(P17-066-23) Maternal Community Peer Training To Reduce Household Cassava Flour Cyanide Is Not Inferior to Specialist-Led Training When Preventing Konzo Disease in DR Congolese Children

Objectives: Konzo is a neuromotor disease caused by reliance on poorly processed cyanogenic cassava as the main source of food. Cyanide levels in household flour and maternal/child urinary level of thiocyanate (U-SCN) are indicative of neurodevelopmental risk in konzo-affected communities.

Methods: The wetting method (WTM) was taught to rural women weekly in small groups to detoxify their cassava flour prior to eating in a non-inferiority cluster (village) randomized controlled trial. Mothers certified in the WTM trained small groups of other mothers for a two-year period intervention (peer training cohort). Cassava flour cyanide and U-SCN levels for these households were compared to villages/homes trained in the WTM by fulltime (specialist) field workers also training weekly. This non-inferiority trial was in Kahemba, a district with the highest known incidence of konzo in the world. Villages were assigned to either the peer- or specialist-intervention arms, and households assessed at baseline, at 6-month intervals during a 2-year intervention, and 1-year following the end of the intervention.

Results: Peer training for the mothers of 361 children 5 to 14 yrs with konzo disease (mean age 10.2 yrs) and 343 neighbor controls without konzo (mean 9.0 yrs) was not inferior to specialist-led training at any time point. The margin of non-inferiority set a priori for urine and flour corresponded to the effect size d=0.375. At baseline, household flour cyanide level was predictive of child U-SCN (OR=3.58, 95% CI [1.24, 10.33], p=0.02). Child neurocognitive and motor proficiency deficits were lower in households with reduced flour cyanide and U-SCN levels through WTM adherence.

Conclusions: Peer-led WTM intervention was non-inferior to specialist-led throughout the 2-year intervention period. This approach for WTM konzo prevention can be brought to scale in at-risk health zones without the infrastructure/capacity for specialist-led community outreach; providing for greater sustainability in the prevention of konzo at lower cost and greater community efficiencies with peer trainers. Mobilizing mothers/food providers can lead to an intergenerational cultural catalyst for reducing this toxic-nutritional risk factor for tens of millions of children throughout sub-Sahara subsisting on toxic cassava for their primary food.

Funding Sources: National Institutes of Health