Beri-beri: the major cause of infant mortality in Karen refugees.
During a prospective evaluation of malaria prophylaxis in pregnancy in a refugee population on the north-western border of Thailand from 1987 to 1990, an extremely high infant mortality rate (18%) was documented despite good access to health care. Infantile beri-beri was recognized as the main cause of death accounting for 40% of all infant mortality. Thereafter, severe vitamin B1 deficiency in infants was diagnosed and treated promptly. The impact of this was assessed prospectively from 1993 to 1996 in a second cohort study. The case fatality of infantile beri-beri fell from almost 100% to 7%. The overall infant mortality rates declined from 183 to 78 per 1000 live births. Post-neonatal deaths fell by 79% (95% CI 65-87%) while neonatal mortality remained unchanged. Mortality resulting from acute respiratory infections did not change (15 and 11 per 1000, respectively), whereas mortality attributable to beri-beri decreased from 73 to 5 per 1000 (P < 0.0001). Before its recognition approximately 7% of all infants in this population died from infantile beri-beri. This lethal but preventable syndrome may be more common than hitherto recognized, particularly in refugee populations, in this populous region.
Shoklo Malaria Research Unit, Mae Sod, Thailand. christine.luxemburger@wanadoo.fr
Christine
C
Luxemburger
Nicholas J
NJ
White
Feiko
F
ter Kuile
H M
HM
Singh
Irène
I
Allier-Frachon
Mya
M
Ohn
Tan
T
Chongsuphajaisiddhi
François
F
Nosten
D001602:Beriberi / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011446:Prospective Studies; D012036:Refugees; D013785:Thailand / Q000453:epidemiology