 3·6/1000; 66% of the patients registered with pellagra were displaced people, 83% were women, and 18% of the patients were younger than age 15 years. No data are available to estimate the case fatality. The current attack rate is most probably an underestimate, because no active case searching is done. Also, the case definition used means that only typical and therefore advanced cases are diagnosed. The classical skin lesions seem to occur in older people, and people who do not go outside do not get the skin lesions either. In truth, most of the population probably have a certain degree of niacin deficiency.
From April, 1999, to February, 2000, food rations distributed principally to the displaced population provided an average of 8 mg niacin per person per day. WHO recommended daily intake of niacin equivalents is 6·6 mg (infants) to 21·1 mg (adults).1 WHO technical report Series 362. Requirements of vitamin A, thiamine, riboflavine and niacin. Report of a Joint FAO/WHO expert group. WHO: Geneva, 1967.1 Fish has been distributed since November, 1999, but solely to beneficiaries of supplementary feeding programmes and those diagnosed with pellagra.
In the absence of an appropriate response, Medecins Sans Frontieres (MSF) organised a distribution of vitamin B complex tablets to all women aged 15 years and over in December, 1999. This targeting was done because lack of resources to organise a distribution to the entire population, which was started at the end of February. This outbreak confirms previous observations that people depending on insufficient food rations (in quantity and quality) suffer from different deficiencies.2, 3 and 4 Epicentre and MSF described a similar outbreak of pellagra among Mozambican refugees in Malawi in 1990.5
Despite official international nutrition recommendations, relief programmes fail in the provision of the minimum recommended daily allowance of essential micronutrients. This pellagra outbreak in Kuito underscores the vulnerability of food-aid dependent populations to such forgotten micronutrient deficiency diseases. An urgent effort to supply niacin-rich (ground-nuts, blended food, or fortified food) to this food-aid-dependent population, has to be done rapidly to stem this outbreak, which started 10 months ago."


1 WHO technical report Series 362. Requirements of vitamin A, thiamine, riboflavine and niacin. Report of a Joint FAO/WHO expert group. WHO: Geneva, 1967.

2 AM Magan, M Warsame, AK Ali-Salad and M Toole, An outbreak of scurvy in Somali refugees camps, Disasters 7 (1982), pp. 93–97.

3 J Seaman and JPW Rivers, Scurvy and anaemia in refugees, Lancet 1 (1989), p. 1204. Abstract | View Record in Scopus | Cited By in Scopus (3)

4 A Berry-Koch, R Moench, P Hakewell and M Dualeh, Alleviation of nutritional deficiency diseases in refugees. Food Nutr, Bull 12 (1990), pp. 106–112. View Record in Scopus | Cited By in Scopus (5) "


Por: Pollana Roberta Alves Campos

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