Scurvy among young male South Sudanese refugees in Kakuma camp: Summary
In 2018, several adolescent and young adult male South Sudanese refugees in Kakuma camp presented with lower limb pain and swelling, lethargy, fatigue, gingival swelling and pain, hyperkeratotic skin changes, and chest pain. For some the limb pain was severe enough to prevent them attending school and playing football (the highlights of their day). Scurvy was suspected and all cases improved when given vitamin C.
Scurvy, which is rare outside refugee camps, was confirmed by a team from the Centers for Disease Control and Prevention who, on behalf of UNHCR, examined the causes of the outbreak. From 2015 there were shortages of food assistance in the camp and a smaller food ration was issued consisting of cereal, pulses, fortified corn-soy blend (CSB+) and vitamin A-fortified oil; electronic cash was given so refugees could buy additional foods to improve dietary diversification. However, rather than purchasing fresh foods rich in vitamin C, the investigation found that those affected with scurvy had selected more calorie-dense cereal and pulses to supplement the energy-deficient food ration.
The suspected scurvy cases occurred in young males whose dietary requirements are high. In addition to the ration being inadequate for this age group, it was found that the retention of vitamin C in cooked CSB+ was lower than expected. Many of the young males in the camp were living and cooking together, often without a female, and were likely to be poorly informed about the need for a diverse diet.
Based on an article in Field Exchange #61 2019 https://www.ennonline.net/fex/61/scurvyoutbreakkenya
Reference: Ververs M, Wambugu Muriithi J, Burton A, Wagacha Burton J, Oman Lawi A. Scurvy outbreak among South Sudanese adolescents and young men – Kakuma refugee camp, Kenya, 2017-2018. Morbidity and Mortality Weekly Report (MMWR) US Department of Health and Human Services/Centers for Disease Control and Prevention, January 25, 2019. Vol. 68/ No. 3. https://www.ncbi.nlm.nih.gov/pubmed/30677009