Evaluation of growth monitoring programme in children in Kinshasa.

A high dropout rate was noted at the under five clinic of the University of Kinshasa Teaching Hospital. A preliminary study carried out in March 1984 on 197 children indicated that none of them had completed the five year period of the growth monitoring programme. Five hundred mothers of children attending the under five year clinic were then randomly selected from the 1224 who registered between September 1983 and August 1984. They were interviewed at home during a six week period. This paper confirms the dropout problem. It discusses whether mothers should abandon the visits early. It concludes that health workers should be trained to advise mothers to bring their children to the programme up to five years though the attendance frequency may be reduced from the second year onwards.

Dietary determinants of a non-progressive spastic paraparesis (Konzo): a case-referent study in a high incidence area of Zaire.

BACKGROUND: Konzo is an upper motor neuron disease in Africa, characterized by an abrupt onset of a permanent but non-progressive spastic paraparesis. It is named after the local designation in the first report from Zaire. Konzo has been attributed to a metabolic insult from the combined effect of high cyanide and low sulphur intake from several weeks of exclusive consumption of insufficiently processed bitter cassava roots. METHODS: The association between insufficient soaking of cassava roots and konzo is assessed in a matched case-referent study with multivariate conditional logistic regression including 57 case-referent pairs from a rural high incidence community of Zaire. RESULTS: In the multivariate analysis short processing of cassava in the form of only 2 nights soaking yielded an odds ratio of 11.0 (95% confidence interval 1.7-73) when controlling for poverty-related factors and diet. We also show a dose-response relationship for insufficient cassava soaking, both unadjusted and adjusted for potential confounders. CONCLUSIONS: This study supports a causal relationship between insufficient processing of bitter cassava and konzo.

[High prevalence of konzo associated with a food shortage crisis in the Bandundu region of zaire]. / Haute prévalence de konzo associée à une crise agro-alimentaire dans la région de Bandundu au Zaire.

Konzo is a form of spastic paraparesis reported from several rural areas in Sub-Saharan Africa. It has been attributed to cyanide exposure from exclusive consumption of insufficiently processed bitter cassava roots. We have tested this attribution in a community based epidemiological survey in an area of Bandundu region in Zaire composed of two agro-ecological zones: savanna and forest. In the savanna area with poor soils we found 78 konzo cases in 1,936 inhabitants, a prevalence of 4%; but in the forest area only 9 cases in 5,531 inhabitants (0.2%). This geographical distribution as well as the temporal distribution coincide with frequent short-soaking of cassava roots (only one night) induced by an agro-ecological crisis. High levels of blood cyanide, mean 13.3 mumol/l (range: 0.1-76.3) and serum thiocyanate, mean (+/- SD) 401 (+/- 126) mumol/l, in a sample of 18 subjects from the savanna area confirm high cyanide exposure in this population with high prevalence of konzo. Prevention of konzo in Zaire is possible by promotion of sufficient soaking of cassava with strict adherence to traditional three nights soaking and the use of completely dry flour.

Cassava cyanogens and konzo, an upper motoneuron disease found in Africa.

Konzo is a distinct form of tropical myelopathy characterised by abrupt onset of spastic paraparesis. Epidemics in East Africa have been attributed to dietary cyanide exposure from insufficiently processed cassava but a study done in Zaire disputed such an aetiology. We investigated a konzo-affected population in rural Zaire and measured the cyanogen content of cassava flour, determined urinary thiocyanate as an indicator of cyanide intake, and compared blood cyanide concentrations in cases and controls. The affected population consumed flour made from short-soaked (one day) cassava roots and thus had high dietary cyanide exposure (urinary thiocyanate in 31 children = 757 mumol/l) compared with the unaffected population (urinary thiocyanate in 46 children = 50 mumol/l) that ate cassava that had been soaked for three days before consumption. 3 konzo patients, but only 2 of 23 controls, had blood cyanide concentrations above 4 mumol/l (p less than 0.01), although serum thiocyanate concentrations were similar. Our findings indicate a causal role in konzo of sustained high blood cyanide concentrations maintained by a deficient sulphur intake impairing cyanide to thiocyanate conversion. The underlying causes of konzo are poverty and food shortage, but a minor improvement of food processing may, as in beri-beri, be preventive.

