When knowledge is not enough: barriers to recommended cassava processing in resource-constrained Kwango, Democratic Republic of Congo.

Background: Despite interventions to provide knowledge and improve bitter cassava processing in the Democratic Republic of Congo (DRC), cassava processing is sub-optimal. Consumption of insufficiently processed bitter cassava is associated with konzo, a neurological paralytic disease. Objective: This study aimed to explore barriers to appropriate cassava processing carried out by women in one deep rural, economically deprived area of DRC. Methods: A qualitative design used focus group discussions (FGDs) and participant observation to collect data among purposively selected women aged 15-61 years in Kwango, DRC. Data were analyzed using thematic analysis. Results: 15 FGDs with 131 women and 12 observations of cassava processing were undertaken. Observations indicated women did not follow recommended cassava processing methods. Although women were knowledgeable about cassava processing, two main barriers emerged: access to water and lack of money. Accessing water from the river to process cassava was burdensome, and the cassava was at risk of being stolen by soaking it in the river; therefore, women shortened the processing time. Cassava was not only used as a staple food but also as a cash crop, which led to households shortening the processing time to reach the market quickly. Conclusion: Knowledge about the risks of insufficient cassava processing and about safe processing methods alone is insufficient to change practices in a context of severe resource constraints. When planning nutrition interventions, it is critical to view the intervention in light of the socio-economic context in which the intervention will take place to improve its outcomes.