Aflatoxin exposure in pregnant women in Kisumu county, Kenya

Abstract

About 4.5 billion people globally and 1.8 million Kenyans are exposed to large amount of aflatoxin. However, little is known about aflatoxin exposure levels in pregnant women through dietary intake. This study aimed to determine levels of aflatoxin exposure of pregnant women in Kisumu County, where up to 40% households have been found to be exposed to the toxin. Assessment of aflatoxin in maternal diet may shed light on potential risk of exposure of their infants to the toxin. Between June and August 2013, we conducted a cross sectional study where aliquot samples of food consumed by 553 pregnant women of up to 8 months gestation, in the preceding 24 hours, were collected and analyzed for aflatoxin using ELISA technique. Aflatoxin levels in the foods consumed by the women ranged from 0 to 39.5 ppb. The proportion of women exposed to aflatoxin levels above the Kenya regulatory limit of 10 ppb was 24.8%, with 37.6% having daily absolute aflatoxin intakes ranging from 10µg to 150µg. Of the exposed women, 14.1% (n=26) were recruited from Kisumu East District Hospital, compared to 30.2% (n=111), from Ahero District Hospital (OR=2.64, 95% CI=1.65- 4.23, p<0.0001); and 14.0% (n=25) were from Kisumu East District, compared to 30.1(n=111) from Nyando District (OR=2.7, 95% CI=1.6-4.3, p<0.0001 and 20% (n=1) from Kisumu West District (OR 1.5, 95% CI=0.2-14.3). Of the 93 households with monthly income of Kshs. ≤2000, 41.9% (n=39) were exposed to aflatoxin above 10 ppb compared to 24.8% (n=77), 16.5% (n=16) and 9.4% of those earning monthly income of, 2001-5000, (OR=0.46, 95% CI=0.282-0.744, p=0.002), 5001- 10000 (OR=0.27, 95% CI=0.139-0.538, p<0.0001); and >10000 (OR=0.144, 95%CI=0.053-0.396) respectively. Pregnant women in Kisumu County are exposed to low-to-high levels of aflatoxin which may in turn expose their infants to the toxin. The effect of such exposure on health should be assessed and appropriate mitigation measures instituted.