Date Published: March 17, 2015
Publisher: Public Library of Science
Author(s): Hubert Barennes, Khouanheuan Sengkhamyong, Jean Pascal René, Maniphet Phimmasane, Carlos Franco-Paredes. http://doi.org/10.1371/journal.pntd.0003581
Abstract: BackgroundInfantile 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 FindingsThree 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.ConclusionThiamine 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.
Partial Text: Thiamine (vitamin B1) acts as an important cofactor in metabolism and energy production. It is required for the biosynthesis of neurotransmitters and the production of substances used in defence against oxidant stress . Thiamine deficiency occurs predominantly in populations, in which the diet consists mainly of very poor sources of thiamine such as milled white cereals, including polished rice (the rich thiamin envelop is removed by polishing) and wheat flour, and where other key sources of thiamine (meat, fish, and vegetables) are infrequently consumed . It is also related to diets that are rich in thiaminase, the natural thiamine-degrading enzyme, which is abundantly present in raw and fermented fish sauce (a common Asian delicacy) certain vegetables and roasted insects consumed primarily in Africa and Asia . Thiamine deficiency can develop within 2–3 months from a deficient intake and can cause illness and death .
This survey suggests the presence of infantile thiamine deficiency and thiamine deficiency in pregnant women and breastfeeding mothers from diverse ethnic groups in Luang Namtha province. Thiamine deficiency was either diagnosed or suspected alone or in association with an infection at the hospital level and in the community. A dramatic therapeutic response to thiamine supplementation was observed in nearly all hospital cases (90.7%). The survey also shows an excessive infant mortality in the 22 villages compared to the national rate . Thiamine deficiency remains a poorly recognized but readily treatable cause of infant death, which strongly advocates for public health prevention and education. We previously recommended using antenatal visits to provide such prevention in Laos . However the rate of antenatal care which varies widely between rural (29%) and urban areas (71%) may limit this recommendation . Extensive public education needs to be conducted with a particular emphasis on mothers belonging to ethnic groups, having a low dietary diversity and those performing hard physical labor or being farmers; three risk factors that were previously pointed out and that also apply to our study population . This survey of highland Lao complements recent work conducted in Vientiane capital where both thiamine deficiency and clinically unapparent thiamin deficiency were described among a majority of lowland Lao (Lao Loum) [39–41]. Another survey shows that 12% of malaria patients (including 165 children less than 15 years of age) had severe biochemical thiamine deficiency in Savannakhet region, southern Laos, without clinical features of thiamine deficiency .