Aflatoxin consumption, Health Aflatoxin consumption, Health Effects and HIV: a preliminary Effects and HIV: a preliminary

report of the St. Markus report of the St. Markus Hospital and five regions of Hospital and five regions of

GhanaGhana

Inas K. Mahdi, MPH Candidate Inas K. Mahdi, MPH Candidate University of Alabama-BirminghamUniversity of Alabama-Birmingham

School of Public HealthSchool of Public HealthDepartment of Epidemiology/International HealthDepartment of Epidemiology/International Health

August 9, 2004August 9, 2004

Kumasi Center for Collaborative ResearchKumasi Center for Collaborative Research

Aflatoxin-BackgroundAflatoxin-Background

Aflatoxin is a fungal toxin found on agricultural Aflatoxin is a fungal toxin found on agricultural products such as maize, groundnuts, millet, and products such as maize, groundnuts, millet, and sorghum that have been improperly stored.sorghum that have been improperly stored.

Derived from Aspergillus flavus, which is Derived from Aspergillus flavus, which is contaminating corn and other widely-consumed crops contaminating corn and other widely-consumed crops in West Africa. The fungus produces Aflatoxin which in West Africa. The fungus produces Aflatoxin which penetrates the body through the consumption of penetrates the body through the consumption of grain-based food, or poultry and cattle fed with such grain-based food, or poultry and cattle fed with such food. food.

Aflatoxin- BackgroundAflatoxin- Background According to the World Health Organisation (WHO), the permitted level in According to the World Health Organisation (WHO), the permitted level in

food products of aflatoxin is zero parts per billion (0 ppb) for children, 20 food products of aflatoxin is zero parts per billion (0 ppb) for children, 20 ppb for adults and 55 ppb for animals. ppb for adults and 55 ppb for animals.

Some West African studies show populations consuming 100 ppb per day Some West African studies show populations consuming 100 ppb per day since they were born. since they were born.

The corn seeds are severely damaged in West Africa because they remain The corn seeds are severely damaged in West Africa because they remain too long in the fields where they are attacked by many insects. As a result, too long in the fields where they are attacked by many insects. As a result, they generally have higher levels of Aflatoxin.they generally have higher levels of Aflatoxin.

Improper drying practicesImproper drying practices

Classified as a Group 1 carcinogen- by WHO- enough evidence in naturally Classified as a Group 1 carcinogen- by WHO- enough evidence in naturally occurring Aflatoxin to cause canceroccurring Aflatoxin to cause cancer

Immunosuppressive, mutagenic, and carcinogenicImmunosuppressive, mutagenic, and carcinogenic Combines with HBV to cause increased harm to the liver.Combines with HBV to cause increased harm to the liver.

Aflatoxin Aflatoxin

Aflatoxin is also indirectly absorbed by children through maternal milk. As Aflatoxin is also indirectly absorbed by children through maternal milk. As a result, children’s immune systems are affected. a result, children’s immune systems are affected.

Found in contaminated cereals which are fed to growing children, have Found in contaminated cereals which are fed to growing children, have been found to cause growth stunting in children. ( Benin & Togo studies)been found to cause growth stunting in children. ( Benin & Togo studies)

Combines with HBV to cause increased harm to the liver.Combines with HBV to cause increased harm to the liver. A recent study done in Sudan, a clear dose response relationship was found A recent study done in Sudan, a clear dose response relationship was found

between increased peanut butter consumption and increasing incidence of between increased peanut butter consumption and increasing incidence of hepatocellulararcinoma in individuals hepatocellulararcinoma in individuals withoutwithout HBV infection ( Omer, RE. et HBV infection ( Omer, RE. et al., 2004)al., 2004)

Omer found that of the cases demonstrated in the study, 27-60% of all Omer found that of the cases demonstrated in the study, 27-60% of all cases can be attributed to Aflatoxin exposure and 49-52% to HBV infection. cases can be attributed to Aflatoxin exposure and 49-52% to HBV infection.

Hepatitis B Prevalence 15% Hepatitis B Prevalence 15%

HIV- Ashanti RegionHIV- Ashanti RegionBackgroundBackground

HIV prevalence in Ashanti Region estimated at 5 %.HIV prevalence in Ashanti Region estimated at 5 %. St. Markus sees a total of 350 patientsSt. Markus sees a total of 350 patients 68 of those patients are on ARV therapy.68 of those patients are on ARV therapy. Interactive effects of HIV and Aflatoxin are yet to be Interactive effects of HIV and Aflatoxin are yet to be

thoroughly documented.thoroughly documented. Aflatoxin suppresses the immune system which in addition Aflatoxin suppresses the immune system which in addition

to HIV further exposes the body to opportunistic infections. to HIV further exposes the body to opportunistic infections. Likelihood of liver cancer is increased with increased Likelihood of liver cancer is increased with increased

regular intake of Aflatoxin and Hepatitis B. regular intake of Aflatoxin and Hepatitis B. Exacerbates the current effects of HIV and can be argued Exacerbates the current effects of HIV and can be argued

that it leads to a faster progression to AIDS decreased that it leads to a faster progression to AIDS decreased quality of life of those infected.quality of life of those infected.

