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Unpublished report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:

1. A vitamin B tablet distribution does not appear to be the most effective solution to control a pellagra outbreak.
2. Targeting women was an emergency measure but not satisfactory as all strata of the population were probably deficient or at risk.
3. 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