Eradicating konzo in the Democratic Republic of Congo
In 2019 we commenced a three year education program in collaboration with the National Institute of Nutrition in the Ministry of Public Health, Democratic Republic of Congo (PRONANUT) and the International Conservation and Education Fund (INCEF) to eradicate Konzo and increase nutritional health in DRC. We aim to spread the word about the wetting method to over 400 villages in the Kwango Province using videos in local languages and training by local educators. Initial funding comes from the ANU Giving appeal in 2016 but we are greatly in need of financial support to continue this work.
ANU is partnering with INCEF to develop an expanded community education program. As villages in the area do not have access to mass media, a program is being developed around locally produced, culturally appropriate videos in local languages. The videos explain the extra step required in the food preparation process (“wetting method”) and the reasons behind it. After being shown in villages, audiences will discuss the video messages with a facilitator. This education approach uses proven scientific methods and will draw on INCEF’s experience running similar programs for the US Centre for Disease Control in DRC since 2005. The expanded education program aims to reach villages across the Kwango Province (estimated population 2 million people) over a three year period. The National Institute of Nutrition estimate that at least 100,000 people in the Kwango Province suffer from Konzo.
Unfortunately this project is currently on hold due to the COVID19 pandemic and a funding shortage.
Drawing on the University’s expertise across public health, epidemiology, biology and chemistry, the Steering Committee will be responsible for evaluating project plans and monitoring project outcomes to ensure that the objective of eradicating Konzo in the villages included in the program is achieved.
- Professor John Carver (Chair), Research School of Chemistry
- Emeritus Professor William (Bill) Foley, Research School of Biology
- Associate Professor Kamalini Lokuge, National Centre for Epidemiology & Population Health
- Professor Darren Gray, School of Population Health
- External Member TBC
The program is supported through partnerships with the Congolese Ministry of Public Health and National Institute for Biological Research.
Preventing konzo in Kay Kalenge village, Bandundu Province, DRC
In 2010 we started a collaborative project with Dr J.P. Banea, Director of the National Institute of Nutrition (PRONANUT), Kinshasa and coworkers, to prevent konzo in Kay Kalenge village, Bandundu Province, DRC. Kay Kalenge has a population of about 1000 with 34 konzo cases. The women of the village were taught that konzo is due to a poison (cyanide) present in the cassava flour and shown how to use the wetting method. Over the 18 month intervention there were no new cases of konzo and the mean urinary thiocyanate content of school children was reduced to a safe level. This is the first time ever that konzo has been prevented. Kay Kalenge village is located in Popokabaka Health Zone, which is where konzo was first discovered by Dr Trolli in 1938. After more than a years absence from Kay Kalenge village we returned and found no new cases of konzo, the women were still using the wetting method, the school children had low urinary thiocyanate levels and the wetting method had spread by word of mouth to three nearby villages. In total, interventions to prevent konzo have now been made in 13 villages involving nearly 10000 people in Kwango District, Bandundu Province DRC, funded by AusAID, but this support has ceased.
We believe that the wetting method should be widely adopted by public health authorities in those countries in Africa that use cassava flour as a food source (see Publications No. 1).
Methodology to prevent Konzo (2010 project). The procedure that is used to prevent konzo involves first a visit to the Health Offices in the District and the Health Zone to identify the konzo villages which most require an intervention followed by a visit to these villages. A second visit of the full team is made one month later, in which a census is taken, all konzo cases examined and cassava flour samples and urinary thiocyanate from school children are analysed, see kit available to measure total cyanide in cassava and urinary thiocyanate. Urinary thiocyanate levels give the best measure of intake of cyanogens over the previous week or so. The senior women are then taught the wetting method for removing cyanogens from flour, using illustrative posters in their language (Kiyaka), see posters. They in turn each teach 12-15 women to use the wetting method and a bowl, knife and a mat is given to each woman. The women readily accept the wetting method, particularly as it improves greatly the flavour of the traditional thick porridge (fufu), which loses the bitter flavour due to the removal of the cyanide compound (linamarin) from the flour. The fufu also stores better than fufu made from untreated flour.
A third and fourth visit are made at four month intervals to the village to teach the wetting method to those unfamiliar with it, and to obtain the urinary thiocyanate contents of school children and cassava flour cyanide results. Between these major visits there are visits every month of a team of women from Caritas to check on the use of the wetting method by the women. In all cases we find no new cases of konzo after the intervention commences and urinary thiocyanate and cassava flour cyanide levels are greatly reduced.
We returned to four villages more than one year after the interventions had ceased to see whether the wetting method was still being used. In all cases there were no new cases of konzo, the great majority of women were still using the wetting method and urinary thiocyanate and cassava flour cyanide levels were low. Best of all, the wetting method was popular with village women and had spread by word of mouth to nearby villages (see Publications No. 4).
Konzo related to high cyanide intake and malnutrition. We surveyed 22793 people with 172 konzo cases in Kwilu District, Bandundu Province, DRC and found that there was less konzo in those villages where there was a better diet and less malnutrition (see Publications No. 2). We have now studied six villages with 4588 people and 144 konzo cases and obtained food consumption scores from which the percentage malnutrition (%M) for each village was calculated. The percentage of children with high urinary thiocyanate content (%T) was obtained, which is a measure of high cyanide intake. It was found that the percentage of konzo prevalence (%K) for each village was related by the simple equation
%K = 0.06 %T + 0.035 %M,
which does not apply if either %T or %M is zero. This is a first attempt to relate mathematically konzo prevalence with high cyanide intake and malnutrition, which are both necessary together for konzo to occur.
This simple mathematical relation, which needs to be confirmed by further work, shows that konzo is related to malnutrition and high cyanide intake, measured by the percentage of children with high urinary thiocyanate levels. The above equation shows that konzo may be prevented not only by reduction of cyanide intake from cassava but also by reduction of malnutrition. Our interventions to prevent konzo are based on reduction of cyanide intake, by village women who use the wetting method every day. The total time of an intervention has decreased from 18 months in the first intervention (see Publications No. 7) to 12 months (see Publications No. 6) and then to 9 months (see Publications No. 3) and the cost reduced to $16 per person.
This is a much less expensive option than a broad-based approach to reduce malnutrition, which is also needed to improve the general health of village people. Our methodology using the wetting method works very well in practice and further reductions in cost would occur if it were scaled up.
In 2019 we commenced a three year education program in collaboration with PRONANUT and INCEF to eradicate Konzo and increase nutritional health in DRC. We aim to spread the word about the wetting method to over 400 villages in the Kwango Province using videos in local languages and training by local educators. Initial funding comes from the ANU Giving appeal in 2016 but we are greatly in need of financial support to continue this work.