Cyclone idai as a trigger for pellagra outbreak in nhamatanda, mozambique: A case-control study

• Authors: Vánio A Mugabe, Universidade Federal da Bahia; Arlete Mahumane, Instituto Nacional de Saúde (INS); Cynthia S Baltazar, Instituto Nacional de Saúde, Maputo; Érika V Rossetto, Assigned to Mozambique Centers for Disease Control Prevention; Crescêncio S Nhabomba, Instituto Nacional de Saúde (INS); Neusa Fataha, Instituto Nacional de Saude Maputo; Unicia Nyamula, Instituto Nacional de Saúde (INS); Angélica Sotomane, Instituto Nacional de Saúde (INS); Wilson Irugula, Direcção Provincial de Sofala; Benigno Canze, Instituto Nacional de Saúde (INS); Osvaldo F Inlamea, Instituto Nacional de Saude Maputo; Uriel Kitron, Emory University; Guilherme S Ribeiro, Universidade Federal da Bahia; Eduardo S Gudo, Instituto Nacional de Saude Maputo
• Journal Title: American Journal of Tropical Medicine and Hygiene
• Volume: Volume 104, Number 6
• Publisher: The American Journal of Tropical Medicine and Hygiene | 2021-06-01, Pages 2233-2237
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.4269/ajtmh.20-1321
• Subjects: Health Sciences, General; Health Sciences, Public Health
• Keywords: Adolescent; Case-Control Studies; Child; Child, Preschool; Cyclonic Storms; Disease Outbreaks; Female; Humans; Infant; Infant, Newborn; Male; Mozambique; Odds Ratio; Pellagra; Skin

Abstract

In mid-June 2019, 3 months after cyclone Idai landfall in Mozambique, health authorities of Nhamatanda district reported an outbreak of Pellagra. Applying a mixed-method protocol, we carried out an investigation to characterize cases of pellagra, identify the associated factors for the outbreak using a case-control study, and explore the perceived impact on food security (availability, access, and usage) before and after Idai.Wecollected data from 121 cases and 121 controls and conducted in-depth interviews with 69 heads of households. The cases were more likely to be female (P < 0.01) and less educated (P < 0.01) than controls. Insufficient consumption of chicken and peanut before cyclone Idai arrival were statistically associated with pellagra (P < 0.05). From interviewed households' heads, 51% were experiencing food shortages even before the cyclone hit. Cyclone Idai served as a trigger to reduce niacin consumption below the threshold that protected Nhamatanda population from pellagra and caused a ≈2,300 case (707.9/100,000 inhabitants) outbreak.