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Beriberi epidemic within rural Muslin fishing communities in Guiné - Bissau
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Beriberi, ou cardiopatia e polineuropatia ligada à deficiência de tiamina, foi, antigamente, um flagelo nas populações. Os mais notáveis surtos de beriberi ocorreram após o advento da moagem de massa de arroz, em várias zonas da Ásia, no final do século XIX. Com a descoberta de vitamina B1, "anti-beriberi", e, subsequentemente, o enriquecimento de alimentos e as campanhas de sensibilização de saúde pública, a doença foi esquecida por muitos profissionais de saúde. Contudo, sabe-se que, hoje em dia, em diferentes partes do mundo, muitos casos de beriberi são os focos primários de epidemias de outras deficiências potencialmentes fatais, em comunidades vulneráveis. Determinados alimentos, assim como o álcool, são conhecidos para reduzir a absorção de vitamina B1. A Encefalopatia de Wernicke, a deficiência de tiamina mais conhecida pelos médicos que trabalham em países desenvolvidos, está associada à ingestão de álcool. Estudos recentes demonstraram, por um lado, atrasos significativos do desenvolvimento neurolinguístico em crianças alimentadas com leite sem tiamina, assim como uma possível correlação entre malária grave e deficiencia em Vitamina B1, o que reforça a importância desta vitamina na saúde das populações.
A Guiné-Bissau, um país fragilizado pelos conflitos coloniais e pós-coloniais, instabilidade política, tráfico de droga e deficiente acesso à Saúde, continua sendo um dos países mais pobres do mundo. A maioria da população vive da agricultura de subsistência, pesca e colheita de cajú. O Islão é practicado por quase metade da população, e as religiões animistas e cristãs compõem as outras religiões principais do país. De acordo com a fé islâmica, os muçulmanos da Guiné-Bissau praticam o jejum, em função da luz do dia, durante o mês de Ramadão. Existe pouca investigação publicada sobre os efeitos nutricionais e na saúde deste ritual. Este trabalho é o primeiro a relacionar uma deficiência de micronutrientes ao mês sagrado do Ramadão.
Esta tese apresenta casos clínicos de beriberi em comunidades rurais muçulmanas, que ocorreram no final da época das chuvas, que coincide com o mês de Ramadão. A análise dos dados mostra que, uma vez que alguns dos doentes apresentavam os mesmos sintomas, repetidamente, todos os anos, estes casos podem refletir a ponta do iceberg da ocorrência de beriberi na Guiné-Bissau. Parte da discussão centra-se na necessidade de mais investigação para confirmar o grau de deficiência na população em geral, efeitos de deficiência de tiamina relacionados com a malária, e consequências possíveis da deficiência marginal, a longo prazo, desta vitamina na saúde. A discussão apresenta ainda sugestões práticas para a redução da incidência da deficiência de vitamina B1 na Guiné-Bissau.
Beriberi, or thiamine deficiency related cardiopathy and polyneuropathy, was a scourge upon past populations with perhaps the most notable outbreaks occurring with the advent of mass rice milling in parts of Asia at the end of the 19th century. Upon the discovery of the “anti-beriberi” vitamin responsible for the disease, and subsequent food enrichment and public health awareness campaigns, the illness has largely been forgotten by many physicians. However, to this day many outbreaks are still being recorded of the potentially fatal deficiency across the globe amongst vulnerable communities. Certain foodstuffs as well as alcohol are well known to reduce vitamin B1 uptake and the latter is associated with Wernicke's encephalopathy, a condition better known amongst doctors practising in affluent countries. Recent findings of significant neurolinguistic delay amongst infants exposed to thiamine depleted formula milk, as well as the the possible correlation with severe malaria emphasise the importance of the vitamin and even marginal deficiency states on well being. Plundered by colonial and post colonial conflict, political instability, drug smuggling and disease burden, Guinea-Bissau remains one of the poorest countries in the world with the majority of the population relying on subsistence farming, fishing and the harvest of the valuable cashew nut. Islam is followed by almost half the population with animistic and Christian faiths making up the other main religions. In keeping with the Islamic faith, those Muslims from Guinea-Bissau observe the month of Ramadan with daylight fasting. Comparatively little research has been published on the nutritional and health effects of this ritual and to the authors knowledge this is the first article that relates a micronutrient deficiency to the holy month. Described are clinical cases of beriberi amongst Muslim rural fishing communities at the end of the rainy season and coinciding with the Ramadan fast. What became evident was that some of the cases described an annual relapse and that this could reflect the tip of the iceberg of vitamin B1 deficiency in Guinea-Bissau. Discussion focuses on the need for further investigation to confirm the extent of the deficiency among the general population, considerations of thiamine deficiency related malaria outcomes and possible long term effects of the problem, followed by practical suggestions of how the disease burden can be reduced.
Beriberi, or thiamine deficiency related cardiopathy and polyneuropathy, was a scourge upon past populations with perhaps the most notable outbreaks occurring with the advent of mass rice milling in parts of Asia at the end of the 19th century. Upon the discovery of the “anti-beriberi” vitamin responsible for the disease, and subsequent food enrichment and public health awareness campaigns, the illness has largely been forgotten by many physicians. However, to this day many outbreaks are still being recorded of the potentially fatal deficiency across the globe amongst vulnerable communities. Certain foodstuffs as well as alcohol are well known to reduce vitamin B1 uptake and the latter is associated with Wernicke's encephalopathy, a condition better known amongst doctors practising in affluent countries. Recent findings of significant neurolinguistic delay amongst infants exposed to thiamine depleted formula milk, as well as the the possible correlation with severe malaria emphasise the importance of the vitamin and even marginal deficiency states on well being. Plundered by colonial and post colonial conflict, political instability, drug smuggling and disease burden, Guinea-Bissau remains one of the poorest countries in the world with the majority of the population relying on subsistence farming, fishing and the harvest of the valuable cashew nut. Islam is followed by almost half the population with animistic and Christian faiths making up the other main religions. In keeping with the Islamic faith, those Muslims from Guinea-Bissau observe the month of Ramadan with daylight fasting. Comparatively little research has been published on the nutritional and health effects of this ritual and to the authors knowledge this is the first article that relates a micronutrient deficiency to the holy month. Described are clinical cases of beriberi amongst Muslim rural fishing communities at the end of the rainy season and coinciding with the Ramadan fast. What became evident was that some of the cases described an annual relapse and that this could reflect the tip of the iceberg of vitamin B1 deficiency in Guinea-Bissau. Discussion focuses on the need for further investigation to confirm the extent of the deficiency among the general population, considerations of thiamine deficiency related malaria outcomes and possible long term effects of the problem, followed by practical suggestions of how the disease burden can be reduced.
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Saúde tropical Doenças tropicais Béribéri Epidemiologia Guiné-Bissau