A diagnosis and treatment gap for thiamine deficiency disorders in sub‐Saharan Africa?

Abstract

Staple diets that are deficient in thiamine can result in low body thiamine levels, which may be subclinical or may manifest as a thiamine-deficiency syndrome. In many communities in the developing countries of Africa, the staple diets of polished rice or processed cassava are deficient in thiamine, and thus the communities are at high risk for marginal or frank thiamine deficiency unless their diets are supplemented by other sources of thiamine, such as protein meals and vegetables. African communities with large numbers of individuals in low socioeconomic strata are more likely to subsist on a monotonous diet of rice or cassava with minimal or no protein supplementation and are therefore particularly at risk of thiamine-deficiency disorders. Indeed, there is evidence of widespread biochemical thiamine deficiency from community-based studies in Africa. The protean manifestations of thiamine deficiency disorders in the developing countries of Africa are presented in this paper. We present evidence supporting the contention that there is a diagnosis and treatment gap for thiamine-deficiency disorders in Africa. We discuss research and clinical options for bridging the putative diagnosis and treatment gap for thiamine-deficiency disorders in the developing countries of Africa.

Thiamine deficiency disorders: diagnosis, prevalence, and a roadmap for global control programs

“…Infantile beriberi is rare in the first 2 months of life, as thiamine levels are higher in newborns, and then falls rapidly in the third month of life, likely due to changes in metabolic activity . It has been recognized in areas of Central and Southeast Asia, especially in Myanmar, Laos, and Cambodia; but, TDDs have also been observed in West Africa, Angola, Mayotte Island, Kiribati, Cuba, and parts of the Caribbean, and may go unrecognized in other settings …”

Thiamine deficiency disorders: a clinical perspective

“…Thiamine deficiency, like other “silent” micronutrient deficiencies, can easily go undetected if epidemiological and monitoring programs are not implemented. Professional education is needed to raise the awareness of TDDs in areas where these conditions are currently going unrecognized, such as in parts of Africa 100 . Then, policy development will be required to make treatments and treatment regimens available and accessible in areas of need.…”

“…recently reviewed the prevalence of thiamine deficiency in LMICs, suggesting that thiamine deficiency is endemic in Southeast Asia, but also noting that several reports of thiamine deficiency have emerged from parts of South Asia, Africa (see also Ref. 100 ), and Latin America, raising concerns that thiamine deficiency may be an important public health concern in these regions. 12 …”

“…Professional education is needed to raise the awareness of TDDs in areas where these conditions are currently going unrecognized, such as in parts of Africa. 100 Then, policy development will be required to make treatments and treatment regimens available and accessible in areas of need.…”

Peripheral nerve disease secondary to systemic conditions in children

“…In low- and middle-income countries of Africa, staple foods of polished rice and incorrectly prepared cassava are deficient in thiamine, which leads to high risk for thiamine deficiency. 119…”