Dietary cyanogen exposure and early child neurodevelopment: An observational study from the Democratic Republic of Congo

Espérance Kashala-Abotnes, Marie Thérèse Sombo, Daniel L. Okitundu, Marcel Kunyu, Guy Bumoko Makila-Mabe, Thorkild Tylleskär, Alla Sikorskii, Jean Pierre Banea, Dieudonné Mumba Ngoyi, Désiré Tshala-Katumbay, Michael J. Boivin

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14 Scopus citations


Background Dietary cyanogen exposure from ingesting bitter (toxic) cassava as a main source of food in sub-Saharan Africa is related to neurological impairments in sub-Saharan Africa. We explored possible association with early child neurodevelopmental outcomes. Methods We undertook a cross-sectional neurodevelopmental assessment of 12–48 month-old children using the Mullen Scale of Early Learning (MSEL) and the Gensini Gavito Scale (GGS). We used the Hopkins Symptoms Checklist-10 (HSCL-10) and Goldberg Depression Anxiety Scale (GDAS) to screen for symptoms of maternal depression-anxiety. We used the cyanogen content in household cassava flour and urinary thiocyanate (SCN) as biomarkers of dietary cyanogen exposure. We employed multivariable generalized linear models (GLM) with Gamma link function to determine predictors of early child neurodevelopmental outcomes. Results The mean (SD) and median (IQR) of cyanogen content of cassava household flour were above the WHO cut-off points of 10 ppm (52.18 [3279]) and 50 (30–50) ppm, respectively. Mean (SD) urinary levels of thiocyanate and median (IQR) were respectively 81781 (47459) and 688 (344–1032) μmole/l in mothers, and 61749 (44948) and 688 (344–688) μmole/l in children reflecting individual high levels as well as a community-wide cyanogenic exposure. The concentration of cyanide in cassava flour was significantly associated with early child neurodevelopment, motor development and cognitive ability as indicated by univariable linear regression (p < 0.05). After adjusting for biological and socioeconomic predictors at multivariable analyses, fine motor proficiency and child neurodevelopment remained the main predictors associated with the concentration of cyanide in cassava flour: coefficients of -008 to -.15 (p < 001). We also found a significant association between child linear growth, early child neurodevelopment, cognitive ability and motor development at both univariable and multivariable linear regression analyses coefficients of 1.44 to 7.31 (p < 001). Conclusion Dietary cyanogen exposure is associated with early child neurodevelopment, cognitive abilities and motor development, even in the absence of clinically evident paralysis. There is a need for community-wide interventions for better cassava processing practices for detoxification, improved nutrition, and neuro-rehabilitation, all of which are essential for optimal development in exposed children.

Original languageEnglish (US)
Article numbere0193261
JournalPloS one
Issue number4
StatePublished - Apr 2018

ASJC Scopus subject areas

  • General


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