Aflatoxin consumption, Health Effects and HIV: a preliminary report of the St. Markus Hospital and f

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Aflatoxin consumption, Health Effects and HIV a
preliminary report of the St. Markus Hospital and
five regions of Ghana

• Inas K. Mahdi, MPH Candidate
• University of Alabama-Birmingham
• School of Public Health
• Department of Epidemiology/International Health
• August 9, 2004
• Kumasi Center for Collaborative Research

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Aflatoxin-Background

• Aflatoxin is a fungal toxin found on agricultural
  products such as maize, groundnuts, millet, and
  sorghum that have been improperly stored.
• Derived from Aspergillus flavus, which is
  contaminating corn and other widely-consumed
  crops in West Africa. The fungus produces
  Aflatoxin which penetrates the body through the
  consumption of grain-based food, or poultry and
  cattle fed with such food.

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Aflatoxin- Background

• 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 ppb for adults and 55 ppb for animals.
• Some West African studies show populations
  consuming 100 ppb per day since they were born.
• 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, they generally have higher levels of
  Aflatoxin.
• Improper drying practices
• Classified as a Group 1 carcinogen- by WHO-
  enough evidence in naturally occurring Aflatoxin
  to cause cancer
• Immunosuppressive, mutagenic, and carcinogenic
• Combines with HBV to cause increased harm to the
  liver.

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Aflatoxin

• Aflatoxin is also indirectly absorbed by children
  through maternal milk. As a result, childrens
  immune systems are affected.
• Found in contaminated cereals which are fed to
  growing children, have been found to cause growth
  stunting in children. ( Benin Togo studies)
• Combines with HBV to cause increased harm to the
  liver.
• A recent study done in Sudan, a clear dose
  response relationship was found between increased
  peanut butter consumption and increasing
  incidence of hepatocellulararcinoma in
  individuals without HBV infection ( Omer, RE. et
  al., 2004)
• 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.

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Hepatitis B Prevalence 15
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HIV- Ashanti RegionBackground

• HIV prevalence in Ashanti Region estimated at 5
  .
• St. Markus sees a total of 350 patients
• 68 of those patients are on ARV therapy.
• Interactive effects of HIV and Aflatoxin are yet
  to be thoroughly documented.
• Aflatoxin suppresses the immune system which in
  addition to HIV further exposes the body to
  opportunistic infections.
• Likelihood of liver cancer is increased with
  increased regular intake of Aflatoxin and
  Hepatitis B.
• Exacerbates the current effects of HIV and can be
  argued that it leads to a faster progression to
  AIDS decreased quality of life of those infected.
• Our objectives were to (1) Examine current immune
  status of patients and opportunistic infections
  they present with and (2) Assess the correlation
  between immune status and AF levels.

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St. Markus

• 91 new patients were recruited and interviewed.
• Questionnaires included questions on the basic
  symptomolgy of Aflatoxin ingestion and questions
  related to contaminated food products.
• Most participants cited (85/91, 93) said they
  could identify spoilage in food items.
• Of those who said they discarded food, some cited
  feeding the spoiled grains and food to animals.
• Symptoms of Hepatitis or Aflatoxin ingestion-
• jaundice, nausea, vomiting, fever, stomach
  or joint pain
• Further analysis of blood and urine samples will
  possibly show linkages between consumption of
  Aflatoxin and its effects on HIV.

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Aflatoxin Consumption in Five Regions of Ghana
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Regions Selected s sampled

• Northern-130 samples
• Brong Ahafo-140 samples
• Ashanti-390 samples
• Central-540 samples
• Greater Accra-140 samples
• Total-1340 samples

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Aflatoxin consumption

• June- August 2004
• Total of 1300 sampled
• Personal interviews-?s related to individual
  health status, family, storage methods, and
  disposal of spoiled foods
• Urine samples collected
• Groundnuts, corn, clay also collected

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Objectives

• Determine the levels of consumption of groundnuts
  and maize in five regions
• Determine the levels of Aflatoxin in stored and
  consumed groundnuts and maize at the household
  level in Ghana.
• Evaluate the levels of Aflatoxin in the urine of
  study participants.

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Methodology-summarized

• Personal survey and collection and testing of
  groundnut, maize, and urine samples
• Market sampling- each region collects 3 samples
  of corn and groundnuts from at least 5 different
  markets.

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Conclusions

• Analyses will be conducted to determine the exact
  concentrations of Aflatoxin at the household
  level in Ghana.
• Bio-agriculturists anticipate developing edible
  products that will work to bind AFs harmful
  effects on the body.

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References

• 1. http//www.saafost.org.za/dutton.html
• 2. Prevalence of Blood-Borne Infectious Diseases
  in Blood Donors in Ghana
• William Ampofo,1 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 Koichi Ishikawa3
• 3. Nutr Cancer. 2004 Jan48(1)15-21. Links
  Population-Attributable Risk of Dietary Respect
  to Aflatoxins and Hepatitis B Virus Infection
  with Hepatocellular Carcinoma. Omer RE, Kuijsten
  A, Kadaru AM, Kok FJ, Idris MO, El Khidir IM, Van
  't Veer P.