title: Outbreak of beriberi in a prison in Côte d'Ivoire.
abstract: BACKGROUND
  A beriberi outbreak occurred in the Maison d'Arrêt et de Correction d'Abidjan (MACA), a detention center in Abidjan, Côte d'Ivoire, between October 2002 and April 2003.
  
  
  OBJECTIVE
  A retrospective investigation was conducted to document the outbreak in April 2003.
  
  
  METHODS
  A descriptive analysis and a case-control study were performed. A probable case patient was defined as a person detained in the center between October 2002 and April 2003 with at least two of the following symptoms: bilateral leg edema, dyspnea, positive squat test, motor deficiencies, and paresthesia. A definite case patient was defined as a probable case patient who showed clinical improvement under thiamin treatment.
  
  
  RESULTS
  Of 712 cases reported, 115 (16%) were probable and 597 (84%) were definite. The overall attack rate was 14.1%, and the case fatality rate was 1.0% (7/712). The highest attack rate was reported in the building housing prisoners with long-term sentences (16.9%). All patients were male, and the mean age was 28 years. During the period studied, the penal ration provided a fifth of the quantity of thiamin recommended by international standards. After adjustment for potential confounders, a history of cholera infection (adjusted odds ratio [OR(a)], 12.9; 95% confidence interval [CI], 2.9 to 54.1) and incarceration in the building for severe penalties (OR(a), 4.8; 95% CI, 1.3 to 18.5) were associated with the disease.
  
  
  CONCLUSIONS
  Beriberi has been underreported among prisoners. Further attention should be given to its risk factors, especially a history of acute diarrhea. Systematic food supplementation with vitamins and micronutrients should be discussed when the penal ration does not provide the necessary nutrient intake recommended according to international standards.
authors.affiliation: Epicentre, 42 boulevard Richard Lenoir, Paris 75011, France. lahoua@epicentre.msf.org
authors.forename: Laurence
authors.initials: L
authors.lastname: Ahoua
authors.forename: William
authors.initials: W
authors.lastname: Etienne
authors.forename: Florence
authors.initials: F
authors.lastname: Fermon
authors.forename: Graziella
authors.initials: G
authors.lastname: Godain
authors.forename: Vincent
authors.initials: V
authors.lastname: Brown
authors.forename: Kassy
authors.initials: K
authors.lastname: Kadjo
authors.forename: Kouamé
authors.initials: K
authors.lastname: Bouaffou
authors.forename: Dominique
authors.initials: D
authors.lastname: Legros
authors.forename: Philippe Jean
authors.initials: PJ
authors.lastname: Guerin
mesh_terms: D000328:Adult; D001602:Beriberi / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D016022:Case-Control Studies; D002771:Cholera / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D016001:Confidence Intervals; D007560:Cote d'Ivoire / Q000453:epidemiology; D004032:Diet; D004196:Disease Outbreaks; D006801:Humans; D007326:Institutionalization; D008297:Male; D016017:Odds Ratio; D011329:Prisoners; D012189:Retrospective Studies; D016019:Survival Analysis; D013831:Thiamine / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D013831:Thiamine