Beriberi (thiamine deficiency) and high infant mortality in northern Laos.
Beriberi (thiamine deficiency) and high infant mortality in northern Laos.
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DOI：
10.1371/journal.pntd.0003581
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发表时间：
2015-03
影响因子：
3.8
通讯作者：
Phimmasane M
中科院分区：
文献类型：
--
作者：
Barennes H;Sengkhamyong K;René JP;Phimmasane M
婴儿脚气病（硫胺素缺乏症）主要发生在母亲因硫胺素摄入不足而母乳喂养的婴儿中，特别是在弱势群体中。我们描述了老挝北方可能发生的婴儿硫胺素缺乏症病例。在琅南塔省进行了三次调查。首先，我们进行了一项回顾性调查，所有诊断为硫胺素缺乏症的婴儿在该省的5家医院（2007年至2009年）。第二，我们前瞻性地记录了在Luang Namtha医院的所有心力衰竭婴儿。第三，我们进一步调查了所有母亲与婴儿（1-6个月）生活在22个村庄的硫胺素缺乏症患者的起源。我们使用预先测试的问卷、体格检查和深蹲试验对所有母亲和婴儿进行了横断面调查。婴儿死亡率通过死因推断进行估计。2010年3月至6月，4名疑似患有硫胺素缺乏症的婴儿被送往琅南塔省医院。所有患者均在静脉注射硫胺素后痊愈。在2007年至2009年期间，54名可能/很可能患有硫胺素缺乏症的婴儿被诊断为急性重度心力衰竭，49名（90.2%）在注射硫胺素后治愈; 3名死亡（5.6%）。在22个村庄，468名活产婴儿中，50名（10.6%，95%CI：8.0-13.8）在第一年内死亡。据报告，1至3个月期间死亡率达到高峰（36例死亡）。口头尸检表明，17例死亡（3.6%）是由于怀疑婴儿硫胺素缺乏症。在127名母亲中，60名（47.2%）报告了水肿和感觉异常以及怀孕期间的蹲试验阳性; 125名（98.4%）尊重产后避免进食，所有人都吃精米。在127名婴儿中，2名（1.6%）可能存在硫胺素缺乏症，8名（6.8%）可能存在硫胺素缺乏症。硫胺素缺乏症可能是老挝北方少数民族婴儿死亡的主要原因。母亲和儿童的症状与维生素B1缺乏症相符。这种营养状况的严重性需要在老挝得到紧急关注。婴儿硫胺素缺乏症（脚气病），是罕见的，经过几十年的强烈公共卫生关注的今天。婴儿脚气病主要发生在母亲母乳喂养的婴儿中，这些婴儿摄入的维生素B1不足。有证据表明，老挝首都万象的婴儿硫胺素缺乏症持续存在，但万象以外的数据不足以证明政策建议的合理性。我们使用回顾性和前瞻性医院数据描述了老挝北方婴儿硫胺素缺乏症的可能和可能病例。此外，我们进行了横断面调查，在22个村庄的婴儿起源。在回顾性和前瞻性调查（医院：54，村庄：17）和横断面调查（医院：4，村庄：10）中，婴儿硫胺素缺乏症相当常见。婴儿死亡率的第二个高峰出现在6个月之前，与那些村庄的高婴儿死亡率有关，每1000名活产婴儿中有106名死亡（95%CI：86-128）。共有60名孕妇和70名哺乳期妇女表现出硫胺素缺乏症的迹象。老挝迫切需要关注这一局势。
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. 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. 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. Infantile thiamine deficiency (beriberi), is rarely seen today after decades of strong public health attention. Infantile beriberi occurs mainly in infants breastfed by mothers with inadequate intake of thiamine. There is evidence of the persistence of infantile thiamine deficiency in Vientiane, the capital of Laos, but insufficient data from outside Vientiane to justify a policy recommendation. We describe possible and probable cases of infantile thiamine deficiency in northern Laos using retrospective and prospective hospital data. In addition we conducted a cross sectional survey in 22 villages where the infants originated. Infantile thiamine deficiency was quite common in retrospective and prospective (hospitals: 54, villages: 17) and cross-sectional surveys (hospital: 4, villages: 10). A second peak of infantile mortality was observed before 6 months and was associated with a high infant mortality in the villages, 106 per 1000 live births (95%CI: 86–128). A total of 60 pregnant mothers and 70 lactating women showed signs of thiamine deficiency. This situation requires urgent attention in Laos.
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影响因子：
3.3
作者：
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通讯作者：
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影响因子：
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DOI：
10.12659/ajcr.890041
发表时间：
2014
期刊：
The American journal of case reports
影响因子：
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作者：
Long L;Cai XD;Bao J;Wu AM;Tian Q;Lu ZQ
通讯作者：
Lu ZQ
DOI：
10.1016/s0035-9203(03)90134-9
发表时间：
2003-03-01
影响因子：
2.2
作者：
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通讯作者：
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