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Democratic Republic of Congo Impact of Cross-Sectoral Approach to Addressing Konzo In

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Democratic Republic of Congo Impact of Cross-Sectoral Approach to Addressing Konzo In DEMOCRATIC REPUBLIC OF CONGO IMPACT OF CROSS-SECTORAL APPROACH TO ADDRESSING KONZO IN DRC Households in Bandundu Province, DRC rely primarily on agriculture for food; cultivating cassava as the main crop and have limited dietary diversity. Due to the presence of cyanide in cassava, a poisonous chemical in unprocessed cassava, the retting process to leach out cyanide prior to consumption is essential. Improperly processed cassava causes konzo, a neurological ailment triggered by sustained dietary exposure to cyanide. Since local knowledge of the food-related origins of the disease is limited, local beliefs and traditional customs were found to be the main drivers of the high incidence of the disease. DRC Kinshasa Bandundu Vulnerability Context Background What is Konzo? From December 2009 to October Konzo is a sudden epidemic spastic 2011, Action Against Hunger paraparesis (paralytic) disease which (ACF-USA) implemented an leads to a permanent paralysis of intervention in the Bandundu province the affected person’s lower limbs. It is of the Democratic Republic of Congo a neurological ailment triggered by (DRC), addressing factors underlying sustained dietary exposure to cyanide the konzo epidemic affecting the present in improperly processed population of Kwango district. cassava. Overall, vulnerability to konzo is heightened by the The “Integrated Programme for the combination of low protein intake Eradication of Konzo in the Territory (associated with low dietary diversity), of Kwango in DRC” project was poor soil conditions (which favor the financed by the European Union (EU) cultivation and consumption of bitter Food Facility and aimed to eradicate cassava varieties high in cyanide), the disease through a cross-sectoral and lack of sufficient water resources approach focused on nutrition for thorough processing. education and training, dietary diversification, improved water access and agricultural processing. Figure 1: ACF program area in Kwango district, Bandundu province, DRC The strategy also aimed to address the high rates of malnutrition seen in konzo cases [25.8% global acute malnutrition (GAM) prevalence in konzo affected children less than 18 years old, 69.3% of GAM in konzo affected adults]. A total of 22,000 households benefited from these activities. Due to limited resources, project activities were not carried out in all konzo locations, but rather in the most affected villages. 3 Programme Overview The project was implemented in 396 Diverse environmental factors, villages in the highly affected areas such as soil fertility and soil water of Kahemba, Kajiji, Feshi and Panzi retention, affect the quantity and and to a lesser extent in Kenge, Boko, quality of harvests. Popokabaka, Kasongo Lunda, Wamba Luadi and Kitenda across the Territory Water access is a critical factor in of Kwango. Prior to implementing the konzo incidence, with access limited project, ACF conducted a baseline by both distance to and seasonality study1 in collaboration with the of water points. Water coverage Ministry of Health (MoH)’s PRONANUT levels are very low (4 to 5% or Programme National de Nutrition coverage)2, leading rural farmers in DRC where 2,388 suspected konzo to directly soak the cassava on river cases were screened and 2,218 were banks, in ponds or in swampy areas confirmed. to avoid carrying water back to their homes. In semi-urban areas, people The average incidence of konzo prefer to ret the cassava in their was 1.07%. Kahemba health zone homes (in buckets or barrels) due to harbored the highest number of the likelihood of theft if the cassavas confirmed cases at project baseline were left overnight in a public area. (1,639), and placed among the top three zones for incidence This practice can be hazardous as (2.08%) largely due to its density of sufficient water is often unavailable population and associated risk factors. for daily water changes during the retting process, greatly increasing Local beliefs and traditional customs the risk of cyanide intoxication. were found to strongly influence the incidence of konzo in the area. Implementation Strategy Local eating customs that favor the male head of household were noted The programme strategy sought to as likely contributors to heightened directly address the range of factors exposure of women and children to related to konzo identified in the konzo. There was a widely held belief baseline including: knowledge and that the disease is caused by black attitudes around the disease, low magic. agricultural and dietary diversity, low water access and poor knowledge and Households also rely primarily on practices around cassava processing. agriculture for food. Cassava is The strategy also aimed to address cultivated as a main crop, with maize, the high rates of malnutrition in groundnuts and beans as secondary konzo cases. crops. 