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Beriberi (thiamine deficiency) and high infant mortality in northern Laos
Hubert Barennes1, Khouanheuan Sengkhamyong2, Jean Pascal René2
1Agence Nationale de Recherche sur le VIH et les Hépatites, Phnom Penh, Cambodia; Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao, PDR; Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia; ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Univ. Bordeaux, Bordeaux, France.
Insights
Infantile thiamine deficiency is a significant cause of infant mortality in northern Laos, particularly among breastfed infants. Urgent nutritional interventions are needed to address this critical public health issue.
Area of Science:
- Nutritional Epidemiology
- Pediatric Public Health
- Maternal and Child Health
Background:
- Infantile beriberi (thiamine deficiency) primarily affects infants of mothers with inadequate thiamine intake.
- This condition is prevalent in vulnerable populations, with cases noted in northern Laos.
Purpose of the Study:
- To describe possible and probable cases of infantile thiamine deficiency in northern Laos.
- To investigate the prevalence and impact of thiamine deficiency on infant mortality.
Main Methods:
- Conducted retrospective and prospective surveys of infants diagnosed with thiamine deficiency and cardiac failure.
- Performed cross-sectional surveys of mothers and infants in affected villages, including questionnaires, physical exams, and verbal autopsies for mortality estimation.
Main Results:
- Between 2007-2009, 54 infants were diagnosed with severe cardiac failure due to thiamine deficiency; 90.2% recovered with treatment.
- In surveyed villages, 10.6% of live-born infants died within the first year, with suspected thiamine deficiency accounting for 3.6% of deaths.
- Maternal symptoms like edema and paresthesia were common, and dietary practices (polished rice, postpartum food avoidance) contributed to deficiency.
Conclusions:
- Thiamine deficiency is a likely major contributor to infant mortality in ethnic groups in northern Laos.
- Maternal and infant symptoms strongly suggest thiamine deficiency as the underlying cause.
- The findings highlight a severe nutritional situation requiring immediate public health attention in Laos.
Background:
Infantile beriberi (thiamine deficiency) occurs mainly in infants breastfed by mothers with inadequate intake of thiamine, typically among vulnerable populations. We describe possible and probable cases of infantile thiamine deficiency in northern Laos.
Methodology/Principal Findings:
Three surveys were conducted in Luang Namtha Province. First, we performed a retrospective survey of all infants with a diagnosis of thiamine deficiency admitted to the 5 hospitals in the province (2007-2009). Second, we prospectively recorded all infants with cardiac failure at Luang Namtha Hospital. Third, we further investigated all mothers with infants (1-6 months) living in 22 villages of the thiamine deficiency patients' origin. We performed a cross-sectional survey of all mothers and infants using a pre-tested questionnaire, physical examination and squat test. Infant mortality was estimated by verbal autopsy. From March to June 2010, four suspected infants with thiamine deficiency were admitted to Luang Namtha Provincial hospital. All recovered after parenteral thiamine injection. Between 2007 and 2009, 54 infants with possible/probable thiamine deficiency were diagnosed with acute severe cardiac failure, 49 (90.2%) were cured after parenteral thiamine; three died (5.6%). In the 22 villages, of 468 live born infants, 50 (10.6%, 95% CI: 8.0-13.8) died during the first year. A peak of mortality (36 deaths) was reported between 1 and 3 months. Verbal autopsy suggested that 17 deaths (3.6%) were due to suspected infantile thiamine deficiency. Of 127 mothers, 60 (47.2%) reported edema and paresthesia as well as a positive squat test during pregnancy; 125 (98.4%) respected post-partum food avoidance and all ate polished rice. Of 127 infants, 2 (1.6%) had probable thiamine deficiency, and 8 (6.8%) possible thiamine deficiency.
Conclusion:
Thiamine deficiency may be a major cause of infant mortality among ethnic groups in northern Laos. Mothers' and children's symptoms are compatible with thiamine deficiency. The severity of this nutritional situation requires urgent attention in Laos.
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