Abstract
Konzo is a sudden spastic paraparesis that causes permanent paralysis of the legs and occurs mainly in children and young women. Konzo results from high cyanogen intake and malnutrition caused by a monotonous diet of bitter cassava. The known incidence of konzo in DRC up to 2009 is 3469 cases, but an estimate in 2002 was 100,000 cases. To help resolve this question a konzo survey was made in three health zones in Kwilu District, Bandundu Province, Democratic Republic of Congo (DRC), and the nutrition of those with konzo recorded. Thirty villages (population 22793) in Kwilu District were surveyed for konzo cases, and food consumption scores and mid upper arm circumferences obtained. There were 172 konzo cases with village konzo prevalences of 0.1-17%. The mean konzo prevalence in Masimanimba and Kingandu health zones was much less than in Payikongila health zone, probably because of the higher rate of malnutrition in Payikongila. Since 2009, konzo incidence has increased greatly in Kwilu District and also in 13 villages in nearby Kwango District, where incidence of new konzo cases has been prevented by use of the wetting method. Averaging the data over 495 konzo cases, 48% occurred from 2009 onwards and 52% occurred in the 20+ years before 2009. The very large increase of konzo incidence since 2009 is a public health problem in Bandundu Province, that could be solved by training women to use the wetting method, which removes cyanogens from cassava flour. The wetting method is more direct, effective and cheaper in preventing konzo than broad based interventions. Key words: Konzo survey, cassava, cyanide, nutrition, sulfur amino acids, food consumption score, mid upper arm circumference.  
Highlights
Cassava contains cyanogens that on consumption liberate cyanide in the body, which can lead to konzo, an irreversible spastic paraparesis of the legs that occurs suddenly amongst very
Konzo is an upper motor neuron disease that causes permanent paralysis of the legs and affects mainly children and young women after childbirth. Many of these people suffer from malnutrition with low protein intake, in particular a shortfall of the essential sulfur amino acids methionine and cysteine/cystine that are needed for detoxification of cyanide (CN) to thiocyanate (SCN) in the body (Cliff et al, 1985)
The four villages in Payikongila health zone had the highest konzo prevalences ranging from 17% down to
Summary
Cassava contains cyanogens (linamarin and a small amount of lotaustralin) that on consumption liberate cyanide in the body, which can lead to konzo, an irreversible spastic paraparesis of the legs that occurs suddenly amongst very. Konzo is an upper motor neuron disease that causes permanent paralysis of the legs and affects mainly children and young women after childbirth. Many of these people suffer from malnutrition with low protein intake, in particular a shortfall of the essential sulfur amino acids methionine and cysteine/cystine that are needed for detoxification of cyanide (CN) to thiocyanate (SCN) in the body (Cliff et al, 1985). Konzo occurs in the Democratic Republic of Congo (DRC), Mozambique, Tanzania, Cameroon, Central African
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