Level of exposure to aflatoxins during pregnancy and its association with adverse birth outcomes in Africa: a meta-analysis

BACKGROUND

Aflatoxins are various poisonous carcinogens and mutagens produced by Aspergillus species. Exposure to aflatoxins during pregnancy results in adverse birth outcomes. This meta-analysis was carried out to determine the estimates of how much aflatoxin is harmful to the pregnancy and its outcome, including birthweight, birth length, low birthweight (LBW), small for gestational age (SGA), stunting, poverty, food insecurity, income, pesticides and stillbirth, in an African context.

METHODS

Both published and unpublished studies in Africa were searched on MEDLINE, PubMed, Embase, SCOPUS, Web of Science and Google Scholar. Stata version 18.2 software was used for cleaning and analysis. The prevalence with a 95% confidence interval (CI) was estimated using the random effects model and a forest plot was used to present the findings. In addition, the heterogeneity of the study was assessed using Cochrane I2 statistics and publication bias was assessed using Egger's intercept and funnel plot.

RESULTS

This review included 28 studies with a total of 6283 pregnant women and newborns. The analysis showed the overall level of exposure to aflatoxins was 64% (95% CI 48 to 78, τ2=0.66, I2=99.34%, p=0.001). In the subgroup analysis by publication year, the highest level of exposure to aflatoxins (82% [95% CI 69 to 92]) was observed among studies published from 2020 to 2023. This study also found that exposure to aflatoxins during pregnancy had an association with prematurity, LBW, SGA and stillbirth.

CONCLUSIONS

The data analysed in this study indicated that three of every five pregnant women had exposure to aflatoxins in Africa. Moreover, pregnant women exposed to aflatoxins had a higher likelihood of having a LBW and SGA newborn. Thus governments and all stakeholders should initiate policies that mitigate the toxicity of aflatoxins in pregnant women, foetuses and newborns.

Deposition, Dietary Exposure and Human Health Risks of Heavy Metals in Mechanically Milled Maize Flours in Mbarara City, Uganda

Consumption of maize and maize-based products contributes a significant percentage to the total food energy intake in Uganda. However, the production of maize-derived foodstuffs is performed traditionally or by small- and medium-scale processors using different processing techniques. This can lead to differences in the quality of these products from processors, raising food safety concerns. In this study, the effects of mechanical processing (milling) methods on deposition of heavy metals into milled maize flour and the associated consumption health risks were assessed. Atomic absorption spectrophotometry was used to quantitatively establish the concentration of iron (Fe), manganese (Mn), zinc (Zn), cadmium (Cd), lead (Pb), chromium (Cr), copper (Cu), cobalt (Co) and nickel (Ni) in 100 samples of maize milled using a wooden mortar (n = 2), a metallic mortar (n = 2), diesel engine-powered mills (n = 48) and electric motor-powered mills (n = 48). Results showed that the mean concentrations of heavy metals in mg/kg were Fe (11.60-34.45), Cu (0.50-8.10), Ni (0.50-1.60), Mn (0.70-25.40), Zn (4.40-15.90), Pb (0.53-10.20), Cd (0.51-0.85), Cr (0.50-1.53) and Co (0.50-1.51). The highest concentrations were found in flour milled using a traditional metallic mortar while the lowest levels were in those samples milled using a wooden mortar. The Fe, Pb and Cd contents of flours produced using the metallic mortar and some commercial mills was found to be higher than the permissible limits set by WHO/FAO. Human health risk assessment showed that there are potential carcinogenic health risks from adults' intake of heavy metals in maize flour milled using a metallic mortar. Therefore, processing of maize flour needs to be monitored by the relevant statutory bodies in Uganda to minimize the possibility of heavy metal contamination of food products and animal feeds.

