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Acute Intoxication from Newly-Introduced Cassava during Drought in Mozambique

Acute intoxication from newly-introduced cassava during drought in Mozambique We report an epidemic of acute intoxication associated with bitter cassava consumption during drought. From June 1992 to August 1992, 70 patients presented to the provincial hospital in Chimoio, Manica Province, with a complaint of poisoning after eating bitter cassava. The main symptoms were vomiting, abdominal pain, and headache. More severe cases had altered consciousness, including coma, and dyspnoea. A 3-year-old comatose child died soon after admission, probably from aspiration pneumonia after vomiting. There was no other apparent cause for the coma. Health workers made a diagnosis of cyanide poisoning because all patients had a history of eating bitter cassava shortly before the onset of symptoms. Bitter cassava contains cyanogenic glycosides: if it is eaten without adequate processing to remove them, cyanide poisoning may result. The onset of the epidemic coincided with the introduction of bitter cassava into the town markets for the first time. In Chimoio, cassava is cooked by boiling, an inefficient method for removing cyanogenic glycosides. There was no consistent history of eating other possible causative agents, such as wild plants, nor of fever or other signs that might suggest an infectious agent. The clinical picture was consistent with acute cyanide intoxication. In other parts of Mozambique, where cassava is the staple, people frequently complain of the same symptoms after eating insufficiently processed bitter cassava. Residents of these areas recognize the cause and we found that patients or their guardians in the current epidemic also quickly attributed the symptoms to bitter cassava. All patients lived in Chimoio town; 74% of patients were children under 15 years; 17070 were adult women; and 9% were adult men. We described a similar age and sex distribution in a previous epidemic of cassava-related disease in northern Mozambique'. Chimoio is the capital of an agriculturally rich highland province. The staple food is maize, eaten as a stiff porridge with relishes of green leaves, beans, or dried fish. In 1990-1991 and 1991-1992, the rains failed, leading to a severe drop in agricultural production. In Chimoio, a community nutritional survey with random cluster sampling in October 1991 showed that 4% of children under 5 years had weight-for-height below the third percentile. By July 1992, the percentage had risen to 8%. The bitter cassava strain that caused the epidemic had been recently introduced as part of efforts to improve food security. Agriculturalists identified it as a strain high 193