title: Suspected outbreak of riboflavin deficiency among populations reliant on food assistance: a case study of drought-stricken Karamoja, Uganda, 2009-2010.
abstract: BACKGROUND
  In 2009, a humanitarian response was launched to address a food security and livelihoods crisis in Karamoja, Uganda. During a polio immunization campaign in mid-August 2009, health workers in Nakapiripit District reported a concern about an increase in mouth sores, or angular stomatitis (AS) and gum ulcerations, among children in one village, and an investigation was launched.
  
  
  OBJECTIVE
  This article describes the investigation, lessons learned, and provides guidance for monitoring micronutrient deficiencies among populations receiving food assistance.
  
  
  METHODS
  An investigation into a suspected outbreak of riboflavin (vitamin B2) deficiency was initiated, including a rapid assessment, mass screening, a convenience sample collection of blood specimens (n = 58 symptomatic cases and n = 18 asymptomatic individuals), and analysis of the general food ration (70% ration).
  
  
  RESULTS
  Findings showed signs of AS in only 399 (0.2%) of 179,172 screened individuals, including adults and children. Biochemical analysis confirmed riboflavin deficiency in 84.5% of specimens from symptomatic individuals and 94.4% of specimens from asymptomatic individuals. Ration distribution data showed that 55% of distributions provided less than half the riboflavin RDA.
  
  
  CONCLUSIONS
  Evidence was insufficient to confirm an actual outbreak of riboflavin deficiency, though the present investigation adds further documentation that micronutrient deficiencies continue to persist among populations in emergency settings. This article describes challenges, lessons learned, and guidance for monitoring micronutrient deficiencies among food assistance recipients, including: ongoing nutrition monitoring and surveillance; training and sensitization about micronutrient deficiencies, sensitization of the population about locally-available food, and identifying ways to improve micronutrient interventions.
authors: Epidemic Intelligence Service assigned to the Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, U.S. Public Health Service Commissioned Corps, Atlanta, Georgia, United States of America. EKNichols@cdc.gov
authors: Erin K
authors: EK
authors: Nichols
authors: Leisel E
authors: LE
authors: Talley
authors: Nelly
authors: N
authors: Birungi
authors: Amanda
authors: A
authors: McClelland
authors: Elizabeth
authors: E
authors: Madraa
authors: Agnes B
authors: AB
authors: Chandia
authors: Jacqueline
authors: J
authors: Nivet
authors: Rafael
authors: R
authors: Flores-Ayala
authors: Mary K
authors: MK
authors: Serdula
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D055864:Droughts; D005260:Female; D063105:Food Assistance; D006282:Health Personnel / Q000193:education; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017410:Practice Guidelines as Topic; D012256:Riboflavin / Q000032:analysis; D012257:Riboflavin Deficiency / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D012256:Riboflavin
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