© 2014

INFLUENCE OF DIETARY AFLATOXIN CONTAMINATION

ON AFLATOXIN LEVELS IN BREAST MILK AMONG

LACTATING MOTHERS IN KIKUMBULYU LOCATION,

KIBWEZI DISTRICT OF MAKUENI COUNTY

PRESENTER:OTIENO ISAAC OGALLO

REG:A56/83054/2012

SUPERVISORS: DR.ALICE M. MWANGI

MR.P.LAMUKA

PROF.G.CHEMININGWA

INTRODUCTIONAflatoxins is of fungal origin (mycotoxins).Geographic, climatic, agricultural and susceptibility of food commodities.Passed to body tissues and fluids eg breast milk, urine and blood.Dietary exposure of lactating mothers also puts breast feeding infants at equal risk of aflatoxin exposure.Severe outbreaks have been reported in eastern region of Kenya, hence selected study area.

PROBLEM STATEMENTEastern region of Kenya prone to aflatoxin contamination.Makueni County reported the highest and severest incidences of contamination in maize, Kenya’s main stapleKilonzi, 2011 found the following in Kibwezi:

*Recommended limit = 10µg/kgLittle still known on aflatoxin contamination in human breast milk in Kenya. And the influence of these high levels of dietary contamination on the levels in human breastmilk is not clearHence dietary maternal to child aflatoxin exposure through breast milk could be an under-evaluated risk factor in Kenya.

Food Item Aflatoxin Contamination

% of Samples Levels* (ng/kg)

Maize kernels 45 18000 - 480000

Muthokoi 20 12000-123000

Maize 30 6000–30000

JUSTIFICATIONRecurrent incidences of aflatoxin contamination, outbreaks of aflatoxicosis in Eastern region of Kenya.

There is severe toxicity even when taken at lower levels both in diet and milk.

As a consequence, deleterious health effect such as carcinoma, hemorrhage, stunting, and immune-suppression has been reported in children.

Hence the need to carry out the study.

Aim of the studyTo contribute towards improvement of food

safety as well as maternal and infant and young child health during the lactation period.

Purpose of the studyTo generate information on the current situation

on the levels of aflatoxins in food and breast milk among lactating mothers from Makueni County as a basis for emphasizing the constant need of monitoring aflatoxin occurrence in at risk regions.

Main objectiveTo determine the influence of dietary aflatoxin

contamination on aflatoxin levels in breast milk among lactating mothers in Kkumbulyu Location, Kibwezi District of Makueni County.

SPECIFIC OBJECTIVES1.To describe the demographic and socio-economic

status of the lactating mothers in the study.2.To determine the food consumption patterns and

dietary diversity of the lactating mothers in the study.

3.To determine the breast feeding practices of the breast fed children between 0 to 6 months

Cont’d4.To determine the levels and types of

aflatoxins in foods susceptible to aflatoxin contamination and are mostly consumed by the lactating mothers in the study.

5.To determine the types and levels of aflatoxins in the breast milk of lactating mothers, and in the urine of the breast fed children between 0-6 months in the study.

No significant association;Socio-demographic characteristics of the

lactating mothers and the levels of aflatoxin in the breast milk.

Food consumption pattern and dietary diversity of the lactating mothers and the levels of aflatoxin in the breast milk and urine of breastfeeding children.

Levels of aflatoxin among foods that are susceptible to aflatoxin contamination.

Study Hypotheses

LITERATURE REVIEW1. General overview of aflatoxins2. Types, Structures and Properties of

Aflatoxins3. Factors Promoting Aflatoxin Occurrence in

the World4. Incidences of Aflatoxin Outbreak5. Global Occurrence6. Aflatoxin Occurrence in Kenya7. Food, Dietary Diversity and Aflatoxin8. Aflatoxin in Human Breast Milk9. Maximum Set Levels for Aflatoxins10.Nutritional and Health Consequences

Related to Aflatoxin Contamination

METHODOLOGYStudy SettingKikumbulyu Location, Kibwezi District, Makueni County.

Makueni County is located in Eastern region of Kenya and covers an area of 8008.9 sq Km

Study DesignA descriptive and analytical cross-sectional study.

