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Cyclone Idai as a Trigger for Pellagra Outbreak in Nhamatanda, Mozambique: A Case–Control Study

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  • 1 Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil;
  • 2 Universidade Licungo, Quelimane, Mozambique;
  • 3 Centro de Investigação Operacional da Beira, Instituto Nacional de Saúde, Beira, Mozambique;
  • 4 Departamento de Vigilância, Instituto Nacional de Saúde, Maputo, Mozambique;
  • 5 MassGenics, Assigned to Mozambique Centers for Disease Control Prevention, Maputo, Mozambique;
  • 6 Direcção Provincial de Saúde de Sofala, Beira, Mozambique;
  • 7 Fundação Oswaldo Cruz, Salvador, Brazil;
  • 8 Emory University, Atlanta, Georgia;
  • 9 Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil

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. We collected 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.

Author Notes

Address correspondence to Vánio André Mugabe, Universidade Licungo, Estrada Regional, n° 642, PC 106, Quelimane, Mozambique, E-mail: vandremu@gmail.com or Guilherme Sousa Ribeiro, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão, 121, Candeal – CEP: 40296-710, Salvador, Brazil, E-mail: guilherme.ribeiro@fiocruz.br.

Authors’ addresses: Vánio André Mugabe, Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil and Universidade Licungo, Quelimane, Mozambique, E-mail: vandremu@gmail.com. Arlete Mahumane, Crescêncio Sequeira Nhabomba, Unicia Nyamula, Angélica Sotomane, and Benigno Canze, Centro de Investigação Operacional da Beira, Instituto Nacional de Saúde, Mozambique, E-mails: cynthiwe@icloud.com, nhabombacrescencio@gmail.com, uniciacelestechibale@gmail.com, asotomane@gmail.com, and nigo755@gmail.com. Cynthia Semá Baltazar, Neusa Fataha, Osvaldo Frederico Inlamea, and Eduardo Samo Gudo, Departamento de Vigilância, Instituto Nacional de Saúde, Maputo, Mozambique, E-mails: cynthiasema@yahoo.com, neusafataha@gmail.com, osvaldosdc@gmail.com, and esamogudojr@gmail.com. Érika Valeska Rossetto, MassGenics, Assigned to Mozambique Centers for Disease Control Prevention, Maputo, Mozambique, E-mail: osc6@cdc.gov. Wilson Irugula, Direcção Provincial de Saúde de Sofala, Beira, Mozambique, E-mail: winrugula@gmail.com. Uriel Kitron, Emory University, Atlanta, GA, E-mail: ukitron@emory.edu. Guilherme Sousa Ribeiro, Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil, and Fundação Oswaldo Cruz, Salvador, Brazil, E-mail: guilherme.ribeiro@fiocruz.br.

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