KONZO ASSOCIATED WITH WAR IN MOZAMBIQUE

We report an epidemic of konzo, symmetric spastic paraparesis associat ed with cassava consumption and cyanide exposure: 384 patients were tr eated in rehabilitation centres; the prevalence rate in a badly affect ed area was 30/1000. Most patients were children over 3 and women. Owi ng to war. communities turned to bitter cassava as their staple and ro ok 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 y ear 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 lo wer than those previously reported in konzo epidemics, probably becaus e we collected specimens before the cassava harvest and epidemic peak. The necessary conditions for konzo were present: intensive cultivatio n of bitter cassava, insufficient processing, a probable high cyanide intake, and a low intake of protein-rich foods.