Control of konzo in DRC using the wetting method on cassava flour

• Published in: Food and chemical toxicology 2012-05, Vol.50 (5), p.1517-1523
• Main Authors: Banea, J.P., Nahimana, G., Mandombi, C., Bradbury, J. Howard, Denton, Ian C., Kuwa, N.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cassava flour; Cerebrospinal fluid. Meninges. Spinal cord; Child; Cyanide; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Environmental Exposure; Female; Flour; Humans; Konzo; Male; Manihot; Medical sciences; Motor Neuron Disease - etiology; Motor Neuron Disease - prevention & control; Nervous system (semeiology, syndromes); Neurology; S-containing amino acids; Thiocyanates - urine; Toxicology; Urinary thiocyanate; Wettability; Wetting method
• ISSN: 0278-6915; 1873-6351
• DOI: 10.1016/j.fct.2012.02.001

► The wetting method to remove cyanogens from cassava flour was taught and used by mothers in a village with 34 konzo cases. ► This reduced the cyanogens in flour to safe levels and greatly reduced the urinary thiocyanate content of school children. ► It produced tastier fufu and prevented new cases of konzo over 1.5years, including two dry seasons when konzo is at a peak. ► Konzo was first identified in 1938 in DRC and has now been prevented for the first time in the same area. ► This methodology is being used in other villages in DRC and we believe it is the way to control konzo in tropical Africa. Fifty konzo cases were identified in four villages in Popokabaka Health Zone, DRC. One third of people had only one meal per day, mainly of cassava flour consumed as a thick porridge (fufu) and pounded, boiled cassava leaves. Retention of cyanogens in flour resulted from short soaking of cassava roots. A 1.5years intervention was made in the largest village Kay Kalenge, where the wetting method was taught to all women of the village, who accepted it willingly. The total cyanide content of cassava flour was reduced to below 10ppm. Fufu from treated flour tasted and stored better than fufu from untreated flour. The mean urinary thiocyanate content of 100 school children reduced from 332 to 130μmole/L and the number of samples exceeding 350μmole/L decreased from 26 to 0 during the intervention. No new konzo cases occurred, which included two dry seasons when konzo peaks. Konzo was first identified by Dr. Trolli in 1938 in Popokabaka Health Zone and it has now been prevented for the first time in the same area. The methodology is now in use in Boko Health Zone and we believe it is the most effective way to control konzo in tropical Africa.