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© 1993 Oxford University Press

research-article

An Outbreak of Pellagra Related to Changes in Dietary Niacin among Mozambican Refugees in Malawi

PHILIPPE MALFAIT*, ALAIN MOREN*,, JEAN CLAUDE DILLON{dagger}, ALICE BRODEL**, GENEVIEVE BEGKOYIAN**, MARC GASTELLU ETCHEGORRY**, GRACE MALENGA{ddagger} and PETER HAKEWILL§

* Epicentre, 8 rue Saint Sabin, Paris 75011, France
** Médecins Sans Frontiéres, Paris, France
{dagger} Institut National d'Agronomie Paris, Girgnon, France
{ddagger} Office of the United Nations High Commissioner for Refugees Blantyre, Malawi
§ Office of the United Nations High Commissioner for Refugees Geneva

Reprint requests: Dr Alain Moren

Between February and October 1990, 18276 cases of pellagra dermatitis (due to niacin deficiency) were reported among 285942 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.

Received 1 November 1992


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