Mycosorb A+® como adsorbente de micotoxinas en la dieta sobre la salud y la producción en cuyes

Los alimentos destinados a los animales están contaminados por hongos filamentosos que producen micotoxinas. El estudio tuvo como objetivo evaluar el efecto de Mycosorb A+® como adsorbente de micotoxinas en la dieta sobre la salud, producción y beneficio económico de cuyes en crianza comercial. Se utilizaron 80 cuyes en crecimiento de la raza Perú, entre machos y hembras, con un peso de 435,5 ± 35,5 gramos (g), distribuidos al azar en dos grupos de alimentación: dieta con Mycosorb A+® (experimental) y dieta sin Mycosorb A+® (control), realizado en el distrito de Ilabaya-Tacna, Perú, a 1.425 metros de altitud, durante 57 días. La dieta se elaboró con heno molido de alfalfa, maíz amarillo, afrecho de trigo, torta de soya, harina integral de soya y fuentes de minerales y vitaminas, ofrecida para consumo ad libitum, más 12,5 g·día-1 de alfalfa fresca (H° 78 %) por cuy. Los resultados indican que todas las variables evaluadas, excepto el consumo de materia seca, fueron significativas (P<0,05): morbilidad 2,5 vs. 35,0 %; consumo de materia seca, 59,8 ± 2,1 vs. 58,0 ± 2,4 g·día-1; ganancia de peso vivo, 9,7 ± 1,4 vs. 7,8 ± 0,9 g·día-1; conversión alimenticia, 6,3 ± 0,9 vs. 7,5 ± 0,6; y relación beneficio-costo, 1,52 vs. 1,35, respectivamente. Se concluye que la inclusión de Mycosorb A+® como adsorbente de micotoxinas en la dieta tiene efecto positivo en la salud, producción y beneficio económico en la crianza comercial de cuyes.

Dietary aflatoxin exposure of lactating mothers of children 0-6 months in Makueni County, Kenya

The southeastern region of Kenya is prone to aflatoxin outbreaks, yet maternal and infant aflatoxin intake levels remain unclear. We determined dietary aflatoxin exposure of 170 lactating mothers breastfeeding children aged 6 months and below in a descriptive cross-sectional study involving aflatoxin analysis of maize-based cooked food samples (n = 48). Their socioeconomic characteristics, food consumption patterns and postharvest handling of maize were determined. Aflatoxins were determined using high-performance liquid chromatography and enzyme-linked immunosorbent assay. Statistical analysis was conducted using Statistical Package Software for Social Sciences (SPSS version 27) and Palisade's @Risk software. About 46% of the mothers were from low-income households, and 48.2% had not attained the basic level of education. A generally low dietary diversity was reported among 54.1% of lactating mothers. Food consumption pattern was skewed towards starchy staples. Approximately 50% never treated their maize, and at least 20% stored their maize in containers that promote aflatoxin contamination. Aflatoxin was detected in 85.4% of food samples. The mean of total aflatoxin was 97.8 μg/kg (standard deviation [SD], 57.7), while aflatoxin B1 was 9.0 μg/kg (SD, 7.7). The mean dietary intake of total aflatoxin and aflatoxin B1 was 7.6 μg/kg/b.w.t/day (SD, 7.5) and 0.6 (SD, 0.6), respectively. Dietary aflatoxin exposure of lactating mothers was high (margin of exposure < 10,000). Sociodemographic characteristics, food consumption patterns and postharvest handling of maize variably influenced dietary aflatoxin exposure of the mothers. The high prevalence and presence of aflatoxin in foods of lactating mothers are a public health concern and calls for the need to devise easy-to-use household food safety and monitoring measures in the study area.

Evaluation of Agronomic Characteristics, Disease Incidence, Yield Performance, and Aflatoxin Accumulation among Six Peanut Varieties (Arachis hypogea L.) Grown in Kenya

