Effectiveness of wetting method for control of konzo and reduction of cyanide poisoning by removal of cyanogens from cassava flour.

BACKGROUND: Konzo is an irreversible paralysis of the legs that occurs mainly among children and young women in remote villages in tropical Africa and is associated with a monotonous diet of bitter cassava. Konzo was discovered in 1938 by Dr. G. Trolli in the Democratic Republic of Congo (DRC). It also occurs in Mozambique, Tanzania, Cameroon, Central African Republic, and Angola. It was first controlled in Kay Kalenge village, DRC, in 2011 with the use of a wetting method to remove cyanogens from cassava flour. Fourteen months later, another visit was made to Kay Kalenge. OBJECTIVE: To determine whether Kay Kalenge women were still using the wetting method, whether there were new cases of konzo, and whether the wetting method had spread to other villages. METHODS: Meetings were held with chiefs, leaders, and heads of mothers' groups, women from 30 households were interviewed, and three nearby villages were visited. Total cyanide and thiocyanate were analyzed in cassava flour and urine samples, respectively. RESULTS: The women in Kay Kalenge village still used the wetting method. There were no new cases of konzo. The mean cyanide content of the flour samples was 9 ppm, and no child had a mean urinary thiocyanate content greater than 350 micromol/L. The use of the wetting method had spread naturally to three adjacent villages. CONCLUSIONS: The wetting method has been readily accepted by rural women as a simple and useful method to control konzo by removing cyanide from cassava flour, and its use has spread to nearby villages. The wetting method should be promoted by health authorities to control konzo and reduce cyanide poisoning from high-cyanide cassava flour.

Screen detection and the WHO stepwise approach to the prevalence and risk factors of arterial hypertension in Kinshasa.

BACKGROUND: The trend of hypertension and other risk factors of cardiovascular disease is changing because of epidemiological, demographic and nutritional transitions in sub-Saharan Africa. OBJECTIVES: The aim of this study is to determine the prevalence and risk factors of arterial hypertension in the Kinshasa region, Democratic Republic of Congo (DRC). DESIGN AND METHODS: Data were collected from random sample cross-sectional surveys of adult black Africans from Kinshasa, with the help of a structured questionnaire, physical examinations and blood samples, using the World Health Organisation (WHO) stepwise approach. Sex, age, place of residence (urban versus rural), psychosocial risk factors (socioeconomic status, stress), overweight status (BMI: 25-29.9 kg/m), general obesity (BMI: >or=30 kg/m), abdominal obesity (waist circumference: >or=94 cm) and diabetes mellitus were considered to be the potential risk factors for screen-detected hypertension. RESULTS: The weighted prevalences of hypertension, diabetes mellitus, overweight status, general obesity and abdominal obesity were 15.2, 140.2, 13.5, 4.8 and 7.5%, respectively. Blood pressure and the proportion of participants with hypertension increased with age and BMI group in the population, for both men and women. Age, rural residence, low socioeconomic status, high socioeconomic status, general obesity and abdominal obesity were the risk factors for hypertension. Women aged 55 years and above had higher levels of blood pressure and hypertension than men. CONCLUSION: Absolute levels of hypertension, all types of obesity and diabetes mellitus are high risk factors in the army camps and semiurban extension cities; general obesity and abdominal obesity are the risk factors for detectable hypertension. Effective control of general obesity and abdominal obesity and psychosocial strategies that target both semirural and urban areas of the Kinshasa region have the potential to prevent much premature cardiovascular disease.