Knowledge, attitude, and practices concerning presence of molds in foods among members of the general public in Malawi

This study assessed knowledge, attitude, and practices (KAP) of the public in Malawi on issues related to molds in foodstuffs. A survey involving structured questionnaire was conducted with 805 respondents from seven districts of Malawi. Descriptive statistics, t tests, and analyses of variance were calculated. A majority of respondents recognized that molds were dangerous to human health (88 %); however, about 50 % of respondents were not informed that mold toxins are thermally stable and that they are not destroyable by normal cooking processes. About 33 % of the respondents asserted that they buy moldy maize, while approximately 20 % of respondents reported that they consume moldy fruits having discarded moldy fraction. There were significant differences in knowledge scores among different demographic groups. Females had significantly (p < 0.05) lower knowledge scores on issues related to molds in foods. Additionally, the respondent’s location had a significant effect. However, respondent’s education had subtle effect on knowledge score and the overall population’s knowledge score was generally low (3.55 ± 1.32 score out of 9). Results of the study underline the need to raise public’s knowledge about health risks associated with spoilage molds in food and prevention and management options

Case–Control Study of an Acute Aflatoxicosis Outbreak, Kenya, 2004

Objectives: During January–June 2004, an aflatoxicosis outbreak in eastern Kenya resulted in 317 cases and 125 deaths. We conducted a case–control study to identify risk factors for contamination of implicated maize and, for the first time, quantitated biomarkers associated with acute aflatoxicosis. Design: We administered questionnaires regarding maize storage and consumption and obtained maize and blood samples from participants. Participants: We recruited 40 case-patients with aflatoxicosis and 80 randomly selected controls to participate in this study. Evaluations/Measurements: We analyzed maize for total aflatoxins and serum for aflatoxin B(1)–lysine albumin adducts and hepatitis B surface antigen. We used regression and survival analyses to explore the relationship between aflatoxins, maize consumption, hepatitis B surface antigen, and case status. Results: Homegrown (not commercial) maize kernels from case households had higher concentrations of aflatoxins than did kernels from control households [geometric mean (GM) = 354.53 ppb vs. 44.14 ppb; p = 0.04]. Serum adduct concentrations were associated with time from jaundice to death [adjusted hazard ratio = 1.3; 95% confidence interval (CI), 1.04–1.6]. Case patients had positive hepatitis B titers [odds ratio (OR) = 9.8; 95% CI, 1.5–63.1] more often than controls. Case patients stored wet maize (OR = 3.5; 95% CI, 1.2–10.3) inside their homes (OR = 12.0; 95% CI, 1.5–95.7) rather than in granaries more often than did controls. Conclusion: Aflatoxin concentrations in maize, serum aflatoxin B(1)–lysine adduct concentrations, and positive hepatitis B surface antigen titers were all associated with case status. Relevance: The novel methods and risk factors described may help health officials prevent future outbreaks of aflatoxicosis

Workgroup report: Public health strategies for reducing aflatoxin exposure in developing countries

10.1289/ehp.9302Environmental Health Perspectives114121898-190

Mycotoxin contamination of sorghum and its contribution to human dietary exposure in four sub-Saharan countries

<p>This research aimed at evaluating the safety, and the type, level and prevalence of mycotoxins in grain sorghum of four sub-Saharan African (SSA) countries (Burkina Faso, Ethiopia, Mali and Sudan). A multi-analyte LC-MS/MS method for quantification of 23 mycotoxins (nivalenol, deoxynivalenol, fusarenon X, neosolaniol, 3-acetyl deoxynivalenol, 15-acetyl deoxynivalenol, diacetoxyscirpenol, roquefortine C, HT-2 toxin, alternariol, T-2 toxin, FB1, FB2, FB3, zearalenone, aflatoxin G₁, aflatoxin G₂, aflatoxin B₁, aflatoxin B₂, sterigmatocystin, OTA, altenuene, alternariol monomethylether) was applied to different sorghum matrices. Of the 1533 analysed samples, 33% were contaminated with at least one of the following mycotoxins: aflatoxins, fumonisins, sterigmatocystin, <i>Alternaria</i> toxins, OTA and zearalenone. Country of origin, colour, source and collection period of sorghum samples significantly influenced the type, level and prevalence of mycotoxins. Sterigmatocystin (15%), fumonisins (17%) and aflatoxins (13%) were the most prevalent. FB1 (274 ± 585 µg/kg) had the highest mean concentration followed by FB2 (214 ± 308 µg/kg) while diacetoxyscirpenol (8.12 ± 19.2 µg/kg) and HT-2 (11.9 ± 0.00 µg/kg) had the lowest concentrations. Neosolaniol, fusarenon-X, 3-acetyl deoxynivalenol, 15-acetyl deoxynivalenol, T-2 toxin, nivalenol and roquefortine C were not detected in any of the samples. Sudan had the lowest prevalence and mean concentration of all mycotoxins. Pink sorghum had the highest concentrations of fumonisins and aflatoxins. Mycotoxins from <i>Aspergillus</i> spp. and <i>Alternaria</i> spp. are the mycotoxins of concern in SSA grain sorghum with regard to prevalence, concentration and possible health risk from exposure. Based on the performed risk characterisation, daily consumption of sorghum containing aflatoxins, alternariol, alternariol monomethyl ether, sterigmatocystin and OTA could result in exceeding the established health-based guidance values for these toxins.</p

Workgroup Report: Public Health Strategies for Reducing Aflatoxin Exposure in Developing Countries

In response to consecutive outbreaks of acute aflatoxicosis in Kenya in 2004–2005 (responsible for over 150 deaths) a workshop of international experts and health officials was convened in Geneva, July 2005, by the United States Centers for Disease Control and Prevention and the World Health Organization. The goals of the workshop were to identify public health strategies for the reduction of morbidity and mortality associated with the consumption of aflatoxin-contaminated food in the developing world and to outline an integrated plan that more effectively combines public health and agricultural approaches to the control of aflatoxins. Following discussions concerning what is known about aflatoxins, participants were able to identify gaps in current knowledge about acute and chronic human health effects of aflatoxins, surveillance and food monitoring, analytic methods, and the efficacy of intervention strategies. Four themes emerged from the workshop and warrant immediate attention: 1) quantify the human health impacts and the burden of disease due to aflatoxin exposure; 2) compile an inventory, evaluate the efficacy, and disseminate results of on-going intervention strategies; 3) develop and augment the disease surveillance, food monitoring, laboratory, and public health response capacity of affected regions; and 4) develop a response protocol that can be used in the event of an outbreak of acute aflatoxicosis. This report summarizes the workshop findings.JRC.D.8-Food safety and qualit