Diseases contribute to attainment of less than 50% of the local groundnut potential yield in Kenya. This study aimed to evaluate the agronomic characteristics (flowering and germination), disease incidence, yield performance (biomass, harvest index, 100-pod, 100-seed, and total pod weight), and aflatoxin accumulation in six peanut varieties. A field experiment was conducted using four newly improved peanut varieties: CG9, CG7, CG12, and ICGV-SM 90704 (Nsinjiro), and two locally used varieties: Homabay local (control) and 12991, and in a randomized complete block design with three replications. The disease identification followed the International Crop Research Institute for the Semi-Arid Tropics (ICRISAT) rating scale and further isolation of fungal contaminants was conducted by a direct plating technique using potato dextrose agar. The aflatoxin levels in the peanuts were determined after harvesting using the ultrahigh performance liquid chromatography and fluorescence detection (UHPLC-FLD) technique. ICGV-SM 90704 showed the least average disease incidence of 1.31 ± 1.75%, (P < 0.05); the lowest total aflatoxin levels (1.82 ± 1.41 μg kg-1) with a range 0.00-0.85 μg kg-1 for total aflatoxins and a range 0.00-1.24 μg kg-1 for Aflatoxin B1. The locally used varieties (12991 and the control) revealed the highest disease incidence (5.41 ± 8.31% and 7.41 ± 1.88%), respectively. ICGV-SM 90704 was the best performing among all the six varieties with an average total pod weight (9.22 ± 1.19 kg), 100-pod weight (262.93 ± 10.8 g), and biomass of (27.21 ± 5.05 kg) per row. The 12991 variety and the control showed the least total pod weight (1.60 ± 0.28 and 1.50 ± 1.11 kg, respectively) (P = 0.0001). The newly improved varieties showed lower disease rates, low levels of aflatoxins, and higher yields than the locally used varieties.

May phytophenolics alleviate aflatoxins-induced health challenges? A holistic insight on current landscape and future prospects

The future GCC-connected environmental risk factors expedited the progression of nCDs. Indeed, the emergence of AFs is becoming a global food security concern. AFs are lethal carcinogenic mycotoxins, causing damage to the liver, kidney, and gastrointestinal organs. Long-term exposure to AFs leads to liver cancer. Almost a variety of food commodities, crops, spices, herbaceous materials, nuts, and processed foods can be contaminated with AFs. In this regard, the primary sections of this review aim to cover influencing factors in the occurrence of AFs, the role of AFs in progression of nCDs, links between GCC/nCDs and exposure to AFs, frequency of AFs-based academic investigations, and world distribution of AFs. Next, the current trends in the application of PPs to alleviate AFs toxicity are discussed. Nearly, more than 20,000 published records indexed in scientific databases have been screened to find recent trends on AFs and application of PPs in AFs therapy. Accordingly, shifts in world climate, improper infrastructures for production/storage of food commodities, inconsistency of global polices on AFs permissible concentration in food/feed, and lack of the public awareness are accounting for a considerable proportion of AFs damages. AFs exhibited their toxic effects by triggering the progression of inflammation and oxidative/nitrosative stress, in turn, leading to the onset of nCDs. PPs could decrease AFs-associated oxidative stress, genotoxic, mutagenic, and carcinogenic effects by improving cellular antioxidant balance, regulation of signaling pathways, alleviating inflammatory responses, and modification of gene expression profile in a dose/time-reliant fashion. The administration of PPs alone displayed lower biological properties compared to co-treatment of these metabolites with AFs. This issue might highlight the therapeutic application of PPs than their preventative content. Flavonoids such as quercetin and oxidized tea phenolics, curcumin and resveratrol were the most studied anti-AFs PPs. Our literature review clearly disclosed that considering PPs in antioxidant therapies to alleviate complications of AFs requires improvement in their bioavailability, pharmacokinetics, tissue clearance, and off-target mode of action. Due to the emergencies in the elimination of AFs in food/feedstuffs, further large-scale clinical assessment of PPs to decrease the consequences of AFs is highly required.

Aflatoxins in Cereals and Cereal-Based Products: Occurrence, Toxicity, Impact on Human Health, and Their Detoxification and Management Strategies

Cereals and cereal-based products are primary sources of nutrition across the world. However, contamination of these foods with aflatoxins (AFs), secondary metabolites produced by several fungal species, has raised serious concerns. AF generation in innate substrates is influenced by several parameters, including the substrate type, fungus species, moisture content, minerals, humidity, temperature, and physical injury to the kernels. Consumption of AF-contaminated cereals and cereal-based products can lead to both acute and chronic health issues related to physical and mental maturity, reproduction, and the nervous system. Therefore, the precise detection methods, detoxification, and management strategies of AFs in cereal and cereal-based products are crucial for food safety as well as consumer health. Hence, this review provides a brief overview of the occurrence, chemical characteristics, biosynthetic processes, health hazards, and detection techniques of AFs, along with a focus on detoxification and management strategies that could be implemented for food safety and security.

