title: Konzo associated with war in Mozambique.
abstract: We report an epidemic of konzo, symmetric spastic paraparesis associated with cassava consumption and cyanide exposure: 384 patients were treated in rehabilitation centres; the prevalence rate in a badly affected area was 30/1000. Most patients were children over 3 and women. Owing to war, communities turned to bitter cassava as their staple and took shortcuts in its processing. When the war ended, they continued to depend on inadequately processed bitter cassava. The epidemic lasted 2 years (the last year of war and the first of peace) with peaks each year during the cassava harvest. Although most cases were reported from rural inland areas, patients also came from small towns and the coast. School children had raised urinary thiocyanate and linamarin and low inorganic sulphate concentrations. Urinary thiocyanate values were lower than those previously reported in konzo epidemics, probably because we collected specimens before the cassava harvest and epidemic peak. The necessary conditions for konzo were present: intensive cultivation of bitter casava, insufficient processing, a probable high cyanide intake, and a low intake of protein-rich foods.
authors.affiliation: Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique.
authors.forename: J
authors.initials: J
authors.lastname: Cliff
authors.forename: D
authors.initials: D
authors.lastname: Nicala
authors.forename: F
authors.initials: F
authors.lastname: Saute
authors.forename: R
authors.initials: R
authors.lastname: Givragy
authors.forename: G
authors.initials: G
authors.lastname: Azambuja
authors.forename: A
authors.initials: A
authors.lastname: Taela
authors.forename: L
authors.initials: L
authors.lastname: Chavane
authors.forename: J
authors.initials: J
authors.lastname: Howarth
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000383:Agriculture; D002648:Child; D002675:Child, Preschool; D004044:Dietary Proteins / Q000008:administration & dosage; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D006856:Hydrogen Cyanide / Q000506:poisoning*; D008297:Male; D002365:Manihot / Q000009:adverse effects*; D008875:Middle Aged; D009073:Mozambique / Q000453:epidemiology; D015493:Paraparesis, Tropical Spastic / Q000453:epidemiology / Q000209:etiology* / Q000652:urine; D012423:Rural Health; D017678:Sex Distribution; D013861:Thiocyanates / Q000652:urine; D014857:Warfare
chemical_list: D004044:Dietary Proteins; D013861:Thiocyanates; D006856:Hydrogen Cyanide; C031760:thiocyanate