title: Use of the wetting method on cassava flour in three konzo villages in Mozambique reduces cyanide intake and may prevent konzo in future droughts.
abstract: Konzo is an irreversible paralysis of the legs that occurs mainly in children and young women associated with large cyanide intake from bitter cassava coupled with malnutrition. In East Africa outbreaks occur during drought, when cassava plants produce much more cyanogens than normal. A wetting method that removes cyanogens from cassava flour was taught to the women of three konzo villages in Mozambique, to prevent sporadic konzo and konzo outbreaks in the next drought. The intervention was in three villages with 72 konzo cases and mean konzo prevalence of 1.2%. The percentage of children with high (>350 μmol/L) urinary thiocyanate content and at risk of contracting konzo in Cava, Acordos de Lusaka, and Mujocojo reduced from 52, 10, and 6 at baseline to 17, 0, and 4 at conclusion of the intervention. Cassava flour showed large reductions in total cyanide over the intervention. The percentage of households using the wetting method was 30-40% in Acordos de Lusaka and Mujocojo and less in Cava. If the wetting method is used extensively by households during drought it should prevent konzo outbreaks and chronic cyanide intoxication. We recommend that the wetting method be taught in all konzo areas in East Africa.
authors.affiliation: Department of Biochemistry Faculdade de Medicina Universidade Eduardo Mondlane Maputo Mozambique.
authors.forename: Dulce
authors.initials: D
authors.lastname: Nhassico
authors.affiliation: EEG Research School of Biology Australian National University Canberra ACT 2601 Australia.
authors.forename: James Howard
authors.initials: JH
authors.lastname: Bradbury
authors.affiliation: Department of Community Health Faculdade de Medicina Unversidade Eduardo Mondlane Maputo Mozambique.
authors.forename: Julie
authors.initials: J
authors.lastname: Cliff
authors.affiliation: Instituto de Investigacao Agraria de Mocambique (IIAM) Nampula Mozambique.
authors.forename: Rita
authors.initials: R
authors.lastname: Majonda
authors.affiliation: Instituto de Investigacao Agraria de Mocambique (IIAM) Nampula Mozambique.
authors.forename: Constantino
authors.initials: C
authors.lastname: Cuambe
authors.affiliation: EEG Research School of Biology Australian National University Canberra ACT 2601 Australia.
authors.forename: Ian C
authors.initials: IC
authors.lastname: Denton
authors.affiliation: EEG Research School of Biology Australian National University Canberra ACT 2601 Australia.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Foster
authors.affiliation: Direccao Provincial de Saude Nampula Mozambique.
authors.forename: Arlinda
authors.initials: A
authors.lastname: Martins
authors.affiliation: Department of Biochemistry Faculdade de Medicina Universidade Eduardo Mondlane Maputo Mozambique.
authors.forename: Adelaide
authors.initials: A
authors.lastname: Cumbane
authors.affiliation: Department of Biochemistry Faculdade de Medicina Universidade Eduardo Mondlane Maputo Mozambique.
authors.forename: Luis
authors.initials: L
authors.lastname: Sitoe
authors.affiliation: Instituto de Investigacao Agraria de Mocambique (IIAM) Nampula Mozambique.
authors.forename: Joao
authors.initials: J
authors.lastname: Pedro
authors.affiliation: Department of Biochemistry Faculdade de Medicina Universidade Eduardo Mondlane Maputo Mozambique.
authors.forename: Humberto
authors.initials: H
authors.lastname: Muquingue
keywords: Cassava flour; cyanide; konzo; urinary thiocyanate; wetting method