Our objectives were to (1) Examine current immune status Our objectives were to (1) Examine current immune status of patients and opportunistic infections they present with of patients and opportunistic infections they present with and (2) Assess the correlation between immune status and and (2) Assess the correlation between immune status and AF levels.AF levels.

St. MarkusSt. Markus 91 new patients were recruited 91 new patients were recruited

and interviewed.and interviewed. Questionnaires included questions Questionnaires included questions

on the basic symptomolgy of on the basic symptomolgy of Aflatoxin ingestion and questions Aflatoxin ingestion and questions related to contaminated food related to contaminated food products.products.

Most participants cited (85/91, Most participants cited (85/91, 93%) said they could identify 93%) said they could identify spoilage in food items.spoilage in food items.

Of those who said they discarded Of those who said they discarded food, some cited feeding the food, some cited feeding the spoiled grains and food to spoiled grains and food to animals.animals.

Symptoms of Hepatitis or Symptoms of Hepatitis or Aflatoxin ingestion-Aflatoxin ingestion-

jaundice, nausea, vomiting, jaundice, nausea, vomiting, fever, stomach or joint painfever, stomach or joint pain

Further analysis of blood and Further analysis of blood and urine samples will possibly show urine samples will possibly show linkages between consumption of linkages between consumption of Aflatoxin and it’s effects on HIV.Aflatoxin and it’s effects on HIV.

Aflatoxin Consumption in Five Aflatoxin Consumption in Five Regions of GhanaRegions of Ghana

Regions Selected & #’s sampledRegions Selected & #’s sampled

Northern-130 samplesNorthern-130 samples Brong Ahafo-140 Brong Ahafo-140

samplessamples Ashanti-390 samplesAshanti-390 samples Central-540 samplesCentral-540 samples Greater Accra-140 Greater Accra-140

samplessamples Total-1340 samplesTotal-1340 samples

Aflatoxin consumptionAflatoxin consumption

June- August 2004June- August 2004 Total of 1300 sampledTotal of 1300 sampled Personal interviews-?’s related to individual health status, Personal interviews-?’s related to individual health status,

family, storage methods, and disposal of spoiled foodsfamily, storage methods, and disposal of spoiled foods Urine samples collectedUrine samples collected Groundnuts, corn, clay also collectedGroundnuts, corn, clay also collected

ObjectivesObjectives

Determine the levels of consumption of Determine the levels of consumption of groundnuts and maize in five regionsgroundnuts and maize in five regions

Determine the levels of Aflatoxin in stored and Determine the levels of Aflatoxin in stored and consumed groundnuts and maize at the consumed groundnuts and maize at the household level in Ghana.household level in Ghana.

Evaluate the levels of Aflatoxin in the urine of Evaluate the levels of Aflatoxin in the urine of

study participantsstudy participants..

Methodology-summarizedMethodology-summarized

Personal survey and collection and testing Personal survey and collection and testing of groundnut, maize, and urine samplesof groundnut, maize, and urine samples

Market sampling- each region collects 3 Market sampling- each region collects 3 samples of corn and groundnuts from at samples of corn and groundnuts from at least 5 different markets.least 5 different markets.

ConclusionsConclusions

Analyses will be conducted to Analyses will be conducted to determine the exact concentrations determine the exact concentrations of Aflatoxin at the household level in of Aflatoxin at the household level in Ghana. Ghana.

Bio-agriculturists anticipate Bio-agriculturists anticipate developing edible products that will developing edible products that will work to bind AF’s harmful effects on work to bind AF’s harmful effects on the body.the body.

ReferencesReferences 1. 1. http://www.saafost.org.za/dutton.htmlhttp://www.saafost.org.za/dutton.html 2. Prevalence of Blood-Borne Infectious Diseases in Blood Donors in Ghana 2. Prevalence of Blood-Borne Infectious Diseases in Blood Donors in Ghana William Ampofo,1William Ampofo,1 Nicholas Nii-Trebi,1 Justina Ansah,2 Kenji Abe,3 Hideo Naito,3 Simeon Nicholas Nii-Trebi,1 Justina Ansah,2 Kenji Abe,3 Hideo Naito,3 Simeon

Aidoo,1 Victor Nuvor,1 James Brandful,1 Naoki Yamamoto,4 David Ofori-Adjei,1 and Aidoo,1 Victor Nuvor,1 James Brandful,1 Naoki Yamamoto,4 David Ofori-Adjei,1 and Koichi Ishikawa3 Koichi Ishikawa3

3. Nutr Cancer. 2004 Jan;48(1):15-21. 3. Nutr Cancer. 2004 Jan;48(1):15-21. LinksLinks Population-Attributable Risk of Dietary Population-Attributable Risk of Dietary Respect to Aflatoxins and Hepatitis B Virus Infection with Hepatocellular Respect to Aflatoxins and Hepatitis B Virus Infection with Hepatocellular Carcinoma. Omer RE, Kuijsten A, Kadaru AM, Kok FJ, Idris MO, El Khidir IM, Carcinoma. Omer RE, Kuijsten A, Kadaru AM, Kok FJ, Idris MO, El Khidir IM, Van 't Veer P.Van 't Veer P.