Abstract
There were 68 konzo cases in three villages in Boko Health Zone, Bandundu Province, Democratic Republic of Congo (DRC), where yearly incidence had increased greatly since 2009. The nine months long intervention to prevent konzo started in the wet season. Village women were taught the wetting method, after which there were no new konzo cases and urinary thiocyanate levels were low. Using data from four different interventions in March 2010, July 2011, September 2013 and the present intervention in October-November 2012, a correlation was found between the monthly cyanide intake (measured by percentage of children with high urinary thiocyanate level) and the monthly konzo incidence. This dose response relationship between cyanide intake and konzo incidence, together with the prevention of konzo in many villages using the wetting method to reduce cyanogen intake, shows that konzo is very likely to be due to high cyanide/low sulfur amino acid intake in a diet of bitter cassava. Key words: Dose-response relation, konzo prevalence, urinary thiocyanate, cyanide, cassava flour, wetting method.
Highlights
In the Democratic Republic of Congo (DRC) the roots of cassava are peeled, soaked in water for 3-4 days, and dried in the sun
The progressive reduction in intervention time from eighteen to nine months still produced good results, reduced the cost of the intervention per person and allowed better use of limited funding. This intervention to control konzo was commenced in the wet season when konzo incidence was low, and gave much lower urinary thiocyanate and cassava cyanide values than in previous interventions (Banea et al, 2012a, 2013)
The yearly records of konzo incidence in all three interventions showed that konzo cases had greatly increased since 2009, in agreement with anecdotal evidence that konzo was increasing in this area
Summary
In the Democratic Republic of Congo (DRC) the roots of cassava are peeled, soaked (retted) in water for 3-4 days, and dried in the sun. Konzo is an irreversible paralysis of the legs that occurs in children and young women after childbirth who live on a monotonous diet of high cyanide cassava, and is associated with high cyanide and low sulfur amino acid intake (Ministry of Health Mozambique, 1984; Cliff et al, 1985; Howlett et al, 1990). This association is supported by many studies at an aggregated level and is strengthened by the recent prevention of konzo by greatly reducing the intake of cyanide from cassava flour, by use of the wetting method (Banea et al, 2012a, 2013). Further support for the hypothesis is given in this paper by showing a month by month correlation between the percentage of school children with high urinary thiocyanate levels and incidence of konzo
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