Epidemiological evidence from Zaire for a dietary etiology of konzo, an upper motor neuron disease.

A clear association between seasonal outbreaks of a paralytic disease called konzo and toxic effects from consumption of insufficiently processed bitter cassava roots has been demonstrated in Bandundu region, Zaire. A community-based survey of 6764 inhabitants identified 110 live and 24 dead konzo-affected persons with a history of isolated non-progressive spastic paraparesis of abrupt onset. The start of these annual outbreaks of konzo in 1974 coincided with the completion of a new tarmac road to the capital, which facilitated the transport of cassava and made it the main cash crop. The extensive cassava sales encouraged the consumption by the peasant families of roots that had not been adequately processed; frequent acute cyanide intoxications resulted when the naturally occurring cyanogens in the roots were eaten. The disease mainly appeared in the dry season when there was high consumption of insufficiently processed cassava and the diet lacked supplementary foods with sulfur-containing amino acids which promote cyanide detoxification. These results, which confirm the earlier findings in East Africa, show that, owing to the high cyanide and low sulfur dietary intake, there is an increased risk of konzo outbreaks in cassava-growing areas during periods of adverse agro-economic changes.

Epidemiological evidence from Zaire for a dietary etiology of konzo, an upper motor neuron disease

A clear association between seasonal outbreaks of a paralytic disease called konzo and toxic effects from consumption of insufficiently processed bitter cassava roots has been demonstrated in Bandundu region, Zaire. A community-based survey of 6764 inhabitants identified 110 live and 24 dead konzo-affected persons with a history of isolated non-progressive spastic paraparesis of abrupt onset. The start of these annual outbreaks of konzo in 1974 coincided with the completion of a new tarmac road to the capital, which facilitated the transport of cassava and made it the main cash crop. The extensive cassava sales encouraged the consumption by the peasant families of roots that had not been adequately processed; frequent acute cyanide intoxications resulted when the naturally occurring cyanogens in the roots were eaten. The disease mainly appeared in the dry season when there was high consumption of insufficiently processed cassava and the diet lacked supplementary foods with sulfur-containing amino acids which promote cyanide detoxification. These results, which confirm the earlier findings in East Africa, show that, owing to the high cyanide and low sulfur dietary intake, there is an increased risk of konzo outbreaks in cassava-growing areas during periods of adverse agro-economic changes

Epidemiological evidence from Zaire for a dietary etiology of konzo, an upper motor neuron disease

A clear association between seasonal outbreaks of a paralytic disease called konzo and toxic effects from consumption of insufficiently processed bitter cassava roots has been demonstrated in Bandundu region, Zaire. A community-based survey of 6764 inhabitants identified 110 live and 24 dead konzo-affected persons with a history of isolated non-progressive spastic paraparesis of abrupt onset. The start of these annual outbreaks of konzo in 1974 coincided with the completion of a new tarmac road to the capital, which facilitated the transport of cassava and made it the main cash crop. The extensive cassava sales encouraged the consumption by the peasant families of roots that had not been adequately processed; frequent acute cyanide intoxications resulted when the naturally occurring cyanogens in the roots were eaten. The disease mainly appeared in the dry season when there was high consumption of insufficiently processed cassava and the diet lacked supplementary foods with sulfur-containing amino acids which promote cyanide detoxification. These results, which confirm the earlier findings in East Africa, show that, owing to the high cyanide and low sulfur dietary intake, there is an increased risk of konzo outbreaks in cassava-growing areas during periods of adverse agro-economic changes