Pellagra on wane in KwaZulu-Natal

WHILE a recent dermatological study has found that certain skin conditions – related to poor nutrition – have been reduced significantly, a local expert warns that food insecurity is still a problem in KwaZuluNatal.

Professor Ncoza Dlova, a skin and hair specialist, is an associate professor of dermatology at the University of KwaZulu-Natal.

She is the lead author of a paper: “Prevalence of skin diseases treated at public referral hospitals in KwaZulu-Natal”.

Dlova found there was no local published or recent data in the country on the epidemiology of skin diseases seen at public health facilities, prompting the study, which was conducted between January and March 2013.

She said that in South Africa, a country of about 50.6 million inhabitants, approximately 85% of the population was dependent on the public health sector.

The importance and the need to quantify the burden of disease, she said, led them to describe the epidemiology of skin conditions in five public referral hospitals in the second-most populous province of South Africa.

“We collected data related to age, gender, ethnic group based on patients’ self-identification, and skin diagnosis. The diagnosis was made on clinical grounds, supported by relevant laboratory investigations or histopathology where necessary.”

Diagnoses

She said in the paper that 4 424 diagnoses were made in 3 814 patients, of whom 77.6% were adults and 22.4% were children under 18 years, with 65% females and 35% males.

Africans made up 69% followed by Indians at 24.7%, and the rest were either white or coloured.

“Of the total diagnoses, 4 242 were categorised. Eczemas and papulosquamous eruptions (like psoriasis) accounted for 41%, followed by infections (16.5%), acne and rosacea (9%), dyschromias (pigmentation problems, 7.5%), and connective tissue disorders at 4.2%.”

One of the more noted findings was that a skin condition associated with poor nutrition was not recorded during the study.

“We believe that we are seeing a changing trend in which pellagra, once a common skin disease, is no longer observed, thus suggesting better nutritional practices of the population, (but) dyschromias (pigmentation problems) which have never been reported as a common skin disease in South Africa were observed in this study.”

Pellagra is caused by a lack of the vitamin niacin, and its precursor tryptophan, an essential amino acid.

The World Health Organisation said in a recent report that in South Africa more than 100 000 cases were reported each year during the 1970s.

The disease, they said, consisted of dermatitis, diarrhoea, dementia, and death.

The director of Pietermaritzburg Community Social Action, Mervyn Abrahams – whose activist organisation tracks the monthly food inflation on 36 basic items – said there were many people in the province who did not seek help for health ailments.

“This means that this disease could still be a problem for those who live in the province, especially those in food-insecure households.”

A 2015 study carried out by the Health Systems Trust, he said, found that for children under five years old, severe acute malnutrition fatality rates were 11.6% during 2014/15, which was well above the national target of 8%.

This meant, he said, that many in the province still suffered from malnutrition.