Compliance problems with vitamin pill distributions
Unpublished report
A pellagra outbreak hit war affected Kuito town, the capital of Bie Province in Angola in the second half of 1999 (see article in this issue of Field Exchange, page 12). MSF Belgium organised a 'vitamin B complex' distribution to all women over the age of 15 years. The response was seen as an emergency measure as other sources of niacin, e.g. ground nuts, CSB and dry fish were not available in the emergency general ration. Women over 15 years were targeted due to lack of resources to organise a distribution to the entire population. MSF Belgium were however aware that although pellagra was diagnosed most frequently in this demographic group, the entire population was also probably equally affected. Thirty tablets were distributed to all women.
MSF Belgium and ICRC conducted a nutrition survey1 shortly after the distribution. Part of the survey was designed to assess compliance with the vitamin distribution. Consumption of the vitamin was recorded by counting the number of tablets left in the distributed tablet bags. A woman was categorised as compliant when the number of tablets corresponded to the 30 tablets distributed less the number of days spent since the distribution allowing for three tablets either way. The survey was conducted 6-11 days after the distribution. Nine hundred and fifty women were assessed.
Results
Forty four percent were compliant in the town and 42% in the camps for IDPs. Compliance was judged to be poor. Several explanations were offered for this:
- There was confusion between vitamins and contraceptive tablets which were only to be taken once monthly
- The vitamin tablet appeared to increase feelings of hunger
- There was a lack of understanding of the concept of prevention of micro-nutrient deficiency amongst beneficiaries
- Twenty percent of women had less tablets than expected as they shared tablets with other family members or because they took more tablets than recommended. (B vitamins are not stored by the body so that excess intake does not afford protection)
The authors of the survey report concluded that:
- A vitamin B tablet distribution does not appear to be the most effective solution to control a pellagra outbreak.
- Targeting women was an emergency measure but not satisfactory as all strata of the population were probably deficient or at risk.
- Distribution of additional foods rich in vitamin B remains the best strategy to control a pellagra outbreak.
1MSF/ICRC (1999) Rapid Nutritional Assessment, Kuito, Province of Bie, Angola, December 1999. Unpublished Field Report. For more information contact:Sophie Baquet MSF Belgium. Emai: sophie.baquet@msf.be
More like this
FEX: A pellagra epidemic in Kuito, Angola
By Sophie Baquet and Michelle van Herp Sophie Baquet is the headquarter nutritionist in MSF Belgium and Michel van Herp, Headquarters epidemiologist in MSF Belgium. This...
FEX: Potential of Using QBmix to Prevent Micronutrient Deficiencies in Emergencies
By Evelyn Depoortere, Epicentre Evelyn Depoortere is currently a medical epidemiologist for Epicentre. Previously she worked on several MSF missions, including Southern Sudan...
FEX: Recurrent pellagra in Angola
Summary of report* Since March 1999, successive waves of people have arrived in the town of Kuito, Angola, displaced by fighting in their native Bie province. As a result,...
FEX: Niacin deficiency and pellagra in Angola
Summary of published research 1 Signs of pellagra observed during survey A recent study initiated by the World Food Programme (WFP), in conjunction with the government of...
FEX: Towards the Overdue Elimination of Deficiency Disease Epidemics
By André Briend Andre Briend is a medical doctor, working for the Institut de Recherche pour le Développement (IRD), a French public research institution with a mandate to...
FEX: Issue 15 Editorial
Two of the field articles in this issue of Field Exchange address to varying degrees the subject of advocacy. The dictionary definition of the word is 'recommendation' or...
FEX: Issue 10 Editorial
Dear Readers, Over the past ten years large-scale outbreaks of pellagra have only occurred amongst populations dependent on emergency food aid. The most recent outbreak in...
FEX: Fortified maize meal improves vitamin A and iron status in refugees
Summary of published field trial1 Premixing at the refugee camp site Nangweshi refugee camp was opened in 2000 in response to the influx of refugees fleeing the Angolan civil...
FEX: Evaluation of WFP relief operations in Angola
Summary of evaluation1 The World Food Program mes's (WFP) assistance in Angola has alternated between relief and recovery since the mid-1970s. To date, nine emergency...
FEX: Micronutrient research in progress
Examination for scurvy in Tanzania An article in the last issue of Field Exchange presented a review of the approaches that agencies and others use for identifying...
FEX: Use of case definitions and awareness of micronutrient deficiencies
Summary of Unpublished Study* Afgani boy with swollen and bleeding gums typical of scurvy. Micronutrient deficiencies have been reported in emergencies in populations who are...
FEX: References for Special Supplement 1
Women selling food in South Sudan AbuSaleh A, 1993. Cost effectiveness of feeding programs in Hartisheik A camp, for Somali refugees, Ethiopia 1988-1989. Unpublished report...
FEX: Issue 30 Editorial
Many pieces in this issue of Field Exchange strengthen our understanding of best practice in nutritional emergencies. We highlight four in this editorial. Victoria Sibson from...
FEX: Ambulatory treatment of severe malnutrition in Afghanistan
By Emmanuelle Lurqin Emmanuelle is a paediatric nurse and since 2000, has worked with MSF Belgium on nutrition programmes in Angola, Burundi, and Afghanistan. She is currently...
FEX: Protecting production in Africa’s forgotten war
By Anthony Robbins, CARE International UK Toby Peters Angola 95 Still bearing the brunt of a 30-year civil war, millions of Angolans are facing severe food and fuel...
FEX: Disparate responses to need in Southern Africa
By Gaëlle Fedida Blanket food distribution in Bunjei, Angola, August, 2002 Since 1993, Gaëlle Fedida has worked in humanitarian aid in a wide variety of countries, including...
FEX: Shared experiences of Southern Africa crisis
Malawi 2002, Medical Missionaries of Mary distribute Concern funded maize to most needy in Lilongwe Summary of meeting By Marie McGrath (ENN) On November 5th, 2002 a meeting...
FEX: Multi–micronutrient supplements for pregnant women from developing countries
Summary of a workshop report* UNICEF/WHO and the United Nations Universities (UNU) recently convened a meeting to decide upon the composition of a multi-micronutrient...
FEX: Huambo: an impending disaster?
By Anna Taylor SCF-UK Update on the current situation The last edition of Field Exchange included an account of discussions on how food aid should be targeted in the siege...
FEX: Scurvy outbreak in Afghanistan: an investigation by Action Contre la Faim (ACF) and WHO
By Philipe Leborgne, Caroline Wilkinson, Sylvie Montembaut, and Mija Tesse Ververs Dr Philippe Leborgne has been Head of the ACF Medical Department since 1994. Before this he...
Reference this page
Compliance problems with vitamin pill distributions. Field Exchange 10, July 2000. p5. www.ennonline.net/fex/10/compliance
(ENN_3433)