Outbreak of beri-beri in The Gambia

Abstract

PIP: This study examined an outbreak of beri-beri which occurred in The Gambia between July and September 1988. 140 people were affected and 22 died. The outbreak resolved after distribution of thiamine in the community. Gradual replacement of traditional cereals with imported milled rice may have increased susceptibility to beri-beri. The 1st reports of beri-beri came from the village of Chilla where 25 of 975 inhabitants described their symptoms. Active case-finding located 38 affected people. All patients had peripheral edema and 1/3 had a mixed motor and sensory neuropathy. The earliest symptoms started 3 weeks after the start of the rainy season. All inhabitants were Muslim whose staple diet is millet and imported rice from Thailand. Attack rates in Chilla and in other clinics were highest in young men. Within a few days of hospitalization (8) all patients responded rapidly to treatment of oral thiamine of 10 mg/day. Since 22 people with symptoms suggestive of beri-beri had already died in the outbreak area before thiamine became available the authors chose not to assign patients to treatment and non-treatment groups. As a result of the response to treatment of the hospital patients, thiamine was distributed to health centers and village health workers in the affected areas. Daily thiamine (200 mg) was given until symptoms were resolved. The trend towards consumption of imported rice and away from other cereals has gradually reduced people's thiamine intake and thiamine stores. In the affected area, this factor, combined with the high rainfall, high agricultural workload, cooking methods, and possible thiamine antagonists, led to the outbreak.