An Outbreak of Pellagra Related to Changes in Dietary Niacin among Mozambican Refugees in Malawi

Between February and October 1990 health workers in Malawi noted 18276 cases of pellagra among 285942 Mozambican refugees. This represented a significant increase in pellagra cases (compared with just 1169 cases in 1989). 5 months before each outbreak the UN High Commission for Refugees and the World Food Program could not obtain groundnuts a source of niacin to include in food rations. The food ration distributed to refugees had an average of just 4 mg available niacin equivalent (or 5 year olds). No infant had pellagra. Researchers compared 126 pellagra cases with 126 controls. The conditional logistic regression indicated that pellagra cases were less likely to eat groundnuts and fish at least once a day within the last 6 months (odds ratio [OR] = .07 and .56 respectively). They tended not to have a garden (OR = .32) and to mill maize at home (OR = .26). Thus eating groundnuts milling maize at home and garden ownership protected the refugees from developing pellagra. In August 1990 relief workers distributed niacin tablets to refugees. The health workers recommended other corrective actions such as early case finding and treatment identification of groundnut supply on the world market and diversification of the food basket through access to local markets.