An ecological paradigm for a health behavior analysis of "konzo", a paralytic disease of Zaire from toxic cassava.

Konzo is an irreversible paralytic disease afflicting tens of thousands of women and children in rural Zaire and throughout sub-Sahara Africa. The disease can occur where bitter, high-yield varieties of cassava that thrive in arid soils provide the basic nutritional staple. The paraparesis is related to upper motor neuron damage stemming from the consumption of insufficiently processed toxic cassava roots (manioc) and a diet poor in the sulfur-based amino acids necessary for the body to detoxify the cyanide in this plant. The ecological paradigm [Kelly (1968) Toward an ecological conception of preventive interventions, in Research Contributions from Psychology to Community Mental Health, ed. J. W. Carter, pp. 75-99, Behavioral Publications, New York] is adapted as the evaluative model for evaluating the potential effectiveness of a proposed health behavior/education intervention for konzo. This qualitative research model involves a consideration of the cycling of resources (human labor and material), adaptation (of personal and social practices related to the health issue), succession (of social institutions, values, customs), interdependence (of human social units), and feasibility (or the congruency of the proposed intervention and cultural traits of the host environment). Based on this evaluative model, a health behavior/education level of intervention focusing specifically on using focus groups and multichannel communication techniques to discourage unsafe manioc short-soaking tendencies among village women farmers seems feasible. Such an approach is not dependent on sophisticated technical or material inputs and is therefore readily sustainable without outside agency support once it is effectively initiated within that culture.