4 © ACF - Haïti Findings Project design used a cross-sectoral Agricultural and Hydraulic Knowledge and Attitudes approach to address underlying Infrastructure Support on Konzo and Nutrition factors in a holistic manner. ACF introduced two improved food Changes in knowledge at endline Community Outreach, Mobilization crop varieties, niébé (cowpea) Vita compared to baseline suggest that and Education 7 and Muyaya, and sweet cassava community outreach and education TME119, Mwuazi, Nsasi, Disanka and activities were effective in challenging Butamu for increased consumption ACF employed a community outreach long held local beliefs on konzo and of sulphur amino acids contained in nutrition. At project baseline, 74% of and mobilization approach with the cereal and leguminous foods and sampled population attributed the creation of 647 community nutrition complement consumption of traditional forums across 395 villages for cyanide-heavy bitter cassava disease to a metaphysical origin, while discussion on konzo and nutrition. varieties. 88% correctly noted the food-related These served as launch pads for a causes of konzo at endline. broadly based educational campaign ACF delivered agricultural trainings extending to churches, schools, local to 12,500 households and supported Participation in a community nutrition health professionals, community installation of 13 village based forum was found to be correlated with volunteers and leaders, traditional mills to increase access to milling knowledge of the food-related cause authorities, etc. services and improve flour quality. In of konzo. In addition, there were order to increase water access, ACF strong inverse correlations between implemented a variety of hydraulic Information, Education & both ‘participation’ and ‘lack of constructions: public retting tanks to knowledge’, and ‘participation’ and Communication (IEC) materials and process cassava, boreholes, springs, ‘belief in a metaphysical origin’. messages on food processing and rainwater harvesting systems and preparation, nutrition and konzo piped distribution networks. were developed in collaboration with These findings reveal the importance PRONANUT, displayed in a variety of of outreach and education activities public areas and broadcast on local delivered both within the community radio. Methods forums and directly by ACF. Similar results were found regarding Mass sensitization sessions were The impact study was conducted knowledge, attitudes and practice organized in churches, mosques and across the project area. A stratified on prevention strategies based on sampling approach was used, with schools. Senior MoH staff, community effective messaging that encouraged six of eleven intervention health leaders and authorities, and local appropriate processing of cassava zones selected purposively, and 40 and inclusion of protein in diets volunteers were trained to pass of 395 intervention villages selected through incorporation of maize flour the message broadly. Volunteers randomly. In each selected village, six supported community nutrition forums beneficiary households were randomly into fufu preparation and legumes and facilitated weekly dialogues. selected to participate in household (pulses) in the diet. Cooking demonstrations were surveys (234 in total). Household organized in each forum around surveys were supplemented with improved fufu recipes based on mixed information from key informants and cassava and maize flour. focus groups. 5 Food Stocks and Cassava Retting Techniques Konzo Incidence Dietary Diversification and Water Access New varieties of niébé were largely ACF supported the installation of A surveillance system for screening accepted across the intervention zone village based mills to increase access and identification of konzo cases in and integrated into the diet, notably to maize and cassava milling services Kahemba health zone was established on the eastern axis (Kahemba, Kajiji) and improve the quality of the flour. by the local health structure in 2009, where populations were unfamiliar ACF also implemented a variety of with annual caseload an estimated with niébé. Sweet cassava was hydraulic construction: public retting 1,300 individuals in 2009. readily integrated into both east and tanks to process cassava, boreholes, west Kwango, with results showing a springs, rainwater harvesting systems MoH educational activities and ACF general increase in the intercropping and piped distribution networks. integrated activities on konzo were of both bitter and sweet varieties, launched in early to mid-2010, with as well as increased cultivation of Knowledge of community leaders and a marked decrease in cases recorded sweet varieties
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