(P18-009-23) Caregiver Early Child Development Training for Enhancing Safe Food Preparation To Prevent Konzo Disease From Toxic Cassava in the DR Congo

Objectives: In the DR Congo (DRC), the wetting method (WTM) for detoxifying cassava flour was taught to rural women to minimize the amount of cyanogens prior to human consumption and prevent further outbreaks of konzo (a permanent neurological disability affecting the lower limbs) in the household. This study evaluated the developmental and growth benefits of combining WTM combined with an early childhood development (ECD) training program to sensitize mothers to their children’s developmental needs and enhance WTM adherence.

Methods: We enrolled 120 village households with children 1 to 4 years of age in a rural health zone with the highest prevalence of konzo disease in the DRC. Households were randomized in 2:1 ratio to either ECD+WTM or WTM alone, with a year of weekly training sessions by a community peer (women) leaders certified in either our ECD and/or WTM programs. Child development was assessed, along with exposure to cyanide toxicity (urinary thiocyanate and household flour assays) at 6- and 12-months post-enrollment in gauging adherence to WTM cassava food detoxification.

Results: Adjusting for baseline, both six- and 12-months post-enrollment, urinary thiocyanate (p-0.015) and Gensini development (p=0.03) were significantly more favorable for ECD/WTM than for WTM only intervention arms. Mullen Scales of Early Learning (MSEL) Gross Motor was also significantly better for the ECD/WTM arm at six months (p=0.042), but not at 12 months. Contrary to previous findings, however, MSEL measures of cognitive development did not significantly differ between arms. Both length-for-age WHO z scores (p=0.02) and height-for-age (p=0.01) were higher for the MISC/WTM arm at 12 months.

Conclusions: Adding an ECD maternal training program as a means of motivating greater adherence to a practical but labor-intensive food preparation method to detoxify cassava flour is feasible in impoverished communities relying on toxic cassava as the basic food staple. ECD/WTM also lessened the risk for konzo disease and improved child growth and early childhood motor and neurodevelopment in the household. Tens of millions of children are at risk for konzo due to ecological degradation and food and water insecurity in central and western Africa, relying on toxic cassava as their primary food staple. Thus, the public health impact of ECD/WTM can be enormous.

Funding Sources: NIH/NICHD Fogarty grant