Study Population Lactating mothers and breastfeeding children

below 6 months old

Sample size Fischer et al.(1992) formula N=Zpq⁄d

where; Z=1.96, p= 50.0%, d=5%where; Z=1.96, p= 50.0%, d=5%

=384 =384 + 4 % attrition rateN=399≈400 200 paired lactating mothers and

breastfeeding children below 6 months of age

Sampling Procedure: Multistage

Purposive Sampling

Purposive Sampling

Purposive Sampling

Random Sampling

Random Sampling

MAKUENI COUNTY

KIBWEZI DISTRICT

KIBWEZI DIVISION

KIKUMBULYU LOCATION

KATHYAKA

SUB-LOCATION

NDETANI

SUB-LOCATION

NGANDANI

SUB-LOCATION

MIKUYUNI

SUB-LOCATION

5

VILLAGES

5

VILLAGES

5

VILLAGES 5

VILLAGES

10 HH

LACTATING

MOTHERS

10 HH

LACTATING

MOTHERS

10 HH

LACTATING

MOTHERS

10 HH

LACTATING

MOTHERS

10 HH

LACTATING

MOTHERS

Inclusion CriteriaAvailable and willing lactating mothers with

children between 0-6 months

Exclusion Criteria Lactating mothers with disease of the breast

or with breast complications such as breast pain, breast engorgement, nipple pain, milk stasis, mastitis and an overactive let down

Eligible but unavailable and/or unwilling mothers

Data Collection Tools and EquipmentThe main study tool used was a semi-

structured questionnaire Equipment for aflatoxin analysis ;MaxSignal ® ELISA kit High Performance Liquid Chromatography

(HPLC).

Data CollectionRecruitment and training of research

assistantsPretesting of the data collection tools and

equipment

Data Collection Procedure Demographic and socio-economic statusSemi-structured pretested questionnaire

administered to 200 lactating mother. This was done through interview.

Dietary diversity, food consumption patterns, consumption levels and breast feeding practices

Semi-quantitative food frequency questionnaires administered.

24 hour Dietary Diversity for the lactating mothers was also done.

Sample collectionFood samplesPurposive sampling .Foods susceptible to aflatoxin contamination

(maize ugali, githeri, muthokoi and maize porridge) collected.

Available during data collection were collected.

A total of 400 food samples were collected.

Cont’d-Sample collectionBreast milk samples100 Breast milk samples . Hand expressed 10ml of breast milk.Urine samples 100 Urine samples collected from breast feeding

children between 0-6 months belonging to mothers’ whose breast milk samples were collected.

Mainstream urine, wet their under wrappings (napkins or clothing).

wrung the under-wrappings, let the urine drip into plastic urine containers

.

Data Management and AnalysisData Quality AssuranceData quality assurance across all the stages

of study Adequate training of field assistants

(community health workers)Pretesting of data collection tools and

standardizing data collection procedures. Close supervision of field assistants. Contamination was minimized during sample

and specimen collection by using sterilized gloves and air tight cryovial tubes.

Strict hygiene observed during specimen collection

Statistical Analyses Data entry into SPSS version 20 is still on

progress.Objective 1: Socio-demographic

characteristics of the lactating mothersDescriptive statistical analyses will be done.ANOVAChi-squareRegression test (inference statistical analysis)

Objective 2/3: Food consumption patterns and dietary diversity of the lactating mothers, and breast feeding practices of children between 0-6 months in the study

Descriptive statistical analyses.Multiple –ANOVA .Regression analysis .

Objective 4: Types and levels of aflatoxin in foods that are mostly consumed and are likely to be contaminated with aflatoxin among lactating mothers in the study.

Descriptive analysis.ANOVA. One sample t-test/one way ANOVA. Multiple correlations between food and

corresponding aflatoxin levels.

Objective 5:Types and levels of aflatoxins in breast milk of lactating mothers and urine of breastfeeding children below 6 months of age.

Descriptive statistical analysis.ANOVA. One sample t-test/one way ANOVA. Correlations.

Generate a predictor model of aflatoxin levels in breast milk from independent variables which significantly contribute to the influence of aflatoxin in breast milk.

Thank You