Prevention of konzo and rehabilitation of konzo cases
Konzo is an irreversible paralysis of the legs in children and women of child bearing age, due to large intakes of cyanide from cassava (see cyanide poisoning, cyanide diseases and stunting of children). It occurs in Mozambique, Tanzania, D.R.Congo, Central African Republic and Cameroon and may also occur in Zambia, Uganda, Malawi and Angola.
Mozambique suffered two large epidemics of konzo in Nampula Province, the first in 1981 due to drought and the second in 1992-3 associated with war. During these two large epidemics rehabilitation centres were set up in the worst affected areas. In more recent times (2001-3) a rehabilitation centre was set up in Mogincual District as a collaborative effort between the Provincial Directorate of Health and the Mozambican Red Cross and supported by AusAID and private Australian funds. To locate konzo cases, we work through community leaders. Red Cross activists have been trained in basic therapeutic exercises, and how to prevent contractures and construct basic exercise training material such as parallel bars and walking ramps. Walking aids were provided where needed.
Outbreaks occurred in Mogincual District due to drought in 1998-9 (Ernesto et al., 2002) and again in 2005 due to drought in both Mogincual District and Zambezia Province (CCDN News 6 , P 3-4). Most patients were young adults, aged between 20 and 29, 47% were mild cases (able to walk without support), 42% were moderate (needing support to walk) while 11% were severe (unable to walk).
A one year program of konzo prevention and rehabilitation of konzo cases funded by AusAID finished in 2008 in Nampula Province and the wetting method was being introduced to rural women in konzo-prone communities. This program involved Mozambican Red Cross, Mr Domingos Nicala and Dr Julie Cliff. A coloured poster, originally produced by Dr Dulce Nhassico has been modified and translated into other languages and is now available in Portuguese, Macua, English, French, Kifuliru and Kiswahili.
Tanzania suffered two recent konzo epidemics in 2001-2 in Mbinga District, Ruvuma Region and in 2002-3 in Mtwara Region in the southern part of the country. In collaboration with Tanzanian Red Cross and Dr Nicholas Mlingi of the Tanzania Food and Nutrition Centre in Dar es Salaam, an AusAID supported project for prevention of konzo and rehabilitation of those with konzo is in progress. These projects will serve as prototypes for further implementation of the wetting method in konzo-prone communities. Free copies of a laminated poster in the local language Kiswahili are available. (Poster Kiswahili).
D.R.Congo, formerly Zaire and before that Belgian Congo, was where konzo was first described in 1928 (see Cyanide poisoning, cyanide diseases and stunting of children). In D.R.Congo in 2004 konzo occurred in four Provinces as a result of the prolonged civil war that caused the largest loss of life since the second world war and extensive disruption of normal village life. There are many thousands of people with konzo: one estimate is 100,000 cases. We have a small collaborative education program with Mr Kalala Karumba in Uvira, which involves the extensive use of laminated posters in Kifuliru (see Poster Kifuliru) but this is hampered by lack of funding. A potential project in D.R.Congo is currently unfunded.
Cameroon. In 2007, about 45000 refugees arrived in Eastern Cameroon from Central African Republic (CAR) diseased, malnourished and in generally poor health as a result of war in CAR. Amongst these are many children who have konzo (see CCDN News 10, P 2-3). We have provided cassava cyanide kits to Medecins Sans Frontieres (MSF) aid workers.
Other African countries. We would greatly appreciate information about the possible incidence of konzo in other African countries where we suspect that konzo may occur including Uganda, Zambia, Angola and Malawi.