**3. Traditional foods in diet of Kahemba's population**

Kahemba in province of Kwango, has a special significance due to recurring outbreaks of konzo disease over the past 20 years and is severely affected by konzo [2]. Food frequency questionnaires (FFQ) were used to identify the most common food items consumed by the local population. The Ministry of Health for the Congo for the ethical conduct of human participant research provided study approval (MD/125/2013). Interviews were conducted with 30 consenting households (families) of which 13 had at least one child affected by konzo (konzo households). Direct observations were also made to document dietary habits adopted by the aforementioned families.

Few households consumed tea, coffee or herbal teas. Other households consumed boiled sweet cassava roots accompanied by peanuts, voandzous (*Vigna subterranea*) and avocado fruits. Konzo households mostly had one meal per day, consumed preferably in the evenings. Readily available ethnic food items in the city of Kahemba, other than starch sources, included wild edible mushrooms, herbal teas, spices, vegetables (legumes), and yams. Among the mushrooms, *Auricularia delicata, Lactarius edulis, Lactarius symoensi* and *Schizophyllum commune* were the most abundant and readily available on the market all year round in dried form. For vegetables, leaves of *Manihot esculenta, Manihot glaziovii, Hibiscus cannabinus, Hibiscus sabdariffa, Ipomea batatas* and *Cucurbita maxima* are the most consumed by the two types of household. Households cultivate some sweet and bitter local varieties of cassava roots. Mwambu variety is the bitterest variety of cassava and was introduced to Kahemba in the year 1937 from Angola. This variety is the most cultivated because its yield of tubers is the highest after

**Figure 2.** Cassava processing and diet for children of Kahemba. Sun drying of cassava roots soaked in a container by a konzo household of Kahemba city (A) and the structure of a meal for households characterized by a high quantity of *fufu*

Traditional Foods as Putative Sources of Antioxidants with Health Benefits in Konzo

http://dx.doi.org/10.5772/intechopen.74523

121

Leaves of *Abelmochus esculentus, Abelmoshus moshatus, Amaranthus viridis, Gnetum africanum, Pteridium acquilium, Psophocarpus scandens, Sesamum angustifolium, Solanum gilo* and *Solanum* 

Fruit consumption by households was low despite the variety of fruits cultivated by households in their family plots. Fruit production was rather intended for sale and not consumption

Caterpillars, larvae, and red meat, especially pig meat and fish, are largely consumed by the

Our findings indicate that konzo households mostly rely on cassava derived products as their main source of food and have limited access to other types of food including vegetables, fish and meats. These findings are consistent with previous studies that suggest that poor nutrition is a risk factor for konzo. This dietary pattern based principally on cassava flour paste exposes the consumer to intoxication with cyanide, especially in children for whom the quan-

*aethiopicum* (fruit) are largely consumed by non-konzo households.

6 months [8].

by the members of the households.

accompanied by few vegetables and insects (B).

households but in small quantities.

Dietary habits of Kahemba's population are centered on cassava, the main staple food. Common foodstuffs include cassava bread-like items known as *chikwange* and *fufu*, a stiff paste made from cassava flour (**Figure 2**). There are different processing techniques to detoxify cassava. These include soaking (retting) for 4 days minimum in water and drying in the sun outside or inside the house under firewood. In practice, the retting of cassava tubers is done in closed containers with little water. Sun drying usually takes several days, except certain households in konzo areas have reduced processing times mainly due to famine (**Figure 2**).

The number of meals per day varies between 1 and 3 depending on household income. These meals do not necessarily correspond to breakfast, lunch and dinner. For konzo or non-konzo households, the basic meal (cassava flour paste + condiment) is consumed 2–3 times and sometimes the condiment varies. Variability of meals per day is weak especially for konzo households due to lack of financial resources. In the majority of cases the same dish is split and eaten morning, midday and evening; consequently the food is not varied in spite of the availability of various traditional foods. For many households, the breakfast meal was cassava porridge, often cooked the day before.

Traditional Foods as Putative Sources of Antioxidants with Health Benefits in Konzo http://dx.doi.org/10.5772/intechopen.74523 121

Konzo is defined by World Health Organization (WHO), as a visible symmetric spastic abnormality of gait while walking or running in a formerly healthy person with a history of onset of less than 1 week. After onset, a non-progressive course follows and bilaterally exaggerated knee or ankle jerks without signs of disease of the spine. WHO definition dedicated konzo as a pure upper-motor neuron disorder, cognitive effects were originally deemed absent or minimal [11]. Recently, Boivin et al. showed that motor proficiency is dramatically affected, and both children with and without konzo have impaired neurocognition compared with control children from a no outbreak area. Therefore, konzo is associated with a subclinical neurocognitive form, extending the human burden of konzo with dramatic public health implications [2]. Dietetic macronutrients and micronutrients play a crucial role in the control of brain physiology, and food intake is known to stimulate the activity of neurotrophic factors regulating synaptic plasticity. In recent years, epidemiological studies have shown that the regular consumption of fruits, vegetables, and spices… had a lower incidence of cardiovascular, neurological disorders and others. Functional foods and nutraceuticals have been proven beneficial for the prevention or amelioration of cognitive impairments in degenerative

