An epidemic of scurvy in Afghanistan: Assessment and response

Edith Cheung, Roya Mutahar, Fitsum Assefa, Mija Tesse Ververs, Shah Mahmood Nasiri, Annalies Borrel, Peter Salama

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


In March 2002, there were reports of a hemorrhagic fever outbreak in western Afghanistan. It was later confirmed that the hemorrhagic symptoms and increased mortality were actually due to scurvy. Most aid workers did not include scurvy in the initial differential diagnosis because it is uncommon throughout the world and has mainly been reported in refugee populations in recent times. A rapid assessment confirmed the cases clinically, estimated a prevalence rate of 6.3% (a severe public health problem), and determined that the attack rates peaked each year in January and February (the end of the winter). Many Afghans have limited dietary diversity due to isolated locations, lengthy winters, the continuing drought of the last four years, asset depletion, and loss of livelihood. After numerous food and fortification options to prevent future outbreaks had been considered, vitamin C tablet supplementation was selected because of the relatively rapid response time as compared with other prevention methods. A three-month course of vitamin C tablets was distributed to 827 villages in at-risk areas. The tablets were acceptable and compliance was good. No cases of scurvy were reported for the winter of 2002-03. The case study from Afghanistan demonstrates that scurvy can occur in nonrefugee or nondisplaced populations; vitamin C supplementation can be an effective prevention strategy; there is an urgent need to develop field-friendly techniques to diagnose micronutrient-deficiency diseases; food-security tools should be used to assess and predict risks of nutritional deficiencies; and the humanitarian community should address prevention of scurvy in outbreak-prone areas.

Original languageEnglish (US)
Pages (from-to)247-255
Number of pages9
JournalFood and nutrition bulletin
Issue number3
StatePublished - Sep 2003
Externally publishedYes


  • Afghanistan
  • Emergencies
  • Micronutrient deficiency
  • Scurvy
  • Vitamin C

ASJC Scopus subject areas

  • Food Science
  • Geography, Planning and Development
  • Nutrition and Dietetics


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