An epidemic of spastic paraparesis of unknown aetiology in Northern Mozambique
Cátia Luciana Abdulfattáhe Taibo, Julie Cliff, Hans Rosling, Casey Daniel Hall, Meeyoung Mattie Park, Joseph Asamoah Frimpong
The Pan African Medical Journal. 2017;27 (Supp 1):6. doi:10.11604/pamj.supp.2017.27.1.12623

Create an account  |  Sign in
Case studies in Public health Supplement 2 Supplement
"Better health through knowledge sharing and information dissemination "

Supplement article

Case Study

An epidemic of spastic paraparesis of unknown aetiology in Northern Mozambique

Cite this: The Pan African Medical Journal. 2017;27 (Supp 1):6. doi:10.11604/pamj.supp.2017.27.1.12623

Received: 27/04/2017 - Accepted: 05/05/2017 - Published: 28/05/2017

Key words: Public health, epidemiology, spastic paraparesis, epidemic, outbreak investigation

© Cátia Luciana Abdulfattáhe Taibo et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.panafrican-med-journal.com/content/series/27/1/6/full

Corresponding author: Cátia Luciana Abdulfattáhe Taibo, Microbiology Department, Eduardo Mondlane University, Maputo, Mozambique Field Epidemiology and Laboratory Training Program, Mozambique (catiaafattahe@yahoo.com.br)

This article is published as part of the supplement “African Case Studies in Public Heath” sponsored by Emory University, African Field Epidemiology Network

Guest editors: Olivia Namusisi, Scott JN McNabb, Ghada N Farhat, Joseph Asamoah Frimpong


An epidemic of spastic paraparesis of unknown aetiology in Northern Mozambique

Cátia Luciana Abdulfattáhe Taibo1,2,&, Julie Cliff3, Hans Rosling4, Casey Daniel Hall5, Meeyoung Mattie Park5, Joseph Asamoah Frimpong6

 

1Microbiology Department, Eduardo Mondlane University, Maputo, Mozambique, 2Mozambique Field Epidemiology and Laboratory Training Program, Mozambique, 3Ministry of Health, Maputo, Mozambique, 4Nacala District Health Department, Nacala, Mozambique, 5Rollins School of Public Health, Emory University, Atlanta, USA, 6Liberia Field Epidemiology Training Program, Liberia

 

 

&Corresponding author
Cátia Luciana Abdulfattáhe Taibo, Microbiology Department, Eduardo Mondlane University, Maputo, Mozambique Field Epidemiology and Laboratory Training Program, Mozambique

 

 

Abstract

This case study is based on a real-life outbreak investigation undertaken in Mozambique in 1981. This case study describes and promotes one particular approach to unknown disease outbreak investigation. Investigational procedures, however, may vary depending on location and outbreak. It is anticipated that the epidemiologist investigating an unknown disease outbreak will work within the framework of a “multidisciplinary investigation team”. It is through the collaborative efforts of this team, with each member playing a critical role, that outbreak investigations are successfully completed. Some aspects of the original outbreak and investigation have, however, been altered to assist in meeting the desired teaching objectives and to allow completion of the case study in less than 3 hours.

 

 

How to use this case study    Down

General instructions: Case studies in applied epidemiology allow students to practice applying epidemiologic skills in the classroom to address real-world public health problems. The case studies are used as a vital component of an applied epidemiology curriculum, rather than as stand-alone tools. They are ideally suited to reinforcing principles and skills already covered in a lecture or in background reading. Ideally, 1 or 2 instructors facilitate the case study for 8 to 20 students in a classroom or conference room. The instructor directs a participant to read aloud a paragraph or two, going around the room and giving each participant a chance to read. When the participant reads a question, the instructor directs all participants to perform calculations, construct graphs, or engage in a discussion of the answer. Sometimes, the instructor can split the class to play different roles or take different sides in answering the question. As a result, participants learn from each other, not just from the instructors. Additional instructor’s notes are included with each question. The instructors must keep Part 4 of the student guide (last 6 pages) as a separate handout. Do not let students see Part 4 until after they have completed Part 3.

 

Audience: residents in Field Epidemiology Training Programs (FETPs), Field Epidemiology and Laboratory Training Programs (FELTPs), Epidemic Intelligence Service (EIS) programs and others who will be engaged in conducting field studies involving humans, or who are interested in this topic.

 

Prerequisites: before using this case study, participants should have working knowledge of descriptive epidemiology, epidemic curves, measures of association, study design, and outbreak investigation. The student will also benefit from having some familiarity with paralysis of unknown aetiology, or unknown disease outbreaks investigation techniques, but will be likely to rely heavily on others with greater expertise in these areas in a real-life outbreak situation.

 

Materials needed: a calculator, the case control study student guide

 

Level of training and associated public health activity: basic to intermediate, i.e., this case study could be used in an introductory course in field epidemiology – outbreak investigation

 

Time required: approximately 3 hours

 

Language: English

 

 

Case study material Up    Down

 

 

Competing interests Up    Down

The authors declare no competing interest.