Kahemba in province of Kwango, has a special significance due to recurring outbreaks of konzo disease over the past 20 years and is severely affected by konzo [2]. Food frequency questionnaires (FFQ) were used to identify the most common food items consumed by the local population. The Ministry of Health for the Congo for the ethical conduct of human participant research provided study approval (MD/125/2013). Interviews were conducted with 30 consenting households (families) of which 13 had at least one child affected by konzo (konzo households). Direct observations were also made to document dietary habits adopted

Dietary habits of Kahemba's population are centered on cassava, the main staple food. Common foodstuffs include cassava bread-like items known as *chikwange* and *fufu*, a stiff paste made from cassava flour (**Figure 2**). There are different processing techniques to detoxify cassava. These include soaking (retting) for 4 days minimum in water and drying in the sun outside or inside the house under firewood. In practice, the retting of cassava tubers is done in closed containers with little water. Sun drying usually takes several days, except certain households in konzo areas have reduced processing times mainly due to famine (**Figure 2**).

The number of meals per day varies between 1 and 3 depending on household income. These meals do not necessarily correspond to breakfast, lunch and dinner. For konzo or non-konzo households, the basic meal (cassava flour paste + condiment) is consumed 2–3 times and sometimes the condiment varies. Variability of meals per day is weak especially for konzo households due to lack of financial resources. In the majority of cases the same dish is split and eaten morning, midday and evening; consequently the food is not varied in spite of the availability of various traditional foods. For many households, the breakfast meal was cassava

**3. Traditional foods in diet of Kahemba's population**

diseases [12].

120 Antioxidants in Foods and Its Applications

by the aforementioned families.

porridge, often cooked the day before.

**Figure 2.** Cassava processing and diet for children of Kahemba. Sun drying of cassava roots soaked in a container by a konzo household of Kahemba city (A) and the structure of a meal for households characterized by a high quantity of *fufu* accompanied by few vegetables and insects (B).

Few households consumed tea, coffee or herbal teas. Other households consumed boiled sweet cassava roots accompanied by peanuts, voandzous (*Vigna subterranea*) and avocado fruits. Konzo households mostly had one meal per day, consumed preferably in the evenings.

Readily available ethnic food items in the city of Kahemba, other than starch sources, included wild edible mushrooms, herbal teas, spices, vegetables (legumes), and yams. Among the mushrooms, *Auricularia delicata, Lactarius edulis, Lactarius symoensi* and *Schizophyllum commune* were the most abundant and readily available on the market all year round in dried form. For vegetables, leaves of *Manihot esculenta, Manihot glaziovii, Hibiscus cannabinus, Hibiscus sabdariffa, Ipomea batatas* and *Cucurbita maxima* are the most consumed by the two types of household. Households cultivate some sweet and bitter local varieties of cassava roots. Mwambu variety is the bitterest variety of cassava and was introduced to Kahemba in the year 1937 from Angola. This variety is the most cultivated because its yield of tubers is the highest after 6 months [8].

Leaves of *Abelmochus esculentus, Abelmoshus moshatus, Amaranthus viridis, Gnetum africanum, Pteridium acquilium, Psophocarpus scandens, Sesamum angustifolium, Solanum gilo* and *Solanum aethiopicum* (fruit) are largely consumed by non-konzo households.

Fruit consumption by households was low despite the variety of fruits cultivated by households in their family plots. Fruit production was rather intended for sale and not consumption by the members of the households.

Caterpillars, larvae, and red meat, especially pig meat and fish, are largely consumed by the households but in small quantities.

Our findings indicate that konzo households mostly rely on cassava derived products as their main source of food and have limited access to other types of food including vegetables, fish and meats. These findings are consistent with previous studies that suggest that poor nutrition is a risk factor for konzo. This dietary pattern based principally on cassava flour paste exposes the consumer to intoxication with cyanide, especially in children for whom the quantity of cassava flour paste represents more than 90% of the consumed meals. Previous studies showed that this dietary pattern is responsible for the persistence of konzo [9]. The Flora of province of Kwango is rich in traditional foods that are mostly unexploited. For this reason, Mbemba et al. assessed the nutritional value of some traditional foods by determining their relative amino acid composition, in order to contribute to the equilibration of the diet in the population of this area severely affected by malnutrition and konzo. Yams such as *D. alata* and *D. cayenensis* are the most widespread. Mbemba et al. reported that some dried yams are richer in proteins than cassava root and can be used with success to prepare porridge for children who represent the most at-risk population for konzo [13]. They are an alternative substitute for cassava especially as they are abundant during the dry season, a period corresponding to high outbreaks of konzo. Among the sources of animal proteins consumed, the fish *Chanmellabes tupus* (known locally as Misombi) and larvae are the foods economically accessible for the majority of Kahemba's population.