Drivers of Post-Harvest Aflatoxin Contamination: Evidence Gathered from Knowledge Disparities and Field Surveys of Maize Farmers in the Rift Valley Region of Kenya

Maize-dependent populations in sub-Saharan Africa are continually exposed to aflatoxin poisoning owing to their regular consumption of this dietetic cereal. Being a staple in Kenyan households, consumption of maize-based meals is done almost daily, thereby exposing consumers to aflatoxicoses. This study assessed awareness levels, knowledge disparities, and perceptions regarding aflatoxin contamination at the post-harvest phase among farmers in the Rift Valley Region of Kenya. Households were randomly selected using a geographical positioning system (GPS) overlay of the agro-ecological zones within Uasin Gishu and Elgeyo Marakwet counties. Face-to-face interviews were conducted in 212 smallholder and large-scale farms. The study documented the demographic profiles of farmers and knowledge, awareness, and perceptions of aflatoxin contamination using a pre-designed structured questionnaire. Most farmers were familiar with aflatoxins and the adverse effects they present to health (61.32%). Almost all the farmers (94.37%) were aware of storage molds and food-spoilage fungi. However, few farmers adopted good post-harvest practices (PHPs), such as avoiding premature harvests (49.8%), using well-ventilated storage spaces (44.6%), grain sorting (30.5%), proper drying of maize (17.8%), and using hermetic bags for storage (30.5%). Conclusively, intensified farmer education is required to train farmers on good PHPs to protect their maize from aflatoxigenic fungi and aflatoxin accumulation.

Mycotoxin Regulatory Status in Africa: A Decade of Weak Institutional Efforts

Food safety problems are a major hindrance to achieving food security, trade, and healthy living in Africa. Fungi and their secondary metabolites, known as mycotoxins, represent an important concern in this regard. Attempts such as agricultural, storage, and processing practices, and creation of awareness to tackle the menace of fungi and mycotoxins have yielded measurable outcomes especially in developed countries, where there are comprehensive mycotoxin legislations and enforcement schemes. Conversely, most African countries do not have mycotoxin regulatory limits and even when available, are only applied for international trade. Factors such as food insecurity, public ignorance, climate change, poor infrastructure, poor research funding, incorrect prioritization of resources, and nonchalant attitudes that exist among governmental organisations and other stakeholders further complicate the situation. In the present review, we discuss the status of mycotoxin regulation in Africa, with emphasis on the impact of weak mycotoxin legislations and enforcement on African trade, agriculture, and health. Furthermore, we discuss the factors limiting the establishment and control of mycotoxins in the region.

Soil and human health: Understanding agricultural and socio-environmental risk and resilience in the age of climate change

Prolonged monocropping of commodity crops, such as peanuts (Arachis hypogea L.) in West Africa, typically strips nutrients from soils and may exacerbate vulnerability to insects and diseases. In this paper, we focus on aflatoxins, toxic chemicals produced by certain molds growing on moist crops, as one risk of growing importance for its negative impacts on human health, crop yields, and agricultural livelihoods and ecosystems. We link the increased prevalence of this deadly fungus to the long history of peanut monoculture, exacerbated by market liberalization and China's increased investment and export demand for peanuts, climate change, food insecurity, as well as disregard for and displacement of traditional agricultural knowledge. We use a political ecology approach to place the public health threat from aflatoxin in the context of both historical pressures for cash-crop production of peanuts and contemporary soil degradation, food insecurity, climate change precarity and changes within social and economic systems of agriculture in Senegal.

