By Dr. Abolude Yusuf
I am pretty sure we all still remember the recent incidence of ‘methanol’ that claimed the lives of over twenty people at Ode Irele in Ondo State. Nigeria can not afford to witness, or even worst still experience such terrible and avoidable incidence again.
Food is known to be any nutritious substance consumed by human or animals to maintain life and growth without detrimental effect on human health.
However, if it is consumed and act otherwise it becomes a poison. In essence what we eat determines the fate of our good health. Medically, nutritional importance of food can not be underestimated within any age group. However if there are no checks and balances on the part of someone consuming it, society within which such an individual find himself or herself, the implications could be very disastrous.
The nutritional imbalances which could either be excessive eating of a particular food or short of it can predispose one to some ailments in infanthood or adulthood. Hence, the need to raise alarm about a food called ’’PUPURU’’ which is one and Infact the major staple food among people of Igbokoda in Ilaje Local government area of Ondo state.
Cassava is one of the staple food with astonishing source of calories to millions of people in tropical areas. Its use as a food source is limited by its low protein content, potential toxicity and perishability among others. Pupuru is a cassava derived food with abundant carbohydrate, very low protein and micro-nutrients. It has a distinctive flavour which confers the difference from the likes of Garri, Fufu and Lafun. It equally has a traditional mode of preparation in rural settings.
This very uncommon food called pupuru is unique to the people of southern coastal part of Ondo state (Ilaje, Ikale, Apoi). Igbokoda, the primary area under study, is a hinterland, about few kilometres to Ode Ireele, where the mysterious death of 23 people occurred last year due to methanol poisoning consumed. Consumption rate is so high that it is a daily routine according to dietary perception in the towns. Public Health Concern About Pupuru
Although the food is an excellent source of energy when consumed, can deliver more than the required glucose needed by the body upon digestion. However burdensome health concerns are too many among of which are:
1. Increasing Prevalence of Diabetes
Mellitus In Ilaje: Descriptive Survey of diagnosed cases at the comprehensive health center level in Igbokoda within a period of 10months, (May 2014-February 2015) is about 110 cases, with females cases higher than males and average diagnosed index case is 2 in a week. Consistent clinical findings of epidemiologist and endocrinologist in this regards include and not limited to the following:
(A) detectable significant glucose in urine in excess of (500mg/dl or 2+) on dipstick urine tests in an healthy adult and children after ‘puppuru’ meal consumption;
(B) high glucose level in blood above acceptable range in acutely ill children of that community (pathological hyperglycemia) with prior exposure to pupuuru meal.
(C) significant high postprandial (after meal) glucose detected in blood and serially observed in patient exposed to the food.
(D) Low glycemic index food (food which has a steady glucose release into the blood upon digestion over period of time) lowers diabetes mellitus and cardiovascular risks.
2) The Many Dangers Associated With Processing of Pupuuru; The risk of extraneous contaminants in the traditional method of preparation which involves smoking of moulded mashed fermented cassava which might have passed through a stage of soaking peeled tubers in artificially dug pit close to flowing rivers in a rural settings as seen in most of the communities. Most of the places visited showed that people were too careless in preparing this food and this poses serious danger to human lives, especially those that consume it.
Contaminants in this case could be microbial or chemical. In the case of microbial, it can arise from organisms in contaminated water used in soaking or washing the peeled cassava tuber which can occur in an oil producing and hinterland town like Igbokoda with no community water system. A risk factor for food poisoning which could be fatal.
The chemical poisoning can occur due to obvious underground and surface water contamination noticeable in this oil producing area.
(3). Cassava Related Epidemic Diseases; This simply means diseases which can arise from consumption of cassava food products (Pupuru), with tendency of the disease outbreak to produce effect across any age group who consumed such. This resulted to different diseases in the past and such diseases includes;
* Acute cyanide intoxication: This is characterised by sudden onset of vertigo, vomiting, collapse and death in some cases within two hours of consumption of inadequately processed cassava foods.
* Epidemic spastic paraparesis: This occurred in Mozambique, an African country where cassava food products account for 80% of their basic diet despite an existing safe standard for cassava consumption. It Manifested with the following symptoms: nausea, vomiting, confusion and sudden paralysis of the lower limbs in women and children following consumption of cassava food products, and attributed to the cyanide level in cassava of which Pupuru is not an exemption.
* Tropical ataxic neuropathy: a neurological disorder which is present with imbalance of gait (ataxia) in an individual with long term consumption of a cassava food products of unsafe cyanide quantity, usually occur in high cassava consumption area. It is infact worsened by lack of protein rich supplementary diets which is the case in Igbokoda.
* Pancreatitis: Chronic low grade exposure to cyanogenic content of cassava food products can cause infections of the pancreas inform of pancreatitis. This Pancreas is an endocrine organ which plays a role in sugar metabolism in the body, only organ that produces insulin critical controller of blood sugar levels in the body can survive it. A possible factor which cannot be overlooked.
* Endemic goitre: this is characterized by enlargement of the thyroid gland and it can occur over time with consumption of poorly processed cassava foods high in cyanide (natural toxins in cassava).Though high thiocynate (breakdown products of cyanide in the body) present in blood is responsible for the thyroid diseases due to interference with iodine uptake by the gland.
* Endemic cretinism: this is another condition characterized by mental retardation and neurologic abnormalities and has been observed to have resulted from thiocynate toxicity, which carries same toxicity risk in a pregnant woman and developing fetus who can suffer congenital mental retardation; A health concern for pediatric neurologist. This is an incident that urgently demanded intervention from Center for diseases control in Nigeria.
All the above mentioned symptoms and the eventual result are just few among public health concern which can occur in Igbokoda owing to the high consumption rate of ‘Pupuru’ with poor processing methods.
To this end, food fortification is very paramount in this regard. According to WHO and Food and Agriculture Organisation (FOA) of United nation; fortification is simply the practice of adding essential micro-nutrients to a food irrespective of whether the nutrients were originally present In the food before processing or not to provide a public health benefit with minimal risk to health. Obviously, there is no fortification being done in this area of high pupuru consumption of Ondo state.
More so, a disease burden will only be reduced in a community like Igbokoda, with identified dietary risk factor to diabetes mellitus menace if it can be addressed, as the observed documented and research findings cannot be overlooked, hence the need for food safety measures needs to be taken. It is therefore incumbent on the government of Ondo state as the major stakeholder in this case to, as a matter of urgent, create a kind of public enlightment for the affected people to know the good and the bad of what they consume.
Futher to this, fortification of food with iodine supplements should be done in all areas of high cassava intake in Ondo state to reduce risk of infantile cretinism in children, as this is a standard food safety measure in a country like Mozambique where cassava constitute 80% of their basic diet.
Also, All areas where cassava food products are being produced and marketed for public consumption must undergo safety check of the Cyanogenic content of the cassava products by food scientist and technologist to prevent cassava related disease outbreak.
“Abuse your stomach, risk having diseases.”
– Dr. Abolude Yusuf is a Medical Practitioner, based in Ondo State. His email address is [email protected]