 

 

Acknowledgments Up    Down

Training materials funded by: AFENET; The Centers for Disease Control and Prevention (National Center for Infectious Diseases); Emory University – Hubert Department of Global Health. Acknowledgment: Esteves António, Kulinski Nicolai, Casadei Enrico Paul, Jansen Martineli António (deceased), Rodrigues Anne (deceased).

 

 

References Up    Down

  1. WHO. Country Cooperation Strategy at a Glance - Mozambique. May 2014. Google Scholar

  2. WHO/AFRO. WHO Country Cooperation Strategy, 2009-2013: Mozambique. Brazzaville, Republic of Congo. 2009. Google Scholar

  3. Casadei E, Jansen P, Rodrigues A. Mantakassa: An epidemic of spastic paraparesis associated with chronic cyanide intoxication in a cassava staple area of Mozambique. 1. Epidemiology and clinical and laboratory findings in patients. Bull World Health Organ. 1984; 62(3): 477-484. PubMed | Google Scholar

  4. Maphill. Silver Style Simple Map of Nampula. 2011. Google Scholar

  5. Mozambique Ministry of Health. 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. Bull World Health Organ. 1984; 62(3): 485–92. PubMed | Google Scholar

  6. Spencer PS, Schaumburg HH. Lathyrism: a neurotoxic disease. Neurobehav Toxicol Teratol. 1983; 5(6): 625–9. PubMed | Google Scholar

  7. Cliff J. An Orphan Disease. In The Practice of International Health - A case-based orientation, Pelman D, Roy A (eds). 1975; 72-90. Google Scholar

  8. Nzwalo H, Cliff Konzo J. From poverty, cassava, and cyanogen intake to toxico-nutritional neurological disease. PLoS Negl Trop Dis. 2011; 5(6): 1-8. PubMed | Google Scholar

  9. Ernesto M, Cardoso A, Nicala D, Mirione E, Massaza F, Cliff J et al. Persistent konzo and cyanogen toxicity from cassava in Northern Mozambique. Acta Trop. 2002; 82(3): 357-62. PubMed | Google Scholar

  10. Cardoso AP, Mirione E, Ernesto M, Massaza F, Cliff J, Rezaul Haque M et al. Processing of cassava roots to remove cyanogens. Journal of Food Composition and Analysis. 2005; 18(5):451- 460. Google Scholar

  11. Tshala-Katumbay D, Mumba N, Okitundu L, Kazadi K, Banea M, Tylleskar T et al. Cassava food toxins, konzo disease, and neurodegeneration in sub-Sahara Africans. Neurology. 2013; 80(10): 949-951. PubMed | Google Scholar

  12. Casadei E, Jansen P, Rodrigues A. 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. Bull World Health Organ. 1984; 62(3): 485-492. PubMed | Google Scholar

  13. Haque MR, Bradbury JH. Simple method for determination of thiocyanate in urine. Clin Chem. 1999; 45(9): 1459-64. PubMed | Google Scholar

  14. Banea J, Bradbury H, Mandombi C, Nahimana D, Ian D, Kuwa N et al. Effectiveness of wetting method for control of konzo and reduction of cyanide poisoning by removal of cyanogens from cassava flour. Food Nutr Bull. 2014 Mar; 35(1): 28-32. PubMed | Google Scholar

  15. Cumbana A, Mirione E, Cliff J, Bradbury JH. Reduction of cyanide content of cassava flour in Mozambique by the wetting method. Food Chem. 2007; 101(3): 894–897. PubMed | Google Scholar

  16. Cliff J. An Orphan Disease in Mozambique. In The Practice of International Health: A Case-based Orientation, Perlman D, Roy A (eds). New York. Oxford University Press. 2009; 72–90. Google Scholar

  17. Cliff J, Muquingue H, Nhassico D, Nzwalo H, Bradbury JH, Muquinque H et al. Konzo and continuing cyanide intoxication from cassava in Mozambique. Food Chem Toxicol. 2011; 49(3): 631–5. PubMed | Google Scholar

  18. Park MM, Hall CD, Frimpong JA, Dacuan L. Case Study Development Course - Types of Experimental and Observational Epidemiologic Studies. In 2016. Atlanta, GA. Emory University. Google Scholar

  19. The Plant List. A Working List of All Plant Species. Accessed 7 July 2016.

  20. The Free Dictionary. Paraparesis. Accessed 7 July 2016.

  21. WHO. Poliomyelitis (polio). Accessed 7 July 2016.

  22. Merriam-Webster. Telex. Accessed 7 July 2016.

  23. Merriam-Webster. Thiocyanate. Accessed 7 July 2016.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


The Pan African Medical Journal articles are archived on Pubmed Central. Access PAMJ archives on PMC here

Current:

Volume 28 (September - December 2017)

Article tools

Rate this article

Altmetric

PAMJ is a member of the Committee on Publication Ethics

PAMJ is published in collaboration with the African Field Epidemiology Network (AFENET)
Currently tracked by: DOAJ, AIM, Google Scholar, AJOL, EBSCO, Scopus, Embase, IC, HINARI, Global Health, PubMed Central, PubMed/Medline, Ulrichsweb, More to come . Member of COPE.

ISSN: 1937-8688. © 2017 - Pan African Medical Journal. All rights reserved