Nearly 30 million people in sub-Saharan Africa are at risk of contracting a neurological disease simply because of what they eat. Konzo, which means “bound legs” in the African Yaka language, is contracted from consuming poorly processed bitter cassava—a resilient, high-yield (yet toxic) form of cassava that is the principal food staple. Konzo disease is perhaps the single biggest public health threat facing early childhood neurodevelopment in Africa today.
Michael Boivin, a Michigan State University professor with joint appointments in psychiatry and in neurology and ophthalmology, is working to change that. He is the recipient of one of 11 grants recently awarded by the Alliance for African Partnership (AAP), a new initiative at MSU that aims to develop a collaborative and cross-disciplinary platform for addressing today’s global challenges. Boivin will use his $200,000, 18-month grant for the project “A Partnership for Training Caregivers to Prevent Konzo Disease from Toxic Cassava and Enhance Neurodevelopment in Very Young Congolese Children.”
“When cassava is fermented and dried properly, its toxins break down to the point where they don’t adversely affect the body,” said Boivin, co-principal investigator on the project and a former Fulbright research scholar to the Democratic Republic of the Congo (DRC). “But if shortcuts are taken—if the cassava is not soaked or processed long enough—the cyanide toxins don’t have enough time to evaporate down. Within just a few weeks of subsisting on short-soaked or poorly prepared cassava, there could be permanent neurological damage. And once the damage occurs to the upper motor neuron pathway, there’s no way to repair it. So the key is prevention.”
A more efficient cassava processing method was recently implemented in the DRC. “The new wetting method of cassava flour preparation involves an extra step, but it’s simple, and it’s effective,” Boivin said. “It can reduce toxicity levels by more than 95 percent.”
The AAP grant will allow researchers to use specially developed technology to detect cyanide levels in the flour. They will also examine urinary biomarkers of cyanide toxin exposure in very young children (ages 2 to 5) and their caregivers in 60 villages. Within these villages, more than 500 households have been identified as having at least one konzo case.
The grant will also be used to investigate the benefit of embedding the wetting method training within a more comprehensive program—Mediational Intervention for Sensitizing Caregivers (MISC)—an approach that was earlier adapted by Boivin and his collaborators at Johns Hopkins University School of Public Health and at Bar-Ilan University, Israel, for Ugandan children whose parents were affected by HIV. Applying this caregiver training model in the DRC could benefit the caregiver's functionality and emotional well-being, resulting in reduced stress in the caregiver and the child; it could also improve child development outcomes.
Over the past 27 years, Boivin has pioneered testing methods for evaluating how the development of children in the sub-Sahara of Africa is affected by public health interventions for disease and other risk factors from severe poverty. In 2013, he was the lead author on a landmark paper published in the journal Pediatrics that revealed the first evidence that konzo could cause neuropsychological injury in children.
“Konzo was initially characterized in 1996 as a purely neuromotor disease that didn’t involve mental or higher-brain function,” Boivin said. “But there was evidence to suspect otherwise.”