Kualitas Kimia dan Profil Serat Bekatul Gandum dengan Kadar Air dan Lama Pemanasan Berbeda

Bekatul gandum (wheat pollard) merupakan hasil samping industri pengolahan gandum yang makin banyak digunakan untuk bahan makanan dan kualitasnya sangat tergantung pada kadar air dan lama pemanasan. Penelitian bertujuan mengkaji pengaruh kadar air dan lama pemanasan yang berbeda terhadap kualitas kimia dan profil serat bekatul gandum. Penelitian menggunakan Rancangan Acak Lengkap faktorial 3 × 2 dengan 3 ulangan. Faktor pertama adalah kadar air 12, 30, dan 60%.  Faktor kedua adalah lama pemanasan 15 dan 30 menit. Kandungan kimia berupa kadar air, abu, lemak kasar, protein kasar, serat kasar, bahan ekstrak tanpa nitrogen (BETN) dan gross energy dianalisis dalam penelitian ini. Demikian juga profil serat (kadar Acid Detergent Fiber (ADF), Neutral Detergent Fiber (NDF), hemiselulosa, selulosa dan lignin.) serta profil serat melalui Scanning Electron Microscope-Energy Dispersive X-Ray (SEM-EDX). Hasil penelitian menunjukkan bahwa tidak ada pengaruh perlakuan kadar air dan pemanasan terhadap kandungan kimia, profil serat bekatul gandum dan profil serat melalui SEM-EDX. Kesimpulan penelitian adalah kadar air dan lama pemanasan tidak menentukan kualitas kimia dan profil serat pada bekatul gandum.Chemical Quality and Fiber Profile Wheat Pollard with Different Water Content and Steaming Durration AbstractWheat bran has known as by product of wheat production which is recently used as food ingredient and its quality could be rely on the water content and heat temperature. The aim of the study was to examine the effect of water content and steaming durration on the chemical quality and fiber profile of wheat bran. The study used a factorial 3 × 2 Completely Randomized Design with 3 replications. The first factor was the water content of 12, 30, and 60%. The second factor was the heating time of 15 and 30 minutes. Moisture content, ash, crude fat, crude protein, crude fiber, nitrogen-free extract material (NFE) and gross energy), fiber profile (Acid Detergent Fiber (ADF) content, Neutral Detergent Fiber (NDF), hemicellulose, cellulose, and lignin.) were analyzed as well as fiber profiles through Scanning Electron Microscope-Energy Dispersive X-Ray (SEM-EDX). The results showed that no remarkable effect of treatment was detected on chemical content, wheat bran fiber profile and fiber profile through SEM-EDX. As conclusion, the water content and heating time did not affect the chemical quality and fiber profile of wheat bran.

Prevalence of Aspergillus-Derived Mycotoxins (Ochratoxin, Aflatoxin, and Gliotoxin) and Their Distribution in the Urinalysis of ME/CFS Patients

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a known complex, multi-organ system disorder with a sudden or subacute onset. ME/CFS occurs most commonly among women between 30 and 50 years of age. The current diagnostic criteria of ME/CFS, as defined by the Centers for Disease Control and Prevention, includes: profound fatigue and post-exertional malaise (>6 mo) unrelieved by rest, persistent cognitive impairment or orthostatic intolerance, and chronic unrefreshing sleep. Despite reported associations between ME/CFS onset and exposure to infectious agents (viral, bacterial, or fungal), the pathophysiology of ME/CFS remains unknown. In this prevalence study, we investigated the rates of Aspergillus-derived toxin levels, Aflatoxin (AF), Ochratoxin A (OTA), and Gliotoxin (GT), in the urinalysis of 236 ME/CFS patients with a history of chronic exposure to mold (i.e., from water-damaged buildings). Among ME/CFS patients reporting chronic exposure to mold, we found evidence of exposure in 92.4 percent of patients, with OTA being the most prevalent mycotoxin. Mold distributions (OTA, AF, and GT) in the urinalysis all demonstrated right skewness, while the distribution of age of ME/CFS patients diagnosed showed no deviation from normality. This study aims to provide preliminary, epidemiological evidence among ME/CFS patients who were diagnosed in South Florida with a history of exposure to mycotoxins. Based on these findings, we proposed how future control studies should approach investigating the association between chronic mold exposure and the diagnosis of ME/CFS.

