Konzo prevention in six villages in the DRC and the dependence of konzo prevalence on cyanide intake and malnutrition

• Main Authors: J.P. Banea, J. Howard Bradbury, C. Mandombi, D. Nahimana, Ian C. Denton, Matthew P. Foster, N. Kuwa, D. Tshala Katumbay
• Format: Article
• Language: English
• Published: Elsevier 2015-01-01
• Series: Toxicology Reports
• Subjects: Konzo prevalence; Urinary thiocyanate; Malnutrition; Konzo prevention; Wetting method; Cassava cyanide
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214750015000463

Six villages in Boko Health Zone, Bandundu Province, DRC, were studied with 4588 people, 144 konzo cases and konzo prevalences of 2.0–5.2%. Konzo incidence is increasing rapidly in this area. Food consumption scores were obtained from the households with konzo and the mean % malnutrition calculated for each village. Urine samples were obtained from 50 school children from each village and % high urinary thiocyanate content (>350 μmol/L) determined. The experimental data relating % konzo prevalence (%K) to % children with high urinary thiocyanate content (%T) and % malnutrition (%M) for the six villages were fitted to an equation %K = 0.06%T + 0.035%M. This confirms that konzo is due to a combination of high cyanide intake and malnutrition. The village women used the wetting method to remove cyanogens from cassava flour. During the 9-month intervention there were no new cases of konzo; cyanide in flour had reduced to WHO safe levels and mean urinary thiocyanate levels were greatly reduced. To prevent konzo at least 60–70% of women should use the wetting method regularly. The wetting method is now accepted by the World Bank, FAO and WHO as a sensitive intervention. Four successful konzo interventions have involved nearly 10,000 people in 13 villages, the cost is now $16 per person and the methodology is well established.