title: Beriberi (thiamine deficiency) and high infant mortality in northern Laos.
abstract: BACKGROUND
  Infantile 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.
  
  
  RESULTS
  Three 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.
  
  
  CONCLUSIONS
  Thiamine 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.
authors.affiliation: Agence Nationale de Recherche sur le VIH et les Hépatites, Phnom Penh, Cambodia; Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao, PDR; Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia; ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Univ. Bordeaux, Bordeaux, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Barennes
authors.affiliation: Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao, PDR.
authors.forename: Khouanheuan
authors.initials: K
authors.lastname: Sengkhamyong
authors.affiliation: Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao, PDR.
authors.forename: Jean Pascal
authors.initials: JP
authors.lastname: René
authors.affiliation: Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao, PDR.
authors.forename: Maniphet
authors.initials: M
authors.lastname: Phimmasane
mesh_terms: D001602:Beriberi / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000208:ethnology*; D007812:Laos / Q000453:epidemiology; D008297:Male; D009035:Mothers / Q000706:statistics & numerical data; D011247:Pregnancy; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires