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Konzo and Cassava Toxicity KONZO AND CASSAVA TOXICITY A STUDY OF ASSOCIATED NUTRITIONAL FACTORS IN THE POPOKABAKA DISTRICT, DEMOCRATIC REPUBLIC OF CONGO Delphin DIASOLUA NGUDI Academic Year 2004-2005 KONZO AND CASSAVA TOXICITY: A STUDY OF ASSOCIATED NUTRITIONAL FACTORS IN THE POPOKABAKA DISTRICT, DEMOCRATIC REPUBLIC OF CONGO KONZO-ZIEKTE EN DE TOXICITEIT VAN MANIOK: EEN STUDIE VAN DE VOEDINGSFACTOREN IN POPOKABAKA DISTRICT, DEMOCRATISCHE REPUBLIEK KONGO Door Delphin DIASOLUA NGUDI, M.Sc. Thesis submitted in fulfilment of the requirements for the degree of Doctor (Ph.D.) in Applied Biological Sciences Proefschrift voorgedragen tot het bekomen van de graad van Doctor in the Toegepaste Biologische Wetenschappen Op gezag van: Rector: Prof. Dr. Apr. A. DE LEENHEER Decaan: Promotoren: Prof. Dr. Ir. Herman VAN LANGENHOVE Prof. Dr. Patrick KOLSTEREN Prof. Dr. Ir. Fernand LAMBEIN CITATION “A person who has food has many problems. A person who has no food has only one problem” Chinese saying DEDICATION To Thérèse Luntala and our sons Berdit, Gaël and Beni In memory of my Grand Oncle André Banketa and my father Bernard Ngudi-a-nkama Promotoren: Prof. Dr. Patrick KOLSTEREN Vakgroep Voedselveiligheid en Voedselkwaliteit, Universiteit Gent Voedings unit, Prins Leopold Instituut voor Tropische Geneeskunde, Antwerpen Prof. Dr. Ir. Fernand LAMBEIN Instituut Planten Biotechnologie voor Ontwikkelingenlanden, Universiteit Gent Decaan: Prof. Dr. Ir. Herman VAN LANGENHOVE Academiejaar 2004 - 2005 Delphin DIASOLUA NGUDI KONZO AND CASSAVA TOXICITY A STUDY OF ASSOCIATED NUTRITIONAL FACTORS IN THE POPOKABAKA DISTRICT, DEMOCRATIC REPUBLIC OF CONGO Proefschrift voorgedragen tot het bekomen van de graad van Doctor in de Toegepaste Biologische Wetenschappen Op gezag van de rector, Prof. Dr. Apr. A. DE LEENHEER Nederlandse vertaling titel: KONZO-ZIEKTE EN DE TOXICITEIT VAN MANIOK: EEN STUDIE VAN DE VOEDINGSFACTOREN IN POPOKABAKA DISTRICT, DEMOCRATISCHE REPUBLIEK KONGO Diasolua Ngudi, D. (2005). Konzo and cassava toxicity: a study of associated nutritional factors in the Popokabaka District, Democratic Republic of Congo. Ph D. thesis Universiteit Gent, Belgium, 160 p ISBN 90-5989-073-6 The author and the promoter give the authorisation to consult and to copy parts of this work for personal use only. Every other use is subject to the copyright laws. Permission to reproduce any material contained in this work should be obtained from the author. Acknowledgments I would like to express my gratitude to all the many people who and institutions that have contributed to this research. I am particularly grateful to my promoter Prof Dr Patrick Kolsteren for his encouragement, his guidance and constructive criticisms. My special thanks to Prof Dr Ir Fernand Lambein, the co-promoter of this thesis for accepting me to work under his supervision. I am indebted to him for improving my skills, including my laboratory techniques and for sharing his knowledge and experience on nutritional and neuro- toxicological disease. I also thank Prof. Em. Dr. Ir André Huyghebaert, my promoter until his retirement for handling the administrative issues of my enrolment to the university. I thank Dr J. Howard Bradbury from the Australian University and chairperson of the Cyanide Cassava Disease Network for his advices and for graciously providing me kits for analyses of cyanide and thiocyanate. I thank Dr Yu-Haey Kuo (Dianna) for the initiation to the use of HPLC instruments and for her meticulous attention in scrutiny of manuscripts. I thank Prof Dr Thorkild Tylleskär for inspiring and encouraging me to initiate this research. Dr Theophile Ntambwe, former Director of PRONANUT has to be thanked for his support and follow up of my scholarship file. I am thankful to Prof Dr JP Banea Mayambu, Director of PRONANUT for the encouragement, guidance and support. I am indebted to both of them for providing me field facilities. The staff and colleagues of PRONANUT are greatly acknowledged for their enthusiasm and encouragement. Prof Dr Simon Malele ma Ludani from the Australia’s University of Southern Queensland/ Dubai and Dr Fabienne Ladrière from Médecins du Monde are thanked for their assistance and for reading and improving this thesis. I am deeply grateful to the members of the examination committee: Prof Dr Ir Georges Hofman, Prof Dr Ir Colin Janssen, Prof Dr Geert Callewaert, Prof Dr Armand Christophe and Dr Ir Bruno De Meulenaer. Their criticism of this work was very constructive. The Belgian Cooperation and Development Ministry has exceptionally granted me a mixed scholarship through the Belgian Technical Cooperation (BTC) in April 2002. I thank Mr Marino Orban, Mr G. Kasende and Mrs Sarah Stijnen of BTC for their efficient management of my dossier. Congolese Ministry of Health through PRONANUT, OXFAM – Destelbergen (Katrien Goddemaer), GTZ (Nour Salua) and anonymous relatives and friends provided also financial support to conduct part of my program. Prof Em Marc Van Montagu, Prof Ann Depicker, Prof Dr Lieve Gheysen and staff of IPBO are thanked for the hospitality and their interest in my research. Konzo and cassava toxicity II Exceptional thanks to Ir. Anne-Marie De Winter, Regine Haspeslagh, Veerle Van Ongeval, Ir. Ann Peters, Christine Graveel, Jean-Pierre Dubois, Ing. Alfons Lenaert, Myriam De Vos and Ing. Yves De Jonge for their assistance, continuous interest and encouragement. I am indebted to the Visie newspaper and to the VRT-film crew Jo Frere and Jasmine De Bruycker for the interest in the topic of my research and for their objective reporting on the disease on the disease konzo and on our research. Piet Meyvaert, Paul Meirsman, Lieve Van Wijmeersch, Fernand Verhoeven, Erik Verhaegen, Willy Mpoyi, Louis Kitenge, Raf Nunga, Elie and Blaise Ndosimau, Sera and Emmanuel Kisuesue, Ir Bernard Lelou, Prof Dr Emmanuel Biey, Dr José Biey, Dr Thomas Mpiana, Dr Clément Mulenda Tshamala, Michel Fazili and other friends, not mentioned by name, are acknowledeged for their help and friendship. I would like to express my cheerfully thanks to my mother, to my sisters Lili, Micheline and Euphrasie,to my sister in law Makiese and to my brothers in law Malueki, Nsinga, Ntondo and Yende for taking care of our sons while we were out of the country and far from them. Many thanks to my uncle Prof Dr Mamingi Nlandu, to my brothers Domi, Sivis and Nsimba, to my cousin Dimbu, to my sisters in law Annie, Julie and Elisée and to all my nephews and nieces. To my sons Berdit, Gäel and Beni, I have to apologise for not giving them all the attention they deserved during the many busy years that research entailed. I thank Thérèse Luntala for often coping with my absence concerning things of life and for her advice, help and love. Last but not the least; I thank the authorities and the population of Popokabaka for their enthousiasm and collaboration during my field trips. Gent, June 2005 Delphin Diasolua Ngudi Konzo and cassava toxicity III CONTENTS Acknowledgments......................................................................................................................I CONTENTS........................................................................................................................... III List of figures ........................................................................................................................... V List of tables............................................................................................................................VI Abbreviations and acronyms..............................................................................................VIII Samenvatting ........................................................................................................................... X Résumé .................................................................................................................................XIII Summary............................................................................................................................ XVII I Literature review.............................................................................................................. 2 I.1 Introduction....................................................................................................................2 I.1.1 Paraparesis and neurodegenerative diseases, what is the meaning? ...................... 2 I.1.2 The “hidden endemias” .......................................................................................... 3 I.2 Konzo.............................................................................................................................. 7 I.2.1 Background information on konzo......................................................................... 7 I.2.2 Clinical features and differential diagnosis.......................................................... 10 I.2.3 Epidemiology ....................................................................................................... 14 I.2.4 Infection or toxico-nutritional etiology? .............................................................. 15 I.3 Dietary exposure to cyanide from cassava .................................................................. 17 I.3.1 Cassava................................................................................................................. 17 I.3.2 Cyanide toxicity................................................................................................... 27 I.4 Conclusion...................................................................................................................
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