Mantakassa: an epidemic of spastic paraparesis associated with chronic cyanide intoxication in a cassava staple area of Mozambique. 2. Nutritional factors and hydrocyanic acid content of cassava products. Ministry of Health, Mozambique.

An outbreak of spastic paraparesis which mostly affected women and children occurred in a northern province of Mozambique in 1981. The epidemic was related to chronic cyanide intoxication associated with a diet consisting almost exclusively of cassava. A prolonged drought in the area had exhausted all food resources except cassava, especially the bitter varieties. A nutritional, toxicological and botanical investigation was carried out in two of the five districts affected. The main findings were that cyanide levels were unusually high in the cassava plant as a consequence of the drought with daily intakes estimated at 15-31.5 mg HCN. Detoxification of the bitter varieties by sun-drying was inadequate because of the general food shortage, and metabolic detoxification was probably reduced owing to the absence of sulfur-containing amino acids in the diet. The raw and dried uncooked cassava was eaten mostly by women and children. The nutritional status of the population, however, was not very poor and symptoms of advanced under-nutrition were rarely seen.