Intraspecific Variation of Phytochemicals, Antioxidant, and Antibacterial Activities of Different Solvent Extracts of Albizia coriaria Leaves from Some Agroecological Zones of Uganda

Albizia coriaria Welw ex. Oliver is a customary African medicinal plant, which has a long history of utilization in the management of oxidative stress-induced and bacterial diseases. However, there is no report on the phytochemicals, antioxidant, and antibacterial activities of its leaves. The aim of this study was therefore to compare the phytochemicals, antioxidant, and antibacterial potential of A. coriaria leaves from Jinja, Kole, and Mbarara districts of Uganda. Shade-dried leaf samples were ground into powder and successively extracted with ethyl acetate, ethanol, and distilled water. Phytochemical screening indicated the presence of alkaloids, phenols, saponins, flavonoids, cardiac glycosides, tannins, and terpenes as the major secondary metabolites in the extracts. Total phenolic and flavonoid contents and total in vitro antioxidant activity were found to be the highest for ethanolic extracts, with the highest contents (101.72 ± 0.22 mg GAE/g DW; 13.23 ± 0.03 mg QE/g DW) and antioxidant potential (IC₅₀ = 18.65 ± 0.06 mg/mL) being for leaves from Mbarara district. Antibacterial activity of the extracts determined by agar disc diffusion method revealed that ethanolic extracts had higher antibacterial activities with mean zones of inhibition of 6.00 ± 1.73 to 10.00 ± 1.73 mm, 5.00 ± 1.00 to 12.30 ± 1.53 mm, 17.00 ± 0.00 to 25.00 ± 2.65 mm, and 9.00 ± 1.73 to 16.00 ± 1.73 mm for Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Salmonella typhi, respectively. Ethyl acetate extracts of A. coriaria leaves from Kole and Mbarara had lower antibacterial activities, while aqueous extracts and ethyl acetate extract of leaves from Jinja showed no antibacterial activity. The current study for the first time established that A. coriaria leaves possess therapeutic phytochemicals with significant in vitro antioxidant and antibacterial activities, which lend credence to their use in traditional management of oxidative stress-induced conditions and bacterial diseases in Uganda. Structural elucidation of the responsible pure compounds for the observed bioactivities as well as toxicity studies of the extracts is recommended.

Management strategies for aflatoxin risk mitigation in maize, dairy feeds and milk value chains—case study Kenya

Widespread aflatoxin contamination of a great number of food and feed crops has important implications on global trade and health. Frequent occurrence of aflatoxin in maize and milk poses serious health risks to consumers because these commodities are staple foods in many African countries. This situation calls for development and implementation of rigorous aflatoxin control measures that encompass all value chains, focusing on farms where food and feed-based commodities prone to aflatoxin contamination are cultivated. Good agricultural practices (GAP) have proven to be an effective technology in mitigation and management of the aflatoxin risk under farm conditions. The prevailing global climate change is shown to increase aflatoxin risk in tropical and subtropical regions. Thus, there is an urgent need to devise and apply novel methods to complement GAP and mitigate aflatoxin contamination in the feed, maize and milk value chains. Also, creation of awareness on aflatoxin management through training of farmers and other stakeholders and enforcement of regular surveillance of aflatoxin in food and feed chains are recommended strategies. This literature review addresses the current situation of aflatoxin occurrence in maize, dairy feeds and milk produced and traded in Kenya and current technologies applied to aflatoxin management at the farm level. Finally, a case study in Kenya on successful application of GAP for mitigation of aflatoxin risk at small-scale farms will be reviewed.

Aflatoxin content and health risks associated with consumption of some herbal products sold in Kampala, Uganda

Persuasive adverts and exaggeration of health benefits from consumption of herbal products as well as the mental picture of ‘natural’ is ‘safe’ has boosted traditional medicine use in Uganda. However, herbal products may be unsafe due to the possibility of their contamination with mycotoxins. In this study, we quantified the levels of aflatoxins (B1, B2, G1 and G2) in Real Koff product, Eddagala ly’e kifuba n’e senyiga, Omusujja, Cough mixture and Fever herbal products sold in Kampala, Uganda using high performance liquid chromatography-tandem mass spectrometry. The associated consumption health risks were assessed using the hazard index method. Only aflatoxin B1 was detected in 60% of the samples, with 40% of these surpassing WHO guidelines of ≤ 5 µg/kg. The hazard indices were all less than 1, implying that Ugandans who heavily rely on the herbal products are exposed to aflatoxins at sublethal doses which may lead to chronic effects in the long run. Studies using a larger sample size should assess whether the current observation is a routine occurrence or a sporadic event.