The United Nations Subcommittee on Nutrition reported that nearly 200 million children under 5 years of age continue to be malnourished. In some regions, such as sub-Saharan Africa and South Asia, the lack of nutritional improvement combined with the rapid rise in population has resulted in an actual increase in the total number of malnourished children. Most of sub-Saharan Africa is now worse off nutritionally than 10 years ago. At the same time, global food aid deliveries have been continuously reduced since 1993 (ACC/SCN, 1997).
There are no data available on the prevalence of scurvy in free-living populations worldwide. The Centers for Disease Control and Prevention (CDC, 1992) indicated that scurvy has been rarely reported in stable populations in developing countries. Global dietary intake data to assess the prevalence of low vitamin C intakes are also lacking. However, Seaman and Rivers (1989) noted that in Central and South America and in Southeast Asia, refugees generally either receive diets adequate in vitamin C or are able to obtain them via trade, cultivation, or other income.
There is evidence of the outbreak of scurvy among refugee populations entirely dependent on emergency relief rations that provide less than 2 mg of vitamin C per day per person. Scurvy outbreaks have been reported in refugee populations during the past three decades, mainly in East Africa (CDC, 1989, 1992; Desenclos et al., 1989; ACC/SCN, 1996). The greatest number of outbreaks occurred in the 1980s in Somalia. Notably, no outbreaks have been reported from West and Central African refugee populations located in Liberia, Sierra Leone, the Great Lakes of Central Africa, and Angola.
Actual numbers of scurvy cases are difficult to assess, mainly because of the lack of adequate surveillance systems in refugee camps. Mortality rates may also be high among vitamin C-deficient individuals, who are likely to suffer from other severe vitamin and mineral deficiencies and to be at increased risk of morbidity and mortality from infectious diseases. Thus, the estimates of 100,000 cases of scurvy among refugee populations in East Africa (Somalia, Sudan, Ethiopia and Kenya) in the late 1970s through the 1980s may have been an under-estimate, to some extent, of the magnitude of the problem at that time (Desenclos et al., 1989).
Four outbreaks of scruvy have been reported since 1994, when the World Food Programme (WFP) and the United Nations High Commissioner for Refugees (UNHCR) adopted the policy of providing fortified, blended foods to populations wholly dependent on food aid, in an effort to preempt any micronutrient deficiencies. One outbreak occurred in Rwandan refugees in eastern Zaire in the spring of 1994 prior to the time that the newly adopted food aid plan could be implemented. Recurring mild incidences of scurvy were reported among Bhutanese refugees in Nepal in 1994, 1995, and 1996, and